Unique Plan Description: Gen Adm Neutropenic Fever
Plan Selection Display: Gen Adm Neutropenic Fever
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2012-03-09 13:14:22
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-09-17 15:20:29
Available at all facilities: Yes

Gen Adm Neutropenic Fever
Admit/Discharge/Transfer
	Admit to Inpatient Status
		T;N, Anticipated LOS 2 midnight or more
	Admit to Observation Status
		T;N
	Admit to Critical Care Inpatient Status (MH)
		T;N, Anticipated LOS 2 midnight or more
	Admit to Critical Care Observation Status (MH)
		T;N
Vital Signs
	Vital Signs
		T;N, Q4H-Sch
Diet
	Regular Diet
		T;N, Immunocompromised Safe Food Handling Die
	Cardiac Diet
		T;N
	Renal Diet
		T;N
	Diabetic Diet
		T;N
Laboratory
	UA (Culture if Positive)
		T;N, Stat, Stat, Urine, spec type = Urine
	Culture Urine
		T;N, Stat, Urine, spec type = Urine
	Sputum Culture
		T;N, Stat, Expectorated, spec type = Sputum
	CBC with Diff
		T;N, Stat, Once, spec type = Blood
	Comprehensive Metabolic Panel
		T;N, Stat, Once, spec type = Blood
	MRSA Screen
		T;N, Stat, spec type = Nose
	MRSA Nasal Screen Rapid - JE
		T;N, Stat, spec type = Nose
	Alkaline Phosphatase
		T;N, Stat, spec type = Blood
	Toxigenic Clostridioides Difficile by EIA Reflex to PCR
		T;N, Routine, spec type = Stool
	C Diff EIA Reflex to PCR
		T;N, Routine, spec type = Stool
	UA (Culture if Positive)
		T;N, Routine, Routine, spec type = Urine
Tomorrow's Lab
	CBC with Diff
		T+1;0400, Routine, DAILY, spec type = Blood
	Comprehensive Metabolic Panel
		T+1;0400, Routine, EVERY OTHER DAY, spec type = Blood
Diagnostic Tests

	Chest 2 View
		T;N, Stat, Fever
Medications
		MonoTherapy-Select One(NOTE)*
	cefepime IVPB
		2,000 mg, Injection-Premix, IVPB, Q8H, Other- type in, Febrile neutropenia
	meropenem IVPB
		1,000 mg, INT, IVPB, Q8H, Other- type in, Febrile neutropenia
		Dual Therapy-Add one medication if indicated(NOTE)*
	tobramycin IVPB
		1.5 mg/kg, INT, IVPB, Q8H, Other- type in, Febrile neutropenia
		7 mg/kg, Injection-Premix, IVPB, Q24H, Other- type in, Febrile neutropenia
	Levaquin IVPB
		750 mg, Injection-Premix, IVPB, Q24H, Febrile neutropenia
	Cipro IVPB
		400 mg, Injection-Premix, IVPB, Q8H, Febrile neutropenia
	vancomycin IVPB
		15 mg/kg, Injection-Premix, IVPB, Q12H, Febrile neutropenia, 250 ml/hr
			Comment: Suspected or history of MRSA
		If severe Beta-Lactam allergy: Select one of the following regimens(NOTE)*
		15 mg/kg, Injection-Premix, IVPB, Q12H, Febrile neutropenia, 250 ml/hr
	Azactam IVPB
		2,000 mg, Injection-Premix, IVPB, Q8H, Other- type in, Febrile neutropenia
	Releuko
		480 mcg, Solution, SUBCUTANEOUS, DAILY
		300 mcg, Solution, SUBCUTANEOUS, DAILY
Patient Care
	Resuscitation Status
		T;N, Full Code
		T;N, No Code
	Notify MD
		T;N, immediately if patient is dyspneic, hypotensive, delirious/confused, has decreased urine output, and/or severe shaking/chills.
	Isolation Precautions
		T;N, Protective Environment, Reason for Isolation: Immune suppressed
			Comment: Neutropenic precautions if WBC < 1.5, temp >100.5
Consults/Follow-up
	Pharmacy Consult
		T;N, to provide pharmacokinetic dosing for vancomycin or aminoglycosides
	Consult Dietitian
		T;N, Regarding: Nutrition Assessment
			Comment: neutropenic fever
	Consult Care Management
		T;N
			Comment: Discharge planning, oncology admission
	Consult Infectious Disease
		Reason for Referral: Neutropenic fever, Refer to/Consult with: Dr. Kotula/Gholami
		Reason for Referral: Neutropenic fever, Refer to/Consult with: Dr. Penn
		Reason for Referral: Neutropenic fever, Refer to/Consult with: Drs. Alvarez/Southard

Oxygen Protocol
Therapies
Respiratory Therapy
	Oxygen Therapy
		T;N
	Pulse Oximetry Spot Check RT
		T;N, BID
	Continuous Pulse Oximetry Monitoring Check
		T;N, BID

Blood Culture Set
Laboratory

	.Blood Culture.
		T;N, Stat, spec type = Blood
		T;N, Routine, spec type = Blood
		T+1;0400, Routine, spec type = Blood
	.Blood Culture
		T;N, Stat, spec type = Blood
		T;N, Routine, spec type = Blood
		T+1;0400, Routine, spec type = Blood

VTE Prophylaxis
Medications
	Lovenox
		40 mg, Syringe, SUBCUTANEOUS, DAILY, T;N
			Comment: (CrCl>30) Pharmacy to adjust dose based on pt weight. VTE Prophylaxis
		40 mg, Syringe, SUBCUTANEOUS, DAILY, T;N+480
			Comment: (CrCl>30) Start 8 hours after admission. Pharmacy to adjust dose based on pt weight. VTE Prophylaxis
		40 mg, Syringe, SUBCUTANEOUS, DAILY, T+1;0900
			Comment: (CrCl>30) Pharmacy to adjust dose based on pt weight. VTE Prophylaxis
	HEParin 5000 units/mL SUBCUTANEOUS
		5,000 units, Injection, SUBCUTANEOUS, Q8H-Sch, T;N
			Comment: VTE Prophylaxis
		5,000 units, Injection, SUBCUTANEOUS, Q8H-Sch, T;N+480
			Comment: Start 8 hours after admission. VTE Prophylaxis
		5,000 units, Injection, SUBCUTANEOUS, Q8H-Sch, T+1;0600
			Comment: VTE Prophylaxis
Patient Care
		Sequential Compression Device and Anti Embolism Device orders will not suppress the VTE Advisor(NOTE)*
	Sequential Compression Device
		T;N, Apply, Once
	Anti Embolism Stockings
		T;N, Apply, Once
			Comment: knee high
	VTE Prophylaxis Contraindication
		High Risk of Bleeding
		Procedure Planned
		ASA order meets prophylaxis requirement
		If patient is low risk or further evaluation needed, complete advisor:(NOTE)*
	VTE Advisor
		Medical

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase