Unique Plan Description: Hospice Inpatient (JE)
Plan Selection Display: Hospice Inpatient (JE)
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2012-02-29 12:57:14
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2021-12-14 09:04:17
Available at all facilities: Yes

Discharge from Acute Care
Admit/Discharge/Transfer
	Admit to Inpatient Status
		T;N, To Inpatient Hospice, Anticipated LOS 2 midnight or more
	Discharge
		T;N
			Comment: From inpatient status AFTER notifying social work.
Patient Care
	Notify
		T;N, Social Worker before patient is discharged to inpatient hospice  Call via cell phone weekdays and weekends
			Comment: Call via cell phone weekdays and weekends
		T;N, Administrative Coordinator
		Select the appropriate Agency as indicated by the Social Worker(NOTE)*
		T;N, Asera Care (712) 325-1751
		T;N, Hospice with Heart (712) 325-6802
		T;N, Hospice of SW Iowa (712) 352- 1389
		T;N, Iowa Hospice 1-800-467-7423
		T;N, Odyssey (402) 397-0990
Consults/Follow-up
	Consult Social Work
		T;N, Hospice Care

Admit to Hospice Inpatient
Admit/Discharge/Transfer
	Admit to Inpatient Status
		T;N, To Inpatient Hospice
			Comment: Name of Hospice:____________; Patient must have new FIN
Vital Signs
	Vital Signs
		T;N, Once
		T;N, Q12H-Start of Shift
			Comment: Do not disturb patient for routine VS
Diet
	Regular Diet
		T;N
			Comment: Family/nursing to assist with ordering appropriate food
Medications
	Tylenol
		650 mg, Tab, BY MOUTH, Q4H, PRN, fever
			Comment: or mild pain (0-3)
		650 mg, Suppository, RECTALLY, Q4H, PRN, fever
			Comment: or mild pain (0-3)
	ibuprofen
		400 mg, Tab, By Mouth, Q4H, PRN, fever
			Comment: or mild pain (0-3)
	morphine 20 mg/mL oral concentrate
		5 mg, Concentrate, SUBLINGUAL, Q2H, PRN, pain-moderate
			Comment: (4-6)
		10 mg, Concentrate, SUBLINGUAL, Q2H, PRN, pain-moderate
			Comment: (4-6)
	morphine  IV
		2 mg, Syringe, IV PUSH, Q1H, PRN, pain-moderate
			Comment: (4-6), restless, gasping for breath.
		4 mg, Syringe, IV PUSH, Q1H, PRN, pain-severe
			Comment: (7-10), restless, gasping for breath.
		2 mg, Syringe, SUBCUTANEOUS, Q1H, PRN, pain-moderate
			Comment: (4-6), restless, gasping for breath.
		4 mg, Syringe, SUBCUTANEOUS, Q1H, PRN, pain-severe
			Comment: (7-10), restless, gasping for breath.
	Dilaudid Injectable
		2 mg, Injection, IV PUSH, Q4H, PRN, pain-severe
			Comment: (7-10)
		2 mg, Injection, SUBCUTANEOUS, Q4H, PRN, pain-severe
			Comment: (7-10)
	morphine 10mg/3mL nebulization
		3 mL, Solution-Nebulization, INHALATION, Q4H, PRN, dyspnea
			Comment: administered by RT
	albuterol 2.5 mg/3 mL (0.083%) inh soln
		3 mL, Solution-Nebulization, INHALATION, Q4H, PRN, see comment
			Comment: bronchospasms if receiving nebulized morphine
	Ativan (JE)
		2 mg, Injection, IV PUSH, Q2H, PRN, anxiety
		4 mg, Injection, IV PUSH, Q2H, PRN, anxiety
		2 mg, Tab, SUBLINGUAL, Q2H, PRN, anxiety
		4 mg, Tab, SUBLINGUAL, Q2H, PRN, anxiety
	Haldol  Oral
		0.5 mg, Tab, BY MOUTH, Q4H, PRN, agitation
		1 mg, Tab, BY MOUTH, Q4H, PRN, agitation
	Ambien
		5 mg Tab BY MOUTH QHS, PRN insomnia
	Senokot S 50 mg-8.6 mg oral tablet
		1 TAB, Tab, By Mouth, BID
		2 TAB, Tab, By Mouth, BID
	Imodium
		2 mg, Capsule, By Mouth, Q1H, PRN, loose stools
			Comment: Not to exceed > 16 mg/day
	Dulcolax
		10 mg Suppository RECTALLY DAILY PRN constipation
	Fleet Enema 19 gm-7 gm rectal enema
		1 EA, Enema, RECTALLY, DAILY, PRN, constipation
	Phenergan oral tablet
		25 mg, Tab, By Mouth, Q4H, PRN, nausea and/or vomiting
	ondansetron
		4 mg, Tablet, Disintegrating, By Mouth, Q6H, PRN, nausea and/or vomiting
	ondansetron (JE)
		4 mg, Injection, IV Push, Q6H, PRN, nausea and/or vomiting
	Benadryl
		25 mg, Tab, BY MOUTH, Q4H, itching
		50 mg, Capsule, BY MOUTH, Q4H, itching
		25 mg, Injection, IV PUSH, Q4H, itching
		50 mg, Injection, IV PUSH, Q4H, itching
	atropine 1% ophthalmic solution
		1 gtt, Solution, SUBLINGUAL, Q30MIN, PRN, secretions
			Comment: /rattling
		2 gtt, Solution, SUBLINGUAL, Q30MIN, PRN, secretions
			Comment: /rattling
	Artificial Tears ophthalmic solution
		1 gtt, Solution, Eye, Affected, Q1H, PRN for dry eyes
		2 gtt, Solution, Eye, Affected, Q1H, PRN for dry eyes
Patient Care
	Resuscitation Status
		T;N, No Code
	Discontinue Lab
		T;N
	Foley Catheter
		T;N, Foley, Insert, urinary discomfort
			Comment: prn pain
	Physical Assessment-Focused
		T;N, Q12H-Start of Shift
			Comment: cancel if requested by family
	Comfort Care Status
		T;N
Therapies

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

*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