Unique Plan Description: MFM Rounds (WH)
Plan Selection Display: MFM Rounds (WH)
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2011-12-09 14:25:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2022-04-26 08:52:17
Available at all facilities: Yes

MFM Rounds (WH)
Diet
	NPO
		
	Regular Diet
		
	Diabetic Diet
		5 Feedings
		6 Feedings
	High Protein, High Calorie Diet
		
	Advance Diet as Tolerated
		
Laboratory
	Creatinine Urine Timed Set
		Routine, Routine, Urine, spec type = Urine
	Protein Urine Timed Set
		Routine, Routine, Urine, spec type = Urine
Today's Lab
	Comprehensive Metabolic Panel
		Stat, spec type = Blood
	CBC with Diff
		Stat, spec type = Blood
	Fetal Fibronectin
		Routine, spec type = Swab
	Urinalysis
		Routine, Routine, spec type = Urine
	UA (Culture if Positive)
		Routine, Routine, spec type = Urine
	Type and Crossmatch (Product Available)
		T;N, Routine, For Possible Transfusion
		T;N, Stat, For Possible Transfusion
	Yeast and Trich Wet Prep (Trich PCR if Neg) - MH/WH
		
Diagnostic Tests
Radiology
	Chest 1 View
		Pregnant, Stat
			Comment: shielded
	PNATE OB US
		Pregnancy
	US Abd Complete
		Routine
Cardiac
	ECG
		Stat
Diagnostics
	Venous Duplex Bil Upper or Lower
		Location Lower Bilateral
	Venous Duplex Unilat Upper or Lower
		Location Left Lower
		Location Right Lower
IV Solutions

Medications
	Dulcolax
		10 mg, Suppository, RECTALLY, DAILY, PRN, constipation
	ibuprofen
		200 mg, Suspension, By Mouth, Q4H, PRN, pain-mild
	acetaminophen-hydrocodone 325 mg-5 mg oral tablet
		1 TAB, Tab, By Mouth, Q4H, PRN, pain-mild
		2 TAB, Tab, BY MOUTH, Q4H, PRN, pain-moderate
	Pepcid
		20 mg, Tab, BY MOUTH, BID
Patient Care
	VTE Advisor
		Pregnancy or Postpartum
	Anti Embolism Stockings
		TED hose, knee high, Remove for 30 minutes and re-apply
	Dressing Care
		T;N, Remove, Once
	Remove Staples and Apply Steri-strips
		
	Heat Therapy
		Aqua K
			Comment: PRN as needed
	Intake and Output
		Q12H-End of Shift
		Q4H
		Q1H
	Discontinue Peripheral Lock
		Once
	Discontinue IV
		Once
	Foley Catheter
		Insert
	Discontinue Urinary Catheter
		Once
	Vaginal Packing
		Once
	Notify MD of Lab results
		
	Patient List
		add patient to MD list.
	Obtain supplies/equipment
		apply eggcrate mattress as needed.
	Non-stress test
		DAILY
		BID
		Once
	Hypoglycemia Treatment Parameters
		T;N, If glucose is < 50, dc insulin infusion and give 4 oz Apple Juice or non diet soda, 15 gm Oral Glucose Gel, or 25mL of Dextrose 50% IV if unable to take PO. Call MD. Repeat blood glucose in 15 min.  May repeat intervention if blood glucose still < 50
Diabetic Mother
	Patient to administer own insulin based on carbohydrate count
		
	Notify MD of Lab results
		blood sugar >180
		of blood sugar results
	Glucose POC - RN
		Q4H, until eating meals
		TIDPC, 2 hours after meals
		TIDAC
		ACBKFST
Consults/Follow-up

	Consult Neonatologist
		
	Consult Cardiologist
		
	Consult Behavioral Health

Transfuse (Administer) Blood Products EKM
Vital Signs
		Refer to Transfusion Guidelines for Blood Components(NOTE)*
	Vital Signs
		T;N
			Comment: VS within 30 minutes before starting the transfusion, within 5-15 minutes after starting infusion, whenever a suspected adverse reaction occurs, and within 30 minutes of when transfusion complete
Laboratory
Packed Cells
	Crossmatch Red Blood Cells
		T;N, Routine
		T;N, Stat
	Administer blood products
		T;N, Packed cells
Plasma
	Frozen Plasma
		T;N, Routine
	Administer blood products
		T;N, Plasma-fresh frozen
Platelet Pheresis
	Platelet Pheresis
		T;N, Routine
	Administer blood products
		T;N, Platelet
Cryopreciptate
	Cryoprecipitate
		T;N, Routine
	Administer blood products
		T;N, Cryoprecipitate
IV Solutions

	Sodium Chloride 0.9%
		500 mL, IV, 1 Dose(s)/Time(s), 20 ml/hr
Medications
	Tylenol
		650 mg, Tab, By Mouth, Once, T;N
Patient Care
	Obtain Consent/Permit for:
		T;N, blood product transfusion
	Patient Education
		T;N, Review education leaflet "When you need a blood transfusion" prior to administering blood.
	Notify MD
		T;N, Temperature >100.0 F prior to transfusion

Peripheral Lock - Access
Medications
	sodium chloride 0.9% flush injectable soln
		10 mL Syringe IV PUSH BID
		10 mL, Syringe, IV PUSH, Q5MIN, PRN, IV line flush
	lidocaine 1% injectable solution (MH/WH/FH)
		0.1 mL, IntraDermal, Q1H, PRN, see comment
			Comment: For IV start
	sodium chloride bacteriostatic 0.9% injectable soln
		0.1 mL, Injection, IntraDermal, Q1H, PRN, see comment
			Comment: For IV start, use if patient has lidocaine allergy.
	Sodium Chloride 0.9% IVPB Flush
		25 mL, IVPB, Q1H, PRN, IV line flush, 5 min(s)
			Comment: Use if medication not compatible with primary line or there is no primary line;  infuse 25mL.
Patient Care
	Peripheral Lock-Insert
		T;N

Insulin Sliding Scale - NovoLOG
Laboratory
	Glucose POC - RN
		T;N, QIDACHS
		T;N, 15 minutes after carbohydrate source or medication administered
	Hemoglobin A1C
		T+1;0400, Routine, spec type = Blood
	Order Lab
		T;N
			Comment: Blood Glucose (POC) as needed for signs and symptoms of hypoglycemia for patients with diabetic medication orders or known diabetic.
Medications
	Standard Dose NovoLOG
		2 - 12 units, Injection, SUBCUTANEOUS, QIDACHS, PRN, sliding scale, Routine
			Comment: << Sliding Scale Comments >>Under 150, Do not give any insulin150 - 199 = 2 units,200 - 249 = 4 units,250 - 299 = 6 units,300 - 349 = 8 units,350 - 399 = 10 units.Over 399 = 12 units,<< Sliding Scale Comments >> Check  POC in 3 hours; notify physician if repeat POC  greater than or equal to 400mg or less than or equal to 100.  Do not give insulin based on repeat POC value.  RN may change sliding scale insulin order and POC glucose order to every 6 hours if patient is NPO or not on oral diet (tube/enteral feedings, TPN, etc).  Enter as Q6H-SCH  PRN
	Moderate Dose NovoLOG
		4 - 24 units, Injection, SUBCUTANEOUS, QIDACHS, PRN, sliding scale
			Comment: << Sliding Scale Comments >>Under 150, Do not give any insulin150 - 199 = 4 units,200 - 249 = 8 units,250 - 299 = 12 units,300 - 349 = 16 units,350 - 399 = 20 units.Over 399 = 24 units,<< Sliding Scale Comments >> Check  POC in 3 hours; notify physician if repeat POC  greater than or equal to 400mg or less than or equal to 100.  Do not give insulin based on repeat POC value.  RN may change sliding scale insulin order and POC glucose order to every 6hours if patient is NPO or not on oral diet (tube/enteral feedings,TPN, etc). Enter as Q6H-SCH PRN
	High Dose NovoLOG
		5 - 30 units, Injection, SUBCUTANEOUS, QIDACHS, PRN, sliding scale
			Comment: << Sliding Scale Comments >>Under 150, Do not give any insulin150 - 199 = 5 units,200 - 249 = 10 units,250 - 299 = 15 units,300 - 349 = 20 units,350 - 399 = 25 units.Over 399 = 30 units, << Sliding Scale Comments >>Check  POC in 3 hours; notify physician if repeat POC  greater than or equal to 400mg or less than or equal to 100.  Do not give insulin based on repeat POC value.  RN may change sliding scale insulin order and POC glucose order to every 6hours if patient is NPO or not on oral diet (tube/enteral feedings, TPN, etc).  Enter as Q6H-SCH  PRN
	glucose oral gel (JE)
		15 gm, Gel, By Mouth, Q15MIN, PRN, low blood sugar
			Comment: For blood glucose is 60-70mg/dL as an alternative to apple juice. Notify provider if given with corresponding POC glucose recheck value
	Dextrose 50%
		25 mL, Injection, IV PUSH, Q15MIN, PRN for low blood sugar, Routine
			Comment: Give if blood glucose less than 60mg/dL or 60-70 mg/dL and patient unable to tolerate oral intake. Notify provider if given with corresponding POC glucose recheck value.
	Dextrose 10% in Water (FH)
		250 mL, Injection, IVPB, Q30MIN, PRN for low blood sugar, infuse over 30 min(s)
			Comment: Give if blood glucose less than 60mg/dL or 60-70 mg/dL and patient unable to tolerate oral intake. Notify provider if given with corresponding POC glucose recheck value.
	glucagon
		1 mg, Injection, IV Push, Q15MIN, PRN for low blood sugar, T;N
			Comment: Give if blood glucose < 70mg/dL AND if dextrose 50% injectable unavailable OR inadequate response to IV dextrose 50%. May give SubQ or IM if patient does not have IV access. Notify provider if given with corresponding POC glucose recheck value.
Patient Care
	Order Lab
		T;N, RN may change schedule of point of care glucose and sliding scale insulin order to every 6 hours if patient is NPO or not on oral diet (tube/enteral feedings, TPN, etc).. Enter POC order as Q6H-SCH, TIMED and medication order as Q6H-SCH PRN.
	Diabetic Snack
		T;N, Give snack (1 complex carb (15g), 1 protein snack (7g) ) anytime insulin is administered after the evening meal is complete and POC glucose is <150mg/dL.
	IV-Maintain
		T;N
			Comment: Patient should have IV site while on hypoglycemia protocol
	Hypoglycemia Treatment Parameters
		T;N, Hypoglycemia protocol initiated for patients with glucose <70mg/dl. Patient should have an IV while in Hypoglycemia protocol.
		T;N, glucose <60 mg/dL treat with Dextrose 50% 25 mL OR glucagon 1mg as per medication orders. Notify provider as per critical result protocol.
			Comment: Repeat treatment as outlined in hypoglycemia parameters. Notify provider of all treatments given and POC glucose recheck values. When notifying provider of hypoglycemic treatment, clarify with provider future instructions on diabetic medication therapy
		T;N, glucose 60-70 mg/dL, administer 4 oz apple juice, 4 oz non-diet soda, or glucose gel (MJE/MFH).  If patient NPO or unable to tolerate oral intake, give Dextrose 50% 25 mL OR glucagon 1mg as per medication orders.
			Comment: Repeat treatment as outlined in hypoglycemia parameters. Notify provider of all treatments given and POC glucose recheck values. When notifying provider of hypoglycemic treatment, clarify with provider future instructions on diabetic medication therapy.
		T;N, After initial treatment of any glucose value </= 70 mg/dL, repeat POC glucose in 15 min; if result </= 70mg/dL continue treating as per protocol and rechecking glucose 15 min after treatment until glucose >70mg/dL.
			Comment: Notify provider of all treatments given and corresponding POC glucose recheck values. When notifying provider of hypoglycemic treatment, clarify with provider future instructions on diabetic medication therapy.
		T;N, Once glucose is within normal limits, give 1 complex carb and 1 protein source (such as ½ sandwich OR 1 individual container of peanut butter and 3 packs of crackers) or patient meal if patient able to take orals to prevent recurrent hypoglycemia.
			Comment: When notifying provider of hypoglycemic treatment, clarify with provider future instructions on diabetic medication therapy.

*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