Unique Plan Description: Newborn Transfer from NICU to Well Baby (WH)
Plan Selection Display: Newborn Transfer from NICU to Well Baby (WH)
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2016-07-05 10:41:21
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-03-12 08:19:41
Available at all facilities: No

Newborn Transfer from NICU to Well Baby (WH)
Admit/Discharge/Transfer
	Transfer
		From NICU to Well baby nursery
Vital Signs
	Vital Signs
		Routine - If axillary temp <97.5 or >100.0 take rectal temp
	Weight
		T;N, Once
			Comment: on discharge day
Diet
	Formula
		Base Caloric Density: 20
	Breast Milk
		Feed Base: Mother Breast Milk
Laboratory
	Bilirubin Total and Direct
		T+1;0400, Routine, spec type = Blood
		Routine, spec type = Blood
	Bilirubin Total
		T+1;0400, Routine, spec type = Blood
		Routine, spec type = Blood
	Direct Coombs
		Routine, spec type = Blood
	Basic Metabolic Panel
		T+1;0400, Routine, spec type = Blood
		Routine, spec type = Blood
	CBC with Diff
		T+1;0400, Routine, spec type = Blood
		Routine, spec type = Blood
	Platelet Count
		T+1;0400, Routine, spec type = Blood
		Routine, spec type = Blood
	Hemoglobin and Hematocrit
		T+1;0400, Routine, spec type = Blood
		Routine, spec type = Blood
	Comprehensive Metabolic Panel
		T+1;0400, Routine, spec type = Blood
		Routine, spec type = Blood
	Magnesium Level
		T+1;0400, Routine, spec type = Blood
		Routine, spec type = Blood
	Newborn Screen Nebraska
		T;N, Routine, spec type = Blood Spot
	IA NB Screen
		T;N, Routine, spec type = Blood Spot
Medications
	Recombivax HB Pediatric/Adolescent
		0.5 mL, Solution-Injection, IM-Intramuscular, Once, T;N
	hepatitis B pediatric vaccine 10 mcg/0.5 mL intramuscular suspension
		0.5 mL, Suspension-Injection, IM-Intramuscular, Once, T;N
	Ayr Saline Nasal No-Drip Spray
		1 gtt, Solution, NASAL, Q1H, PRN, congestion
			Comment: Notify provider if no improvement from saline.
Patient Care
	Resuscitation Status
		Full Code
		No Code
	Intake and Output
		T;N, Q12H-End of Shift
	Glucose POC - RN
		as needed
			Comment: for symptoms of hypoglycemia-irritability, tremors, jitteriness, exaggerated moro reflex,high-piched cry, seizures, lethargy, floppiness, cyanosis, twitching, hypothermia, or hypotonia.
	Newborn Glucose Management
		T;N
			Comment: - If glucose is > 120 draw serum glucose.- If serum glucose is > 120 Notify MD.- For any glucose value < 40, follow Hypoglycemia Algorithm for feeding and follow-up management of blood sugars.
	Newborn Hearing Screening
		T;N+720
			Comment: in mom's room after 12 hours of age and prior to discharge. Repeat x 1 if one or both ears
	Follow Bilirubin Protocol
		Document the presence or absence of jaundice when taking vital signs. If Jaundice present at 24 hrs or less, or significant jaundice during stay especially in darkly pigmented baby, order tcBili
	Car Seat Study
		T;N
			Comment: MD Verbatim: Infant being transferred to newborn nursery
	Notify MD
		T;N, if rectal temp <97.5 or >100.
		T;N, immediately if VS unstable, cyanotic, lethargic.
		T;N, if newborn has had 10% weight loss  by discharge.
		T;N, if oxygen saturation is less than 90% on supplemental oxygen.
		T;N, if signs of hypoglycemia
		T;N, if serum glucose >120
		T;N, if serum glucose < 30
		T;N, when infant returns to newborn nursery
	Free Flow Oxygen, Nurse to Administer
		Via Free Flow Oxygen, Continuous
			Comment: if cyanosis or respiratory distress present
	Newborn Oxygen Check
		as needed
	Newborn Gavage Feeding Protocol
		respirations > ....
			Comment: prn if RR >60, poor suck/swallow, severe work of breathing (retracting, etc.).  Note 2-3 gavage feed
	Congenital Heart Disease Screening
		T+2;0400

*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