Unique Plan Description: NICU Admission (WH) EKM
Plan Selection Display: NICU Admission (WH)
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2011-07-11 18:44:38
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-03-12 10:58:00
Available at all facilities: Yes

NICU Admission (WH) EKM
Admit/Discharge/Transfer
	Admit to Inpatient Status
		T;N, To NICU, Level 3, Anticipated LOS 2 midnight or more
		T;N, To NICU, Level 2, Anticipated LOS 2 midnight or more
Vital Signs
	Vital Signs
		Q1hr, until stable, then q3h
		Q3H with Feeds
Diet
	Feeding Safety Assessment
		Q24H
	NPO
		T;N
	Formula
		
	Breast Milk
		Feed Base: Mother Breast Milk, If No Breast Milk: Donor Milk
	Breast Milk for Oral Immune Therapy
		
Laboratory
		Order if Mother RH Negative(NOTE)*
	Cord Blood Panel
		T;N, Routine, spec type = Cord Blood
		If baby was not admitted to NICU directly from L&D, select MRSA STAT and the MRSA T+6 orders below(NOTE)*
	Newborn Screen Nebraska
		T;N, Stat, spec type = Blood Spot
	Newborn Screen Nebraska Repeat
		T;N+2880, Routine, spec type = Blood
		T+28;0600, Routine, spec type = Blood
	IA NB Screen - WH
		T;N, Stat, spec type = Blood Spot
	IA NB Screen Repeat
		T;N+2160, Routine, spec type = Blood
	CBC with Diff
		Stat, spec type = Blood
	Basic Metabolic Panel
		Stat, spec type = Blood
	Comprehensive Metabolic Panel
		Stat, spec type = Blood
	hsCRP
		Stat, spec type = Blood
	Blood Gases Arterial (ABG) - MH/WH/JE
		Stat, spec type = Blood
	Blood Gases Capillary (CBG) - MH/WH/JE
		Stat, spec type = Blood
	Blood Gases VENOUS (VBG)
		Lab Collect, Stat, spec type = Blood
	Lactate
		Stat, spec type = Blood
	Type and Screen (No Product on hold)
		T;N, Stat, spec type = Blood
	Direct Coombs
		Stat, spec type = Blood
	.Blood Culture
		T;N, Stat, spec type = Blood
	Glucose POC - NICU
		Once
		T;N+60, Q1H, 2, Dose(s)/Time(s)
		T;N+240, Once
	Umbilical Cord Tissue Drug Scr and THC Metabolite - Qual
		T;N, Routine, spec type = Umbilical Cord
Diagnostic Tests
Radiology
	Chest 1 View
		Stat, Tube Placement F/U
	Chest 1 View include Abd
		Stat
	KUB
		Stat, Tube Placement F/U
	US Head Complete
		T+7;0600, Routine, Prematurity
		T+35;0600, Routine, Prematurity
	US Abd Complete
		Stat, Congenital Anomalies
	US Renal Retro Complete
		Stat
Cardiology
	Echocardiogram to be done by CH
		Stat, Indication: Congenital heart disease
IV Solutions

	Dextrose 10% in Water
		250 mL, IV, 1 ml/hr
	Dextrose 10% in water NICU syringe
		50 mL, IV, 1 ml/hr
	Dextrose 10% 250 mL w/HEParin 0.5 units/mL
		250 mL, UVC, 1 ml/hr
		125 units, EVERY BAG
		Vanilla Bag 4%(NOTE)*
	Dextrose 10%Acid 4%0.5units/mL
		250 mL, IV, 1 ml/hr
	Dextrose 10%Acid 4%0.5units/mL syringe
		50 mL, IV, 1 ml/hr
	DOPamine 40 mg/D5W 25 mL Syringe (NICU)-Standard
		25 mL, IV
		40 mg, EVERY BAG, 2.5 mcg/kg/min
		Arterial Line Solutions: UAC(NOTE)*
	Sodium Chloride 0.9% w/HEParin 1 unit/mL (NICU)
		50 mL, UAC, Routine, T;N, 0.5 ml/hr
		50 units, EVERY BAG
	Sodium Chloride 0.45% w/HEParin 1 unit/mL (NICU)
		50 mL, UAC, Routine, T;N, 0.5 ml/hr
		50 units, EVERY BAG
		1/2 Normal Acetate(NOTE)*
	sodium acetate 3.85 mEq/HEParin 50 units/Water 50 mL (NICU)
		50 mL, UAC, Routine, T;N, 0.5 ml/hr
		3.85 mEq, EVERY BAG
		50 units, EVERY BAG
		Normal Acetate(NOTE)*
	sodium acetate 7.7mEq/HEParin 50 units/Water 50 mL (NICU)
		50 mL, UAC, Routine, T;N, 0.5 ml/hr
		7.7 mEq, EVERY BAG
		50 units, EVERY BAG
		Bolus(NOTE)*
	Dextrose 10% intravenous soln (Bolus)
		2 mL/kg, Syringe, IV Push, Once, NOW
	Sodium Chloride 0.9% Intravenous Solution (NICU Bolus)
		10 mL/kg, Injection, IV Push, Once, NOW
			Comment: Bolus over 20 minutes.
		Arterial Line Flushes(NOTE)*
	heparin flush 1 units/mL intravenous solution
		1 units, Syringe, IV PUSH, Q5MIN, PRN, IV line flush
	sodium chloride 0.9% flush injectable soln
		1 mL, Syringe, IV PUSH, Q5MIN, PRN for IV line flush
	sodium chloride 0.9% 10mL flush (NICU)
		1 mL, Syringe, IV Push, Q1H, PRN for IV line flush
Medications
	ampicillin IVPB (NICU)
		100 mg/kg, Solution-Injection, IVPB, TID, Early onset neonatal sepsis, T;N, 36 hr
			Comment: Ampicillin: 100mg/kg/dose IV TID        PNA < 7 days old Ampicillin: 75mg/kg/dose IV QID          PNA >7 days old
	gentamicin IVPB (NICU)
		5 mg/kg, Injection, IVPB, Once, Early onset neonatal sepsis, T;N
			Comment: < 30 weeks: 5 mg/kg q48h> =30 weeks: 5 mg/kg q36h
	acyclovir IVPB (NICU)
		20 mg/kg, Solution-Injection, IVPB, Q8H, Indication: Early onset neonatal sepsis
			Comment: PMA (Weeks)         Interval (hours)< 30                         Q12H30-36                       Q8H                                                                                                                                       > 36                        Q6H
		20 mg/kg, Solution-Injection, IVPB, Q12H, Indication: Early onset neonatal sepsis
			Comment: PMA (Weeks)         Interval (hours)< 30                         Q12H30-36                       Q8H                                                                                                                                       > 36                        Q6H
		20 mg/kg, Solution-Injection, IVPB, Q6H, Indication: Early onset neonatal sepsis
			Comment: PMA (Weeks)         Interval (hours)< 30                         Q12H30-36                       Q8H                                                                                                                                       > 36                        Q6H
	Ativan Injection (NICU)
		0.1 mg/kg, Syringe, IV PUSH, Q1H, PRN, agitation
	fentanyl (NICU)
		1 mcg/kg, Syringe, IV Push, Q1H, PRN for agitation
	Versed 2mg/2ml
		0.1 mg/kg, Injection, IV Push, Q1H, PRN, agitation
	morphine IV (NICU)
		0.1 mg/kg, Solution-Injection, IV Push, Q1H, PRN for agitation
	Infasurf
		3 mL/kg, Suspension, Endotracheal, Once
	Vitamin K
		1 mg, Injection, IM-IntraMUSCULAR, Once
			Comment: for birth weight => 1.5kg
		0.5 mg/kg, Injection, IM-IntraMUSCULAR, Once
			Comment: for birth weight <1.5kg
	erythromycin ophth 0.5% oint 1gm
		1 appl, Ointment, EYE, BOTH, Once
	Recombivax HB Pediatric/Adolescent
		0.5 mL, Solution-Injection, IM-Intramuscular, Once, T+1;1600
			Comment: If greater than 2kg upon admission
	hepatitis B pediatric vaccine 10 mcg/0.5 mL intramuscular suspension
		0.5 mL, Suspension-Injection, IM-Intramuscular, Once, T+1;1600
			Comment: If greater than 2kg upon admission
	Sucrose 24%
		0.2 mL, Liquid, By Mouth, Q5MIN, PRN, discomfort
			Comment: As needed for mild pain or discomfort. Place on tongue.
	caffeine citrate 20 mg/mL intravenous solution
		20 mg/kg, Injection, IVPB, Once, Infuse Over 30 min(s)
		10 mg/kg, Injection, IVPB, DAILY, T+1;0900, Infuse Over 10 min(s)
	Indocin IVPB (NICU)
		0.1 mg/kg, Solution-Injection, IVPB, Q24H, 3 Dose(s)/Time(s)
			Comment: (IVH Prophylaxis).
	vitamin A
		5,000 units, Injection, IM-IntraMUSCULAR, M-W-F, 12 Dose(s)/Time(s)
		Central Line (PICC, Broviac, UVC)(NOTE)*
	heparin flush 1 units/mL intravenous solution
		1 units, Syringe, IV PUSH, DAILY
		1 units, Syringe, IV PUSH, Q1H, PRN, IV line flush
		2nd Lumen UVC(NOTE)*
		1 units, Syringe, IV PUSH, DAILY
			Comment: in 2nd lumen UVC.
		1 units, Syringe, IV PUSH, Q1H, PRN, IV line flush
			Comment: in 2nd lumen UVC.
	cholecalciferol - D3
		20 mcg, Liquid, Buccal, DAILY
Patient Care
	Resuscitation Status
		Full Code
		No Code
	Intake and Output
		Weigh diaper
			Comment: record urine output q4h
	Modified Finnegan Neonatal Abstinence Assessment
		
	Isolation Precautions
		T;N
	Date of first eye exam (ROP)
		T;N
	Crib, place in
		T;N, If stable after 4 to 6 hours, transfer to crib
	Glucose POC - NICU
		T;N, Once
		T;N, Before each feeding
			Comment: Comment: X3, feed infant within 1 hour
Therapies
	Oxygen Saturation Alarm Limits - NICU
		T;N, Alarm limits: 90 - 95%
			Comment: if on room air, high alarm can be 100%
Consults/Follow-up
	Pharmacy Consult
		T;N, pharmacy to enter appropriate peak and trough levels around 3rd dose of aminoglycosides.
	Consult Cardiologist
		
	Consult Endocrinologist
		
	Consult Gastroenterologist
		Refer to/Consult with: Laurel Prestridge, MD
		Refer to/Consult with: Sharad Kunnath, MD
	Consult Genetics
		
	Consult Hematologist/Oncologist
		
	Consult Infectious Disease
		Refer to/Consult with: Robert Penn, MD
	Consult Metabolism
		
	Consult Neurologist
		Refer to/Consult with: Hannah Klein, MD
	Consult Neurosurgery
		Refer to/Consult with: Mark Puccioni, MD
	Consult Ophthalmologist
		Refer to/Consult with: Sebastian Troia, MD
		Refer to/Consult with: Robert Troia, MD
		Refer to/Consult with: Eyal Margalit, MD
		Refer to/Consult with: Thomas Hejkal, MD
	Consult Orthopedics
		Refer to/Consult with: Paul Esposito, MD
	Consult Urology
		Refer to/Consult with: John Donovan, MD

NICU Ventilation (WH)
Laboratory
	Methemoglobin
		T;N, Stat, spec type = Blood
Diagnostic Tests
	Chest 1 View
		T;N, Stat, Respiratory Distress
	Chest 1 View include Abd
		Respiratory Distress, T;N, Routine
Medications
	Infasurf
		3 mL/kg, Suspension, Endotracheal, Once
Therapies
	Oxygen Saturation Alarm Limits - NICU
		T;N, Alarm limits: 90 - 95%
			Comment: if on room air, high alarm can be 100%
	Oxygen Saturation Target - NICU
		T;N, Oxygen Sat Target Standard (85-95%)
			Comment: if on room air, high alarm can be 100%
	Mechanical Ventilation NICU
		Constant Indicator:
	Mechanical Ventilation (HFOV) NICU
		Constant Indicator:
	Mechanical Ventilation (JET) NICU WH
		Constant Indicator:
	Heated, Humidified, High Flow Nasal Cannula - NICU
		Constant Indicator
	Nasal Cannula Oxygen (< 1L/min flow rate) NICU
		Constant Indicator
	Oxyhood - NICU
		Constant Indicator
	Trach Collar - NICU
		Constant Indicator
	Chest Physiotherapy - NICU
		
	Heat Moisture Exchanger (HME) - NICU
		Constant Indicator
	NCPAP  - NICU
		Constant Indicator:
		Reminder to order Methemoglobin if ordering Inhaled Nitric Oxice(NOTE)*
	Inhaled Nitric Oxide -NICU

NICU POC Labs
Patient Care
	Blood Gas 1 Nurse Collect - RN
		T;N, Once
		T;N, Q2H-Sch
		T;N, Q4H
		T;N, Q6H
	Blood Gas 2 Nurse Collect - RN
		T;N, Once
		T;N, Q2H-Sch
		T;N, Q4H
		T;N, Q6H
	Chem 7 Nurse Collect - RN
		T;N, Once
		T;N, Q2H-Sch
		T;N, Q4H
		T;N, Q6H
	WB Triage Panel Nurse Collect - RN
		T;N, Once
		T;N, Q2H-Sch
		T;N, Q4H
		T;N, Q6H
	Glucose POC - NICU
		T;N, Once
		T;N, Q2H-Sch
		T;N, Q4H
		T;N, Q6H
		If patient has arterial line, order POC WB Glucose Nurse Collect - NICU(NOTE)*
	POC WB Glucose Nurse Collect - NICU
		T;N, Once
		T;N, Q2H-Sch
		T;N, Q4H
		T;N, Q6H

*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