Unique Plan Description: NICU NEC (WH)
Plan Selection Display: NICU NEC (WH)
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2022-03-22 17:20:02
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2023-11-16 09:08:54
Available at all facilities: Yes

NICU NEC (WH)
Diet
	NPO
		
Laboratory
Today's Lab
	CBC with Diff
		Stat, spec type = Blood
	Basic Metabolic Panel
		Nurse Collect, Routine, spec type = Blood
	Comprehensive Metabolic Panel
		Routine, spec type = Blood
	Blood Gases Arterial (ABG) - MH/WH/JE
		Stat, spec type = Blood
	.Blood Culture
		T;N, Stat, spec type = Blood
	Culture Urine
		Routine, Urine, spec type = Urine
	Urinalysis
		Routine, Routine, spec type = Urine
	Basic Metabolic Panel POC LC-JE
		T;N, Stat, spec type = Blood
		T;N+360, Routine, Q6H, spec type = Blood
		T;N+480, Routine, Q8H, spec type = Blood
PM Lab
	CBC with Diff
		T;2000, Routine, spec type = Blood
	Comprehensive Metabolic Panel
		T;2000, Routine, spec type = Blood
	Basic Metabolic Panel
		T;2000, Routine, spec type = Blood
Tomorrow's Lab
	CBC with Diff
		T+1;0400, Routine, spec type = Blood
	Basic Metabolic Panel
		T+1;0400, Routine, spec type = Blood
	Comprehensive Metabolic Panel
		T+1;0400, Routine, spec type = Blood
Diagnostic Tests
Radiology
	Abd & Decub
		Stat, Necrotizing Enterocolitis, ONCE AT
		T;N+360, Routine, Necrotizing Enterocolitis, Q6H-Sch
		T;N+480, Routine, Necrotizing Enterocolitis, Q8H-Sch
	KUB
		Stat, Necrotizing Enterocolitis, ONCE AT
		T;N+360, Routine, Necrotizing Enterocolitis, Q6H-Sch
		T;N+480, Routine, Necrotizing Enterocolitis, Q8H-Sch
IV Solutions

Medications
Antibiotics
	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
	Zosyn (NICU)
		110 mg/kg, Injection-Premix, IVPB, Q8H, Late onset neonatal sepsis
			Comment: Body weight <=2 kg:     PNA <=7 days: 110 mg/kg/dose every 8 hours    PNA 8 to 28 days and <=30 weeks: 110 mg/kg/dose every 8 hours    PNA 8 to 28 days and > 30 weeks:  90 mg/kg/dose every 6 hours    PNA 29 to 60 days for all PMA:  90 mg/kg/dose every 6 hoursBody weight >2 kg:PNA <=60 days: 90 mg/kg/dose every 6 hours
	vancomycin IVPB (NICU)
		15 mg/kg, Injection-Premix, IVPB, Q8H, Late onset neonatal sepsis
			Comment: PMA (Weeks)         Postnatal (days)         Interval (hours)<= 29                      0 to 14                       Q18H<= 29                       >14                           Q12H30 to 36                  0 to 14                       Q12H30 to 36                  >14                            Q8H37 to 44                  0 to 7                         Q12H37 to 44                  >7                              Q8H>= 45                      All                               Q6H
		15 mg/kg, Injection-Premix, IVPB, Q12H, Late onset neonatal sepsis
			Comment: PMA (Weeks)         Postnatal (days)         Interval (hours)<= 29                      0 to 14                       Q18H<= 29                       >14                           Q12H30 to 36                  0 to 14                       Q12H30 to 36                  >14                            Q8H37 to 44                  0 to 7                         Q12H37 to 44                  >7                              Q8H>= 45                      All                               Q6H
		15 mg/kg, Injection-Premix, IVPB, Q6H, Late onset neonatal sepsis
			Comment: PMA (Weeks)         Postnatal (days)         Interval (hours)<= 29                      0 to 14                       Q18H<= 29                       >14                           Q12H30 to 36                  0 to 14                       Q12H30 to 36                  >14                            Q8H37 to 44                  0 to 7                         Q12H37 to 44                  >7                              Q8H>= 45                      All                               Q6H
	nystatin  100,000 units/mL oral suspension
		1 mL, Suspension, BY MOUTH, Q6H, Other- type in, Late onset neonatal sepsis, 10 Day(s)
	nystatin topical 100,000 units/gm ointment
		1 appl, Ointment, TOPICAL, Q2H, PRN, diaper rash, 10 Day(s)
			Comment: Apply with diaper change.
Patient Care

	Blood Gas 1 Nurse Collect - RN
		T;N
		T;N+360
		T;N+480
	Blood Gas 2 Nurse Collect - RN
		T;N
		T;N+360
		T;N+480
	Enteral Tube
		Insert | Connect to low continuous suction Sterile Water Irrigate with normal saline, 2ml, Q2H
			Comment: (40-60mmHg) suction
Therapies

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 IV Solutions (WH)
IV Solutions
Peripheral
	Dextrose 10% in Water
		250 mL, IV, 1 ml/hr
	Dextrose 10% w/0.225% NS
		250 mL, IV, Routine, T;N, 1 ml/hr
		9.6 mEq, EVERY BAG
	Dextrose 10% w/0.45% NS
		250 mL, IV, Routine, T;N, 1 ml/hr
		19.2 mEq, EVERY BAG
		D10W 1/4 NS/KCL 20 mEg/L/Calcium Gluconate 10mEg/L(NOTE)*
	Dextrose 10% w/0.225% NS w/KCl 20mEq/L and calcium gluc 10mEq/L
		250 mL, IV, 1 ml/hr
		9.6 mEq, EVERY BAG
		5 mEq, EVERY BAG
		2.5 mEq, EVERY BAG
		D10W 1/2 NS/KCL 20 mEg/L/Calcium Gluconate 10mEg/L(NOTE)*
	Dextrose 10% w/0.45% NS w/KCl 20mEq/L &cagluc10mEq/L
		5 mEq, EVERY BAG
		250 mL, IV, 1 ml/hr
		19.2 mEq, EVERY BAG
		2.5 mEq, EVERY BAG
	Dextrose 10% in water NICU syringe
		50 mL, IV, 1 ml/hr
	Dextrose 5% in Water NICU syringe
		50 mL, IV, 1 ml/hr
	Dextrose 2.5% in Water NICU syringe
		50 mL, IV, 1 ml/hr
Central
	Dextrose 10% 250 mL w/HEParin 0.5 units/mL
		250 mL, UVC, Routine, T;N, 1 ml/hr
		125 units, EVERY BAG, T;N
	Dextrose 10% w/0.225% NS w/HEParin 0.5 units/mL
		250 mL, UVC, 1 ml/hr
		9.6 mEq, EVERY BAG
		125 units, EVERY BAG
	Dextrose 10% w/0.45% NS w/ heparin 0.5un/mL
		125 units, EVERY BAG
		250 mL, UVC, 1 ml/hr
		19.2 mEq, EVERY BAG
	Dext 10% w/.225% NS w/KCl 20mEq/L &cagluc10mEq/L&Hep0.5un/mL
		250 mL, IV, 1 ml/hr
		9.6 mEq, EVERY BAG
		5 mEq, EVERY BAG
		2.5 mEq, EVERY BAG
		125 units, EVERY BAG
	Dextrose 10% w/0.45% NS w/KCl 20mEq/L &cagluc10mEq/L&Hep0.5un/mL
		19.2 mEq, EVERY BAG
		2.5 mEq, EVERY BAG
		250 mL, IV, 1 ml/hr
		5 mEq, EVERY BAG
		125 units, EVERY BAG
	Dext 12.5% w/.225% NS w/KCl 20mEq/L &cagluc10mEq/L&Hep0.5un/
		250 mL, IV, 1 ml/hr
		9.6 mEq, EVERY BAG
		5 mEq, EVERY BAG
		2.5 mEq, EVERY BAG
		125 units, EVERY BAG
	Dextrose 12.5% w/0.45% NS w/KCl 20mEq/L &cagluc10mEq/L&Hep0.5un/mL
		250 mL, IV, 1 ml/hr
		19.2 mEq, EVERY BAG
		5 mEq, EVERY BAG
		2.5 mEq, EVERY BAG
		125 units, EVERY BAG
	Dext 15% w/.225% NS w/KCl 20mEq/L &cagluc10mEq/L&Hep0.5un/mL
		250 mL, IV, 1 ml/hr
		9.6 mEq, EVERY BAG
		5 mEq, EVERY BAG
		2.5 mEq, EVERY BAG
		125 units, EVERY BAG
	Dextrose 15% w/0.45% NS w/KCl 20mEq/L &cagluc10mEq/L&Hep0.5un/mL
		250 mL, IV, 1 ml/hr
		19.2 mEq, EVERY BAG
		5 mEq, EVERY BAG
		2.5 mEq, EVERY BAG
		125 units, EVERY BAG
	Dext 17.5% w/.225% NS w/KCl 20mEq/L &cagluc10mEq/L&Hep0.5un/
		250 mL, IV, 1 ml/hr
		9.6 mEq, EVERY BAG
		5 mEq, EVERY BAG
		2.5 mEq, EVERY BAG
		125 units, EVERY BAG
	Dextrose 17.5% w/0.45% NS w/KCl 20mEq/L &cagluc10mEq/L&Hep0.5un/mL
		250 mL, IV, 1 ml/hr
		19.2 mEq, EVERY BAG
		5 mEq, EVERY BAG
		2.5 mEq, EVERY BAG
		125 units, EVERY BAG
	Dextrose 20% w/0.225% NS w/KCl 20mEq/L &cagluc10mEq/L&Hep0.5un/mL
		250 mL, IV, 1 ml/hr
		9.6 mEq, EVERY BAG
		5 mEq, EVERY BAG
		2.5 mEq, EVERY BAG
		125 units, EVERY BAG
	Dextrose 20% w/0.45% NS w/KCl 20mEq/L &cagluc10mEq/L&Hep0.5un/mL
		19.2 mEq, EVERY BAG
		250 mL, IV, 1 ml/hr
		5 mEq, EVERY BAG
		2.5 mEq, EVERY BAG
		125 units, EVERY BAG
Starter TPN
	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
Bolus
	Sodium Chloride 0.9% Intravenous Solution (NICU Bolus)
		10 mL/kg, Injection, IV Push, Once, T;N
			Comment: Bolus over 20 minutes.
	Dextrose 10% intravenous soln (Bolus)
		2 mL/kg, Syringe, IV Push, Once
Arterial Line Solutions
	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
		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
		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
Peripheral Arterial Line
	Papaverine 6mg/HEParin 50 units/Sodium Chloride 0.9% 50mL
		50 mL, PAL, 0.5 ml/hr
		6 mg, EVERY BAG
		50 units, EVERY BAG
	Papaverine 6mg/HEParin 50 units/Sodium Chloride 0.45% 50mL
		50 mL, PAL, 0.5 ml/hr
		6 mg, EVERY BAG
		50 units, EVERY BAG
		Normal Acetate(NOTE)*
	Papaverine 6mg/Sodium Acetate 7.7mEq/HEParin 50 units/Water
		50 mL, PAL, 0.5 ml/hr
		6 mg, EVERY BAG
		7.7 mEq, EVERY BAG
		50 units, EVERY BAG
		1/2 Normal Acetate(NOTE)*
	Papaverine 6mg/Sodium Acetate 3.85mEq/HEParin 50 units/Water
		50 mL, PAL, 0.5 ml/hr
		6 mg, EVERY BAG
		3.85 mEq, EVERY BAG
		50 units, EVERY BAG

CSF/Meningitis Panel (MH WH FH)
Laboratory

	Protein CSF
		T;N, Stat, spec type = Cerebrospinal Fluid
	Glucose CSF
		T;N, Stat, spec type = Cerebrospinal Fluid
	Cell Count and Diff CSF
		T;N, Stat, spec type = Cerebrospinal Fluid
	Culture Routine
		T;N, Stat, Body Fluid, spec type = Cerebrospinal Fluid

*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