Unique Plan Description: NICU Rounds (WH)
Plan Selection Display: NICU Rounds (WH)
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2022-04-05 12:10:37
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2022-04-05 12:13:09
Available at all facilities: No

NICU Rounds (WH)
Admit/Discharge/Transfer
	Home Oxygen Therapy - NICU
		
	Home Apnea Monitoring - NICU
		
Vital Signs
	Vital Signs
		Routine
Diet
	NPO
		
	Formula
		
	Breast Milk
		Feed Base: Mother Breast Milk, If No Breast Milk: Donor Milk
	Feeding Safety Assessment
		Q24H
Laboratory
STAT, one time
	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)
		Stat, spec type = Blood
	Lactate
		Stat, spec type = Blood
	Ammonia
		Stat, spec type = Blood
	CBC with Diff
		Stat, spec type = Blood
	Hemoglobin and Hematocrit
		Stat, spec type = Blood
	Comprehensive Metabolic Panel
		Stat, spec type = Blood
	Basic Metabolic Panel
		Stat, spec type = Blood
	Bilirubin Total and Direct
		Stat, spec type = Blood
	Bilirubin Total
		Stat, spec type = Blood
	Gentamicin Random
		Stat, spec type = Blood
	Vancomycin Random
		Stat, spec type = Blood
	hsCRP
		Stat, spec type = Blood
	Type and Screen (No Product on hold)
		Stat, spec type = Blood
		To administer products other than packed cells, select both the administer blood products order and the product.(NOTE)*
	Administer Blood Products - NICU
		
	Frozen Plasma
		Stat
	Platelet Pheresis
		Stat
	Cryoprecipitate
		Stat
Glucose Studies
	Glucose POC - NICU
		T;N, Once
		T;N
			Comment: 30 minutes after Insulin
		T;N
			Comment: AC for 1 feeding
		T;N
			Comment: AC for 2 feedings
		T;N
			Comment: AC for 3 feedings
		T;N
			Comment: AC for 4 feedings
		T;N
			Comment: Every Other Feeding
		If patient has arterial line, order POC WB Glucose Nurse Collect - NICU(NOTE)*
	POC WB Glucose Nurse Collect - NICU
		T;N, Once
		T;N, 30 minutes after Insulin
		T;N, AC for 1 feeding
		T;N, AC for 2 feedings
		T;N, AC for 3 feedings
		T;N, AC for 4 feedings
		T;N, Every Other Feeding
Timed Lab
	Blood Gases Arterial (ABG) - MH/WH/JE
		Timed, spec type = Blood
		Routine, Q2H, spec type = Blood
		Routine, Q4H, spec type = Blood
		Routine, Q6H, spec type = Blood
	Blood Gases Capillary (CBG) - MH/WH/JE
		Timed, spec type = Blood
	Blood Gases VENOUS (VBG)
		Timed, spec type = Blood
	Lactate
		Timed, spec type = Blood
	CBC with Diff
		Timed, spec type = Blood
	Hemoglobin and Hematocrit
		Timed, spec type = Blood
	hsCRP
		Timed, spec type = Blood
	Comprehensive Metabolic Panel
		Timed, spec type = Blood
	Basic Metabolic Panel
		Timed, spec type = Blood
		Routine, Q6H, spec type = Blood
	Bilirubin Total
		Timed, spec type = Blood
		Routine, Q4H, spec type = Blood
	Bilirubin Total and Direct
		Timed, spec type = Blood
	Direct Coombs
		Timed, spec type = Blood
	Gentamicin Random
		Timed, spec type = Blood
	Vancomycin Random
		Timed, spec type = Blood
PM Lab
	Blood Gases Arterial (ABG) - MH/WH/JE
		T;2000, Routine, spec type = Blood
	Blood Gases Capillary (CBG) - MH/WH/JE
		T;2000, Routine, spec type = Blood
	Blood Gases VENOUS (VBG)
		T;2000, Routine, spec type = Blood
	CBC with Diff
		T;2000, Routine, spec type = Blood
	Hemoglobin and Hematocrit
		T;2000, Routine, spec type = Blood
	hsCRP
		T;2000, Routine, spec type = Blood
	Comprehensive Metabolic Panel
		T;2000, Routine, spec type = Blood
	Basic Metabolic Panel
		T;2000, Routine, spec type = Blood
	Bilirubin Total and Direct
		T;2000, Routine, spec type = Blood
	Bilirubin Total
		T;2000, Routine, spec type = Blood
Tomorrow's Lab
	Blood Gases Arterial (ABG) - MH/WH/JE
		T+1;0400, Routine, spec type = Blood
	Blood Gases Capillary (CBG) - MH/WH/JE
		T+1;0400, Routine, spec type = Blood
	Blood Gases VENOUS (VBG)
		T+1;0400, Routine, spec type = Blood
	Lactate
		T+1;0400, Routine, spec type = Blood
	CBC with Diff
		T+1;0400, Routine, spec type = Blood
	Hemogram
		T+1;0400, Routine, spec type = Blood
	Platelet Count
		T+1;0400, Routine, spec type = Blood
	Hemoglobin and Hematocrit
		T+1;0400, Routine, spec type = Blood
	Reticulocyte Count
		T+1;0400, Routine, spec type = Blood
	hsCRP
		T+1;0400, Routine, spec type = Blood
	Comprehensive Metabolic Panel
		T+1;0400, Routine, spec type = Blood
	Basic Metabolic Panel
		T+1;0400, Routine, spec type = Blood
	Bilirubin Total and Direct
		T+1;0400, Routine, spec type = Blood
	Bilirubin Total
		T+1;0400, Routine, spec type = Blood
	Magnesium Level
		T+1;0400, Routine, spec type = Blood
	Phosphorus
		T+1;0400, Routine, spec type = Blood
	Triglycerides
		T+1;0400, Routine, spec type = Blood
Diagnostic Tests
STAT
	Chest 1 View
		Stat
	Chest 1 View include Abd
		Stat
	Abd
		Stat
	Abd & Decub
		Stat
	Chest AP & Crosstable Lat include Abd
		Stat, PICC/UAC/UVC Placement
	Chest 1 View Crosstable Lat Only
		Stat, PICC/UAC/UVC Placement
Ultrasound
	US Renal Retro Complete
		T;N, Routine, Once
			Comment: Covers bladder, IVC/Aorta, Kidneys and ureters.
		T+1;0600, Routine
			Comment: Covers bladder, IVC/Aorta, Kidneys and ureters.
	US Renal Retro Limited
		T;N, Routine, Once
			Comment: Used to follow-up specific area already documented, ie hydro, renal cysts, etc. Covers specific area only or bladder only.
		T+1;0600, Routine
			Comment: Used to follow-up specific area already documented, ie hydro, renal cysts, etc. Covers specific area only or bladder only.
	US Abd Complete
		T;N, Routine, Once
			Comment: Covers all abdominal organs from umbilicus to Chest, RUQ and LUQ.
		T+1;0600
			Comment: Covers all abdominal organs from umbilicus to Chest, RUQ and LUQ.
	US Abd Limited
		T;N, Routine, Once
			Comment: US Abdomen Limited: RUQ/LUQ Covers a specific area of interest, ie RUQ or LUQ or covers specific organ, ie pancreas, gallbladder, etc. Used to look for ascites or abscess.
		T+1;0600
			Comment: US Abdomen Limited: RUQ/LUQ Covers a specific area of interest, ie RUQ or LUQ or covers specific organ, ie pancreas, gallbladder, etc. Used to look for ascites or abscess.
	US Head Complete
		T;N, Routine, Once
		T+1;0600
	US Spine
		T;N, Routine, Once
		T+1;0001, Routine
	US Duplex Aorta IVC Limited
		T;N, Routine
			Comment: Doppler shows velocity and resistance of blood flow; color flow  displays the direction of blood flow of the aorta/IVC
Radiology
	Chest 1 View
		T;N, Routine
		T;2000, Routine
		T+1;0600, Routine
	Chest 1 View include Abd
		T;N, Routine
		T;2000, Routine
		T+1;0600, Routine
	Chest Lat Decub Lt Only
		T;N, Routine
		T;2000, Routine
		T+1;0600, Routine
	Chest Lat Decub RT Only
		T;N, Routine
		T;2000, Routine
		T+1;0600, Routine
	Abd
		T;N, Routine
		T;2000, Routine
		T+1;0600, Routine
	Abd & Decub
		T;N, Routine
		T;2000, Routine
		T+1;0600, Routine
	Abd Decub
		T;N, Routine
		T;2000, Routine
		T+1;0600, Routine
Diagnostics
	Newborn Hearing Screening
		Once
		T+1;0600
	Car Seat Study
		
	Echocardiogram to be done by CH
		Stat
		T+1;0600, Routine
	Modified Barium Swallow Study
		T;N
IV Solutions

	Dextrose 10% intravenous soln (Bolus)
		2 mL/kg, Syringe, IV PUSH, Once, T;N
	sodium bicarbonate 4.2% (NICU)
		1 mEq/kg, Injection, IVPB, Once, infuse over 1 hr, T;N
	Sodium Chloride 0.9% Intravenous Solution (NICU Bolus)
		10 mL/kg, Injection, IV Push, Once, T;N
			Comment: Sodium Chloride 0.9% Intravenous Solution (NICU Bolus)
Medications
	glycerin pediatric suppository
		0.25 supp, Suppository, RECTALLY, Q12H, PRN, constipation
IV
	potassium chloride IVPB - Central line
		1 mEq/kg, IVPB, Once, T;N
			Comment: Max rate of over 2 hours while on telemetry
	potassium chloride IVPB - Peripheral line
		1 mEq/kg, Solution-Injection, IVPB, Once, T;N
			Comment: Max rate of over 2 hours while on telemetry
	calcium gluconate IVPB (NICU)
		100 mg/kg, Solution-Injection, IVPB, Once, T;N
	magnesium sulfate IVPB (NICU)
		10 mg/kg, Solution-Injection, IVPB, Once, T;N
Oral
	sodium chloride 4mEq/mL for oral use
		0.5 mEq/kg, Solution, Gastric Tube, Q6H
			Comment: Give with feeding.
	calcium gluconate 10% for oral use
		10 mg/kg, Solution, Gastric Tube, Q6H
	potassium chloride 2 mEq/mL for oral use
		0.25 mEq/kg, Soln, Gastric Tube, Q6H
Patient Care

	Crib, Wean to as Tolerated
		
	Phototherapy
		T;N, Spot Lights, Initiate
		T;N, NeoBlue, Initiate
		T;N, Bili Blanket, Initiate
		T;N, Phototherapy Double, Initiate
		T;N, Phototherapy Triple, Initiate
	Modified Finnegan Neonatal Abstinence Assessment
		
	TIPS - NICU
		
	Obtain Consent/Permit for:
		PICC line placement.
	Congenital Heart Disease Screening
		T;N, Once
Therapies
Consults/Follow-up
	Consult Cardiologist
		
	Consult Endocrinologist
		
	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 Espisito, MD
	Consult Urology
		Refer to/Consult with: John Donovan, MD
	Consult Gastroenterologist
		Refer to/Consult with: Laurel Prestridge, MD
		Refer to/Consult with: Sharad Kunnath, MD
	Consult Ear Nose and Throat
		Refer to/Consult with: Rodney Lusk, MD
		Refer to/Consult with: Ryan Sewell, MD
	Consult Plastic/Reconstructive
		Refer to/Consult with: Jason Miller, MD
	Consult Pediatrics Surgery
		Refer to/Consult with: Stephen Raynor, MD

NICU Immunizations (WH)
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
	hepatitis B immune globulin
		0.5 mL, Syringe, IM-Intramuscular, Once, T;N
	pneumococcal 20-valent conjugate vaccine
		0.5 mL, Suspension-Injection, IM-Intramuscular, Once, T;N
	Synagis
		15 mg/kg, Injection, IM-IntraMUSCULAR, Once, T;N
	Pentacel (DTaP-IPV/Hib)
		0.5 mL, Solution-Injection, IM-Intramuscular, Once, T;N
		<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"><HTML><HEAD><META content="text/html; charset=windows-1252" http-equiv=Content-Type><STYLE> BODY background-color: rgb(255,255,255);margin:0; P margin:0 </STYLE><META name=GENERAT(NOTE)*
	Beyfortus (cvx 306)
		0.5 mL, Solution-Injection, IM-Intramuscular, Once, T;N
		<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"><HTML><HEAD><META content="text/html; charset=windows-1252" http-equiv=Content-Type><STYLE> BODY background-color: rgb(255,255,255);margin:0; P margin:0 </STYLE><META name=GENERAT(NOTE)*
	Beyfortus (cvx 307)
		1 mL, Solution-Injection, IM-Intramuscular, Once, T;N

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 Nursing Instructions (WH)
Activity
	NICU Positioning Device
		T;N, Once
Patient Care
	Discontinue Chest Tube
		T;N, Once
	Crib, Wean to as Tolerated
		T;N, Once
	Crib, place in
		T;N
	Feeding Safety Assessment
		T;N, Q24H
	Discontinue Feeding Tube
		T;N, Once
	Discontinue Enteral Tube
		T;N, Once
	Incubator Transfer
		T;N, Once
	Discontinue IV Fluids
		T;N, Once
	Head Circumference
		T;N, DAILY
	Discontinue Peripheral Lock
		T;N, Once
	Phototherapy, Discontinue
		T;N, Once
	Discontinue Umbilical Artery Catheter
		T;N, Once
	Umbilical Vein Catheter
		T;N, Pull Back, Once
	Discontinue Umbilical Vein Catheter
		T;N, Once
	Umbilical Artery Catheter
		T;N, Pull Back, Once
	Straight Catheter
		T;N, Insert, Once
	Foley Catheter
		T;N, Insert, Once
	Discontinue Urinary Catheter
		T;N, Once
	Intake and Output
		T;N, Weigh diaper
	Discontinue Oxygen SAT Probe
		T;N
	Discontinue Humidity in Incubator
		T;N, Once
	Turn Humidity on in Incubator
		T;N, Once
	Rectal Wash
		T;N, Normal Saline, Q8H, Amount: 10ml/kg
Therapies
	Discontinue ET Tube
		T;N, Once
	ET Tube
		T;N, Once, Reposition
		T;N, Once, Advance
		T;N, Once, Pull Back

Discharge Plan Newborn
Admit/Discharge/Transfer
	Discharge
		T;N
	Discharge Conditional
		T;N
	Discharge Newborn Safety
		T;N, Back to sleep
		T;N, Use car seat
		T;N, Use car bed
	Discharge Instructions Home Health
		T;N, Nursing Care
		T;N, Occupational Therapy
		T;N, Physical Therapy
		T;N, Speech Therapy
Diet
	Discharge Newborn Feeding
		T;N, Breast feed as needed
		T;N, Breast feed every 2-3 hours during day
		T;N, Breast feed every 2 1/2 to 3 1/2 hours
		T;N, Breast feed every 3-4 hours during night
		T;N, Breast milk fortifiers
		T;N, Bottle feed as needed
		T;N, Formula feed every 3 hours
		T;N, Bottle feed every 1-4 hours
		T;N, Formula feed as needed
		T;N, Bottle feed at least every 2 hours
		T;N, Bottle feed every 2 ½ to 3 ½ hours
		T;N, Bottle feed every 2-3 hours during day
		T;N, Bottle feed every 3-4 hours at night
		T;N, Breast feed every 1-4 hours
		T;N, Supplement as Needed
	Home NG Tube NICU
		
Laboratory
	Discharge Diagnostics
		T;N, Bilirubin
		T;N, US Hips
		T;N, US Spine
		T;N, US Renal
	Discharge Hearing Followup Newborn
		T;N, Boystown Audiology 531-355-6520
		T;N, CMH Audiology 402-955-6799
Patient Care
	Discharge Instructions Other
		T;N
Therapies
	Home Oxygen Therapy - NICU
		
	Home Apnea Monitoring - NICU
		
	Home Pulse Oximetry-NICU

*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