Unique Plan Description: OB Low Intervention Labor Admission
Plan Selection Display: OB Low Intervention Labor Admission
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2021-10-19 07:17:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2022-07-13 00:20:21
Available at all facilities: Yes

OB Low Intervention Labor Admission
Admit/Discharge/Transfer
	Admit to Inpatient Status
		T;N, Anticipated LOS 2 midnight or more
Vital Signs
	Vital Signs
		Routine Labor Vital Signs
Activity
	Ambulate
		T;N
			Comment: as tolerated prn
Diet
	Clear Liquid Diet
		T;N
			Comment: low risk laboring patients may have moderate amount of clear liquids.
Laboratory
	Type and Screen (No Product on hold)
		T;N, Routine, spec type = Blood
	CBC with Diff
		T;N, Routine, spec type = Blood
	Glucose POC - RN
		T;N, Q1H, Notify MD if less than 70 or greater than 120
		T;N, Q2H-Sch, Notify MD if less than 70 or greater than 120
	Glucose Level, patient to do own
		
IV Solutions
	Lactated Ringers Injection
		1,000 mL, IV, PRN, see comment, 125 ml/hr
			Comment: to be run with IV GBS antibiotics
		1,000 mL, IV, PRN, labor, 999 ml/hr
			Comment: for category II or III tracing as needed
	Pitocin 30 units/lactated ringers 500 mL Premix IV
		500 mL, IV, Routine, T;N, 24 hr
			Comment: Infuse 15 units over 15 minutes (999mL/hr) immediately post partumFollowed by 15 units over 3 hours (83.3mL/hr) immediately after first bolus dose is completed - The Initial postpartum infusion rate may be decreased prior to 15 minutes based on patient's clinical status and communication between the surgeon and anesthesia provider. - RN will be responsible to adjust IV rate.
		30 units, EVERY BAG, 59.94 units/hr
Medications
	lidocaine 1% preservative-free injectable solution
		30 mL, Injection, SUBCUTANEOUS, Once, PRN for see comment
			Comment: for episiotomy repair
	Pitocin
		10 units, Injection, IM-Intramuscular, Once, PRN for uterine relaxation
			Comment: Have at bedside prior to delivery
	ondansetron
		4 mg, Injection, IV Push, Q6H, PRN for nausea and/or vomiting
Patient Care
	Fetal Monitoring
		T;N
			Comment: Obtain baseline fetal monitoring for 30 minutes. If baseline fetal monitoring is not Category I, notify provider for plan of care. Intermittent auscultation with Doppler as appropriate per policy and patient preference.
	Straight Catheter
		Insert, unable to void
			Comment: PRN
	Notify MD
		if mother HBsAG positive or unknown
		Anesthesia if patient is a VBAC
		Obstetric Call Parameters: SBP >160 mmHg and/or DBP >110 mmHg, P: >120 or <50, O2 Sat: <90%, RR: <10 or >30, Oliguria: <60 mL in 2 hours, Single Temp > 39.0C (102.2F), OR 2 temps between 38.0C (100.4F) and 39C (102.2F), at least 30 min apart
Consults/Follow-up
	Consult Neonatologist
		Reason for Referral: NNP for pending delivery

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

OB GBS Prophylaxis Protocol
Medications
	penicillin G potassium
		6 millionunits, Injection-Premix, IVPB, Once, GBS prophylaxis, STAT
		3 millionunits, Injection-Premix, IVPB, Q4H, GBS prophylaxis
		Low Risk penicillin Allergy--If patient has a penicillin allergy and is at low risk for anaphylaxis, select the 2 ceFAZolin (Ancef) orders below:(NOTE)*
	Ancef IVPB
		2,000 mg, Injection-Premix, IVPB, Once, Other- type in, GBS prophylaxis, STAT, 100 ml/hr
		1,000 mg, Injection-Premix, IVPB, Q8H, Other- type in, GBS prophylaxis, 100 ml/hr
	Ancef IVPB (FH)
		2,000 mg, Injection-Premix, IVPB, Once, Other- type in, GBS Prophylaxis, STAT, 100 ml/hr
		1,000 mg, INT, IVPB, Q8H, Other- type in, GBS Prophylaxis, 100 ml/hr
		High Risk Penicillin Allergy  WITH documented sensitivity--If patient has a high risk Penicillin allergy AND there is documented GBS sensitivity to Clindamycin select order below:(NOTE)*
	Cleocin IVPB
		900 mg, Injection-Premix, IVPB, Q8H, Other- type in, GBS prophylaxis, STAT
		High Risk Penicillin Allergy with resistance OR no sensitivity testing--If patient has a high risk Penicillin allergy AND there is documented Clindamycin resistance OR no sensitivity testing completed, select the vancomycin order below:(NOTE)*
	vancomycin IVPB
		20 mg/kg, Injection-Premix, IVPB, Q8H, Indication: Other- type in, GBS prophylaxis, STAT
			Comment: Maximum single dose is 2000mg; please ensure doses greater than 1000mg are infused no faster than 500mg/30 min to prevent infusion related reactions.
	vancomycin IVPB (FH)
		20 mg/kg, Injection-Premix, IVPB, Q8H, Indication: Other- type in, GBS Prophylaxis, STAT
			Comment: Comment: Maximum single dose is 2000mg; please ensure doses greater than 1000mg are infused no faster than 500mg/30 min to prevent infusion related reactions

*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