Unique Plan Description: Pneumonia Hospital Acquired and Ventilator Associated (HAP/VAP)
Plan Selection Display: Pneumonia Hospital Acquired and Ventilator Associated (HAP/VAP)
PlanType: Medical                                 
Version: 4          
Begin Effective Date: 2022-02-22 12:08:59
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2025-05-12 08:57:32
Available at all facilities: Yes

Pneumonia Hospital Acquired and Ventilator Associa
Activity
	Activity-Up as Tolerated
		T;N
	Ambulate
		QID
	Up in Chair
		TIDWM
Laboratory
STAT Lab
	CBC with Diff
		Stat, spec type = Blood
	Comprehensive Metabolic Panel
		Stat, spec type = Blood
	hsCRP
		Stat, spec type = Blood
	Sputum Culture
		Stat, spec type = Sputum
	MRSA Screen
		Stat, spec type = Nose
	Procalcitonin
		Stat, spec type = Blood
	Blood Gases Arterial (ABG) - MH/WH/JE
		T;N, Stat, spec type = Blood
	Blood Gases Arterial (ABG) - FH
		T;N, Stat, spec type = Blood
	Influenza A and B Screen PCR
		T;N, Routine, spec type = Nasopharynx
	Respiratory Panel Flu-RSV-Covid
		T;N, Stat, spec type = Nasopharynx
	Lactic Acid
		T;N, Stat, spec type = Blood
	Streptococcus pneumoniae Antibodies IgG (14 Serotypes)
		T;N, Stat, spec type = Blood
	Legionella Antigen - Urine
		T;N, Routine, Routine, spec type = Urine
	Culture Routine
		T;N, Stat, Aspirate, spec type = Aspirate
			Comment: Tracheal Aspirate
	Mycoplasma pneumonia Ab IgG and IgM
		T;N, Routine, spec type = Blood
Diagnostic Tests
Radiology
	Chest 1 View
		Stat, Pneumonia
	Chest 2 View
		Stat, Pneumonia
Medications

	Tylenol
		650 mg, Tab, BY MOUTH, Q4H, PRN, temperature > ....
			Comment: 101.9
		Select 1 Antibiotic(NOTE)*
	cefepime IVPB
		2,000 mg, Injection-Premix, IVPB, Q8H, Indication: Pneumonia-Hospital acquired
			Comment: If unable to obtain blood cultures on initial attempt, start antibiotics.
	cefepime (FH/WH)
		2,000 mg, INT, IVPB, Q8H, Indication: Pneumonia-Hospital acquired
			Comment: If unable to obtain blood cultures on initial attempt, start antibiotics
	Zosyn IVPB
		4.5 gm, Injection-Premix, IVPB, Q8H, Indication: Pneumonia-Hospital acquired
			Comment: If unable to obtain blood cultures on initial attempt, start antibiotics.
	Zosyn IVPB (FH)
		4.5 gm, INT, IVPB, Q8H, Indication: Pneumonia-Hospital acquired
			Comment: If unable to obtain blood cultures on initial attempt, start antibiotics
	Levaquin IVPB
		750 mg, Injection-Premix, IVPB, Q24H, Indication: Pneumonia-Hospital acquired
			Comment: If unable to obtain blood cultures on initial attempt, start antibiotics.
		Add MRSA Antibiotic(NOTE)*
	vancomycin IVPB
		15 mg/kg, IVPB, PHARMACY TO DETERMINE, Indication: Pneumonia-Hospital acquired
	vancomycin IVPB (FH)
		15 mg/kg, INT, IVPB, PHARMACY TO DETERMINE, Indication: Pneumonia-Hospital acquired
	Zyvox IVPB
		600 mg, Injection-Premix, IVPB, Q12H, Indication: Pneumonia-Hospital acquired
			Comment: If unable to obtain blood cultures on initial attempt, start antibiotics.
		If structural lung disease (i.e. bronchiectasis, cystic fibrosis), received IV antibiotics in the preceding 90 days, ventilator support, septic shock, ARDS preceding VAP, >5 days in hospital prior to VAP, acute renal replacement therapy prior to VAP onset(NOTE)*
		ADD 1 antibiotic (if Cefepime or Zosyn selected above, choose Levofloxacin)(NOTE)*
	cefepime IVPB
		2,000 mg, Injection-Premix, IVPB, Q8H, Indication: Pneumonia-Hospital acquired
			Comment: If unable to obtain blood cultures on initial attempt, start antibiotics
	cefepime (FH/WH)
		2,000 mg, INT, IVPB, Q8H, Indication: Pneumonia-Hospital acquired
			Comment: If unable to obtain blood cultures on initial attempt, start antibiotics.
	Zosyn IVPB
		4.5 gm, Injection-Premix, IVPB, Q24H, Indication: Pneumonia-Hospital acquired
			Comment: If unable to obtain blood cultures on initial attempt, start antibiotics
	Zosyn IVPB (FH)
		4.5 gm, INT, IVPB, Q8H, Indication: Pneumonia-Hospital acquired
			Comment: If unable to obtain blood cultures on initial attempt, start antibiotics
	Levaquin IVPB
		750 mg, Injection-Premix, IVPB, Q24H, Indication: Pneumonia-Hospital acquired
			Comment: If unable to obtain blood cultures on initial attempt, start antibiotics
	gentamicin IVPB (FH)
		5 mg/kg, INT, IVPB, Q24H, Indication: Pneumonia-Hospital acquired
			Comment: Pharmacy to dose.  If unable to obtain blood cultures on initial attempt, start antibiotics
Therapies
	Bronchodilator Therapy per Respiratory Protocol (FH)
		T;N
	Incentive Spirometer
		Q1HAWAKE
	Aerosol Treatment for sputum induction
		
	albuterol-ipratropium 2.5 mg-0.5 mg/3 mL inhalation solution
		3 mL, Solution-Nebulization, NEBULIZED, QID
		3 mL, Solution-Nebulization, NEBULIZED, Q2H, PRN for wheezing and/or shortness of breath
	albuterol concentrate 2.5mg/0.5mL (0.5%) inh soln
		0.5 mL, Solution-Nebulization, NEBULIZED, Q2H, PRN for wheezing and/or shortness of breath
	sodium chloride 0.9% inhalation solution
		3 mL, Solution-Nebulization, Inhalation, Q2H, PRN for wheezing and/or shortness of breath
	levalbuterol 1.25 mg/3 ml inhalation solution
		3 mL, Solution-Nebulization, NEBULIZED, Q8H
		3 mL, Solution-Nebulization, NEBULIZED, Q4H, PRN for wheezing and/or shortness of breath
	Smoking Cessation Education
		
	Smoking Cessation Education RT (FH)
		
	Consult Respiratory Therapy-Assess and Treat
		T;N
Consults/Follow-up
	Consult Pulmonologist
		Reason for Referral: Pneumonia
	Consult Infectious Disease
		Reason for Referral: Pneumonia

Oxygen Protocol
Therapies
Respiratory Therapy
	Oxygen Therapy
		T;N
	Pulse Oximetry Spot Check RT
		T;N, BID
	Continuous Pulse Oximetry Monitoring Check
		T;N, BID

Blood Culture Set
Laboratory

	.Blood Culture.
		T;N, Stat, spec type = Blood
		T;N, Routine, spec type = Blood
		T+1;0400, Routine, spec type = Blood
	.Blood Culture
		T;N, Stat, spec type = Blood
		T;N, Routine, spec type = Blood
		T+1;0400, Routine, spec type = Blood

*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