Unique Plan Description: Sotalol IV to Oral Dosing Initiation
Plan Selection Display: Sotalol IV to Oral Dosing Initiation
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2021-12-14 16:12:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-03-19 12:28:19
Available at all facilities: No

Sotalol IV to Oral Dosing Initiation
Admit/Discharge/Transfer
	Admit to Observation Status
		T;N
Vital Signs
	Vital Signs
		Prior to initiation of infusion, then every 15 min for 1 hour, then every hour times two.
Activity
	Bedrest
		T;N
			Comment: until IV sotalol infusion complete
Laboratory
	Comprehensive Metabolic Panel
		Stat, spec type = Blood
	Magnesium Level
		Stat, spec type = Blood
	PTT - MH/WH/JE
		Stat, spec type = Blood
Diagnostic Tests
	ECG
		T;N, Stat, Indication: Arrhythmia
Medications
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	sotalol
		60 mg, INT, IVPB, Once, infuse over 1 hr
			Comment: monitor QTc Q 15 minutes, if interval prolongs >500ms, hold infusion & notify provider.  IV dose for 80mg po BID, CrCl > 90ml/min
		80 mg, Tab, By Mouth, Once, T;N+300
			Comment: 4 hours after end of infusion. Order ECG 2 hours post medication admin
		80 mg, Tab, By Mouth, Q12H, T;N+1020
			Comment: 12 hours after first sotalol PO dose. Order ECG 2 hours post medication admin
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		82.5 mg, INT, IVPB, Once, infuse over 1 hr
			Comment: monitor QTc Q 15 minutes, if interval prolongs >500ms, hold infusion & notify provider.  IV dose for 80mg po BID, CrCl 60-90ml/min.
		80 mg, Tab, By Mouth, Once, T;N+300
			Comment: 4 hours after end of infusion Order ECG 2 hours post medication admin
		80 mg, Tab, By Mouth, Q12H, T;N+1020
			Comment: 12 hours after first sotalol PO dose. Order ECG 2 hours post medication admin
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		75 mg, INT, IVPB, Once, infuse over 1 hr
			Comment: monitor QTc Q 15 minutes, if interval prolongs >500ms, hold infusion & notify provider.  IV dose for 80mg po BID, CrCl 40-60ml/min.
		80 mg, Tab, By Mouth, Once, T;N+420
			Comment: 6 hours after end of infusion. Order ECG 2 hours post medication admin
		80 mg, Tab, By Mouth, Once, T;N+1860
			Comment: 24 hours after first sotalol PO dose Order ECG 2 hours post medication admin
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		90 mg, INT, IVPB, Once, infuse over 1 hr
			Comment: monitor QTc Q 15 minutes, if interval prolongs >500ms, hold infusion & notify provider.  IV dose for 120mg po BID, CrCl > 90ml/min.
		120 mg, Tab, By Mouth, Once, T;N+300
			Comment: 4 hours after end of infusion. Order ECG 2 hours post medication admin
		120 mg, Tab, By Mouth, Q12H, T;N+1020
			Comment: 12 hours after first sotalol PO dose. Order ECG 2 hours post medication admin
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		125 mg, INT, IVPB, Once, infuse over 1 hr
			Comment: monitor QTc Q 15 minutes, if interval prolongs >500ms, hold infusion & notify provider.  IV dose for 120mg po BID, CrCl 60-90ml/min.
		120 mg, Tab, By Mouth, Once, T;N+300
			Comment: 4 hours after end of infusion. Order ECG 2 hours post medication admin
		120 mg, Tab, By Mouth, Q12H, T;N+1020
			Comment: 12 hours after first sotalol PO dose. Order ECG 2 hours post medication admin
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		112.5 mg, INT, IVPB, Once, infuse over 1 hr
			Comment: monitor QTc Q 15 minutes, if interval prolongs >500ms, hold infusion & notify provider.  IV dose for 120mg po BID, CrCl 40-60 ml/min.
		120 mg, Tab, By Mouth, Once, T;N+420
			Comment: 6 hours after end of infusion. Order ECG 2 hours post medication admin
		120 mg, Tab, By Mouth, Q24H, T;N+1860
			Comment: 24 hours after first sotalol PO dose Order ECG 2 hours post medication admin
	Sodium Chloride 0.9% IVPB Flush
		25 mL, IVPB, Q1H, PRN, IV line flush, 5 min(s)
			Comment: Use to flush entire medication volume
Patient Care
	Notify MD
		T;N, if QT greater than 500ms, hold sotalol and notify provider.
	Order ECG
		T;N, prior to first po dose and 2 hours after each po medication administration
	Notify MD
		T;N, See Comments
			Comment: if patient has bronchial asthma or related bronchospastic conditions, sinus bradycardia (<50bpm during waking hours), 2nd or 3rd degree AV block (unless functioning pacemaker is present), congenital or acquired long QT syndromes, cardiogenic shock, decompensated heart failure, sick sinus syndrome
	Notify MD of Lab results
		T;N, of abnormal lab results prior to initiating sotalol
	Cardiac Telemetry Monitoring
		T;N, Telemetry Indications: ACS/Arrhythmia/QTc
			Comment: Measure QTc Q15 minutes during IV infusion, prior to each po dose of Sotalol and 2 hours after each dose. Notify MD if QT exceeds 500ms
	Discharge Instructions Other
		Instructions: Call Heart Consultants @ 402.391-5055 to schedule an appointment for 3-5 days after hospital discharge with EP Clinic APRN to include EKG.
		Instructions: Call Heart Consultants @ 402.391-5055 to schedule an appointment for 4 weeks after hospital discharge with Cardiologist to include EKG.
Consults/Follow-up
	Pharmacy Consult
		Sotalol prescribed; follow policy to evaluate, drug interactions, appropriate dosing, and provide education. Notify provider if patient has CrCL<60ml/min or is taking any interacting medications

*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