Stroke Order Set 2 - Pharmacy Practice News

USE BALL POINT PEN ONLY – WRITE FIRMLY.
AUTOMATIC STOP ORDERS:
24 Hours OXYTOCICS and ANTINEOPLASTICS
72 Hours Schedule II Control Drugs
3 Days All I.V. Solutions
5 Days All Oral and I.V. Antibiotics, Anti-infectives
7 Days Anticoagulants, Corticosteroids, (EXCEPT TOPICAL),
Schedule III, IV, V Control Drugs
14 Days All Other Medication
*Unless otherwise specified by physician
HEIGHT WEIGHT ALLERGIES
Page 1 of 4
DIAGNOSIS
DATE & TIME
OF ORDER
STROKE UNIT ADMISSION ORDE RS:
PATIENTS NOT RECE IVING ALTEP L AS E (t-PA) THERAP Y
1. Admitting Diagnosis: Acute Ischemic Stroke, Transient Ischemic Attack (TIA)
Admit to: MICU/SICU Telemetry ________________
Admitting Dr:
Neurologist: Dr
2. DIET
∞ NPO until repeat swallow screen completed
∞ Swallow Screen Results: Pass Fail Performed by: Date: Time:
♦ If Swallow Screen results FAIL, consult speech therapist for swallowing evaluation
within 24 hours
♦ If Swallow Screen results PASS, Ice chips and sips of water X 4 hours then:
Full liquid diet Mechanical soft diet Other
∞ Nutrition Assessment by Dietician within 24 hours
3. ACTIVITY
Bedrest with Head of Bed elevated 30 degrees while in bed
Bedrest X 12 hours then out of bed with assistance
Out of Bed with assistance
Other
4. Place anti-embolic compression device on patient’s legs if not OOB
5. Fall Precautions
6. Vital Signs including Neuro Checks, pulse oximetry, temp. and BP
∞ Every 4 hours X 2 then,
∞ Every 8 hours thereafter
7. Continuous Cardiac Monitor
8. Continuous Pulse Oximetry
9. Record Intake and Output every shift
10. Notify Attending physician and/or Neurologist immediately if any signs or symptoms of
decreasing level of consciousness, severe headache, nausea, vomiting, or increased
hypertension > 10% above baseline. Baseline_________________
11. Respiratory Therapy: O2 via:
Mask Nasal Cannula @ liters/min to maintain SaO2 > 95%.
ORDER
NUMBER
PHYSICIAN SIGNATURE:
DATE:
TIME:
RN SIGNATURE: DATE: TIME:

USE BALL POINT PEN ONLY – WRITE FIRMLY.
AUTOMATIC STOP ORDERS:
24 Hours OXYTOCICS and ANTINEOPLASTICS
72 Hours Schedule II Control Drugs
3 Days All I.V. Solutions
5 Days All Oral and I.V. Antibiotics, Anti-infectives
7 Days Anticoagulants, Corticosteroids, (EXCEPT TOPICAL),
Schedule III, IV, V Control Drugs
14 Days All Other Medication
*Unless otherwise specified by physician
HEIGHT WEIGHT ALLERGIES
Page 2 of 4
DIAGNOSIS
DATE & TIME
OF ORDER
STROKE UNIT ADMISSION ORDE RS:
PATIENTS NOT RECE IVING ALTEP L AS E (t-PA) THERAP Y
12. Medications: REMINDER: If swallow screen failed - no PO medications until evaluation by
speech pathologist is completed.
IV line # 1 - IV: Solution Volume Rate
IV line # 2 - Saline lock; flush with 2 ml of Normal Saline every shift.
Hypertension Management – Please see Page 4
GI PROPHYLAXIS/BOWEL REGIMEN
Pantoprazole (Protonix) 40mg by mouth once daily OR
Pantoprazole (Protonix) 40mg IV once daily if patient is NPO OR
Prevacid 30 mg NGT once daily
Docusate (Colace) 100mg by mouth twice daily.
Bisacodyl (Dulcolax) 10mg suppository per rectum once daily as needed for bowel movement.
ANTITHROMBOTIC/DVT PROPHYLAXIS/ATRIAL FIBRILLATION MANAGEMENT (please specify).
Aspirin 81 mg by mouth now and daily Indication: Antithrombotic DVT Proph
Aspirin 325mg by mouth now and daily. Indication: Antithrombotic DVT Proph
Aspirin 25mg/Dipyridamole 200mg (Aggrenox) by mouth BID Indication: Antithrombotic DVT
Proph
Enoxaparin (Lovenox) 40mg subcutaneously daily. Indication: Antithrombotic DVT Proph A-fib
Warfarin (Coumadin) mg PO Indication: Antithrombotic DVT Proph A-fib
Heparin
PT/INR daily
Indication: Antithrombotic DVT Proph A-fib
PAIN MANAGEMENT / ANTIPYRETIC
Acetaminophen (Tylenol) 650mg by mouth every 4 hours as needed for mild pain or temperature >
99.6°
Other:
Notify physician if temperature > 101°
Glucose Monitoring (fingerstick) every
Glucose Management (please specify)
hours.
ORDER
NUMBER
Hyperlipidemia Management (please specify)
PHYSICIAN SIGNATURE:
DATE:
TIME:
RN SIGNATURE: DATE: TIME:

USE BALL POINT PEN ONLY – WRITE FIRMLY.
AUTOMATIC STOP ORDERS:
24 Hours OXYTOCICS and ANTINEOPLASTICS
72 Hours Schedule II Control Drugs
3 Days All I.V. Solutions
5 Days All Oral and I.V. Antibiotics, Anti-infectives
7 Days Anticoagulants, Corticosteroids, (EXCEPT TOPICAL),
Schedule III, IV, V Control Drugs
14 Days All Other Medication
*Unless otherwise specified by physician
HEIGHT WEIGHT ALLERGIES
Page 3 of 4
DIAGNOSIS
DATE & TIME
OF ORDER
Other Medications:
STROKE UNIT ADMISSION ORDERS -
PATIENTS NOT RECEIVING ALTEPLASE (t-PA) THERAPY
13. Rehabilitation Medicine Consults: (to be completed within 24 hours of admission)
Physiatrist Evaluation and Treatment
P.T. Evaluation and Treatment. Extension 42050
Occupational Therapy Evaluation. Extension 42382
14. Case Management referral and discharge planning evaluation. Extension 42280
15. Clinical Laboratory Testing: Indication: Acute Ischemic Stroke
CBC with automated differential (if not done in ED)
Lipid profile (if not done in ED)
BMP (if not done in Emergency Department)
B12, Folate, RPR
Homocysteine level
16. Additional Diagnostic Tests
Carotid Ultrasound
2-D Cardiac Echo
Other Labs:
Indication: Acute Ischemic Stroke
Indication: Acute Ischemic Stroke
Chest X ray, PA/Lateral; if not done in ED Indication: Acute Ischemic Stroke
MRI Brain with diffusion weighted imaging/
without contrast
Indication:
MRA
Other diagnostic tests:
17. OTHER ORDERS:
Indication:
ORDER
NUMBER
PHYSICIAN SIGNATURE: ______________________________________
DATE: ____________________________________ TIME: _____________________________
RN SIGNATURE: __________________________ DATE: TIME: ________

USE BALL POINT PEN ONLY – WRITE FIRMLY.
AUTOMATIC STOP ORDERS:
24 Hours OXYTOCICS and ANTINEOPLASTICS
72 Hours Schedule II Control Drugs
3 Days All I.V. Solutions
5 Days All Oral and I.V. Antibiotics, Anti-infectives
7 Days Anticoagulants, Corticosteroids, (EXCEPT TOPICAL),
Schedule III, IV, V Control Drugs
14 Days All Other Medication
*Unless otherwise specified by physician
HEIGHT WEIGHT ALLERGIES
Page 4 of 4
DIAGNOSIS
DATE & TIME
OF ORDER
STROKE UNIT ADMISSION ORDERS -
PATIENTS NOT RECEIVING ALTEPLASE (t-PA) THERAPY
Blood Pressure Management: Non-rtPA Patients
Goal BP Management = 15% Reduction In BP from baseline
If Systolic BP is 180 mm Hg or Diastolic BP 100 mm Hg, do not treat BP unless other
end organ failure e.g., aortic dissection, acute MI, pulmonary edema, hypertensive
encephalopathy is present.
Systolic BP >180 mm Hg OR diastolic BP 100 mm Hg
Labetalol 10 mg IV over 1-2 minutes. (Note: Labetalol may be repeated every 10-20 minutes to
maximum dose of 300 mg)
If BP systolic >180 mg Hg or diastolic >100 mm Hg within 10 minutes of initial dose, notify physician
and
Repeat Labetalol 10 mg IV over 1-2 minutes.
Labetalol Infusion
start.
OR
Labetolol 10 mg IV over 1-2 minutes bolus then start Labetalol infusion at 2-8 mg/minute
Infusion: Labetalol 200 mg in 160 ml normal saline (concentration =1 mg/1ml)
Notify physician if BP systolic >180 mg Hg or diastolic >100 mm Hg 15 minutes after infusion
Nitropaste 1 inch to chest wall. Notify physician If BP systolic >180 mg Hg or
diastolic >100 mm Hg within 10 minutes, OR
Nitropaste 2 inches to chest wall. Notify physician If BP systolic >180 mg Hg or
diastolic >100 mm Hg within 10 minutes, OR
Nicardipine infusion 25 mg in 250 ml at 5 mg/hour, titrate up by 2.5 mg/hour
at 5-15 minute intervals to maximum dose of 15 mg/hour. Reduce to 3 mg/hour when
BP