CHN4104 Hip Fracture Admission Orders.pdf - Carondelet

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CARONDELET HEALTH NETWORK
HOSPITAL PROVIDED PRE-PRINTED PHYSICIAN’S ORDERS
HIP FRACTURE ADMISSION ORDERS
(TO BE USED WITH MEDICINE ADMISSION ORDERS)
Physician Signature: Date Signed: Time Signed:
STAT/NOW
(Check Box to Left)
1. Verify/Witness consent for blood transfusion (Physician to sign consent form and document consenting
process)
2. Nursing:
Initiate Fractured Hip Clinical Pathway
If patient not competent, locate medical power of attorney and obtain contact information
Emergency Center to notify Charge RN on Orthopedic Unit for initial contact and fracture educational materials
Notify physician if surgery delayed greater than 24 hours from time of arrival to hospital
Bathe patient with 2% Chlorhexidine Gluconate (CHG) wipes per CHN Pre-surgical Patient Hygiene Policy &
Procedure one hour prior to surgery.
3. ANTIBIOTIC PROPHYLAXIS: Patient Weight: ________kg
If patient is currently receiving scheduled antibiotics, indicate reason____________________________
NOTE: A pre-operative prophylactic antibiotic must be given regardless of the patient being on therapeutic antibiotics.
All Antibiotics are to be administered 0-60 minutes prior to the first incision
(exception: within 120 minutes if using a fluoroquinolone or vancomycin)
First Choice
CeFAZolin (KEFZOL)
• For patients less than 120 kg, CeFAZolin (KEFZOL) 2 grams IV push once
• For patients greater than or equal to 120 kg, CeFAZolin (KEFZOL) 3 grams IV push once
For documented High Risk MRSA:
Vancomycin AND CeFAZolin (KEFZOL)
• For patients less than 80 kg, Vancomycin 1 gram IVPB once
• For patients greater than or equal to 80 kg, Vancomycin 1.5 grams IVPB once
AND
• For patients less than 120 kg, CeFAZolin (KEFZOL) 2 grams IV push once
• For patients greater than or equal to 120 kg, CeFAZolin (KEFZOL) 3 grams IV push once
Alternative if Beta Lactam Allergy:
Clindamycin (CLEOCIN) 900 mg IVPB once
Vancomycin
• For patients less than 80 kg, Vancomycin 1 gram IVPB once
• For patients greater than or equal to 80 kg, Vancomycin 1.5 grams IVPB once
Vancomycin reasons: Must have physician/APN/PA documentation
Beta-lactam (penicillin or cephalosporin ) allergy
MRSA colonization or infection
High risk due to acute inpatient hospitalization within last year prior to admission
High risk due nursing home or extended care facility within last year prior to admission
Facility wide or operation-specific increased MRSA rate
Chronic wound care or dialysis
Continuous inpatient stay of more than 24 hours prior to principal procedure
Transfer of patient following a 3-day inpatient hospitalization at another facility
Other Reason_____________________________________________
4. For Pruritus:
DiphenhydrAMINE (BENADRYL) 25 mg IV every 6 hours PRN pruritus
Physician Printed Name / License # / Telephone #:
PATIENT IDENTIFICATION
MEC Approval CSJ – 10/24/13 CSM – 10/24/13
CHN4104 Expires – 10/2016
Page 1 of 2
UNLESS NOTED AS PBO (PRESCRIBED BRAND ONLY), A FORMULARY EQUIVALENT MEDICATION MAY BE DISPENSED

P
H
Y
S
I
C
I
A
N
‘
S
O
R
D
E
R
USE BALL POINT PEN – PRESS FIRMLY
CARONDELET HEALTH NETWORK
HOSPITAL PROVIDED PRE-PRINTED PHYSICIAN’S ORDERS
HIP FRACTURE ADMISSION ORDERS
(TO BE USED WITH MEDICINE ADMISSION ORDERS)
STAT/NOW
(Check Box to Left)
5. For Pain:
Ketorolac (TORADOL) 30 mg IV now, then 15 mg IV every 6 hours x 24 hours
Choose one
Severe Pain (Prescribe One):
Morphine 2 mg IV every hour PRN severe pain. May repeat once within same one hour time frame. If patient
does not achieve acceptable pain relief after repeat dose, notify physician for further orders.
Morphine _________ mg IV every __________ hour(s) PRN severe pain.
HydroMORPHone (DILAUDID) 0.5 mg IV every 4 hours PRN severe pain. May repeat once within same four
hour time frame. If patient does not achieve acceptable pain relief after repeat dose notify physician for further
orders. Max Dose: 1 mg in four hours.
Moderate Pain (PRIORITIZE and Check one box within each category):
____ Acetaminophen 325 mg/OXYcodone 5 mg (PERCOCET)
1 tablet PO every 4 hours PRN moderate pain. May repeat once within same four hour time frame. If
patient does not achieve acceptable pain relief after repeat dose, notify physician for further orders.
(Total Acetaminophen not to exceed 4 grams/day).
2 tablets PO every 4 hours PRN moderate pain. (Total Acetaminophen not to exceed 4
grams/day)
____ Acetaminophen 325 mg/HydroCODONE 5 mg
1 tablet PO every 4 hours PRN moderate pain. May repeat once within same four hour time frame. If
patient does not achieve acceptable pain relief after repeat dose, notify physician for further orders.
(Total Acetaminophen not to exceed 4 grams/day)
2 tablets PO every 4 hours PRN moderate pain. (Total Acetaminophen not to exceed 4
grams/day)
____ Morphine ________ mg IV every ______ hours PRN moderate pain. May repeat once within same time
frame.
Other (No range order accepted) Drug ______________________ Dose _____ Route_____
every ______ hours ____ PRN (indication) ____________________________
6. INITIATE PREOP ANESTHESIA PROTOCOL (SEE CHN8215)
7. Do not start anticoagulants until after surgery
VTE Mechanical Prophylaxis
TED hose on unaffected limb (caution in peripheral arterial insufficiency) Calf high Thigh high
SCDs on unaffected limb (caution in peripheral arterial insufficiency)
8. Labs: SAIL tests on blood already drawn in the EC, if possible
Blood Bank Hold Clot
Vitamin D (25 hydroxy) Level
Other _____________________________________________________________
9. Consultant: ________________________________ Indication: ___________________________________
Notified: (Date) _________________ (Time) ____________________
10. Other Orders:
Physician Signature: Date Signed: Time Signed:
Physician Printed Name / License # / Telephone #:
PATIENT IDENTIFICATION
MEC Approval CSJ – 10/24/13 CSM – 10/24/13
CHN4104 Expires – 10/2016
Page 2 of 2
UNLESS NOTED AS PBO (PRESCRIBED BRAND ONLY), A FORMULARY EQUIVALENT MEDICATION MAY BE DISPENSED