BHS Cardiac or Peripheral Intervention Post Procedure

Physician Orders SWIFT ORDERS
Orders without checkboxes will be initiated. Orders with checkboxes will be initiated only if checked. ALLERGIES:
HEIGHT :
BHS Cardiac or Peripheral Intervention Post Procedure WEIGHT : ___________
1. ADMISSION / DIAGNOSIS / CONDITION a. Placement: To care of (Physician): ______________________________ Inpatient status
Observation status
Outpatient Bedded b. Diagnosis: __________________________________________________ c. Condition: Stable
Fair
Guarded
Critical d. Level of Care: Physician MUST document in notes the risk, severity, and skilled nursing need of the patient to justify the status below. Specify unit, if appropriate. Critical / Intensive Care CVU Intermediate / Step Down / Progressive Care Unit Preference: ________________________________________ 2. VITAL SIGNS Document vital signs, access site, and pulses q 15 min x 4, then q 30 min x 2, then q 1 hour x 2, then routine per unit scope of service. Check peripheral pulses and distal extremities for warmth, color, sensation q 15 min x 4, the q 30 min x 2, then q 1 hour x 4, then per unit scope of service. Notify physician for significant deviation from baseline blood pressure (greater than or equal to 20 mmHg) or heart rate, bleeding, hematoma, diminished pulses, or chest pain. Mark access site if any hematoma is noted. Continuous pulse oximetry monitoring for the first six hours. If O2 sats remain greater than or equal to 92% without oxygen therapy during this time, may D/C continuous pulse oximetry monitoring. 3. ACTIVITY / LIMITATIONS Complete bed rest while sheaths in place and x _____ hours after sheath removed, or longer if groin or vital signs unstable. HOB may be elevated to 30 degrees after 2 hours bedrest, and patient may turn from sidetoside with assistance while keeping sheath leg straight. If patient received ReoPro, may not ambulate for 12 hours after sheath removal. Bed rest x _______ hrs if vascular closure device utilized. 4. NURSING INSTRUCTIONS Strict I&Os q shift. Monitor and record Weigh daily Vascular closure device utilized Type: _______________ a. Sheath Removal Orders: Follow nursing policy Femoral Arterial/Venous Sheath Removal 1) Collect ACT at _______________ and q 1 hours until: ACT is less than 150, then remove sheath ACT is less than ____________, then remove sheath Post sheath removal check vital signs, pulses, and entry site q 15 minutes x 4, q 30 minutes x 4, q 1 hour x 4, then per unit scope of service. PHYSICIAN MUST INITIAL ALL PAGES NOT SIGNED:
ORDER SET # CACL07
BHS Cardiac or Peripheral Intervention Post Procedure Approved: OCTOBER 2012 Page 1 of 6
PUBLISHED: V6 APRIL 29, 2014 Physician Orders SWIFT ORDERS
Orders without checkboxes will be initiated. Orders with checkboxes will be initiated only if checked. ALLERGIES:
HEIGHT :
b. TR Band Removal: Begin TR Band radial compression device removal at ___________________ (time) 1) Deflate by __________ mL every 10 minutes, provided hemostasis maintained. 1 mL
2 mL 2) If bleeding occurs: Reinflate cuff with the same amount that was removed Begin process over in __________ minutes WEIGHT : ___________ 5. DIET Post Cardiac or Perhipheral Intervention patient allowed finger foods while on bedrest, once awake and alert Regular Cardiac, low cholesterol Diabetic ____________ cal ADA Other: _____________________________________________ 6. MEDICATIONS: Reconcile preinterventional medications. Medications may be subject to auto substitution by pharmacy due to BHS formulary changes. For continuation of medications: see Medication Reconciliation form These orders are required on all Medicare ACE Cardiac Demonstration Project Patients No Metformin x 48 hours after procedure. (ie: Glucophage, Glucovance, Metaglip) Discontinue heparin, Dalteparin [ Fragmin ], Fondaparinux [ Arixtra ], Enoxaparin [ Lovenox ], dabigatrin [ Pradaxa ], rivaroxaban [ Xarelto ], Warfarin [Coumadin], apixaban [Eliquis] NOW. a. Beta Blocker 1) Metoprolol tartrate [ Lopressor ]: Hold for HR less than ____________ or BP less than _____________. a.) Dose: Metoprolol [ Lopressor ] 12.5 mg PO Metoprolol [ Lopressor] 25 mg PO Metoprolol [ Lopressor] 50 mg PO b.) Frequency: q 12 hours
q 24 hours 2) Carvedilol [ Coreg ] a.) Dose: Carvedilol [ Coreg ] 3.125 mg PO Carvedilol [ Coreg ] 6.25 mg PO Carvedilol [ Coreg ] 12.5 mg PO b.) Frequency: q 12 hours
q 24 hours Other: ___________________________________________________ b. Platelet Inhibitors 1) Call STAT if allergic. No Platelet inhibitors due to: Allergic to ________________________________________ Going to surgery Bleeding complications Other: _____________________________________________ Enteric Coated Aspirin Enteric Coated Aspirin 81 mg PO daily Enteric Coated Aspirin 162 mg PO daily Enteric Coated Aspirin 325 mg PO daily PHYSICIAN MUST INITIAL ALL PAGES NOT SIGNED:
BHS Cardiac or Peripheral Intervention Post Procedure ORDER SET # CACL07
Approved: OCTOBER 2012 Page 2 of 6
PUBLISHED: V6 APRIL 29, 2014 Physician Orders SWIFT ORDERS
Orders without checkboxes will be initiated. Orders with checkboxes will be initiated only if checked. ALLERGIES:
HEIGHT :
WEIGHT : ___________ Clopidogrel [ Plavix ] Clopidogrel [ Plavix ] 300 mg PO now (if not given prestent) + 75 mg PO daily Clopidogrel [ Plavix ] 600 mg PO now (if not given prestent) + 75 mg PO daily Clopidogrel [ Plavix ] 75 mg PO daily Prasugrel [ Effient ]: Avoid use in patients greater than 75 years of age or less than 60 kg Prasugrel [ Effient ] 60 mg PO now loading dose (if not given prestent) + Prasugrel [ Effient ] 10 mg PO daily Prasugrel [ Effient ] 60 mg PO now loading dose (if not given prestent) + Prasugrel [ Effient ] 5 mg PO daily (for patients weighing less than 60kg) Prasugrel [ Effient ] 10 mg PO daily Prasugrel [ Effient ] 5 mg PO daily Ticagrelor [ Brilinta ] Ticagrelor [ Brilinta ] 180 mg PO now (if not given prestent) + Ticagrelor [ Brilinta ] 90 mg PO Q12HRS Ticagrelor [ Brilinta ] 90 mg PO q 12 hours. c. Statins Atorvastatin [ Lipitor ] 20 mg PO QHS 40 mg PO QHS 80 mg PO QHS Simvastatin [ Zocor ] 5 mg PO QHS 10 mg PO QHS 20 mg PO QHS 40 mg PO QHS Rosuvastatin [ Crestor ] 40 mg PO QHS d. PRN Medications: 1) Nitrates: Nitrostat 0.4mg SL q 5 minutes PRN chest pain. Notify physician if nitroglycerin needed. Nitroglycerin 100mg/250 mL D5W, start at 10mcg/min and titrate to keep systolic B/P 110150 mmHg. 2) Antiemetics Select only one Ondansetron [ Zofran ] ODT 4 mg PO q 6 hr PRN nausea / vomiting Ondansetron [ Zofran ] 4 mg IV (slow push) over 2 minutes q 6 hr PRN nausea / vomiting Promethazine [ Phenergan ] 12.5 mg PO q6h PRN nausea. May give Promethazine 12.5 mg IM if patient unable to tolerate PO Promethazine [ Phenergan ] 25 mg PO q6h PRN nausea. May give Promethazine 25 mg IM if patient unable to tolerate PO PHYSICIAN MUST INITIAL ALL PAGES NOT SIGNED:
BHS Cardiac or Peripheral Intervention Post Procedure ORDER SET # CACL07
Approved: OCTOBER 2012 Page 3 of 6
PUBLISHED: V6 APRIL 29, 2014 Physician Orders SWIFT ORDERS
Orders without checkboxes will be initiated. Orders with checkboxes will be initiated only if checked. ALLERGIES:
HEIGHT :
WEIGHT : ___________ 3) Analgesics Please Select ONLY ONE IV and ONE PO pain medication per category when applicable ENCOURAGE PO MEDICATIONS FIRST IF ABLE TO TOLERATE PO INTAKE Do NOT exceed 3.25 grams Acetaminophen per day. Consider all sources. 1) For SEVERE pain (710) Morphine 4 mg IV q 2 hr PRN if not taking or unable to tolerate oral medications HYDROmorphone [ Dialudid ] 0.5 mg IV q 3 hr PRN if not taking or unable to tolerate oral medications HYDROcodone / Acetaminophen [ Norco ] 10/325 mg 1 tablet q 4 hr PRN PO if patient is able to tolerate oral medications. 2) For MODERATE pain (36) Morphine 2 mg IV q 2 hr PRN if not taking or unable to tolerate oral medications HYDROmorphone [ Dialudid ] 0.25 mg IV q 3 hr PRN if not taking or unable to tolerate oral medications HYDROcodone / Acetaminophen [ Norco ] 5/325 mg 1 tablet q 4 hr PRN PO if patient is unable to tolerate oral medications. 3) For MILD pain (12) Acetaminophen [ Tylenol ] 325 mg PO q 4 hr PRN Acetaminophen [ Tylenol ] 650 mg PO q 4 hr PRN mild pain or temperature greater than 100 degrees F 4) Sleeping Aids (Select one only) Zolpidem [ Ambien ] 5mg PO 1 time daily at bedtime PRN insomnia: recommended dose for elderly greater than or equal to age 65. Temazepam [ Restoril ] 7.5mg PO 1 time daily at bedtime PRN insomnia: recommended dose for elderly greater than or equal to age 65. Temazepam [ Restoril ] 15mg PO 1 time daily at bedtime PRN insomnia 5) Anxiolytic ALPRAZolam [ Xanax ] 0.25mg PO q 4 hrs PRN anxiety. LORazepam [ Ativan ] 0.5mg PO q 8 hrs PRN anxiety. e. Glycoprotein IIbIIIa Receptor Inhibitors: Abciximab [Reopro] (7.2 mg/250mL): Maintenance IV infusion at a rate of 0.125 mcg/kg/min for 12 hours (MAX infusion rate of 21 mL/h) Eptifibatide [Integrilin] (75mg/100mL) Maintenance IV infusion at a rate of ______ mcg/kg/min (MAX infusion rate of 20mL/hr) infuse over 18 hours infuse over 24 hours f. AFTER SHEATH REMOVAL ANTICOAGULATION ORDERS: Follow BHS Heparin Protocol for ACS + Start 4 hours after sheath removal. + No initial heparin bolus. + If heparin drip active preprocedure, begin at preprocedure rate. Fondaparinux [ Arixtra ] 2.5mg subcutaneously. Start 4 hours after sheath removed, then daily. Contraindicated with CrCl less than 30ml/min. Enoxaparin [ Lovenox ] 1mg/kg subcutaneously. Start 4 hours after sheath removed, then q 12 hours. 7. IV FLUIDS Continue IV of NS at _____ mL/hour x _____ hours, then KVO. Saline lock Other: ______________________________________________ PHYSICIAN MUST INITIAL ALL PAGES NOT SIGNED:
BHS Cardiac or Peripheral Intervention Post Procedure ORDER SET # CACL07
Approved: OCTOBER 2012 Page 4 of 6
PUBLISHED: V6 APRIL 29, 2014 Physician Orders SWIFT ORDERS
Orders without checkboxes will be initiated. Orders with checkboxes will be initiated only if checked. ALLERGIES:
HEIGHT :
WEIGHT : ___________ 8. LABS These orders are required on all Medicare ACE Cardiac Demonstration Project Patients: a. CBC w/Auto diff NOW in AM b. BMP NOW in AM c. Troponin NOW in AM d. CPK NOW in AM Fasting Lipid profile if not done previously. HgbA1c P2Y12 now (if patient on Clopidrogel or treated for thrombosed stent) Other: __________________________________________________ 9. RADIOLOGY Chest Xray (PA) Indication:__________________________ 10. DIAGNOSTIC STUDIES 2D Echo with color flow and doppler Indication:_________________________ to be read by __________________________________ 1) EKG NOW If patient develops chest pain in AM Indication: Coronary Atherosclerosis Hypertension Atrial Fib or Flutter Hypotension Myocardial infarction PVD Heart Failure Angina TIA Other: ___________________________________________ PHYSICIAN MUST INITIAL ALL PAGES NOT SIGNED:
BHS Cardiac or Peripheral Intervention Post Procedure ORDER SET # CACL07
Approved: OCTOBER 2012 Page 5 of 6
PUBLISHED: V6 APRIL 29, 2014 Physician Orders SWIFT ORDERS
Orders without checkboxes will be initiated. Orders with checkboxes will be initiated only if checked. ALLERGIES:
HEIGHT :
WEIGHT : ___________ 11. MISCELLANEOUS a. EDUCATION Provide postinterventional procedure education (in native language) regarding groin care, dressing removal, potential complications, and activity. Provide education (in native language) for any appropriate risk factors including CHF, DM, obesity/sedentary lifestyle, prescribed diet, and medication therapy. Evaluate for smoking cessation education. b. CARDIAC REHAB: Referral to Cardiac Rehab Program unless exclusion reason indicated below: Not indicated Not eligible No cardiac program near patient's home Patient refused Patient has high risk condition or contraindication to exercise Other: __________________________________ c. DISCHARGE ORDERS Discharge Diagnosis (required): ___________________________________ Discharge home in AM if groin site and postprocedure vital signs are stable. Discharge home at ______________ if groin site and postprocedure vital signs are stable. Followup with Dr. _________________________________ in his/her office in _____ weeks. 12. ADDITIONAL ORDERS :______________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ DO NOT WRITE IN THIS SPACE PHYSICIAN'S PRINTED NAME, ID# and SIGNATURE: DATE:
TIME:
BHS Cardiac or Peripheral Intervention Post Procedure ORDER SET # CACL07
Approved: OCTOBER 2012 Page 6 of 6
PUBLISHED: V6 APRIL 29, 2014

Download Report