Unique Plan Description: Admission Acute Alcohol Withdrawal AWS
Plan Selection Display: Admission Acute Alcohol Withdrawal AWS
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2020-04-19 11:51:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-06-12 10:38:37
Available at all facilities: Yes

Admission Acute Alcohol Withdrawal AWS
Admit/Discharge/Transfer
	Admit to Inpatient Status
		T;N, Anticipated LOS 2 midnight or more
			Comment: ICU_____   Psych______
	Admit to Observation Status
		T;N
	Admit to Critical Care Inpatient Status (MH)
		T;N, Anticipated LOS 2 midnight or more
	Admit to Critical Care Observation Status (MH)
		T;N
	Admit to Psych - Voluntary
		T;N
	Admit to Psych - Involuntary
		T;N
	Transfer
		T;N, to ICU
		T;N, to Psych
	Transfer to Critical Care (MH)
		
Vital Signs
	Vital Signs
		every 4 hours if alcohol withdrawal score is 1-5, every 2 hours if alcohol withdrawal score is 6-10, every 1 hour if alcohol withdrawal score >11. Reassess alcohol withdrawal score with each set of vital signs.
Activity
	Activity-As Tolerated
		T;N
Diet
	Regular Diet
		T;N
	Sodium Restricted Diet
		T;N
	Diabetic Diet
		T;N
	NPO
		T;N
Laboratory
Today's Lab
	Comprehensive Metabolic Panel
		Stat, spec type = Blood
	CBC with Diff
		Stat, spec type = Blood
	GGT
		Stat, spec type = Blood
	Magnesium Level
		Stat, spec type = Blood
	Phosphorus
		Stat, spec type = Blood
	Ethanol Level
		Stat, spec type = Blood
		T;N+720, Routine, spec type = Blood
	Toxicology Screen DAU - MH/WH/JE
		Stat, spec type = Urine
	Drug Screen Urine - FH
		Stat, Stat, spec type = Urine
	Pregnancy Test Urine
		Stat, spec type = Urine
IV Solutions

	Banana Bag IV
		10 mL, IVPB, Once, Routine, 125 ml/hr, T;N, duration: 1 Dose(s)/Time(s)
		100 mg, EVERY BAG
		1,000 mL, EVERY BAG
		1 mg, EVERY BAG
Medications
		Discontinue previous PRN Ativan (lorazepam) orders.(NOTE)*
	Ativan
		1 mg, Tab, By Mouth, Once, NOW
		2 mg, Tab, By Mouth, Once, NOW
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		1 mg, Tab, BY MOUTH, Q4H, PRN, see comment
			Comment: PRN agitation, anxiety, tremors, pulse >92 Mild withdrawal: AWS score of 1-5
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		2 mg, Tab, BY MOUTH, Q2H, PRN, see comment
			Comment: PRN agitation, anxiety, tremors,pulse >100 Moderate withdrawal: AWS score of 6-10. Watch for delerium; monitor respiratory status.
		2 mg, Injection, IM-IntraMUSCULAR, Q2H, PRN, see comment
			Comment: PRN agitation, anxiety, tremors,pulse >100 Moderate withdrawal: AWS score of 6-10. Watch for delerium; monitor respiratory status.
		2 mg, Injection, IV Push, Q2H, PRN for see comment
			Comment: PRN agitation, anxiety, tremors,pulse >100 Moderate withdrawal: AWS score of 6-10. Watch for delerium; monitor respiratory status.
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		2 mg, Tab, BY MOUTH, Q1H, PRN for see comment
			Comment: PRN agitation, anxiety, tremors,pulse >100 Severe withdrawal: AWS score >11. Watch for delerium; monitor respiratory status.
		2 mg, Injection, IM-IntraMUSCULAR, Q1H, PRN, see comment
			Comment: PRN agitation, anxiety, tremors,pulse >100 Severe withdrawal: AWS score >11. Watch for delerium; monitor respiratory status.
		2 mg, Injection, IV Push, Q1H, PRN for see comment
			Comment: PRN agitation, anxiety, tremors,pulse >100 Severe withdrawal: AWS score >11. Watch for delerium; monitor respiratory status.
	Notify MD
		Notify Provider if Lorazepam dose exceeds 12mg in 12hr or 24mg in 24hr
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	diazePAM
		2.5 mg, Injection, IV Push, Q4H, PRN for AWS score of 1-5
			Comment: Do Not Give if AWS score ONLY caused by tremors or nausea/vomiting, May be used when lorazepam is not available
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		5 mg, Injection, IV Push, Q2H, PRN for AWS score of 6-10
			Comment: Watch for delirium; monitor respiratory status. May be used when lorazepam is not available
		5 mg, Injection, IM-Intramuscular, Q2H, PRN for AWS score of 6-10
			Comment: Watch for delirium; monitor respiratory status. May be used when lorazepam is not available, if IV route not available.
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		5 mg, Injection, IV Push, Q1H, PRN for AWS score >10
			Comment: Watch for delierium; monitor respiratory status. May be used when lorazepam is not available
		5 mg, Injection, IM-Intramuscular, Q1H, PRN for AWS score >10
			Comment: Watch for delierium; monitor respiratory status. May be used when lorazepam is not available, if IV route not available.
	Notify MD
		Notify Provider if Diazepam dose exceeds 30mg in 12hr or 60mg in 24hr
	Haldol  Oral
		2 mg, Tab, By Mouth, Q4H, PRN, agitation
	Haldol  injectable
		2 mg, Injection, IM-Intramuscular, Q4H, PRN, agitation
		5 mg, Injection, IM-Intramuscular, Q4H, PRN, agitation
	chlordiazePOXIDE
		25 mg, Capsule, BY MOUTH, QID, 3 Day(s)
	folic acid
		1 mg, Tab, BY MOUTH, DAILY, 30 Day(s)
	Vitamin B1
		100 mg, Tab, By Mouth, DAILY, 5 Day(s)
		100 mg, Injection, IV Push, DAILY, duration: 5 Day(s)
	Vitamin B1 (FH)
		100 mg, Tab, By Mouth, DAILY, duration: 5 Day(s)
		100 mg, INT, IVPB, DAILY, duration: 5 Day(s)
	multivitamin Oral Tablet
		1 TAB Tab BY MOUTH DAILY
PRN
	RisperDAL
		0.5 mg, Tab, By Mouth, TID, PRN, agitation
	cloNIDine
		0.1 mg, Tab, BY MOUTH, Q1H, PRN for see comment
			Comment: For SBP>150 mmHg to a maximum of 0.6 mg/24 hours. Contact MD if ineffective.
	ondansetron
		4 mg, Injection, IV PUSH, Q6H, PRN for nausea and/or vomiting
			Comment: Use if patient unable to take PO
		4 mg, Tablet-Disintegrating, By Mouth, Q6H, PRN for nausea and/or vomiting
	traZODone
		100 mg Tab BY MOUTH QHS, PRN insomnia
Patient Care

	Resuscitation Status
		T;N, Full Code
		T;N, No Code
	Notify MD
		T;N, PCP if pulse >120, SBP <90, DBP >110; RR < 12 or shallow quality
		T;N, PCP if patient has seizures or hallucinations
	Neurological Assessment-Focused
		T;N, Q2H-Sch
	Fall Precautions
		T;N
	Cardiac Telemetry Monitoring
		T;N
	Seizure Precautions
		T;N
	Suicide Precautions
		T;N
	Discontinue Medication
		T;N, PRN Ativan
Consults/Follow-up
	Consult Social Work
		T;N
	Consult Psychiatrist
		Reason for Referral: Alcohol Withdrawal

Peripheral Lock - Access
Medications
	sodium chloride 0.9% flush injectable soln
		10 mL Syringe IV PUSH BID
		10 mL, Syringe, IV PUSH, Q5MIN, PRN, IV line flush
	lidocaine 1% injectable solution (MH/WH/FH)
		0.1 mL, IntraDermal, Q1H, PRN, see comment
			Comment: For IV start
	sodium chloride bacteriostatic 0.9% injectable soln
		0.1 mL, Injection, IntraDermal, Q1H, PRN, see comment
			Comment: For IV start, use if patient has lidocaine allergy.
	Sodium Chloride 0.9% IVPB Flush
		25 mL, IVPB, Q1H, PRN, IV line flush, 5 min(s)
			Comment: Use if medication not compatible with primary line or there is no primary line;  infuse 25mL.
Patient Care
	Peripheral Lock-Insert
		T;N

VTE Prophylaxis
Medications
	Lovenox
		40 mg, Syringe, SUBCUTANEOUS, DAILY, T;N
			Comment: (CrCl>30) Pharmacy to adjust dose based on pt weight. VTE Prophylaxis
		40 mg, Syringe, SUBCUTANEOUS, DAILY, T;N+480
			Comment: (CrCl>30) Start 8 hours after admission. Pharmacy to adjust dose based on pt weight. VTE Prophylaxis
		40 mg, Syringe, SUBCUTANEOUS, DAILY, T+1;0900
			Comment: (CrCl>30) Pharmacy to adjust dose based on pt weight. VTE Prophylaxis
	HEParin 5000 units/mL SUBCUTANEOUS
		5,000 units, Injection, SUBCUTANEOUS, Q8H-Sch, T;N
			Comment: VTE Prophylaxis
		5,000 units, Injection, SUBCUTANEOUS, Q8H-Sch, T;N+480
			Comment: Start 8 hours after admission. VTE Prophylaxis
		5,000 units, Injection, SUBCUTANEOUS, Q8H-Sch, T+1;0600
			Comment: VTE Prophylaxis
Patient Care
		Sequential Compression Device and Anti Embolism Device orders will not suppress the VTE Advisor(NOTE)*
	Sequential Compression Device
		T;N, Apply, Once
	Anti Embolism Stockings
		T;N, Apply, Once
			Comment: knee high
	VTE Prophylaxis Contraindication
		High Risk of Bleeding
		Procedure Planned
		ASA order meets prophylaxis requirement
		If patient is low risk or further evaluation needed, complete advisor:(NOTE)*
	VTE Advisor
		Medical

DVT VTE Prophylaxis (FH)
Laboratory
	CBC with Diff
		T;N, Routine, spec type = Blood
		T+1;0500, Routine, EVERY OTHER DAY, spec type = Blood
		T+1;0500, Routine, Q24H 3 Day(s), spec type = Blood
		T+1;0500, Routine, Q24H, spec type = Blood
	BMP
		T;N, Routine, spec type = Blood
	Prothrombin Time (PT) - FH
		T;N, Routine, spec type = Diagnostic Blood
		T+1;0500, Q24H, spec type = Therapeutic Blood
	Partial Thromboplastin Time (PTT) - FH
		T;N, Routine, spec type = Diagnostic Blood
Medications
		See VTE Risk Assessment for patient risk score(NOTE)*
	Lovenox
		40 mg, Syringe, SUBCUTANEOUS, DAILY
			Comment: NOTIFY physician if platelets < 130,000
		30 mg, Syringe, SUBCUTANEOUS, BID
			Comment: NOTIFY physician if platelets < 130,000
		For CrCl < 30 mL/min(NOTE)*
		30 mg, Syringe, SUBCUTANEOUS, DAILY
			Comment: NOTIFY physician if platelets < 130,000. D/C lovenox if INR > 1.8
		For Patients > 150 kg(NOTE)*
		40 mg, Syringe, SUBCUTANEOUS, BID
			Comment: NOTIFY physician if platelets < 130,000
		40 mg, Syringe, SUBCUTANEOUS, DAILY
			Comment: NOTIFY physician if platelets < 130,000
Anticoagulants
		Baseline INR required for Coumadin(NOTE)*
	warfarin
		5 mg, Tab, By Mouth, Once
			Comment: Notify MD and Hold Coumadin if INR > 2.5
		2.5 mg, Tab, By Mouth, Once
			Comment: Notify MD and Hold Coumadin if INR > 2.5
		10 mg, Tab, By Mouth, Once
			Comment: Notify MD and Hold Coumadin if INR > 2.5
		5 mg, Tab, By Mouth, DAILY
			Comment: Notify MD and Hold Coumadin if INR > 2.5
		2.5 mg, Tab, By Mouth, DAILY
			Comment: Notify MD and Hold Coumadin if INR > 2.5
		10 mg, Tab, By Mouth, DAILY
			Comment: Notify MD and Hold Coumadin if INR > 2.5
		ORTHO ONLY(NOTE)*
	Xarelto
		10 mg, Tab, By Mouth, DAILY
	dabigatran
		150 mg, Capsule, By Mouth, BID
			Comment: Check renal function
	Eliquis
		2.5 mg, Tab, By Mouth, BID
			Comment: Hip Replacement: Duration of therapy 35 days  Knee Replacement: 12 days
	HEParin 5000 units/mL SUBCUTANEOUS
		5,000 units, Syringe, SUBCUTANEOUS, TID
		5,000 units, Syringe, SUBCUTANEOUS, BID
Patient Care

	Impulse Foot Pumps
		To be worn at all time while patient is not bearing weight
	Sequential Compression Device
		T;N, Wear, Both legs
			Comment: To be worn at all times while patient is not bearing weight
	Anti Embolism Stockings
		TED hose, knee high, Both legs
		TED hose, knee high, Left leg
		TED hose, knee high, Right leg
		TED hose, thigh high, Both legs
		TED hose, thigh high, Left leg
		TED hose, thigh high, Right leg
	Notify MD
		Contact Physician if INR < 1.8 on Day of Dismissal
Therapies
	Consult Physical Therapy, Evaluate and Treat
		
Consults/Follow-up
	Pharmacy Consult
		D/C Lovenox if INR > 1.8
		D/C Lovenox if INR > 2.0
		Contact MD and Hold Coumadin if INR > 2.5
		Contact MD and Hold Coumadin if INR > 3.0
		Contact MD and Hold Coumadin if INR > 3.5

*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