Unique Plan Description: Iowa Organ (JE)
Plan Selection Display: Iowa Organ (JE)
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2012-03-23 13:19:35
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2021-12-20 11:03:29
Available at all facilities: Yes

Iowa Organ (JE)
Vital Signs
	Vital Signs
		T;N, Q1H
		T;N, Q15MIN, if patient is on vasopressors
Activity
	Turn patient
		T;N, Q2H-Sch
Laboratory
STAT, one time
	Hemoglobin A1C
		T;N, Stat, spec type = Blood
	Amylase Level
		T;N, Stat, Once, spec type = Blood
	Lipase Level
		T;N, Stat, Once, spec type = Blood
	Culture Urine
		T;N, Stat, spec type = Urine
	Sputum Culture
		T;N, Stat, spec type = Sputum
	Cholesterol
		T;N, Stat, spec type = Blood
		Order the following for patients with bleeding disorders(NOTE)*
	Fibrinogen Level - MH/WH/JE
		T;N, Stat, Once, spec type = Blood
			Comment: Label Comment: Draw FDP
	D-Dimer - MH/WH/JE
		T;N, Stat, spec type = Blood
STAT and q4h
	Comprehensive Metabolic Panel
		T;N, Stat, Once, spec type = Blood
		T;N+240, Routine, Q4H, spec type = Blood
	Blood Gases Arterial (ABG) - MH/WH/JE
		T;N, Stat, Once, spec type = Blood
		T;N+240, Routine, Q4H, spec type = Blood
	Hemoglobin and Hematocrit
		T;N, Stat, Once, spec type = Blood
		T;N+240, Routine, Q4H, spec type = Blood
	Osmolality
		T;N, Stat, spec type = Blood
		T;N+240, Routine, spec type = Blood
STAT and q8h
	Comprehensive Metabolic Panel
		T;N, Stat, Once, spec type = Blood
		T;N+480, Routine, spec type = Blood
	INR - MH/WH/JE
		T;N, Stat, Once, spec type = Blood
		T;N+480, Routine, Q8H, spec type = Blood
	PTT - MH/WH/JE
		T;N, Stat, Once, spec type = Blood
		T;N+480, Routine, Q8H, spec type = Blood
	Bilirubin Direct
		T;N, Stat, Once, spec type = Blood
		T;N+480, Routine, Q8H, spec type = Blood
	LDH
		T;N, Stat, Once, spec type = Blood
		T;N+480, Routine, Q8H, spec type = Blood
	CK
		T;N, Stat, Once, spec type = Blood
		T;N+480, Routine, Q8H, spec type = Blood
	CKMB
		T;N, Stat, Once, spec type = Blood
		T;N+480, Routine, Q8H, spec type = Blood
	hs Troponin T - MH/WH/JE
		T;N, Stat, spec type = Blood
		T;N+480, Routine, Q8H, spec type = Blood
	hs Troponin I - FH
		T;N, Stat, Once, spec type = Blood
		T;N+480, Routine, Q8H, spec type = Blood
	Lactate
		T;N, Stat, Once, spec type = Blood
		T;N+480, Routine, Q8H, spec type = Blood
	CBC with Diff
		T;N, Stat, Once, spec type = Blood
		T;N+480, Routine, Q8H, spec type = Blood
STAT and q12h
	UA (Culture if Positive)
		T;N, Stat, Stat, spec type = Urine
		T;N+720, Routine, Routine, spec type = Urine
Diagnostic Tests

	ECG
		T;N, Stat, Indication: Ventricular Function-Assess
			Comment: Donor patient
	Echo w Doppler resting
		T;N, Stat, Indication: Organ donor
	Chest 1 View
		Lung evaluation for Iowa Donor, T;N, Stat
			Comment: Do after central line inserted if appropriate
		Lung Evaluation, T;N, Routine, DAILY
			Comment: Donor patient
Medications
	Ancef IVPB
		1,000 mg, IVPB, Q8H, Surgical prophylaxis
	Muro 128 5% ophthalmic solution
		2 gtt Soln EYE, BOTH Q4H
			Comment: If cornea donor
		2 gtt, Soln, EYE, BOTH, Q4H, PRN, dry eyes
			Comment: If cornea donor; every time the eyes have been re-opened
Patient Care
		Discontinue all previous physician orders except any cardiac medications or current antibiotics.  DO NOT order any additional labs or tests without consulting with the Iowa Donor Network staff member.(NOTE)*
	Notify MD
		T;N, For placement of central line if not present
		T;N, For placement of arterial line if not present
	Intake and Output
		T;N, Q1H
	Notify
		T;N, Iowa Donor Network staff member if lab results will be delayed > 8 hours
		T;N, Iowa Donor Network Staff if: Urine output < 100 mL/ hr or >300 mL/ hr
		T;N, Blood pressure < 90 mmHg systolic
		T;N, Pediatric SBP < ____ mmHg
		T;N, Core temperature < 96.8 F (36 C) or > 99.5 F (37.5 C)
		T;N, CVP < 5 or >8 mmHG
		T;N, Pulse Ox <= 94% or change in oxygen saturation +/- 4%
	Cooling Blanket
		T;N
			Comment: PRN
	Warming Blanket
		T;N
			Comment: PRN
	Airway Suction
		T;N, Q2H-Sch
			Comment: PRN
	Enteral Tube
		T;N, Per Nasogastric Tube (NG), Connect to low continuous suction | Insert
			Comment:  if not already present
	Tape eyes closed
		T;N, Continuously If cornea donor
	Type and Crossmatch (Product Available)
		T;N, Stat, For Possible Transfusion
		Prior to transport to OR: Empty the Foley bag, suction the patient, and document completed I&O(NOTE)*
	Cardiac Telemetry Monitoring
		T;N, Cardiac/ Pressure alarms ON
Therapies
	Mechanical Ventilator Settings
		
			Comment: Oxygen challenge test:  Increase FiO2 to 100% with PEEP of +5 for 20 minutes; obtain Blood Gases then return to previous FiO2 maintaining the PEEP +5
Consults/Follow-up
	Consult Pulmonologist
		Reason for Referral: Bronchoscopy, upon direction of IDN staff member

T4 Protocol (JE)
IV Solutions
	levothyroxine 100 mcg/250mL NS
		250 mL, IV
			Comment: Increase levothyroxine (T4) drip as necessary to maintain SBP > 100 mmHG;  Maximum dose not to exceed 20 micrograms (50 mL) per hour
		100 mcg, EVERY BAG, 10 mcg/hr
Medications
	Dextrose 50%
		50 mL, Injection, IV Push, Once, STAT
	Solu-MEDROL IVPB
		2 gm, IVPB, Once
			Comment: in 50 mL D5W, Infuse over 30 minutes
	insulin regular
		20 units, Solution-Injection, IV Push, Once
	levothyroxine
		20 mcg, Injection, IV PUSH, Once
Patient Care
		Wean Vasopressors as possible(NOTE)*

Blood Culture Set
Laboratory
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	.Blood Culture.
		T;N, Stat, spec type = Blood
		T;N, Routine, spec type = Blood
		Timed, spec type = Blood
		T+1;0400, Routine, spec type = Blood
	.Blood Culture
		T;N, Stat, spec type = Blood
		T;N, Routine, spec type = Blood
		Timed, spec type = Blood
		T+1;0400, Routine, spec type = Blood

*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