Unique Plan Description: Nephro Dialysis, Outpatient (FH)
Plan Selection Display: Nephro Dialysis, Outpatient (FH)
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2021-12-28 14:29:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2023-05-02 15:30:30
Available at all facilities: Yes

Nephro Dialysis, Outpatient (FH)
Vital Signs
	Hemodialysis
		T;N
		BIW
		TIW
		QIW
	Vital Signs
		Maintain SBP >/= to ______mmHg
Laboratory
	Comprehensive Metabolic Panel
		Stat, spec type = Blood
	Phosphorus
		Stat, spec type = Blood
	Iron
		Stat, spec type = Blood
	Ferritin
		Stat, spec type = Blood
	Hemogram
		Stat, spec type = Blood
	Transferrin Profile
		Stat, spec type = Blood
	Hepatitis B Surface Antigen
		T;N, Routine, spec type = Blood
			Comment: to be done every 12 months
	Hepatitis B Core Antibody Total
		T;N, Routine, spec type = Blood
	Hepatitis B Surface Antibody
		T;N, Routine, spec type = Blood
			Comment: to be done every 12 months
	Hepatitis C Virus (HCV) Antibody with Rflx to PCR Confirmation
		T;N, Routine, spec type = Blood
			Comment: to be done every 12 months
	PTH
		T;N, Routine, spec type = Blood
Recurring lab every 30 days
	Comprehensive Metabolic Panel
		Routine, Orders for Future Visit Every 30 Day(s) For 90 Day(s) Grace Period (+/-) 7 Day(s), spec type = Blood
	Phosphorus
		Routine, Orders for Future Visit Every 30 Day(s) For 90 Day(s) Grace Period (+/-) 7 Day(s), spec type = Blood
	Iron
		Routine, Orders for Future Visit Every 30 Day(s) For 90 Day(s) Grace Period (+/-) 7 Day(s), spec type = Blood
	Ferritin
		Routine, Orders for Future Visit Every 30 Day(s) For 90 Day(s) Grace Period (+/-) 7 Day(s), spec type = Blood
	Hemogram
		Routine, Orders for Future Visit Every 30 Day(s) For 90 Day(s) Grace Period (+/-) 7 Day(s), spec type = Blood
	Transferrin Profile
		Routine, Orders for Future Visit Every 30 Day(s) For 90 Day(s) Grace Period (+/-) 7 Day(s), spec type = Blood
	PTH
		Routine, Orders for Future Visit Every 30 Day(s) For 90 Day(s) Grace Period (+/-) 7 Day(s), spec type = Blood
Diagnostic Tests

	Chest 2 View
		T;N, Routine
			Comment: to be done every 12 months
IV Solutions
	Sodium Chloride 0.9% Intravenous Solution (Bolus)
		250 mL, IV, PRN, systolic blood pressure > (see comment), Bolus
			Comment: to keep systolic blood pressure > 90___mmHg
		1,000 mL, IV, 48 hr, bolus, Total Volume = 1,000
			Comment: 1 dose only to prime the dialysis machine
Medications
	HEParin 1000 units/mL injectable soln
		1,000 units, Injection, IV Push, MonWedFri, T;N
			Comment: during dialysis
		3,800 units, Solution-Injection, Catheter, MonWedFri, T;N
			Comment: lock catheter using heparin 1000u/cc for volume of catheter lumen, for catheter locking or loading
		3,700 units, Solution-Injection, Catheter, MonWedFri, T;N
			Comment: lock catheter using heparin 1000u/cc for volume of catheter lumen, for catheter locking or loading
		3,600 units, Solution-Injection, Catheter, MonWedFri, T;N
			Comment: lock catheter using heparin 1000u/cc for volume of catheter lumen, for catheter locking or loading
		3,500 units, Solution-Injection, Catheter, MonWedFri, T;N
			Comment: lock catheter using heparin 1000u/cc for volume of catheter lumen, for catheter locking or loading
		3,400 units, Solution-Injection, Catheter, MonWedFri, T;N
			Comment: lock catheter using heparin 1000u/cc for volume of catheter lumen, for catheter locking or loading
		3,300 units, Solution-Injection, Catheter, MonWedFri, T;N
			Comment: lock catheter using heparin 1000u/cc for volume of catheter lumen, for catheter locking or loading
		3,200 units, Solution-Injection, Catheter, MonWedFri, T;N
			Comment: lock catheter using heparin 1000u/cc for volume of catheter lumen, for catheter locking or loading
		3,100 units, Solution-Injection, Catheter, MonWedFri, T;N
			Comment: lock catheter using heparin 1000u/cc for volume of catheter lumen, for catheter locking or loading
		500 units, Injection, IV Push, Q1H, PRN dialysis
			Comment: during dialysis
	Procrit
		3,000 units, Injection, IV, MonWedFri, T;N
			Comment: during dialysis
		4,000 units, Injection, IV, MonWedFri, T;N
			Comment: during dialysis
		5,000 units, Injection, IV, MonWedFri, T;N
			Comment: during dialysis
		6,000 units, Injection, IV, MonWedFri, T;N
			Comment: during dialysis
		7,000 units, Injection, IV, MonWedFri, T;N
			Comment: during dialysis
		8,000 units, Injection, IV, MonWedFri, T;N
			Comment: during dialysis
		9,000 units, Injection, IV, MonWedFri, T;N
			Comment: during dialysis
		10,000 units, Injection, IV, MonWedFri, T;N
			Comment: during dialysis
	Zemplar
		2.5 mcg, Injection, IV Push, MonWedFri, T;N
			Comment: during dialysis
		10 mcg, Injection, IV Push, MonWedFri, T;N
			Comment: during dialysis
		5 mcg, Injection, IV Push, MonWedFri, T;N
			Comment: during dialysis
	Hectorol
		4 mcg, Solution, IV Push, MonWedFri, T;N
			Comment: during dialysis
		6 mcg, Solution, IV Push, MonWedFri, T;N
			Comment: during dialysis
		8 mcg, Solution, IV Push, MonWedFri, T;N
			Comment: during dialysis
	Venofer
		50 mg, Injection, IV Push, MonWedFri, T;N
			Comment: administered slow IV injection (undiluted, directly into dialysis line)
		100 mg, Injection, IV Push, MonWedFri, T;N
			Comment: administered slow IV injection (undiluted, directly into dialysis line)
		200 mg, Injection, IV Push, MonWedFri, T;N
			Comment: administered slow IV injection (undiluted, directly into dialysis line)
	sodium ferric gluconate complex
		125 mg, INT, IVPB, Once, infuse over 1 hr, T;N
		250 mg, INT, IVPB, Once, infuse over 2 hr, T;N
	albumin human 25% intravenous solution
		12.5 gm, 50 mL, Injection-Premix, IVPB, Q1H, PRN, dialysis, 12 hr
			Comment: may repeat x1 if BP <_____mmHg systolic during dialysis
		12.5 gm, 25 mL, Injection-Premix, IVPB, Q1H, PRN, dialysis, 12 hr
			Comment: may repeat x1 if BP <_____mmHg systolic during dialysis
		12.5 gm, 100 mL, Injection-Premix, IVPB, Q1H, PRN, dialysis, 12 hr
			Comment: may repeat x1 if BP <_____mmHg systolic during dialysis
	EMLA 2.5%-2.5% topical cream
		1 appl, Cream, TOPICAL, MonWedFri, T;N
	acetaminophen
		1,000 mg, Tab, By Mouth, MonWedFri
			Comment: For case duration < 6 hrs
	Prevnar 20
		0.5 mL, Suspension, IM-Intramuscular, Once
	influenza virus vaccine QUADrivalent
		0.5 mL, Suspension, IM-Intramuscular, Once, NOW
	hepatitis B adult vaccine 20 mcg/mL intramuscular suspension
		1 mL, Solution-Injection, IM-Intramuscular, Once, STAT
Therapies

Oxygen Protocol
Respiratory Therapy
	Oxygen Therapy
		T;N
	Pulse Oximetry Spot Check RT
		T;N, BID
	Continuous Pulse Oximetry Monitoring Check
		T;N, BID

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