Unique Plan Description: NICU Sepsis (WH)
Plan Selection Display: NICU Sepsis (WH)
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2011-12-09 14:35:54
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2022-03-22 17:31:06
Available at all facilities: Yes

NICU Sepsis (WH)
Diet
	NPO
		
Laboratory
	Basic Metabolic Panel
		Stat, spec type = Blood
	.Blood Culture
		T;N, Stat, spec type = Blood
	CBC with Diff
		Stat, spec type = Blood
	Comprehensive Metabolic Panel
		Stat, spec type = Blood
	Enterovirus RNA PCR Blood
		T;N, Stat, spec type = Blood
	Cytomegalovirus (CMV) by Qualitative PCR
		T;N, Routine, spec type = Urine
	Enterovirus PCR CSF
		T;N, Stat, spec type = Cerebrospinal Fluid
	hsCRP
		Stat, spec type = Blood
	Urinalysis
		Nurse Collect, Stat, spec type = Urine
	Culture Urine
		Routine, spec type = Urine, from catheter or suprapubic
	Influenza A and B Screen PCR
		T;N, Stat, spec type = Nasopharynx
	Sputum Culture
		T;N, Routine, spec type = Sputum
		CSF Meningitis/Encephalitis Panel below includes enterovirus and HSV(NOTE)*
	CSF Meningitis/Encephalitis Panel
		T;N, Routine, spec type = Cerebrospinal Fluid
Diagnostic Tests
Radiology
	Chest 1 View
		Stat, Respiratory Distress
		Cross table, Stat
	Chest 2 View
		Stat
	Chest 1 View include Abd
		Stat
	Abd & Decub
		Perforation, Stat, Abnormal Findings
	KUB
		Stat, Bowel Gas Pattern
Medications

	ampicillin IVPB (NICU)
		100 mg/kg, Solution-Injection, IVPB, TID, Late onset neonatal sepsis, T;N, 36 hr
			Comment: Ampicillin: 100mg/kg/dose IV TID        PNA < 7 days old Ampicillin: 75mg/kg/dose IV QID          PNA >7 days old
	gentamicin IVPB (NICU)
		5 mg/kg, Injection, IVPB, Once, Late onset neonatal sepsis, T;N
			Comment: < 30 weeks: 5 mg/kg q48h> =30 weeks: 5 mg/kg q36h
	tobramycin IVPB (NICU)
		5 mg/kg, Injection, IVPB, Once, Late onset neonatal sepsis, T;N
	Zosyn (NICU)
		110 mg/kg, Injection-Premix, IVPB, Q8H, Late onset neonatal sepsis
			Comment: Body weight <=2 kg:     PNA <=7 days: 110 mg/kg/dose every 8 hours    PNA 8 to 28 days and <=30 weeks: 110 mg/kg/dose every 8 hours    PNA 8 to 28 days and > 30 weeks:  90 mg/kg/dose every 6 hours    PNA 29 to 60 days for all PMA:  90 mg/kg/dose every 6 hoursBody weight >2 kg:PNA <=60 days: 90 mg/kg/dose every 6 hours
	vancomycin IVPB (NICU)
		15 mg/kg, Injection-Premix, IVPB, Q8H, Late onset neonatal sepsis
			Comment: PMA (Weeks)         Postnatal (days)         Interval (hours)<= 29                      0 to 14                       Q18H<= 29                       >14                           Q12H30 to 36                  0 to 14                       Q12H30 to 36                  >14                            Q8H37 to 44                  0 to 7                         Q12H37 to 44                  >7                              Q8H>= 45                       All                               Q6H
		15 mg/kg, Injection-Premix, IVPB, Q6H, Late onset neonatal sepsis
			Comment: PMA (Weeks)         Postnatal (days)         Interval (hours)<= 29                      0 to 14                       Q18H<= 29                       >14                           Q12H30 to 36                  0 to 14                       Q12H30 to 36                  >14                            Q8H37 to 44                  0 to 7                         Q12H37 to 44                  >7                              Q8H>= 45                       All                               Q6H
		15 mg/kg, Injection-Premix, IVPB, Q12H, Late onset neonatal sepsis
			Comment: PMA (Weeks)         Postnatal (days)         Interval (hours)<= 29                      0 to 14                       Q18H<= 29                       >14                           Q12H30 to 36                  0 to 14                       Q12H30 to 36                  >14                            Q8H37 to 44                  0 to 7                         Q12H37 to 44                  >7                              Q8H>= 45                       All                               Q6H
	clindamycin IVPB (NICU)
		5 mg/kg, Injection, IVPB, Q12H, Bacteremia
			Comment: PMA (Weeks)         Postnatal (days)         Interval (hours)<= 29                      0 to 28                       Q12H<= 29                       >28                           Q8H30 to 36                  0 to 14                       Q12H30 to 36                  >14                            Q8H37 to 44                  0 to 7                         Q12H37 to 44                  >7                              Q8H>=45                       All                               Q6H
		5 mg/kg, Injection, IVPB, Q8H, Bacteremia
			Comment: PMA (Weeks)         Postnatal (days)         Interval (hours)<= 29                      0 to 28                       Q12H<= 29                       >28                           Q8H30 to 36                  0 to 14                       Q12H30 to 36                  >14                            Q8H37 to 44                  0 to 7                         Q12H37 to 44                  >7                              Q8H>=45                       All                               Q6H
		5 mg/kg, Injection, IVPB, Q6H, Bacteremia
			Comment: PMA (Weeks)         Postnatal (days)         Interval (hours)<= 29                      0 to 28                       Q12H<= 29                       >28                           Q8H30 to 36                  0 to 14                       Q12H30 to 36                  >14                            Q8H37 to 44                  0 to 7                         Q12H37 to 44                  >7                              Q8H>=45                       All                               Q6H
	Maxipime (NICU)
		50 mg/kg, Solution-Injection, IVPB, Q12H, Late onset neonatal sepsis
		30 mg/kg, Solution-Injection, IVPB, Q12H, Late onset neonatal sepsis
	Penicillin G potassium NICU 60,000units/mL/D5W
		125,000 units/kg, Injection-Premix, IVPB, Q6H, Late onset neonatal sepsis
			Comment: Program IV pump as ____mL/kg (round to nearest tenth).
	AmBisome (NICU)
		5 mg/kg, Solution-Injection, IVPB, Q24H, Other- type in, late onset neonatal sepsis
	immune globulin intravenous - Privigen
		0.5 gm/kg, IVPB, Once, T;N
			Comment: 0-15 minutes = 0.25mL/kg/hr = 0.025gm/kg/hr15-30 minutes = 0.5mL/kg/hr = 0.05gm/kg/hr30-45 minutes = 1mL/kg/hr = 0.1gm/kg/hr45-60 minutes = 2mL/kg/hr = 0.2gm/kg/hr60-75 minutes = 4mL/kg/hr = 0.4gm/kg/hr  The listed infusion time is ~ max time needed for a 1gm/kg dose, follow titration schedule.
	valGANciclovir
		12 mg/kg, Suspension, By Mouth, Q12H, CMV-treatment
	Ganciclovir (NICU)
		6 mg/kg, INT, IVPB, Q12H, CMV-treatment
	Hazardous Drug Precautions
		Ganciclovir
Patient Care
	Enteral Tube
		Insert | Connect to low intermittent suction
			Comment: Comment (40-60mmHg) suction.
		Connect to gravity drainage | Irrigate with normal saline, Q2H, 2ml
	Isolation Precautions
		Reason for Isolation: other
	Foley Catheter
		Insert, Once
Consults/Follow-up
	Pharmacy Consult
		T;N, Pharmacy to enter appropriate peak and trough levels around 3rd dose of gentamicin or vancomycin if applicable
	Consult Infectious Disease
		Refer to/Consult with: Robert Penn, MD

Herpes Panel (NICU)
Laboratory
	Herpes Simplex Virus (HSV-1/HSV-2) Subtype by PCR (disseminated infection only)
		Nurse Collect, T;N, Stat, spec type = Blood
	Herpes Simplex Virus 1/2 PCR. Other than blood
		Routine, spec type = Cerebrospinal Fluid
		Routine, spec type = Ocular, Nurse Collect, Eye
		Routine, spec type = Throat, Nurse Collect, Throat
		Routine, spec type = Skin, Nurse Collect, Rectal
		Routine, spec type = Skin, Nurse Collect

CSF/Meningitis Panel (MH WH FH)
	Protein CSF
		T;N, Stat, spec type = Cerebrospinal Fluid
	Glucose CSF
		T;N, Stat, spec type = Cerebrospinal Fluid
	Cell Count and Diff CSF
		T;N, Stat, spec type = Cerebrospinal Fluid
	Culture Routine
		T;N, Stat, Body Fluid, spec type = Cerebrospinal Fluid

Respiratory Panel Expanded
	Influenza A and B Screen PCR
		T;N, Stat, spec type = Nasopharynx
			Comment: spec type=Nasoph Micro Swab, RT to Collect
	Respiratory Syncytial Virus (RSV) PCR
		T;N, Stat, spec type = Nasopharynx
	COVID-19 (2019 Novel Coronavirus) by PCR
		T;N, Stat, spec type = Nasopharynx
	.Respiratory Panel Reflex to RVP
		T;N, Stat, spec type = Nasopharynx
			Comment: spec type=Nasoph Micro Swab, RT to Collect
Therapies
	Influenza specimen collection
		T;N

*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