Unique Plan Description: OB High Risk Admission
Plan Selection Display: OB High Risk Admission
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2020-04-22 19:21:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2023-06-28 13:57:23
Available at all facilities: Yes

OB High Risk Admission
Admit/Discharge/Transfer
	Admit to Inpatient Status
		T;N, Anticipated LOS 2 midnight or more
	Admit to Observation Status
		T;N
Vital Signs
	Vital Signs
		Q4H-Sch
		Routine
		Q2H-Sch
		Q15MIN, 4, hr
			Comment: Until stable
	Weight
		DAILY
Activity
	Bedrest with Bathroom Privileges
		
	Bedrest
		Left lateral position
			Comment: Strict bed rest
		Bed in trendelenburg
	Activity-Wheelchair Ride
		
	Ambulate
		T;N, DAILY
			Comment: ad lib
Diet
	Regular Diet
		T;N
		T+1;0600
	Clear Liquid Diet
		Advance as Tolerated
	Diabetic Diet
		
	NPO
		
Laboratory
	CBC with Diff
		Stat, spec type = Blood
		Routine, spec type = Blood
	Hepatic Function Panel
		Stat, spec type = Blood
		Routine, spec type = Blood
	Comprehensive Metabolic Panel
		Stat, spec type = Blood
		Routine, spec type = Blood
	Type and Crossmatch (Product Available)
		T;N, Stat, For Possible Transfusion
	Kleihauer-Betke
		Routine, spec type = Blood
	UA (Culture if Positive)
		Nurse Collect, Routine, Routine, spec type = Urine, Clean Catch
		Nurse Collect, Routine, Routine, spec type = Urine, Straight Cath
	Fetal Fibronectin
		Routine, spec type = Swab
	Vaginitis Panel PCR
		T;N, Stat, spec type = Genital
	GC/Chlamydia PCR-MH/WH/PC
		T;N, Routine, spec type = Cervix
		T;N, Routine, spec type = Vaginal
	Urine GC/Chlamydia PCR - MH/WH/PC
		T;N, Routine, spec type = Urine
	GC/Chlamydia(Rapid) DNA - FH/JE
		T;N, Routine, spec type = Cervix
		T;N, Routine, spec type = Urine
		T;N, Routine, spec type = Vaginal
	Group B Strep by PCR
		T;N, Routine, spec type = Vaginal/Rectal
	Glucose POC - RN
		TIDPC
		ACBKFST
	Protein Creatinine Ratio Urine
		Routine, Routine, spec type = Urine
		Stat, Stat, spec type = Urine
Diagnostic Tests
	PNATE OB US
		T;N, Pregnancy
IV Solutions
	Lactated Ringers Injection
		500 mL, IV, Bolus
		250 mL, IV, Bolus
		1,000 mL, IV, Bolus
		1,000 mL, IV, 125 ml/hr
			Comment: once oral intake adequate, decrease to TKO
		1,000 mL, IV, 125 ml/hr
			Comment: after bolus complete
		1,000 mL, IV, 25 ml/hr
			Comment: after bolus complete
	D5LR
		500 mL, IV, Bolus
		250 mL, IV, Bolus
		1,000 mL, IV, Bolus
		1000 mL IV, 125 ml/hr
			Comment: After bolus completed.  Once oral intake adequate, decrease to TKO
		1,000 mL, IV, 25 ml/hr
			Comment: After bolus completed.  Once oral intake adequate, decrease to TKO
	Sodium Chloride 0.9%
		500 mL, IV, Bolus
		250 mL, IV, Bolus
		1,000 mL, IV, Bolus
		1,000 mL, IV, 125 ml/hr
			Comment: After bolus completed.  Once oral intake adequate, decrease to TKO
		1,000 mL, IV, 25 ml/hr
			Comment: After bolus complete, Once oral intake adequqte, decrease to TKO
Medications
	Tylenol
		500 mg, Tab, BY MOUTH, Q4H, PRN, pain-mild
	Celestone Soluspan
		12 mg, Injection, IM-IntraMUSCULAR, Q24H, 2 Dose(s)/Time(s)
		12 mg, Injection, IM-IntraMUSCULAR, Once
			Comment: 12 hours after first dose
	Ambien
		5 mg, Tab, BY MOUTH, QHS, PRN, insomnia
			Comment: May repeat x1 if insomnia persists after 60 minutes
	multivitamin, prenatal
		1 TAB Tab BY MOUTH DAILY
	folic acid
		1 mg Tab BY MOUTH DAILY
	ferrous sulfate
		325 mg, Tab, BY MOUTH, DAILY
	iron polysaccharide
		150 mg, Capsule, BY MOUTH, DAILY
Patient Care
	Resuscitation Status
		Full Code
		No Code
	Intake and Output
		Q12H-Sch
	Non-stress test
		T+1;0600, Q24H
			Comment: Complete prior to MD rounds. Notify provider with non-reactive non-stress test as defined per health system policy.
		BID
			Comment: Complete prior to MD rounds. Notify provider with non-reactive non-stress test as defined per health system policy.
		TID
			Comment: Complete prior to MD rounds. Notify provider with non-reactive non-stress test as defined per health system policy.
	Notify MD
		Obstetric Call Parameters: SBP >160 mmHg and/or DBP >110 mmHg, P: >120 or <50, O2 Sat: <95%, RR: <10 or >30, Oliguria: <60 mL in 2 hours, Single Temp > 39.0C (102.2F), OR 2 temps between 38.0C (100.4F) and 39C (102.2F), at least 30 min apart
	FHR per doppler
		DAILY
	External Toco Monitoring
		BID
		TID
	No Vaginal Exams
		
	Room/Environment
		Apply eggcrate mattress prn
	Foley Catheter
		Foley, Insert, Once, PRN, unable to void, If foley catheter needed, enter order for foley catheter insert, once, and select the appropriate criteria for insertion and then insert the foley catheter.
	Straight Catheter
		Straight, Insert, unable to void
	Glucose Level, patient to do own
		TIDPC
		ACBKFST
	Pulse Oximetry Spot Check by nurse
		T;N
			Comment: If Sat < 95%, enter order for Oxygen Protocol, titrate/wean to keep sats  > or = 95%.
Therapies
	Consult Social Work
		Evaluation
	Consult Dietitian
		Regarding: Nutrition Assessment
	Consult Physical Therapy, Evaluate and Treat
		T+1;0900, Reason to See: High Risk OB
			Comment: High Risk OB
Consults/Follow-up
	Consult Perinatologist
		
	Consult Neonatologist High Risk OB
		
	Consult Behavioral Health

DIC Panel - MH/WH/JE
Laboratory
	.Protime - MH/WH/JE
		T;N, Stat, spec type = Blood
	PTT - MH/WH/JE
		T;N, Stat, spec type = Blood
	Fibrinogen Level - MH/WH/JE
		T;N, Stat, spec type = Blood
	D-Dimer - MH/WH/JE
		T;N, Stat, spec type = Blood
	.SchistoDIC
		T;N, Stat, spec type = Blood
	Platelet Count
		T;N, Stat, spec type = Blood

Constipation Protocol
Medications
	MiraLax oral powder for reconstitution
		17 gm, Packet, BY MOUTH, Q12H, PRN, constipation
			Comment: Mix in 6 oz of juice or water.
		17 gm, Packet, BY MOUTH, DAILY, PRN, constipation
			Comment: Mix in 6 oz juice or water
	Milk of Magnesia 8% oral suspension
		30 mL, Suspension, By Mouth, DAILY, PRN for constipation
			Comment: If Miralax not effective; do not use if creatinine clearance or GFR < 30mL/min
		30 mL, Suspension, By Mouth, Q12H, PRN for constipation
			Comment: If Miralax not effective; do not use if creatinine clearance or GFR < 30mL/min
	Dulcolax
		10 mg, Suppository, RECTALLY, DAILY, PRN, constipation
			Comment: If MOM ineffective or if patient NPO
		10 mg, Suppository, RECTALLY, Q12H, PRN, constipation
			Comment: If MOM ineffective or if patient NPO
	Fleet Enema 19 gm-7 gm rectal enema
		1 EA, Enema, RECTALLY, DAILY, PRN, constipation
			Comment: If bisacodyl ineffective
Patient Care
	Notify MD
		if no results from enema.
	Enema-Administer
		T;N, Tap water, Q12H constipation
			Comment: PRN,  if suppository ineffective

OB Hypoglycemia Protocol
Laboratory
	Order Lab
		T;N, Blood Glucose (POC) as needed for signs and symptoms of hypoglycemia
Medications
	Dextrose 50%
		25 mL, Injection, IV Push, Q15MIN, PRN for low blood sugar, Routine
			Comment: Give if blood glucose less than 55mg/dL or 56-79 mg/dL and patient unable to tolerate oral intake. Notify provider if given with corresponding POC glucose recheck value.
	Dextrose 10% in Water (FH)
		250 mL, Injection, IVPB, Q30MIN, PRN for low blood sugar, infuse over 30 min(s)
			Comment: Give if blood glucose less than 55mg/dL or 56-79 mg/dL and patient unable to tolerate oral intake. Notify provider if given with corresponding POC glucose recheck value.
	glucagon
		1 mg, Injection, IV Push, Q15MIN, PRN for low blood sugar, Routine
			Comment: Give if blood glucose < 55mg/dL, if dextrose 50% injectable unavailable and blood glucose 56-79 mg/dL, or inadequate response to IV dextrose 50%. May give SubQ or IM if patient does not have IV access. Notify provider if given with corresponding POC glucose recheck value.
Patient Care
	IV-Maintain
		T;N
			Comment: Patient must have IV site while on hypoglycemia protocol.
	Hypoglycemia Treatment Parameters
		T;N, Hypoglycemia protocol initiated for patients with glucose <80mg/dl.
			Comment: Patient must have IV site while on hypoglycemia protocol.
		T;N, blood glucose <40mg/dl (critical value),
			Comment: Discontinue any insulin infusion and treat with Dextrose 50%, 25 ml. Notify physician immediately and repeat glucose 15 minutes after treatment
		T;N, glucose 40-55 mg/dL give Dextrose 50% 25 mL.
			Comment: Discontinue any insulin infusion and treat with Dextrose 50%, 25 ml. Notify physician immediately and repeat glucose 15 minutes after treatment
		T;N, glucose 56-79 mg/dL,
			Comment:  if Patient asymptomatic, recheck blood glucose in 30 minutes.  If symptomatic, administer 4 oz apple juice.  If patient NPO or unable to tolerate oral intake, give Dextrose 50%, 25ml.  Repeat glucose in 15 minutes after treatment
		T;N
			Comment: Give 1 complex carb and 1 protein snack or patient meal if patient able to take orals any time hypoglycemia is treated.
		T;N
			Comment: When blood glucose is greater than 100 mg/dL; if indicated, restart Insulin infusion at ½ previous rate and change glucose checks to every hour until glucose is in the target range (101 - 140) for 6 hours, then may change to Q2H glucose checks.

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

OB Seizure Prophylaxis
Laboratory
	Magnesium Level
		T;N, Routine, Q6H, spec type = Blood
IV Solutions
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	magnesium sulfate 4gm in 100mL water
		4 gm, IVPB, Once, 200 ml/hr
			Comment: 4 gm in 100 mL water, infuse over 30 minutes
	magnesium sulfate 6gm/D5W 100mL (JE)
		6 gm, INT, IVPB, Once, 200 ml/hr, T;N
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	magnesium sulfate 20 gm in 500 mL water Premix IV
		500 mL, IV
			Comment: 1 gm/hr = 25 mL/hr1.5 gm/hr = 37.5 mL/hr2 gm/hr = 50 mL/hr2.5 gm/hr = 62.5 mL/hr3 gm/hr = 75 mL/hr
		20 gm, EVERY BAG, 2 gm/hr
	Lactated Ringers Injection
		1,000 mL, IV, 75 ml/hr
			Comment: Adjust rate so LR and Magnesium Sulfate TOTAL fluid intake is 125ml/hr.
Medications
	calcium gluconate
		1 gm, Solution, IV Push, Q5MIN, PRN, absence of deep tendon reflexes
			Comment: Flush IV line before administering. May give 1gm IV Push over 5 minutes (max rate: 200mg/min). Administer in large vein to decrease risk of thrombophlebitis and extravasation. May repeat as necessary. Patient must be placed on telemetry if this drug is administered.
Patient Care
	Notify MD
		T;N, If Serum magnesium level greater than 8 and Discontinue Magnesium Maintenance IV stat
		T;N, If O2 sat less than 95%
		T;N, If respiration less than 12, patient still pregnant
		T;N, If DTRs absent
	Discontinue IV
		T;N, If serum magnesium greater than 8mg/dL, Once

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

Nausea Protocol EKM
Medications
	ondansetron
		4 mg, Injection, IV PUSH, Q24H, PRN for nausea and/or vomiting
			Comment: Administer for nausea if not previously administered by anesthesia, PACU, or ED and unable to take oral meds.
		4 mg, Injection, IV PUSH, Q6H, PRN for nausea and/or vomiting
			Comment: Administer for nausea if not previously administered by anesthesia, PACU, or ED and unable to take oral meds.
		4 mg, Tablet-Disintegrating, By Mouth, Q6H, PRN for nausea and/or vomiting
			Comment: Administer for nausea if not previously administered by anesthesia, PACU, or ED
		Select either promethazine or prochlorperazine orders:(NOTE)*
	prochlorperazine
		10 mg, Injection, IV PUSH, Q6H, PRN, nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures
		25 mg, Suppository, RECTALLY, BID, PRN, nausea
			Comment: Give if ondansetron ineffective and if no history of seizures, give if IV access not available
	Phenergan (JE)
		25 mg, Tab, By Mouth, BID, PRN, nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures
		25 mg, Suppository, RECTALLY, BID, PRN, nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures, give if IV access not available
	Phenergan (MH/WH)
		25 mg, Tab, By Mouth, BID, PRN, nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures; give if unable to take oral meds.
		25 mg, Suppository, RECTALLY, BID, PRN, nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures; give if unable to take oral meds.
		6.25 mg, Injection, IM-Intramuscular, Q6H, PRN for nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures; give if unable to take oral meds
	Phenergan (FH)
		25 mg, Tab, By Mouth, BID, PRN for nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures; give if unable to take oral meds.
		25 mg, Suppository, RECTALLY, BID, PRN for nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures; give if unable to take oral meds.
		12 mg, INT, IVPB, Q6H, PRN for nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures; give if unable to take oral meds.
	Benadryl
		12.5 mg, Injection, IV PUSH, Q6H, PRN, nausea and/or vomiting
			Comment: Give if ondansetron and phenothiazine ineffective
	Ativan
		1 mg, Tab, BY MOUTH, Q8H, PRN, nausea and/or vomiting
			Comment: Give if ondansetron, phenothiazine, or other anti-nausea medications ineffective
		1 mg, Injection, IV PUSH, Q8H, PRN, nausea and/or vomiting
			Comment: Give if ondansetron, phenothiazine, or other anti-nausea medications ineffective
	Reglan
		10 mg, Injection, IV PUSH, Q6H, PRN, nausea and/or vomiting
			Comment: Give if ondansetron, phenothiazine, or other anti-nausea medications ineffective; avoid in patients > 65yo
		10 mg, Injection, IM-Intramuscular, Q6H, PRN, nausea and/or vomiting
			Comment: Give if ondansetron, phenothiazine, or other anti-nausea medications ineffective; avoid in patients > 65yo

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

DIC Profile - FH
Laboratory
	CBC with Diff
		T;N, Stat, spec type = Blood
	Prothrombin Time (PT) - FH
		T;N, Stat
	Partial Thromboplastin Time (PTT) - FH
		T;N, Stat, spec type = Diagnostic Blood
	Fibrinogen Level - FH
		T;N, Stat, spec type = Blood
	D-Dimer Level - FH
		T;N, Stat, spec type = Blood
	.SchistoDIC
		T;N, Stat, 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