Unique Plan Description: Organ Retrieval (Live On) Diagnostic Orders
Plan Selection Display: Organ Retrieval (Live On) Diagnostic Orders
PlanType: Medical                                 
Version: 3          
Begin Effective Date: 2020-04-23 11:11:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-06-04 15:01:54
Available at all facilities: Yes

Organ Retrieval (Live On) Diagnostic Orders
Vital Signs
	Temperature
		T;N, Q1H, via rectal or bladder
			Comment: may use warming blanket as needed to keep temp > 97F/36-37.5C
	Vital Signs/Hemodynamic Monitoring
		T;N, Q1H, (keep MAP>60/SBP >100mmHg), UOP, Temp, pulse oximetry, CVP and PRN as needed
Activity
	Elevate head of bed
		T;N
			Comment: keep head of bed elevated > or = to 30 degrees
	Turn patient
		T;N, Q2H-Sch
Laboratory
	Glucose POC - RN
		T;N, Once, Notify Live On coordinator if >180
		T;N, TIDAC, Notify Live On coordinator if >180
		T;N, Q4H, Notify Live On coordinator if >180
		T;N, Q2H-Sch, Notify Live On coordinator if >180
		T;N, Q1H, Notify Live On coordinator if >180
	ABORh Patient Type
		T;N, Stat, spec type = Blood
		T;N, Stat, spec type = Blood
			Comment: x 2, (two different draw times)
		Stat, spec type = Blood
			Comment: Live On requests patient subtype
		T;N, Stat, spec type = Blood
			Comment: with subtype for A1, as applicable (two different draw times)
	HGB A1C
		T;N, Stat, spec type = Blood
	Beta-HCG Quantitative - Pregnancy
		T;N, Stat, spec type = Blood
			Comment: if female less than or equal to 55 yrs of age
	Culture Urine
		T;N, Stat, Urine, spec type = Urine
			Comment: to be run regardless of reflex (UNOS requirement)
	CBC with Diff
		T;N, Stat, Once, spec type = Blood
		T;N+240, Timed, Q4H, spec type = Blood
		T;N+360, Timed, Q6H, spec type = Blood
		T;N+480, Timed, Q8H, spec type = Blood
	Comprehensive Metabolic Panel
		T;N, Stat, Once, spec type = Blood
		T;N+240, Timed, Q4H, spec type = Blood
		T;N+360, Timed, Q6H, spec type = Blood
		T;N+480, Timed, Q8H, spec type = Blood
	Magnesium Level
		T;N, Stat, Once, spec type = Blood
		T;N+240, Timed, Q4H, spec type = Blood
		T;N+360, Timed, Q6H, spec type = Blood
		T;N+480, Timed, Q8H, spec type = Blood
	Phosphorus
		T;N, Stat, Once, spec type = Blood
		T;N+240, Timed, Q4H, spec type = Blood
		T;N+360, Timed, Q6H, spec type = Blood
		T;N+480, Timed, Q8H, spec type = Blood
	Ionized Calcium
		T;N, Stat, spec type = Blood
		T;N+240, Timed, spec type = Blood
		T;N+360, Timed, Q6H, spec type = Blood
		T;N+480, Timed, Q8H, spec type = Blood
	LD
		T;N, Stat, Once, spec type = Blood
		T;N+240, Timed, Q4H, spec type = Blood
		T;N+360, Timed, Q6H, spec type = Blood
		T;N+480, Timed, Q8H, spec type = Blood
	GGT
		T;N, Stat, spec type = Blood
	Alkaline Phosphatase
		T;N, Stat, spec type = Blood
		T;N+240, Timed, spec type = Blood
		T;N+360, Timed, spec type = Blood
		T;N+480, Timed, spec type = Blood
	Bilirubin Direct
		T;N, Stat, spec type = Blood
		T;N+240, Timed, Q4H, spec type = Blood
		T;N+360, Timed, Q6H, spec type = Blood
		T;N+480, Timed, Q8H, spec type = Blood
	Bilirubin Total
		T;N, Stat, spec type = Blood
		T;N+240, Timed, Q4H, spec type = Blood
		T;N+360, Timed, Q6H, spec type = Blood
		T;N+480, Timed, Q8H, spec type = Blood
	Amylase Level
		T;N, Stat, Once, spec type = Blood
		T;N+240, Timed, Q4H, spec type = Blood
		T;N+360, Timed, Q6H, spec type = Blood
		T;N+480, Timed, Q8H, spec type = Blood
	Lipase Level
		T;N, Stat, Once, spec type = Blood
		T;N+240, Timed, Q4H, spec type = Blood
		T;N+360, Timed, Q6H, spec type = Blood
		T;N+480, Timed, Q8H, spec type = Blood
	CK
		T;N, Stat, Once, spec type = Blood
		T;N+240, Timed, Q4H, spec type = Blood
		T;N+360, Timed, Q6H, spec type = Blood
		T;N+480, Timed, Q8H, spec type = Blood
	CKMB
		T;N, Stat, Once, spec type = Blood
		T;N+240, Timed, Q4H, spec type = Blood
		T;N+360, Timed, Q6H, spec type = Blood
		T;N+480, Timed, Q8H, spec type = Blood
	hs Troponin T - MH/WH/JE
		T;N, Stat, Once, spec type = Blood
		T;N+240, Timed, Q4H, spec type = Blood
		T;N+360, Timed, Q6H, spec type = Blood
		T;N+480, Timed, Q8H, spec type = Blood
	hs Troponin I - FH
		T;N, Stat, spec type = Blood
		T;N+240, Timed, Q4H, spec type = Blood
		T;N+360, Timed, Q6H, spec type = Blood
		T;N+480, Timed, Q8H, spec type = Blood
	Blood Gases Arterial (ABG) - MH/WH/JE
		T;N, Stat, Once, spec type = Blood
		T;N, Timed, Q4H, spec type = Blood
		T;N+360, Timed, Q6H, spec type = Blood
		T;N+480, Timed, Q8H, spec type = Blood
	Blood Gases Arterial (ABG) - FH
		T;N, Stat, spec type = Blood
		T;N, Timed, Q4H, spec type = Blood
		T;N+360, Timed, Q6H, spec type = Blood
		T;N+480, Timed, Q8H, spec type = Blood
	PT - MH/WH/JE
		T;N, Stat, spec type = Blood
		T;N+240, Timed, Q4H, spec type = Blood
		T;N+360, Timed, Q6H, spec type = Blood
		T;N+480, Timed, Q8H, spec type = Blood
	Prothrombin Time (PT) - FH
		T;N, Stat, spec type = Diagnostic Blood
		T;N+240, Q4H, Timed, spec type = Diagnostic Blood
		T;N+360, Q6H, Timed, spec type = Diagnostic Blood
		T;N+480, Q8H, Timed, spec type = Diagnostic Blood
	PTT - MH/WH/JE
		T;N, Stat, Once, spec type = Blood
		T;N+240, Timed, Q4H, spec type = Blood
		T;N+360, Timed, Q6H, spec type = Blood
		T;N+480, Timed, Q8H, spec type = Blood
	Partial Thromboplastin Time (PTT) - FH
		T;N, Stat, spec type = Diagnostic Blood
		T;N+240, Q4H, Timed, spec type = Diagnostic Blood
		T;N+360, Q6H, Timed, spec type = Diagnostic Blood
		T;N+480, Q8H, Timed, spec type = Diagnostic Blood
	Sputum Culture
		T;N, Stat, Expectorated, spec type = Sputum
			Comment: do NOT perform AFB or fungal cultures
	Type and Screen (No Product on hold)
		T;N, Routine, spec type = Blood
	Crossmatch Red Blood Cells
		T;N, Routine
Diagnostic Tests
	Chest 1 View
		Lung evaluation for Live On, T;N, Stat, Findings/Abnormal
		T;N+360, Routine, Q6H-Sch
		T;N+480, Routine, Q8H-Sch
	ECG
		T;N, Stat, Indication: Cardiac Evaluation for Live On
			Comment: if not done in last 12 hours
	Echo w Doppler resting
		Indication: Heart Transplant
IV Solutions
	Lactated Ringers Injection
		1,000 mL, IV, 50 ml/hr
		1,000 mL, IV, 75 ml/hr
		1,000 mL, IV, 100 ml/hr
		1,000 mL, IV, 125 ml/hr
		1,000 mL, IV, 150 ml/hr
		1,000 mL, IV, 20 ml/hr
	Dextrose 5% in Water
		1,000 mL IV, 50 ml/hr
		1,000 mL IV, 75 ml/hr
		1,000 mL IV, 100 ml/hr
		1,000 mL IV, 125 ml/hr
		1,000 mL IV, 150 ml/hr
		1,000 mL, IV, 20 ml/hr
	Sodium Chloride 0.9%
		1,000 mL, IV, 50 ml/hr
		1,000 mL, IV, 75 ml/hr
		1,000 mL, IV, 100 ml/hr
		1,000 mL, IV, 125 ml/hr
		1,000 mL, IV, 150 ml/hr
		1,000 mL, IV, 20 ml/hr
	Sodium Chloride 0.9% with KCl 20mEq
		1,000 mL, IV, 50 ml/hr
		1,000 mL, IV, 75 ml/hr
		1,000 mL, IV, 100 ml/hr
		1,000 mL, IV, 125 ml/hr
		1,000 mL, IV, 150 ml/hr
		1,000 mL, IV, 20 ml/hr
Medications
	Solu-MEDROL IVPB
		1 gm, IVPB, Once, STAT
			Comment: In D5W  100 mL (total Volume).  Infuse over 15 minutes
		1 gm, IVPB, Q12H
			Comment: In D5W  100 mL (total Volume).  Infuse over 15 minutes
	Ancef IVPB
		1,000 mg, Injection-Premix, IVPB, Q8H, Surgical prophylaxis, 2 Dose(s)/Time(s)
			Comment: if allergy, check with Live On coordinator for alternative
	Ancef IVPB (FH)
		1,000 mg, INT, IVPB, Q8H, Surgical prophylaxis, 2 Dose(s)/Time(s)
			Comment: if allergy, check with Live On coordinator for alternative
	albuterol-ipratropium 2.5 mg-0.5 mg/3 mL inhalation solution
		3 mL, Solution-Nebulization, NEBULIZED, Q24H
			Comment: if duoneb not available, enter order for: Albuterol 2. 5mg w/0.5mg Ipatropium q4h
		3 mL, Solution-Nebulization, NEBULIZED, Q4H, PRN, wheezing
	vasopressin 10units/NS 50mL
		10 units, EVERY BAG, 0.01 unit/min
		50 mL, IV, Increment Increase: 0.01 unit/min, Increment Decrease: 0.01 unit/min, Increment Freq: 30 min(s), Max Dose: 0.1 unit/min
			Comment: If the dose has been titrated twice within the specified timeframe and goal parameter is not achieved, the titration dose can be doubled until the ordered parameter is achieved or maximum dose is reached.  IV may be re-initiated after weaning within 12hours, re-initiate at the last dosing rate that maintained Goal parameter. Discontinue order after 12hr if patient does not require IV re-initiation.
	acetylcysteine 20% inhalation soln
		10 mL, Solution, NEBULIZED, Q4H
Patient Care
	Discontinue
		T;N, current vasopressors, antibiotics and maintenance fluids
	Arterial Line Monitoring
		T;N, arterial line if one is not already in place.
	Notify MD
		T;N, Notify Intensivist for arterial line/central line placement
	Vital Signs/Hemodynamic Monitoring
		T;N, Live On Donor management goals:  Temp >97 F, Heart rate 60-120, SBP >100mmHg/MAP >60mmgHG, CVP 6-10 mmHG, SpO2 >/=95%, pH 7.30-7.45, Glucose <180mg/dL, minimum urine output 1-3ml/kg/hr.
	Cardiac Telemetry Monitoring
		Telemetry Indications: Other
	Monitor Central Venous Pressure (CVP)
		
	Enteral Tube
		T;N, insert if not already in place.
		T;N, connect to low intermittent suction
	OG Tube
		T;N, Insert if not already in place.
		T;N, connect to low intermittent suction
		Hypernatremia Protocol(NOTE)*
	Enteral Tube
		T;N
			Comment: Hypernatremia Protocol (Na+ >/= to 165). Give 200ml of tap water per NG tube and clamp for 2 hours. Repeat every 2 hours. Check residual q4h. Re-instill residual and add difference for a total 200ml. Repeating until Na+ level normal. If patient continues to have elevated residuals, notify Live On coordinator for consideration of gut stimulator such as Reglan (10mg q6h) or Erythromycin (500mg IV q6h)
	OG Tube
		T;N
			Comment: Hypernatremia Protocol (Na+ >/= to 165). Give 200ml of tap water per OG tube and clamp for 2 hours. Repeat every 2 hours. Check residual q4h. Re-instill residual and add difference for a total 200ml. Repeating until Na+ level normal. If patient continues to have elevated residuals, notify Live On coordinator for consideration of gut stimulator such as Reglan (10mg q6h) or Erythromycin (500mg IV q6h)
	Discontinue Feeding Tube
		T;N, and put feeding tube to low continuous suction
	Enteral Tube
		T;N, install 200ml tap water via NG/OG and clamp for 1 hour, then turn to low continuous suction for 1 hour, and repeat continuously
	OG Tube
		T;N, install 200ml tap water via NG/OG and clamp for 1 hour, then turn to low continuous suction for 1 hour, and repeat continuously
	Airway Suction
		T;N, Q2H-Sch
			Comment: Deep pharyngeal to remove sub glottal secretions
	Oral Care
		T;N, Q2H-Sch
	Warming Blanket
		T;N, PRN to keep temp >97F (36-37.5 degrees C)
	Intake and Output
		T;N, Q1H
			Comment: monitor urine output to keep 1-3ml/kg/hr. If urine output is >3ml/kg/hr  or <1ml/kg/hr x 2hr notify Live On coordinator or result.
	Notify
		T;N, Live On clinical coordinator of specific gravity if done
	Order Lab
		T;N, Urine specific gravity if Urine output is >3ml/kg/hr x 2 hours, and notify Live On clinical coordinator of result.
Therapies
	Communication RT
		T;N
			Comment: fully inflate ETT cuff. Live On patient
	Continuous Pulse Oximetry Monitoring Check
		T;N
			Comment: monitor BP (keep MAP>60/SBP >90mmHg) cardiac rhythm, pulse ox and CVP continuously. Record measurements every hour, and PRN.
	Chest Physiotherapy
		T;N

Blood Culture Set
Laboratory
		<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"><HTML><HEAD><META content="text/html; charset=windows-1252" http-equiv=Content-Type><STYLE> BODY margin:0; P margin:0 </STYLE><META name=GENERATOR content="MSHTML 11.00.10570.1001(NOTE)*
		<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"><HTML><HEAD><META content="text/html; charset=windows-1252" http-equiv=Content-Type><STYLE> BODY margin:0; P margin:0 </STYLE><META name=GENERATOR content="MSHTML 11.00.10570.1001(NOTE)*
		<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"><HTML><HEAD><META content="text/html; charset=windows-1252" http-equiv=Content-Type><STYLE> BODY margin:0; P margin:0 </STYLE><META name=GENERATOR content="MSHTML 11.00.10570.1001(NOTE)*
		<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"><HTML><HEAD><META content="text/html; charset=windows-1252" http-equiv=Content-Type><STYLE> BODY margin:0; P margin:0 </STYLE><META name=GENERATOR content="MSHTML 11.00.10570.1001(NOTE)*
		<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"><HTML><HEAD><META content="text/html; charset=windows-1252" http-equiv=Content-Type><STYLE> BODY margin:0; P margin:0 </STYLE><META name=GENERATOR content="MSHTML 11.00.10570.1001(NOTE)*
		<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"><HTML><HEAD><META content="text/html; charset=windows-1252" http-equiv=Content-Type><STYLE> BODY margin:0; P margin:0 </STYLE><META name=GENERATOR content="MSHTML 11.00.10570.1001(NOTE)*
	.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

Organ Retrieval Levothyroxine (T4) Protocol
IV Solutions
	levothyroxine 100 mcg/250mL NS
		250 mL, IV
		100 mcg, EVERY BAG, 10 mcg/hr
Medications
	Dextrose 50%
		50 mL, Injection, IV Push, Once, STAT
	Solu-MEDROL IVPB
		2 gm, IVPB, Once, T;N
			Comment: in 50 mL D5W, Infuse over  1 hour
		1 gm, IVPB, Q12H, T;N+720
			Comment: Start if not already initiated. Infuse over 1 hour
	insulin regular
		20 units, Solution-Injection, IV Push, Once, T;N
			Comment: Give in rapid succession prior to starting T4 drip

Central Line Venous Access
	sodium chloride 0.9% flush injectable soln
		10 mL, Syringe, IV PUSH, BID
		10 mL, Syringe, IV Push, Q5MIN, PRN, IV line flush
		20 mL, Syringe, IV PUSH, Q5MIN, PRN, IV line flush
		30 mL, Syringe, IV PUSH, Q5MIN, PRN, IV line flush
	heparin flush 100 units/mL
		600 units, IV Push, Q24H, PRN for IV line flush
			Comment: PRIOR TO DISCHARGE: For open ports only at discharge.
		500 units, IV Push, Q24H, PRN for IV line flush
			Comment: PRIOR TO DISCHARGE: For open ports only at discharge.
	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
	Central Line-Insert
		T;N

Insulin Drip (IV Infusion) Protocol
Laboratory
	Glucose POC - RN
		T;N, Q1H
		T;N, As needed for signs and symptoms of hypoglycemia
IV Solutions
		<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"><HTML><HEAD><META content="text/html; charset=windows-1252" http-equiv=Content-Type><STYLE> BODY margin:0; P margin:0 </STYLE><META name=GENERATOR content="MSHTML 11.00.10570.1001(NOTE)*
		<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"><HTML><HEAD><META content="text/html; charset=windows-1252" http-equiv=Content-Type><STYLE> BODY margin:0; P margin:0 </STYLE><META name=GENERATOR content="MSHTML 11.00.10570.1001(NOTE)*
		<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"><HTML><HEAD><META content="text/html; charset=windows-1252" http-equiv=Content-Type><STYLE> BODY margin:0; P margin:0 </STYLE><META name=GENERATOR content="MSHTML 11.00.10570.1001(NOTE)*
		<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"><HTML><HEAD><META content="text/html; charset=windows-1252" http-equiv=Content-Type><STYLE> BODY margin:0; P margin:0 </STYLE><META name=GENERATOR content="MSHTML 11.00.10570.1001(NOTE)*
		<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"><HTML><HEAD><STYLE> BODY margin:0; </STYLE><STYLE>         ul              margin-top: 0;             margin-bottom: 0;                          </STYLE><META content=(NOTE)*
		<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"><HTML><STYLE> BODY margin:0; </STYLE><HEAD> <style>         ul              margin-top: 0;             margin-bottom: 0;              </style> <META content="text/html; char(NOTE)*
		<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"><HTML><STYLE> BODY margin:0; </STYLE><HEAD> <style>         ul              margin-top: 0;             margin-bottom: 0;              </style> <META content="text/html; char(NOTE)*
		<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"><HTML><HEAD><STYLE> BODY margin:0; </STYLE><STYLE>         ul              margin-top: 0;             margin-bottom: 0;              </STYLE><META content="text/html;(NOTE)*
		<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"><HTML><HEAD><STYLE> BODY margin:0; </STYLE><STYLE>         ul              margin-top: 0;             margin-bottom: 0;                         </STYLE><META content="(NOTE)*
		<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"><HTML><HEAD><META content="text/html; charset=windows-1252" http-equiv=Content-Type><STYLE> BODY background-color: rgb(232,235,245);margin:0; P margin:0 </STYLE><META name=GENERAT(NOTE)*
	insulin regular 100 units/NS 100 mL Premix
		100 units, EVERY BAG, 2 units/hr
		100 mL, IV, Routine, T;N, Total Volume = 100
			Comment: Concentration: 1 unit/mL, Initial rate based on initial glucose:  181-300: 2 units/hr;  301-400:  3 units/hr; 401 or greater: 4 units/hr;   Titrate infusion to target glucose of 140-180: If glucose is:1) Less than 100 discontinue infusion, ,continue blood glucose monitoring and follow Insulin IV infusion hypoglycemia treatment parameters if necessary; restart drip at 1/2 previous rate when glucose >120.2) 100-120, decrease infusion by 1 unit/hr3) 121-139,decrease rate by 0.5unit/hr4) 140-180 , no change5) 181-249, and is greater than or equal to the previous glucose, increase infusion by 0.5 unit/hr6) 181-249, and is less than the previous glucose, maintain same rate7) 250-350, increase infusion by 1 unit/hr8) > 351, increase infusion by 2 unit/hr. Contact MD if rate >10 unit/hr.  If the glucose decreases >75mg/dl from the last glucose check, decrease insulin rate by 50% and check blood glucose in 30 minutes. If enteral and/or parenteral nutrition support is stopped or held, decrease infusion to 0.5 unit/hour and notify physician
	Dextrose 5% with 0.45% NaCl
		1,000 mL, IV, Routine, 50 ml/hr, Total Volume = 1,000
			Comment: Begin if patient not currently on dextrose containing IV or TPN when glucose is 200 or less.  If patient has a current IV order that doesn't contain dextrose, add dextrose to that IV and do not start this D5/45 Order.
Medications
	insulin regular
		5 units, Solution-Injection, IV Push, Once, PRN see comment
			Comment: Prior to starting insulin drip if initial blood glucose 301 or greater
	Dextrose 50% injection
		25 mL, Injection, IV Push, Q15MIN, PRN low blood sugar, Routine
			Comment: Give if blood glucose less than 60mg/dL or 60-70 mg/dL and patient unable to tolerate oral intake. Notify provider if given with corresponding POC glucose recheck value.
		50 mL, Injection, IV Push, Q15MIN, PRN low blood sugar, Routine
			Comment: Give if blood glucose less than 60mg/dL or 60-70 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 low blood sugar, infuse over 30 min(s)
			Comment: Give if blood glucose less than 60mg/dL or 60-70 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 low blood sugar, Routine, T;N
			Comment: Give if blood glucose < 70mg/dL AND if dextrose 50% injectable unavailable 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
	Notify MD
		T;N, for instructions if dietary change: abrupt change in oral intake, change to NPO status, tube feedings are held or discontinued, TPN held or discontinued.  (caloric intake necessary to prevent hypoglycemia)
		T;N, If insulin requirements > 10units/hr for further instruction
	Notify MD of Lab results
		T;N, if blood glucose is not less than 180 after 6 hours on the Insulin IV Infusion protocol.
	IV Insulin Parameters
		T;N, Decrease infusion to 0.5 units/hour if enteral and/or parenteral nutrition support is stopped or held and notify physician.
		T;N, If the glucose decreases >75mg/dl from the last glucose check, decrease insulin rate by 50% and check blood glucose in 30 minutes.
		T;N, If initial glucose < 180, do not start infusion.  Enter order for blood glucose Q4H and start infusion if necessary based on parameters.
		T;N, When glucose </= 200, and patient not on a dextrose containing IV/TPN: add D5W to current IV.  Continue same IV base, electrolytes and rate.  If patient not currently on IV or TPN, initiate D5W/0.45% sodium chloride.
		T;N, Stop insulin infusion 2 hours after administration of antidiabetic medication ordered for transition from IV infusion (long-acting insulin, etc.)
	Order Lab
		When glucose is in target range (140-180) for 6 hours, cancel glucose Q1H order and enter new glucose order Q2H.  If glucose falls out of target range, change glucose checks back to Q1H until in range again for 6 hours.
	Hypoglycemia Treatment Parameters
		T;N, When blood glucose is greater than 120 mg/dL, restart infusion at 1/2 previous rate and change glucose checks to every hour until glucose is in the target range (140-180) for 6 hours, then may change to Q2H glucose checks.
		T;N, Hypoglycemia protocol initiated for patients with glucose <70mg/dl.  Patient should have an IV while on insulin protocol.
		T;N, glucose <60 mg/dL, discontinue infusion and treat with Dextrose 50% 25 mL OR glucagon 1mg as per medication orders. Notify provider as per critical result protocol.
			Comment: Repeat treatment as outlined in hypoglycemia parameters. Notify provider of all treatments given and POC glucose recheck values. When notifying provider of hypoglycemic treatment, clarify with provider future instructions on diabetic medication therapy
		T;N, glucose 60-70 mg/dL, discontinue infusion, and administer 4 oz apple juice, 4 oz non-diet soda, or glucose gel.  If patient NPO or unable to tolerate oral intake, give Dextrose 50% 25 mL OR glucagon 1mg as per medication orders.
			Comment: Repeat treatment as outlined in hypoglycemia parameters. Notify provider of all treatments given and POC glucose recheck values. When notifying provider of hypoglycemic treatment, clarify with provider future instructions on diabetic medication therapy.
		T;N, After initial treatment of any glucose value </= 70 mg/dL, repeat POC glucose in 15 min; if result </= 70mg/dL continue treating as per protocol and rechecking glucose 15 min after treatment until glucose >70mg/dL.
			Comment: Notify provider of all treatments given and corresponding POC glucose recheck values. When notifying provider of hypoglycemic treatment, clarify with provider future instructions on diabetic medication therapy.
		T;N, If the patient has a diet ordered and Once glucose is within normal limits, give 1 complex carb and 1 protein source.
			Comment: (such as ½ sandwich OR 1 individual container of peanut butter and 3 packs of crackers) or patient meal if patient able to take orals to prevent recurrent hypoglycemia.When notifying provider of hypoglycemic treatment, clarify with provider future instructions on diabetic medication therapy.

*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