Unique Plan Description: Palliative Care Comfort Care
Plan Selection Display: Palliative Care Comfort Care
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2022-02-03 16:26:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2022-09-21 11:48:46
Available at all facilities: No

Palliative Care Comfort Care
Admit/Discharge/Transfer
	Comfort Care Status
		T;N
			Comment: initiate Nursing comfort care plan, and provide comfort care cart and education packet to family/door hanger
Vital Signs
	Vital Signs
		Q12H-Sch
			Comment: Or as requested by family.  Do not disturb patient for routine vital signs.  No automatic blood pressures. Use manual cuff only.  Discontinue Pulse Oximetry. Routine assessments and screening to q12h and prn based on comfort needs or as desired by family
Activity
	Activity-As Tolerated
		
Diet
	Regular Diet
		T;N
			Comment: As tolerated and desired by patient
Medications
Pain/Dyspnea
		Scheduled(NOTE)*
	MS Contin
		15 mg, Tab, By Mouth, Q12H
			Comment: for pain or dyspnea
		30 mg, Tab, By Mouth, Q12H
			Comment: for pain or dyspnea
		45 mg, Tab, By Mouth, Q12H
			Comment: for pain or dyspnea
		60 mg, Tab, By Mouth, Q12H
			Comment: for pain or dyspnea
	oxyCODONE extended release
		10 mg, Tab, By Mouth, Q12H
			Comment: for pain or dyspnea
		20 mg, Tab, By Mouth, Q12H
			Comment: for pain or dyspnea
		30 mg, Tab, By Mouth, Q12H
			Comment: for pain or dyspnea
		40 mg, Tab, By Mouth, Q12H
			Comment: for pain or dyspnea
	HYDROmorphone oral
		1 mg, Tab, By Mouth, Q4H
			Comment: for pain or dyspnea
		2 mg, Tab, By Mouth, Q4H
			Comment: for pain or dyspnea
		3 mg, Tab, By Mouth, Q4H
			Comment: for pain or dyspnea
		4 mg, Tab, By Mouth, Q4H
			Comment: for pain or dyspnea
	morphine  oral immediate release
		7.5 mg, Tab, By Mouth, Q4H
			Comment: pain-breakthrough, or dyspnea
		15 mg, Tab, By Mouth, Q4H
			Comment: pain-breakthrough, or dyspnea
		30 mg, Tab, By Mouth, Q4H
			Comment: pain-breakthrough, or dyspnea
	morphine 20 mg/mL oral concentrate
		5 mg, Concentrate, SUBLINGUAL, Q4H-Sch
		8 mg, Concentrate, SUBLINGUAL, Q4H-Sch
		10 mg, Concentrate, SUBLINGUAL, Q4H-Sch
		15 mg, Concentrate, SUBLINGUAL, Q4H-Sch
		17.5 mg, Concentrate, SUBLINGUAL, Q4H-Sch
		20 mg, Concentrate, SUBLINGUAL, Q4H-Sch
		30 mg, Concentrate, SUBLINGUAL, Q4H-Sch
	oxyCODONE 20 mg/mL oral concentrate
		2.5 mg, Liquid, SUBLINGUAL, Q4H-Sch
		5 mg, Liquid, SUBLINGUAL, Q4H-Sch
		7.5 mg, Liquid, SUBLINGUAL, Q4H-Sch
		10 mg, Liquid, SUBLINGUAL, Q4H-Sch
		15 mg, Liquid, SUBLINGUAL, Q4H-Sch
		20 mg, Liquid, SUBLINGUAL, Q4H-Sch
	dexAMETHasone
		4 mg, Tab, By Mouth, DAILY, T+1;0900
			Comment: for pain or dyspnea
		8 mg, Tab, By Mouth, DAILY, T+1;0900
			Comment: for pain or dyspnea
		10 mg, Tab, By Mouth, DAILY, T+1;0900
			Comment: for pain or dyspnea
		12 mg, Tab, By Mouth, DAILY, T+1;0900
			Comment: for pain or dyspnea
		16 mg, Tab, By Mouth, DAILY, T+1;0900
			Comment: for pain or dyspnea
		20 mg, Tab, By Mouth, DAILY, T+1;0900
			Comment: for pain or dyspnea
		4 mg, Tab, By Mouth, NOW
			Comment: for pain or dyspnea
		8 mg, Tab, By Mouth, NOW
			Comment: for pain or dyspnea
		10 mg, Tab, By Mouth, NOW
			Comment: for pain or dyspnea
		12 mg, Tab, By Mouth, NOW
			Comment: for pain or dyspnea
		16 mg, Tab, By Mouth, NOW
			Comment: for pain or dyspnea
		20 mg, Tab, By Mouth, NOW
			Comment: for pain or dyspnea
	Decadron injectable
		4 mg, Injection, IV Push, DAILY, T+1;0900
			Comment: for pain or dyspnea
		8 mg, Injection, IV Push, DAILY, T+1;0900
			Comment: for pain or dyspnea
		10 mg, Injection, IV Push, DAILY, T+1;0900
			Comment: for pain or dyspnea
		12 mg, Injection, IV Push, DAILY, T+1;0900
			Comment: for pain or dyspnea
		16 mg, Injection, IV Push, DAILY, T+1;0900
			Comment: for pain or dyspnea
		20 mg, Injection, IV Push, DAILY, T+1;0900
			Comment: for pain or dyspnea
		4 mg, Injection, IV Push, NOW
			Comment: for pain or dyspnea
		8 mg, Injection, IV Push, NOW
			Comment: for pain or dyspnea
		10 mg, Injection, IV Push, NOW
			Comment: for pain or dyspnea
		12 mg, Injection, IV Push, NOW
			Comment: for pain or dyspnea
		16 mg, Injection, IV Push, NOW
			Comment: for pain or dyspnea
		20 mg, Injection, IV Push, NOW
			Comment: for pain or dyspnea
		As needed(NOTE)*
	morphine  oral immediate release
		7.5 mg, Tab, By Mouth, Q1H, PRN pain-breakthrough
			Comment: or dyspnea
		15 mg, Tab, By Mouth, Q1H, PRN pain-breakthrough
			Comment: or dyspnea
		30 mg, Tab, By Mouth, Q1H, PRN pain-breakthrough
			Comment: or dyspnea
	morphine 20 mg/mL oral concentrate
		5 mg, Concentrate, SUBLINGUAL, Q1H, PRN pain-breakthrough
			Comment: or dyspnea
		7.5 mg, Concentrate, SUBLINGUAL, Q1H, PRN pain-breakthrough
			Comment: or dyspnea
		10 mg, Concentrate, SUBLINGUAL, Q1H, PRN pain-breakthrough
			Comment: or dyspnea
		15 mg, Concentrate, SUBLINGUAL, Q1H, PRN pain-breakthrough
			Comment: or dyspnea
		17.5 mg, Concentrate, SUBLINGUAL, Q1H, PRN pain-breakthrough
			Comment: or dyspnea
		20 mg, Concentrate, SUBLINGUAL, Q1H, PRN pain-breakthrough
			Comment: or dyspnea
		30 mg, Concentrate, SUBLINGUAL, Q1H, PRN pain-breakthrough
			Comment: or dyspnea
	Roxicodone
		2.5 mg, Tab, By Mouth, Q1H, PRN pain-breakthrough
			Comment: or dyspnea
		5 mg, Tab, By Mouth, Q1H, PRN pain-breakthrough
			Comment: or dyspnea
		10 mg, Tab, By Mouth, Q1H, PRN pain-breakthrough
			Comment: or dyspnea
	oxyCODONE 20 mg/mL oral concentrate
		2.5 mg, Liquid, SUBLINGUAL, Q1H, PRN, pain-breakthrough
			Comment: OR dyspnea
		5 mg, Liquid, SUBLINGUAL, Q1H, PRN, pain-breakthrough
			Comment: OR dyspnea
		10 mg, Liquid, SUBLINGUAL, Q1H, PRN, pain-breakthrough
			Comment: OR dyspnea
		15 mg, Liquid, SUBLINGUAL, Q1H, PRN, pain-breakthrough
			Comment: OR dyspnea
		20 mg, Liquid, SUBLINGUAL, Q1H, PRN, pain-breakthrough
			Comment: OR dyspnea
	HYDROmorphone oral
		1 mg, Tab, By Mouth, Q1H, PRN pain-breakthrough
			Comment: OR dyspnea
		2 mg, Tab, By Mouth, Q1H, PRN pain-breakthrough
			Comment: OR dyspnea
		3 mg, Tab, By Mouth, Q1H, PRN pain-breakthrough
			Comment: OR dyspnea
		4 mg, Tab, By Mouth, Q1H, PRN pain-breakthrough
			Comment: OR dyspnea
	morphine  IV
		1 mg, Syringe, IV Push, Q1H, PRN pain-breakthrough
			Comment: or dyspnea. May give if unable to take oral medications.
		2 mg, Syringe, IV Push, Q1H, PRN pain-breakthrough
			Comment: or dyspnea. May give if unable to take oral medications.
		3 mg, Syringe, IV Push, Q1H, PRN pain-breakthrough
			Comment: or dyspnea. May give if unable to take oral medications.
		4 mg, Syringe, IV Push, Q1H, PRN pain-breakthrough
			Comment: or dyspnea. May give if unable to take oral medications.
		5 mg, Syringe, IV Push, Q1H, PRN pain-breakthrough
			Comment: or dyspnea. May give if unable to take oral medications.
	Dilaudid Injectable
		0.2 mg, Injection, IV Push, Q1H, PRN pain-breakthrough
			Comment: or dyspnea. May give if unable to take oral medications.
		0.4 mg, Injection, IV Push, Q1H, PRN pain-breakthrough
			Comment: or dyspnea. May give if unable to take oral medications.
		0.5 mg, Injection, IV Push, Q1H, PRN pain-breakthrough
			Comment: or dyspnea. May give if unable to take oral medications.
		0.8 mg, Injection, IV Push, Q1H, PRN pain-breakthrough
			Comment: or dyspnea. May give if unable to take oral medications
		1 mg, Injection, IV Push, Q1H, PRN pain-breakthrough
			Comment: or dyspnea. May give if unable to take oral medications.
Nausea Vomiting
		Scheduled(NOTE)*
	Haldol  Oral
		0.5 mg, Concentrate, By Mouth, Q4H
			Comment: for nausea
		1 mg, Concentrate, By Mouth, Q4H
			Comment: for nausea
		2 mg, Concentrate, By Mouth, Q4H
			Comment: for nausea
	Haldol  injectable
		0.5 mg, Injection, IV, Q4H
			Comment: for nausea.
		1 mg, Injection, IV, Q4H
			Comment: for nausea.
		2 mg, Injection, IV, Q4H
			Comment: for nausea.
	Reglan
		1, Tab, By Mouth, Q6H
			Comment: for nausea
		10 mg, Injection, IV Push, Q6H
			Comment: for nausea
	ondansetron
		4 mg, Tablet-Disintegrating, By Mouth, Q6H
			Comment: for nausea
		8 mg, Tablet-Disintegrating, By Mouth, Q8H
			Comment: for nausea
		4 mg, Injection, IV Push, Q6H
			Comment: for nausea
		8 mg, Injection, IV Push, Q8H
			Comment: for nausea
	dexAMETHasone
		4 mg, Tab, By Mouth, DAILY, T+1;0900
			Comment: nausea adjunct
		8 mg, Tab, By Mouth, DAILY, T+1;0900
			Comment: nausea adjunct
		10 mg, Tab, By Mouth, DAILY, T+1;0900
			Comment: nausea adjunct
		12 mg, Tab, By Mouth, DAILY, T+1;0900
			Comment: nausea adjunct
		16 mg, Tab, By Mouth, DAILY, T+1;0900
			Comment: nausea adjunct
		20 mg, Tab, By Mouth, DAILY, T+1;0900
			Comment: nausea adjunct
		4 mg, Tab, By Mouth, NOW
			Comment: nausea adjunct
		8 mg, Tab, By Mouth, NOW
			Comment: nausea adjunct
		10 mg, Tab, By Mouth, NOW
			Comment: nausea adjunct
		12 mg, Tab, By Mouth, NOW
			Comment: nausea adjunct
		16 mg, Tab, By Mouth, NOW
			Comment: nausea adjunct
		20 mg, Tab, By Mouth, NOW
			Comment: nausea adjunct
	Decadron injectable
		4 mg, Injection, IV Push, DAILY, T+1;0900
			Comment: nausea adjunct
		8 mg, Injection, IV Push, DAILY, T+1;0900
			Comment: nausea adjunct
		10 mg, Injection, IV Push, DAILY, T+1;0900
			Comment: nausea adjunct
		12 mg, Injection, IV Push, DAILY, T+1;0900
			Comment: nausea adjunct
		16 mg, Injection, IV Push, DAILY, T+1;0900
			Comment: nausea adjunct
		20 mg, Injection, IV Push, DAILY, T+1;0900
			Comment: nausea adjunct
		4 mg, Injection, IV Push, NOW
			Comment: nausea adjunct
		8 mg, Injection, IV Push, NOW
			Comment: nausea adjunct
		10 mg, Injection, IV Push, NOW
			Comment: nausea adjunct
		12 mg, Injection, IV Push, NOW
			Comment: nausea adjunct
		16 mg, Injection, IV Push, NOW
			Comment: nausea adjunct
		20 mg, Injection, IV Push, NOW
			Comment: nausea adjunct
		As Needed(NOTE)*
	Haldol  Oral
		0.5 mg, Concentrate, By Mouth, Q4H, PRN nausea
		1 mg, Concentrate, By Mouth, Q4H, PRN nausea
		2 mg, Concentrate, By Mouth, Q4H, PRN nausea
	Haldol  injectable
		0.5 mg, Injection, IV Push, Q4H, PRN nausea
			Comment: May give if unable to take oral medications.
		1 mg, Injection, IV Push, Q4H, PRN nausea
			Comment: May give if unable to take oral medications.
		2 mg, Injection, IV Push, Q4H, PRN nausea
			Comment: May give if unable to take oral medications.
	Reglan
		1, Tab, By Mouth, Q6H, PRN nausea
	ondansetron
		4 mg, Tablet-Disintegrating, By Mouth, Q6H, PRN for nausea
			Comment: for nausea
		8 mg, Tablet-Disintegrating, By Mouth, Q8H, PRN for nausea
			Comment: for nausea
	Benadryl
		25 mg, Capsule, By Mouth, Q4H, PRN nausea
	Reglan
		10 mg, Injection, IV Push, Q6H, PRN nausea
			Comment: may give if unable to take oral medications.
	ondansetron
		4 mg, Injection, IV PUSH, Q8H, PRN for nausea
			Comment: may give if unable to take oral medications
		8 mg, Injection, IV PUSH, Q8H, PRN for nausea
			Comment: may give if unable to take oral medications
		10 mg, INT, IVPB, Q8H, PRN for nausea
			Comment: may give if unable to take oral medications
	Benadryl
		25 mg, Injection, IV Push, Q4H, PRN nausea
			Comment: may give if unable to take oral medications
		12.5 mg, Injection, IV Push, Q4H, PRN nausea
			Comment: may give if unable to take oral medications
Dyspnea
		As Needed(NOTE)*
	albuterol 2.5 mg/3 mL (0.083%) inh soln
		3 mL, Solution-Nebulization, NEBULIZED, Q4H-Sch, PRN wheezing
	Oxygen Therapy for Comfort Care Patient
		T;N, Via Nasal Cannula, PRN
			Comment: O2 @ 1L/min
		T;N, Via Nasal Cannula, PRN
			Comment: O2 @ 2L/min
		T;N, Via Nasal Cannula, PRN
			Comment: O2 @ 3L/min
		T;N, Via Nasal Cannula, PRN
			Comment: O2 @ 4L/min
		T;N, Via Nasal Cannula, PRN
			Comment: O2 @ 1L/min as needed for mild dyspnea
		T;N, Via Nasal Cannula, PRN
			Comment: O2 @ 2L/min as needed for moderate dyspnea
		T;N, Via Nasal Cannula, PRN
			Comment: O2 @ 4L/min as needed for severe dyspnea
Cough
		As Needed(NOTE)*
	chlorpheniramine-hydrocodone 8 mg-10 mg/5 mL oral suspension, extended release
		5 mL, Suspension, Extended-Release, By Mouth, Q12H, PRN cough
	Tessalon Perles
		100 mg, Capsule, By Mouth, Q6H, PRN cough
	Mucinex
		600 mg, Tablet-Extended-Release, By Mouth, Q6H, PRN cough
Constipation
		Scheduled(NOTE)*
	Senokot S 50 mg-8.6 mg oral tablet
		1 TAB, Tab, By Mouth, BID
			Comment: for constipation
		2 TAB, Tab, By Mouth, BID
			Comment: for constipation
		3 TAB, Tab, By Mouth, BID
			Comment: for constipation
		4 TAB, Tab, By Mouth, BID
			Comment: for constipation
	MiraLax oral powder for reconstitution
		17 gm, Packet, By Mouth, Q12H
			Comment: Mix in 6 oz of juice or water.
		17 gm, Packet, By Mouth, DAILY
			Comment: Mix in 6 oz of juice or water.
	lactulose
		
		As Needed(NOTE)*
	Senokot S 50 mg-8.6 mg oral tablet
		1 TAB, Tab, By Mouth, Q12H, PRN constipation
		2 TAB, Tab, By Mouth, Q12H, PRN constipation
		3 TAB, Tab, By Mouth, Q12H, PRN constipation
		4 TAB, Tab, By Mouth, Q12H, PRN constipation
		1 TAB, Tab, By Mouth, Q24H, PRN constipation
		2 TAB, Tab, By Mouth, Q24H, PRN constipation
		3 TAB, Tab, By Mouth, Q24H, PRN constipation
		4 TAB, Tab, By Mouth, Q24H, PRN constipation
		1 TAB, Tab, By Mouth, Q24H, PRN constipation
		2 TAB, Tab, By Mouth, Q24H, PRN constipation
		3 TAB, Tab, By Mouth, Q24H, PRN constipation
		4 TAB, Tab, By Mouth, Q24H, PRN constipation
	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 of juice or water.
	Dulcolax
		10 mg, Suppository, RECTALLY, DAILY, PRN constipation
		10 mg, Suppository, RECTALLY, Q12H, PRN constipation
	Enema-Administer
		T;N, Fleets, DAILY, constipation
			Comment: If bisacodyl ineffective
Diarrhea
		As Needed(NOTE)*
	Imodium
		2 mg, Capsule, By Mouth, Q6H, PRN diarrhea
	Lomotil
		1 TAB, Tab, By Mouth, Q4H, PRN diarrhea
			Comment: 2 tabs PRN, then 1 tab PRN after each loose stool; max 8 tabs/day
Delirium
		Scheduled(NOTE)*
	Haldol  Oral
		1 mg, Tab, By Mouth, Q4H
			Comment: for delirium
		2 mg, Tab, By Mouth, Q4H
			Comment: for delirium
		3 mg, Tab, By Mouth, Q4H
			Comment: for delirium
		4 mg, Tab, By Mouth, Q4H
			Comment: for delirium
		5 mg, Tab, By Mouth, Q4H
			Comment: for delirium
	Haldol 2 mg/mL oral concentrate
		1 mg, Concentrate, SUBLINGUAL, Q4H
			Comment: for delirium
		2 mg, Concentrate, SUBLINGUAL, Q4H
			Comment: for delirium
		3 mg, Concentrate, SUBLINGUAL, Q4H
			Comment: for delirium
		4 mg, Concentrate, SUBLINGUAL, Q4H
			Comment: for delirium
		5 mg, Concentrate, SUBLINGUAL, Q4H
			Comment: for delirium
	Haldol  injectable
		1 mg, Injection, IV Push, Q4H
			Comment: for delirium
		2 mg, Injection, IV Push, Q4H
			Comment: for delirium
		3 mg, Injection, IV Push, Q4H
			Comment: for delirium
		4 mg, Injection, IV Push, Q4H
			Comment: for delirium
		5 mg, Injection, IV Push, Q4H
			Comment: for delirium
		As Needed(NOTE)*
	Haldol  Oral
		1 mg, Tab, By Mouth, Q1H, PRN agitation
		2 mg, Tab, By Mouth, Q1H, PRN agitation
		3 mg, Tab, By Mouth, Q1H, PRN agitation
		4 mg, Tab, By Mouth, Q1H, PRN agitation
		5 mg, Tab, By Mouth, Q1H, PRN agitation
		1 mg, Tab, By Mouth, Q2H, PRN agitation
		2 mg, Tab, By Mouth, Q2H, PRN agitation
		3 mg, Tab, By Mouth, Q2H, PRN agitation
		4 mg, Tab, By Mouth, Q2H, PRN agitation
		5 mg, Tab, By Mouth, Q2H, PRN agitation
		1 mg, Tab, By Mouth, Q4H, PRN agitation
		2 mg, Tab, By Mouth, Q4H, PRN agitation
		3 mg, Tab, By Mouth, Q4H, PRN agitation
		4 mg, Tab, By Mouth, Q4H, PRN agitation
		5 mg, Tab, By Mouth, Q4H, PRN agitation
	Haldol 2 mg/mL oral concentrate
		1 mg, Concentrate, SUBLINGUAL, Q1H, PRN delirium
		2 mg, Concentrate, SUBLINGUAL, Q1H, PRN delirium
		3 mg, Concentrate, SUBLINGUAL, Q1H, PRN delirium
		4 mg, Concentrate, SUBLINGUAL, Q1H, PRN delirium
		5 mg, Concentrate, SUBLINGUAL, Q1H, PRN delirium
		1 mg, Concentrate, SUBLINGUAL, Q2H, PRN delirium
		2 mg, Concentrate, SUBLINGUAL, Q2H, PRN delirium
		3 mg, Concentrate, SUBLINGUAL, Q2H, PRN delirium
		4 mg, Concentrate, SUBLINGUAL, Q2H, PRN delirium
		5 mg, Concentrate, SUBLINGUAL, Q2H, PRN delirium
		1 mg, Concentrate, SUBLINGUAL, Q4H, PRN delirium
		2 mg, Concentrate, SUBLINGUAL, Q4H, PRN delirium
		3 mg, Concentrate, SUBLINGUAL, Q4H, PRN delirium
		4 mg, Concentrate, SUBLINGUAL, Q4H, PRN delirium
		5 mg, Concentrate, SUBLINGUAL, Q4H, PRN delirium
	Haldol  injectable
		1 mg, Injection, IV Push, Q1H, PRN delirium
			Comment: may give if unable to give oral medications.
		2 mg, Injection, IV Push, Q1H, PRN delirium
			Comment: may give if unable to give oral medications.
		3 mg, Injection, IV Push, Q1H, PRN delirium
			Comment: may give if unable to give oral medications.
		4 mg, Injection, IV Push, Q1H, PRN delirium
			Comment: may give if unable to give oral medications.
		5 mg, Injection, IV Push, Q1H, PRN delirium
			Comment: may give if unable to give oral medications.
		1 mg, Injection, IV Push, Q2H, PRN delirium
			Comment: may give if unable to give oral medications.
		2 mg, Injection, IV Push, Q2H, PRN delirium
			Comment: may give if unable to give oral medications.
		3 mg, Injection, IV Push, Q2H, PRN delirium
			Comment: may give if unable to give oral medications.
		4 mg, Injection, IV Push, Q2H, PRN delirium
			Comment: may give if unable to give oral medications.
		5 mg, Injection, IV Push, Q2H, PRN delirium
			Comment: may give if unable to give oral medications.
		1 mg, Injection, IV Push, Q4H, PRN delirium
			Comment: may give if unable to give oral medications.
		2 mg, Injection, IV Push, Q4H, PRN delirium
			Comment: may give if unable to give oral medications.
		3 mg, Injection, IV Push, Q4H, PRN delirium
			Comment: may give if unable to give oral medications.
		4 mg, Injection, IV Push, Q4H, PRN delirium
			Comment: may give if unable to give oral medications.
		5 mg, Injection, IV Push, Q4H, PRN delirium
			Comment: may give if unable to give oral medications.
Dyspepsia
		Scheduled(NOTE)*
	Pepcid
		20 mg, Tab, By Mouth, BID
		20 mg, Injection, IV Push, BID
	Protonix
		40 mg, Tablet-Enteric-Coated, By Mouth, DAILY
		40 mg, Injection, IV Push, Q24H
		As Needed(NOTE)*
	sucralfate 1 g/10 mL oral suspension
		1 gm =, Suspension, By Mouth, QIDACHS
	sucralfate
		1 gm, Tab, By Mouth, QIDACHS
		2 gm, Tab, By Mouth, QIDACHS
	aluminum hydroxide/magnesium hydroxide/simethicone 200 mg-200 mg-20 mg/5 mL oral susp
		30 mL, Suspension-Oral, By Mouth, Q12H, PRN dyspepsia
Anxiety
		As Needed(NOTE)*
	Ativan
		0.5 mg, Tab, By Mouth, Q1H, PRN anxiety
		1 mg, Tab, By Mouth, Q1H, PRN anxiety
		2 mg, Tab, By Mouth, Q1H, PRN anxiety
	LORazepam Oral Concentrate
		0.5 mg, Concentrate, SUBLINGUAL, Q1H, PRN anxiety
		1 mg, Concentrate, SUBLINGUAL, Q1H, PRN anxiety
		2 mg, Concentrate, SUBLINGUAL, Q1H, PRN anxiety
	Ativan Injectable
		0.5 mg, Injection, IV Push, Q1H, PRN anxiety
		1 mg, Injection, IV Push, Q1H, PRN anxiety
		2 mg, Injection, IV Push, Q1H, PRN anxiety
Seizures
		For seizure control until a physician is consulted for ongoing orders.(NOTE)*
	Ativan
		2 mg, Injection, IV Push, Q5MIN, PRN seizure activity, duration: 2 Dose(s)/Time(s)
			Comment: Notify MD if seizure activity
		2 mg, Injection, SUBCUTANEOUS, Q5MIN, PRN seizure activity, duration: 2 Dose(s)/Time(s)
			Comment: Notify MD if seizure activity
Secretions
	glycopyrrolate
		0.2 mg, Injection, IV Push, Q4H, PRN secretions
			Comment: PRN Terminal Secretions
		0.4 mg, Injection, IV Push, Q4H, PRN secretions
			Comment: PRN Terminal Secretions
	atropine 1% ophthalmic solution
		3 gtt, Solution, SUBLINGUAL, Q2H, PRN secretions
	Levsin
		0.125 mg, SUBLINGUAL, Q4H, PRN secretions
		0.25 mg, SUBLINGUAL, Q4H, PRN secretions
Fever
	Tylenol
		650 mg, Tab, By Mouth, Q4H, PRN temperature >  (see comment)
			Comment: > 100F
		650 mg, Suppository, RECTALLY, Q4H, PRN temperature >  (see comment)
			Comment: > 100F. may give if unable to take oral medications
	acetaminophen 10 mg/mL intravenous solution
		1,000 mg, Solution-Injection, IVPB, Q8H, PRN for see comment
			Comment: fever > 100.4F
Sleep
	traZODone
		25 mg, Tab, By Mouth, QHS, PRN insomnia
		50 mg, Tab, By Mouth, QHS, PRN insomnia
	Seroquel
		25 mg, Tab, By Mouth, QHS, PRN insomnia
		50 mg, Tab, By Mouth, QHS, PRN insomnia
	Remeron
		7.5 mg, Tab, By Mouth, QHS, PRN insomnia
		15 mg, Tab, By Mouth, QHS, PRN insomnia
	Restoril
		7.5 mg, Capsule, By Mouth, QHS, PRN insomnia
			Comment: MR x 1
	melatonin
		3 mg, Tab, By Mouth, QHS, PRN insomnia
		5 mg, Tab, By Mouth, QHS, PRN insomnia
		10 mg, Tab, By Mouth, QHS, PRN insomnia
Mucous Membrane Care
		Scheduled(NOTE)*
	nystatin  100,000 units/mL oral suspension
		5 mL, Suspension, By Mouth, Q6H, Indication: Prophylaxis
		As Needed(NOTE)*
	magic mouthwash
		10 mL, Suspension, Mouthwash, Q4H, PRN oral care
			Comment: for mouth sore, pain. Swish and spit or swallow
	lidocaine Viscous 2% solution
		
	Artificial Tears ophthalmic solution
		1 gtt, Solution, Eye, Affected, Q30MIN, PRN dry eyes
Stridor
Withdrawal of High Flow Oxygen Device
	Extubate
		T;N
			Comment: At the direction of palliative care provider when adequate comfort achieved.One-step process (preferred option for obtunded/comatose patient)Suction patient. Turn off ventilator. Deflate cuff. Extubate patientTerminal Weaning (preferred option for patient who is more alert and likely to experience distress) Goal is FiO2 21%, PEEP 5, Pressure Support (PS) 5. Note the ventilator default backup rate and tidal volume settings (typically this is set at rate of (12) and tidal volume of 500). Typically these are left intact prior to apnea or removal of endotracheal tube or high flow oxygen device. Titrate rate and tidal volume as appropriate for individual patient.Decrease FiO2 by 10-20% every 2-10 minutes until at 21%Decrease PEEP by 5 cm H2O every 2-10 minutes until at 5 cm H20Decrease PS by 5 cm H2O every 2-10 minutes until 5 cm H2OSuction patient. Extubate patient as appropriate. If symptoms are not controlled with current orders, contact provider and consider increase in settings to comfort while administering additional medications to assure comfort. Coordinate with RN caring for the patient.
	Discontinue High Flow Oxygen Device
		
	glycopyrrolate
		0.2, Injection, IV Push, Q4H, PRN secretions
		0.4 mg, Injection, IV Push, Q4H, PRN secretions
		0.2, Injection, IV Push, Once
			Comment: give prior to withdrawal of high flow oxygen device or extubation.  May be given up to 1 hour prior to planned withdrawal of high flow oxygen device or extubation.
		0.4 mg, Injection, IV Push, Once
			Comment: give prior to withdrawal of high flow oxygen device or extubation. May be given up to 1 hour prior to planned withdrawal of high flow oxygen device or extubation
	Lasix Injection
		10, Injection, IV Push, Once
			Comment: prior to withdrawal of high flow oxygen device or withdrawal of high flow oxygen device or extubation
		20 mg, Injection, IV Push, Once
			Comment: prior to withdrawal of high flow oxygen device or withdrawal of high flow oxygen device or extubation
	midazolam
		2.5 mg, Injection, IV Push, Q5MIN, PRN anxiety, duration: 2 Dose(s)/Time(s)
			Comment: or restlessness at time of extubation
		5 mg, Injection, IV Push, Q5MIN, PRN anxiety, duration: 2 Dose(s)/Time(s)
			Comment: or restlessness at time of extubation
		2.5 mg, Injection, IV Push, Once
			Comment: prior to withdrawal of high flow oxygen device or extubation.  May give up to 10 minutes prior to withdrawal of high flow oxygen device or extubation. Notify provider if patient does not appear comfortable prior to withdrawal of high flow oxygen device or extubation for further direction.
		5 mg, Injection, IV Push, Once
			Comment: prior to withdrawal of high flow oxygen device or extubation.  May give up to 10 minutes prior to withdrawal of high flow oxygen device or extubation. Notify provider if patient does not appear comfortable prior to withdrawal of high flow oxygen device or extubation for further direction.
	fentaNYL
		25 mcg, Injection, IV Push, Q15MIN, PRN pain-severe
			Comment: or dyspnea
		50 mcg, Injection, IV Push, Q15MIN, PRN pain-severe
			Comment: or dyspnea
		100 mcg, Injection, IV Push, Q15MIN, for pain-severe
			Comment: or dyspnea
		25 mcg, Injection, IV Push, Once
			Comment: prior to withdrawal of high flow oxygen device or extubation. May give up to 15 minutes prior to withdrawal of high flow oxygen device or extubation. Notify provider if patient does not appear comfortable prior to withdrawal of high flow oxygen device or extubation for further direction
		50 mcg, Injection, IV Push, Once
			Comment: prior to withdrawal of high flow oxygen device or extubation.  May give up to 15 minutes prior to withdrawal of high flow oxygen device or extubation.  Notify provider if patient does not appear comfortable prior to withdrawal of high flow oxygen device or extubation for further direction
		100 mcg, Injection, IV Push, Once
			Comment: prior to withdrawal of high flow oxygen device or extubation.  May give up to 15 minutes prior to withdrawal of high flow oxygen device or extubation.  Notify provider if patient does not appear comfortable prior to withdrawal of high flow oxygen device or extubation for further direction.
	HYDROmorphone Injectable
		0.5 mg, Injection, IV Push, Q1H, PRN pain-breakthrough
			Comment: or dyspnea
		1 mg, Injection, IV Push, Q1H, PRN pain-breakthrough
			Comment: or dyspnea
		2 mg, Injection, IV Push, Q1H, PRN pain-breakthrough
			Comment: or dyspnea
		3 mg, Injection, IV Push, Q1H, PRN pain-breakthrough
			Comment: or dyspnea
		4 mg, Injection, IV Push, Q1H, PRN pain-breakthrough
			Comment: or dyspnea
		5 mg, Injection, IV Push, Q1H, PRN pain-breakthrough
			Comment: or dyspnea
		0.5 mg, Injection, IV Push, Once
			Comment: prior to withdrawal of high flow oxygen device or extubation.  May give up to 15 minutes prior to withdrawal of high flow oxygen device or extubation. Notify provider if patient does not appear comfortable prior to withdrawal of high flow oxygen device or extubation for further direction.
		1 mg, Injection, IV Push, Once
			Comment: prior to withdrawal of high flow oxygen device or extubation.  May give up to 15 minutes prior to withdrawal of high flow oxygen device or extubation. Notify provider if patient does not appear comfortable prior to withdrawal of high flow oxygen device or extubation for further direction.
		2 mg, Injection, IV Push, Once
			Comment: prior to withdrawal of high flow oxygen device or extubation.  May give up to 15 minutes prior to withdrawal of high flow oxygen device or extubation. Notify provider if patient does not appear comfortable prior to withdrawal of high flow oxygen device or extubation for further direction.
		3 mg, Injection, IV Push, Once
			Comment: prior to withdrawal of high flow oxygen device or extubation.  May give up to 15 minutes prior to withdrawal of high flow oxygen device or extubation. Notify provider if patient does not appear comfortable prior to withdrawal of high flow oxygen device or extubation for further direction.
		4 mg, Injection, IV Push, Once
			Comment: prior to withdrawal of high flow oxygen device or extubation.  May give up to 15 minutes prior to withdrawal of high flow oxygen device or extubation. Notify provider if patient does not appear comfortable prior to withdrawal of high flow oxygen device or extubation for further direction.
		5 mg, Injection, IV Push, Once
			Comment: prior to withdrawal of high flow oxygen device or extubation.  May give up to 15 minutes prior to withdrawal of high flow oxygen device or extubation. Notify provider if patient does not appear comfortable prior to withdrawal of high flow oxygen device or extubation for further direction.
	Ativan
		0.5 mg, Injection, IV Push, Q1H, PRN restlessness
			Comment: or anxiety
		1 mg, Injection, IV Push, Q1H, PRN restlessness
			Comment: or anxiety
		2 mg, Injection, IV Push, Q1H, PRN restlessness
			Comment: or anxiety
		3 mg, Injection, IV Push, Q1H, PRN restlessness
			Comment: or anxiety
		4 mg, Injection, IV Push, Q1H, PRN restlessness
			Comment: or anxiety
		5 mg, Injection, IV Push, Q1H, PRN restlessness
			Comment: or anxiety
		0.5 mg, Injection, IV Push, Once
			Comment: prior to withdrawal of high flow oxygen device or extubation.  May give up to 15 minutes prior to withdrawal of high flow oxygen device or extubation. Notify provider if patient does not appear comfortable prior to withdrawal of high flow oxygen device or extubation for further direction.
		1 mg, Injection, IV Push, Once
			Comment: prior to withdrawal of high flow oxygen device or extubation.  May give up to 15 minutes prior to withdrawal of high flow oxygen device or extubation. Notify provider if patient does not appear comfortable prior to withdrawal of high flow oxygen device or extubation for further direction.
		2 mg, Injection, IV Push, Once
			Comment: prior to withdrawal of high flow oxygen device or extubation.  May give up to 15 minutes prior to withdrawal of high flow oxygen device or extubation. Notify provider if patient does not appear comfortable prior to withdrawal of high flow oxygen device or extubation for further direction.
		3 mg, Injection, IV Push, Once
			Comment: prior to withdrawal of high flow oxygen device or extubation.  May give up to 15 minutes prior to withdrawal of high flow oxygen device or extubation. Notify provider if patient does not appear comfortable prior to withdrawal of high flow oxygen device or extubation for further direction.
		4 mg, Injection, IV Push, Once
			Comment: prior to withdrawal of high flow oxygen device or extubation.  May give up to 15 minutes prior to withdrawal of high flow oxygen device or extubation. Notify provider if patient does not appear comfortable prior to withdrawal of high flow oxygen device or extubation for further direction.
		5 mg, Injection, IV Push, Once
			Comment: prior to withdrawal of high flow oxygen device or extubation.  May give up to 15 minutes prior to withdrawal of high flow oxygen device or extubation. Notify provider if patient does not appear comfortable prior to withdrawal of high flow oxygen device or extubation for further direction.
	Notify Health Care Provider
		T;N, , if patient does not appear comfortable prior to withdrawal of high flow oxygen device or extubation for further direction
Patient Care

	Foley Catheter
		T;N, Foley, Insert, Comfort care/end-of-life, PRN, as desired, as needed
	Notify
		All providers of comfort care status prior to initiation of comfort care
		T;N, Respiratory therapy for daily oxygen checks and charges
	Discontinue
		Monitor in room when family ready
	Do Not
		Restart IV fluids if infiltrates
			Comment: maintenance/continuous fluids
	Discontinue Medication
		vasopressors, titrate off
			Comment: asdfasdf
	Discontinue Enteral Tube
		
	Discontinue Enteral Feeding
		T;N, Enteral Nutrition
	Discontinue Anti Embolism Device
		T;N
			Comment: venodynes/teds
	Verify No Code/DNR order has been obtained from MD
		
	VTE Prophylaxis Contraindication
		Comfort Cares
Consults/Follow-up
	Consult Dietitian
		Regarding: Comfort Care
	Consult Chaplain
		T;N, No one dies alone
			Comment: to initiate "No one dies alone" volunteer service
	Consult Social Work
		T;N
			Comment: Hospice Care- GIP evaluation

racemic epinephrine-NS (racepinephrine)
Medications
	racepinephrine 2.25% inhalation soln
		0.5 mL, Solution-Nebulization, NEBULIZED, Once, NOW
			Comment: Mix with 3 mL sodium chloride 0.9% inh soln.
	sodium chloride 0.9% inhalation solution
		3 mL, Solution-Nebulization, NEBULIZED, Once, NOW
			Comment: Mix with 0.5 mL racemic EPINEPHrine

*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