Physician Order Sets
Please Use Ball Point Pen! PHYSICIANS MUST SIGN, Date and Time ALL ORDERS Please Use Ball Point Pen!
|DATE/TIME |CHK'D BY |PHYSICIAN'S ORDER SHEET |
| | |Psychiatric Treatment Order Set Emergency Department |
| | |Order Set No. 10462 |
| | |Allergies: Reactions: |
| | |Allergies: Reactions: |
| | | Admitting M.D.:/DO/DDS |
| | |Attending M.D.:/DO/DDS |
| | |Referring M.D.:/DO/DDS |
| | | |
| | |1. Emergency Detention due to potential danger of harm to self and/or others |
| | | ( Yellow gown and secure belongings |
| | | ( UDS |
| | | ( Home medication reconciliation |
| | | ( Safe tray |
| | | ( Scan transfer authorization form |
| | | ( Sitter with constant observation |
| | | ( Alcohol, serum |
| | | ( Breath alcohol |
| | | ( Fingerstick glucose Q12 (if diabetic) |
| | | ( Consult Crisis response team |
| | |2. Vitals q 12 hours |
| | |3. Psychosocial assessment per nursing q 12 hours |
| | |4. Call physician IF |
| | | Temp > 100.5 F or < 96.0 F |
| | | Systolic BP > 180mmHg or < 90mmHg |
| | | Diastolic BP > 100mmHg or < 40mmHg |
| | | HR > 110bpm or < 50bpm |
| | | RR > 24 or < 8 per minute or |
| | | SpO2 < 90%. |
| | | |
| | |Precautions |
| | | ( Suicide |
| | | ( Assaultive |
| | | ( Seizure |
| | | ( Elopement |
| | | ( Fall Risk |
| | | ( Other: |
| | | |
| | |Page1 of 4 |
| | |New: June 2017 Physician’s Signature |
| |
|PROHIBITED ABBREVIATIONS |
|PROHIBITED: INSTEAD WRITE |PROHIBITED: INSTEAD WRITE |
|MS, MgSO4 magnesium sulfate |Q.D. daily |
|MS, MSO4 morphine sulfate |QOD every other day |
|U units |.5 mg 0.5 mg – always use zero before decimal |
|IU international units |5.0 mg 5 mg – never use trailing zeroes |
Revised: 4/2014
PHYSICIAN'S ORDER SHEET
THE PHARMACY IS AUTHORIZED TO DISPENSE DRUGS FOR ADMINISTRATION OF ANOTHER GENERICALLY EQUIVALENT BRAND, IDENTICAL IN STRENGTH, DOSAGE FORM, AND CONTENT OF ACTIVE THERAPEUTIC INGREDIENT(S).
*PO2300*
PO2300
Physician Orders
Patient Identification
Please Use Ball Point Pen! PHYSICIANS MUST SIGN, Date and Time ALL ORDERS Please Use Ball Point Pen!
|DATE/TIME |CHK'D BY |PHYSICIAN'S ORDER SHEET |
| | |Psychiatric Treatment Order Set Emergency Department |
| | |Order Set No. 10462 |
| | |Allergies: Reactions: |
| | |Allergies: Reactions: |
| | | |
| | |Diet |
| | | ( Regular diet |
| | | ( Low sodium 2gm diet |
| | | ( Diabetic 2000kcal diet |
| | | |
| | |Medications |
| | | ( Nicotine Patch 14mg patch topical daily for ≤ 20 cigarettes/day |
| | | OR |
| | | ( Nicotine Patch 20mg patch topical daily for > 20 cigarettes/day |
| | | ( Acetaminophen 650mg po q4 hours PRN for pain level 0-4, Max APAP 3g/24hrs |
| | | ( Ibuprofen 400mg po q4 hours PRn for pain level 0-4 |
| | | ( Trazodone 50mg po qhs PRN insomnia; May repeat x1 in 1 hour if not effective for sleep |
| | | |
| | |Consider restarting home medications for chronic medical condition if no contraindications. |
| | | |
| | |If BP 160 mmHg |
| | | or Diastolic BP > 95 mmHg |
| | | |
| | |Mild to Moderate Agitation |
| | |(For PRN use in those patients experiencing mild to moderate agitation or dangerous |
| | |Behavior, consenting to oral medications.) |
| | |Check only one regime |
| | | ( Haloperidol 5mg PO Q4 hrs PRN agitation |
| | | ( Quetiapine 50mg PO Q2 hrs PRN agitation (Geripsych neurocognitive disorder) |
| | | ( Risperidone disintegrating tab 2mg PO q12 hours PRN agitation |
| | | ( Olanzapine disintegrating tab 10mg PO q12 hours PRN agitation |
| | |With optional addition of: |
| | | ( Lorazepam 2mg PO q4 hours PRN agitation |
| | | Page|
| | |2 of 4 |
| | |New: June 2017 Physician’s Signature |
| |
|PROHIBITED ABBREVIATIONS |
|PROHIBITED: INSTEAD WRITE |PROHIBITED: INSTEAD WRITE |
|MS, MgSO4 magnesium sulfate |Q.D. daily |
|MS, MSO4 morphine sulfate |QOD every other day |
|U units |.5 mg 0.5 mg – always use zero before decimal |
|IU international units |5.0 mg 5 mg – never use trailing zeroes |
Revised: 4/2014
PHYSICIAN'S ORDER SHEET
THE PHARMACY IS AUTHORIZED TO DISPENSE DRUGS FOR ADMINISTRATION OF ANOTHER GENERICALLY EQUIVALENT BRAND, IDENTICAL IN STRENGTH, DOSAGE FORM, AND CONTENT OF ACTIVE THERAPEUTIC INGREDIENT(S).
*PO2300*
PO2300
Physician Orders
Patient Identification
Please Use Ball Point Pen! PHYSICIANS MUST SIGN, Date and Time ALL ORDERS Please Use Ball Point Pen!
|DATE/TIME |CHK'D BY |PHYSICIAN'S ORDER SHEET |
| | |Psychiatric Treatment Order Set Emergency Department |
| | |Order Set No. 10462 |
| | |Allergies: Reactions: |
| | |Allergies: Reactions: |
| | | |
| | |Extreme Agitation or Dangerous Behavior |
| | |(for PRN use in those patients experiencing moderate to extreme agitation or |
| | | dangerous behavior and who likely lack capacity to consent to treatment.) |
| | | ( Haloperidol 5mg PLUS Lorazepam 2mg PLUS Diphenhydramine 25mg IM every |
| | | 2 hours PRN agitation |
| | | |
| | |Extreme Agitation or Dangerous Behavior (Cont.) |
| | | ( Ziprasidone 20mg IM PLUS Lorazepam 2mg IM every 12 hours |
| | | (Dose related QTc prolongation and risk of cardiac arrhythmias with Ziprasidone) |
| | | ( Olanzapine 10mg IM q 8 hours PRN agitation |
| | |Alternative for extreme combative/violent behavior: |
| | | ( Ketamine 4mg per kg IM WEIGHT: |
| | | (Monitor bp and O2 status. In most cases, only effective for initial control.) |
| | | |
| | |Mood Stabilization (may use alone or in combination with any of those below) |
| | |( Divalproex Sodium 1000mg PO at completion of physical and mental assessment. |
| | | (Contraindicated in severe hepatic impairment: Child-Pugh Class C) |
| | | (Caution in women of childbearing age who may be or become pregnant.) |
| | | |
| | |Mood Stabilization and/or Treatment of Psychosis (choose only one) |
| | |( Lurasidone 40mg PO dail7 |
| | | (Consider use in women of child bearing age who may be or become pregnant.) |
| | |( Risperdone 1mg PO BID |
| | | OR |
| | |( Risperidone 0.5 PO BID (for patients with severe hepatic impairment) |
| | | |
| | |( Haloperidol 5mg PO BID (only indicated for psychosis) |
| | | |
| | | Page 3 of 4 |
| | |New: June 2017 Physician’s Signature |
| |
|PROHIBITED ABBREVIATIONS |
|PROHIBITED: INSTEAD WRITE |PROHIBITED: INSTEAD WRITE |
|MS, MgSO4 magnesium sulfate |Q.D. daily |
|MS, MSO4 morphine sulfate |QOD every other day |
|U units |.5 mg 0.5 mg – always use zero before decimal |
|IU international units |5.0 mg 5 mg – never use trailing zeroes |
Revised: 4/2014
PHYSICIAN'S ORDER SHEET
THE PHARMACY IS AUTHORIZED TO DISPENSE DRUGS FOR ADMINISTRATION OF ANOTHER GENERICALLY EQUIVALENT BRAND, IDENTICAL IN STRENGTH, DOSAGE FORM, AND CONTENT OF ACTIVE THERAPEUTIC INGREDIENT(S).
*PO2300*
PO2300
Physician Orders
Patient Identification
Please Use Ball Point Pen! PHYSICIANS MUST SIGN, Date and Time ALL ORDERS Please Use Ball Point Pen!
|DATE/TIME |CHK'D BY |PHYSICIAN'S ORDER SHEET |
| | |Psychiatric Treatment Order Set Emergency Department |
| | |Order Set No. 10462 |
| | |Allergies: Reactions: |
| | |Allergies: Reactions: |
| | | |
| | |For prevention of extrapyramidal side effects and to promote mild sedation |
| | |( Diphenhydramine 50mg PO BID |
| | | OR |
| | |( Benztropine 1mg PO BID |
| | | |
| | |For geriatric agitation in context of major neurocognitive disorder: |
| | |( Quetiapine 50mg PO BID |
| | | AND |
| | |( Quetiapine 200mg PO at HS (Hold if sedated) |
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| | | Page 4 of 4 |
| | |New: June 2017 Physician’s Signature |
| |
|PROHIBITED ABBREVIATIONS |
|PROHIBITED: INSTEAD WRITE |PROHIBITED: INSTEAD WRITE |
|MS, MgSO4 magnesium sulfate |Q.D. daily |
|MS, MSO4 morphine sulfate |QOD every other day |
|U units |.5 mg 0.5 mg – always use zero before decimal |
|IU international units |5.0 mg 5 mg – never use trailing zeroes |
Revised: 4/2014
PHYSICIAN'S ORDER SHEET
THE PHARMACY IS AUTHORIZED TO DISPENSE DRUGS FOR ADMINISTRATION OF ANOTHER GENERICALLY EQUIVALENT BRAND, IDENTICAL IN STRENGTH, DOSAGE FORM, AND CONTENT OF ACTIVE THERAPEUTIC INGREDIENT(S).
*PO2300*
PO2300
Physician Orders
Patient Identification
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