UMC COMMUNITY-ACQUIRED PNEUMONIA
ADULT ADMISSION ORDERS / PATIENT ID LABEL
A UMC Health System Performance Improvement Initiative for use in all units where patients with pneumonia are admitted
þ Denotes guideline requirement
1. Attending Physician:______Resident/Fellow______
q Consult: ______
______
2. Status: q Medical Floor q ____ICU q Telemetry q Full Admission q Observation
3. Code Status: q Full Code q DNR/DNI q Comfort Care q Other ______
4. Co-Morbidities: ______
______
5. Condition: q Stable q Fair q Serious q Critical
6. Allergies: q NKDA Allergic to: ______
7. Nursing:
q Vital Signs every q 4hrs or q ______Notify MD for ______
q Weigh on admission and daily q Intake and output every shift
q Diet: q NPO q Clear Liquids q Full Liquids q Mechanical Soft q Regular q Renal q ADA
q Other______
q Activity: q Bedrest q Up with assist q Bedside commode q Bathroom privileges q Ambulate______
8. Laboratory/Diagnostics: (DO NOT REPEAT IF DONE IN THE EC UNLESS OTHERWISE INDICATED)
þ Blood C&S X 2, PRIOR to initial antibiotics
q CBC with differential
q Sputum gram stain, C&S, if not already obtained
q Urinalysis
q Chest X-ray (Posterior-Anterior & Lateral)
q ______
9. Respiratory therapy:
q Respiratory Care Plan
þ SaO2 Monitoring þ Place pulse oximeter on arrival q O2 @ ____ liters per ______
q Vent Settings: ______Settings ______FIO2 ______Rate ______TV ______Peep
q ABG q NOW q Every AM q Every 8 hours q 1 hour after Vent changes
10. IV:
q Maintain saline lock q Routine central line care and flushes
Continuous IV fluids______to run at ______ml/hr
11. MEDICATIONS: Refer also to Admission Medication Reconciliation Form and Discomfort Orders
* See below for pneumonia antibiotic consensus recommendations *
INPATIENT- NON ICU (Select one antibiotic regimen only)
*Give first dose of antibiotics within 4 hours of arrival to hospital after blood C&S obtained. *
q Levofloxacin (Levaquin) 750 mg every 24 hrs X 5 days q IV or q PO
q Ceftriaxone (Rocephin) 1 gm IV Q24 hrs PLUS Azithromycin (Zithromax) 500 mg q IV or q PO Q24 hrs
q Ceftriaxone (Rocephin) 1 gm IV Q24 hrs PLUS Doxycycline 100 mg q IV or q PO BID
q Unless contraindicated as listed here ______
INPATIENT- ICU (select one antibiotic regimen only unless possible MRSA)
*Give first dose of antibiotics within 4 hours of arrival to hospital after blood C&S obtained. *
q Ceftriaxone (Rocephin) 1 gm IV Q24 hrs PLUS Levofloxacin (Levaquin) 750 mg IV Q 24 hrs
q Ceftriaxone (Rocephin) 1 gm IV Q24 hrs PLUS Azithromycin (Zithromax) 500 mg IV Q24 hrs
q Unless contraindicated as listed here ______
q Possible MRSA:
q Add Vancomycin ______gm IV Q ______hrs (P&T with 3rd dose)
Possible Pseudomonas:
q Piperacillin-Tazobactam (Zosyn) 4.5g IV Q6 hrs PLUS Levofloxacin (Levaquin) 750 mg IV q 24 hrs
PCN allergy:
q Levofloxacin (Levaquin) 750 mg IV Q24 hrs PLUS Aztreonam (Azactam) 1gm IV Q8 hrs
12. Immunizations:
Influenza Vaccine
All eligible patients will receive the influenza vaccine 0.5 mL IM prior to discharge as per Standing Delegation Orders.
q Unless contraindicated as listed here ______
Pneumococcal Vaccine
All eligible patients will receive the pneumococcal vaccine (Pneumovax) 0.5 mL IM prior to discharge as per Standing Delegation Orders.
q Unless contraindicated as listed here ______
13. Patient Counseling:
þ Provide smoking cessation counseling for patients with history of smoking cigarettes within the past year.
UMC CAP Protocol is based on the 2007 IDSA/ATS guidelines and complies with JCAHO/CMS standards for the treatment of CAP
q VO q TO q Read back
Order taken by Signature: ______Date/Time: ______
Physician Signature ______Date/Time______
Page 2 of 2- UMC Community-Acquired-Pneumonia Adult Admission Orders 07/02/08