Place Label Here

PLACE LABEL HERE

DELIRIUM

ORDERS

The following orders will be implemented. Orders with a “” are choices and are NOT implemented unless checked.

Initial all handwritten order modifications and the bottom of each page when indicated (multipage).

1.DiagnosisAdmit asInpatient ______(reason for admission)

& Status:Place in Observation ______(reason for observation)

2.Unit:  ICU  IMCU/PCU  Cardiac Telemetry  Any Floor Telemetry

3.Consults: Hospitalist for delirium workup

4.ICU-CAM positive per nursing assessment(Only done in ICU/IMCU/PCU)

5. Verify Home Medication Reconciliation form is completed

6.Review current medications with the physician to identify possible pharmacologic causes of delirium

7.If neurological check reveals a focal abnormality or coma, institute stroke alert

8.Place patient on fall precautions

9. Reinforce environmental prevention therapies

10.Diagnostics (IF NOT DONE IN EMERGENCY DEPARTMENT)

Urinalysis and urine culture, Other culture ______

CBC

CMP

Serum levels of: digoxin theophylline antiepileptic drugs ______

Ammonia level

Fingerstick Blood Glucose

EKG NOW

11.Vital signs now and q 4 hrsor Unit Specific

12. Urinary Retention Orders (form #31620), initiate if patient has urinary retention or difficulty voiding

13. Diet: ______

14. Nutrition Supplement Orders (form #31417), initiate if patient meets criteria

15.Activity orders:

 OOB to chair q shift

 Ambulate q shift

 Bedrest

REFERENCE: All require orders

If patient is receiving medications known to cause QT prolongation, Haldol (haloperidol) and Geodon (ziprasidone) are contraindicated. Known to cause QT prolongations: amiodarone, Cipro (ciprofloxacin), Avelox (moxifloxacin), Diflucan (fluconazole), erythromycin, Risperdal (risperidone) and Mellaril (thioridazine, Geodon (ziprasidone) and Haldol (haloperidol).

1.Evaluate all medications, especially medications added over the past 24 - 48 hours

(including drug levels where appropriate)

Anticholinergics

Sedatives / Hypnotics

Analgesics (especially meperidine)

Histamine - 2 receptor antagonists

Digoxin

Antiepileptic drugs

Corticosteroids

Quinolones and other antibiotics

Dopamine

Recently added drugs

2.Complete neurologic exam, including visual field checks

Consider neuroimaging if comatose or new focal abnormality

3.Evaluate for the following

Fluid and electrolyte disturbances

Infection

Drug toxicity

Metabolic disorders

Low perfusion state

Withdrawal from alcohol and sedatives

4.Environmental therapy

Try to keep same staff members with patient

Have family sit with patient

Bring in familiar items

“Busy work” - Baby dolls and folding towels

Identify yourself to patient and give slow, clear, simple, repetitive instructions

Encourage self care and mobility

Discontinue Foley catheter as soon as possible

5.Drug therapy

Avoid benzodiazepines unless withdrawal suspected (alcohol or benzo)

6.Consider EEG if diagnosis obscure or (rarely) LP, if warranted

FORM 4-26785REV. 07/2012 Reference Page Page 1 of 3

PLACE LABEL HERE

DELIRIUM

ORDERS

The following orders will be implemented. Orders with a “” are choices and are NOT implemented unless checked.

Initial all handwritten order modifications and the bottom of each page when indicated (multipage).

MEDICATIONS:

Choose One:

Zyprexa (olanzapine) 5 mg po or per tube now and daily at HS (for patients > 65 yrs)

10 mg po or per tube now and daily at HS

PRN:10 mg IM now and repeat q 2 hrs prn delirium. Max 30 mg/day

Geodon (ziprasidone)20 mg po or per tube BID

PRN:10 mg IM now and repeat q 2 hrs prn delirium. Max 40 mg/day

Baseline QTc and q 24 hrs (daily EKG) while on Geodon (ziprasidone)

If QTc is > 500, DC Geodon (ziprasidone) and notify physician

Critical Care Units ONLY:

Haldol (haloperidol) PRN:

2 mg slow IVP and q 6 hrs prn delirium (for patients >65 yrs). Max 20 mg/day

5 mg slow IVP and q 6 hrs prn delirium. Max 20 mg/day

Baseline QTc and q 24 hrs while on Haldol (haloperidol) therapy

If QTc is > 500, DC Haldol (haloperidol) and notify physician

ADDITIONAL ORDERS:______

______

______

______

______

______

______

______

______

______

DateTimePhysician SignaturePID Number

FORM 4-26785REV. 07/2012 Reference Page Page 1 of 3