ED SDO's
A set of orders that have been approved by the medical staff to allow authorized staff to utilize orders in specific situation
What is Standing Delegated Orders
Rapid EKG Criteria
What is age greater than or equal to 30 with chest pain
Age greater than or equal to 50 with dyspnea, AMS, non-trauma arm/jaw pain, syncope/weakness, upper abdominal pain, nausea/vomiting
Age greater than 12 with heart rate less than 50 or greater than 140
Palpitations
Criteria for modified SIRS
What is
Change in mental status
HR > than 90, SBP < than 90 or MAP less than 65, temp < 96.8 or > than 100.9, temp > than 100.9 in 24 hrs
RR > 20
WBC > than 12 or < 4, Bannds >10%
Order set use when patient presenting with focal neuro deficit such as
Central facial droop/paralysis, Aphasia, Facial sensory loss/deficit, motor deficit, extremity sensory deficit, limb/gait ataxia, Hemianopsia, Dysarthria, Diplopia
What is ED Stroke Work-up (Activation) order set
Order set used for sepsis screen positive
When should SDO's be utilized?
What is when a provider is not available and the RN would be addressing an effective emergency response, timely care necessary, not practical to obtain verbal order, or other patient safety advances
Goal for door to EKG time
What is 10 minutes or less
Tool for managing sepsis bundle in patient is 18yr or older, with possible severe sepsis or septic shock, patient must meet following criteria (2 or more SIRS, + organ dysfunction) to trigger BPA
What is the sepsis narrator
Acute Stroke Practice Guideline goals
What is door to CT < or = to 10 min
Door to draw < or = to 15 min
Door to EKG < or = 45 min
Door to tPA < or = to 30 min
What is Oxygen titrate to Sats > 95% unless COPD and then >92%
EKG less than 10 min from arrival
IV
CBC, CMP, Troponin, CXR
Process for implementing a SDO
What is placing SDO into EPIC, selecting per standing delegated order, this will add the order into the provider que for sign off
Code STEMI goals
Door to PCI less than or equal to 90 minutes (stretch goal at BUMC 60 min), door to EKG 10 minutes or less
Criteria for high risk patients with sepsis
What is
Age > 70
Immunocompromised
Diabetic
ESRD Dialysis patient
Cirrhosis
Indwelling line present
All stroke patients should be NPO until what is complete
What is a Yale Swallow screen
Patient presents after a fall with swelling and deformity to the right wrist, what SDO can be used
What is Extremity Injury
Ice, Elevate, Splint, Xray, NPO, use acute pain SDO
CMS regulation states
what is all order's must be authenticated, dated, and timed by the provider
Medications to be given to STEMI patients, these are not an SDO and require provider order
Aspirin 325 mg or Aspirin 81 mg X 4
Plavix 600 mg PO
Heparin Bolus 4000 units
NS with pump and extension tubing
Definition of End Organ dysfunction
What is
SBP <90
Lactic Acid > 2
APTT> 60
Total Bili >2
Platelet count < 100,000
INR > 1.5 (not on Coumadin)
Creatinine > 2 with no hx of ESRD
Frequency of vital signs/ NIH/ Pupils/ GC/ Risk of bleeding in patients that receive tPA
What is
Within 15 min of starting Alteplase
Q 15 min X 2 hours after bolus
Q 30 min X 6 hours
Q 1 hours until departure from ED
Initial lactate, draw blood cultures, administer antibiotics, administer fluid bolus must be completed in what time frame?
What is within 1 hour of Sepsis being identified but no later than 3 hours
Total number of ED Standing Delegated Orders
What is 15
EKG less than 10 minutes
IV
Chest Xray 1 view
CBC, BMP, Troponin
Aspirin 325 mg PO, if not allergic and not taken in last 24 hours
Tool used to monitor completed, reported and outstanding tasks on patient
What is Sepsis tracking checklist
Labs to be collected for stroke patients
What is
POC Glucose, CSC, PT/INR, PTT, CMP, i-stat creatinine (if needed for CTA), Serum pregnancy (females child-bearing females)
SDO for pediatric fever treatment
What is
Acetaminophen 15mg/kg PO max dose 650 mg
Ibuprofen 10mg/kg PO, max 400 mg