PHYSICIAN ORDERS. Alcohol Withdrawal [ ] Alcohol Withdrawal [ ] Height Weight Allergies

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1 Height Weight Allergies Please consider these other order sets: -Medical-Surgical Electrolyte Replacement -Critical Care Electrolyte Replacement General Discontinue all previously ordered benzodiazepines and haloperidol before starting Vital Signs [X] Vital signs, Every 4 hours, Starting today For Until specified, Vital signs with each CIWA-Ar score. Monitor for symptoms of alcohol withdrawal using Pasero-McCaffery Sedation Score Notify Physician [X] Provider communication order, Until discontinued, Starting today, - Notify Provider if CIWA-Ar score is 17 or above for 3 consecutive assessments - Notify Provider immediately if CIWA-Ar score is 25 or greater. Consider RRT if patient continues at this level for greater than 2 assessments - If CIWA-Ar score is greater than 32, call an RRT and notify provider immediately Nursing Assessments [X] Follow CIWA-Ar protocol [X] Alcohol Withdrawal Assessment Scoring Guidelines (CIWA-Ar) [X] Cardiac monitoring, Until discontinued, Starting today, Follow Alcohol Withdrawal Protocol for Adults and CIWA-Ar Medication and Intervention Protocol STAT, Once, Starting today, Initial CIWA-Ar score, Until discontinued, Starting today Nursing Interventions [X] Seizure precautions, Continuous, Starting today For Until specified Ancillary Consult [ ] Inpatient consult to Dietary Reason for Consult? Alcohol withdrawal [X] Pharmacy general consult - Ativan,, Verify all prior doses of ativan are discontinued EXCEPT IV dosing for PRN seizures [X] Inpatient consult to Care Management Reason for Consult? Substance Abuse and AA 12-Step referral RN/Secretary to contact the consulting provider? Yes Labs Chemistry Page 1 of 5

2 [X] Comprehensive metabolic panel [X] Magnesium [X] Phosphorus [X] Vitamin B1, whole blood [X] Folate [X] Ethanol Urine Testing [X] Urinalysis [X] Rapid drug screen, urine [X] Straight cath Straight cath if unable to void within 6 hrs Straight cath if unable to void within 6 hrs, As needed, Starting today, If unable to void for UA within 6 hrs Vitamins Fluids & Electrolytes Magnesium Replacement Do not re-order if patient is already on Mag replacement per electrolyte protocol [ ] Electrolyte Protocol [ ] Electrolyte Replacement Protocol: Med Surg or Med Details Surg/Tele [ ] Magnesium As needed, Starting today PRN. Check level 2 hour post infusion or 4 hours after oral dose(s) and replace per order Vitamins Fluids and Electrolytes [X] Vitamin Panel [X] thiamine (vitamin B-1) tablet [X] multivitamin (ONE-A-DAY) tablet [X] folic acid (FOLVITE) tablet "And" Linked Panel 100 mg, Oral, Daily, Starting today First dose now, before starting any glucose solutions. If able to take PO. Administer thiamine as soon as possible, especially before any meals or dextrose containing solutions, in order to avoid Wernicke's encephalopathy. 1 tablet, Oral, Daily If able to take PO. 1 mg, Oral, Daily If able to take PO. Page 2 of 5

3 [X] Dextrose 5% and NaCl 0.45% 1000 ml with multivitamin 10mL, thiamine 100 mg & folic acid 1 mg 100 ml/hr, IntraVENous, Daily as needed, PRN unable to tolerate PO If unable to tolerate PO. Hold IV fluid while banana bag infusing. Convert to PO when able. Administer thiamine as soon as possible, especially before any meals or dextrose containing solutions, in order to avoid Wernicke's encephalopathy. [ ] IV Fluids (Single Response) ( ) dextrose 5 % and NaCl 0.9 % infusion 100 ml/hr, IntraVENous, Continuous, ( ) dextrose 5 % and NaCl 0.45 % infusion 100 ml/hr, IntraVENous, Continuous, ( ) dextrose 5 % and NaCl 0.45 % with KCl 20 meq/l infusion 100 ml/hr, IntraVENous, Continuous, ( ) dextrose 5 % and NaCl 0.45 % with KCl 30 meq/l infusion RATE REQUIRED IntraVENous, Continuous, ( ) dextrose 5 % and NaCl 0.45 % with KCl 40 meq/l infusion RATE REQUIRED IntraVENous, Continuous, ( ) dextrose 5 % and NaCl 0.9 % with KCl 20 meq/l infusion RATE REQUIRED IntraVENous, Continuous, ( ) dextrose 5 % and NaCl 0.9 % with KCl 40 meq/l infusion RATE REQUIRED IntraVENous, Continuous, Adjunct Medications Clonidine Panel (Single Response) ( ) clonidine (CATAPRES) tablet 0.1 mg, Oral, 2 times daily ( ) clonidine (CATAPRES) tablet 0.2 mg, Oral, 2 times daily ( ) clonidine (CATAPRES) tablet 0.3 mg, Oral, 2 times daily Harrison Alcohol Replacement Harrison Beer, Wine or Hard alcohol Prophylaxis Regimens [ ] Inpatient consult to Dietary - Beer Reason for Consult? Alcohol Withdrawal Mild/Moderate [ ] Inpatient consult to Dietary - Wine Reason for Consult? Alcohol Withdrawal Mild/Moderate [ ] alcohol ethyl 40% (vodka/whiskey eqv) liquid 30 ml, Oral, 3 times daily with meals Alcohol Withdrawal Mild/Moderate - Hard alcohol Prophylaxis regimen. Patient may refuse. Long Acting Benzodiazepine Provider must re-order scheduled benzodiazepines after 96 hours if still clinically indicated. If patient will transfer to KRC, prefer chlordiazepoxide. Recommended dose for chlordiazepoxide is mg. Recommended dose for diazepam is mg. Scheduled Benzodiazepine [ ] Chlordiazepoxide Panel "Followed by" Linked Panel [ ] chlordiazepoxide (LIBRIUM) capsule 50 mg, Oral, Once, For 1 Doses (recommend mg) [ ] chlordiazepoxide (LIBRIUM) capsule 25 mg, Oral, Every 6 hours, Starting H+6 Hours, For 96 Hours (Recommend mg) [ ] Diazepam Loading Dose Panel "Or" Linked Panel Page 3 of 5

4 [ ] diazepam (VALIUM) tablet 10 mg, Oral, Once, For 1 Doses Recommended mg. [ ] diazepam (VALIUM) syringe 10 mg, IntraVENous, Once, For 1 Doses Recommended mg [ ] Diazepam Scheduled Panel "Or" Linked Panel [ ] diazepam (VALIUM) tablet DOSE REQUIRED Oral, Every 6 hours, Starting H+6 Hours, For 96 Hours, [ ] diazepam (VALIUM) syringe IntraVENous, Every 6 hours, Starting H+6 Hours, For 96 Hours, CIWA-Ar Medications and Interventions Highline Lorazepam prn dose based on CIWA-Ar [X] Lorazepam prn dose based on CIWA-Ar "Or" Linked Panel mg, Oral, As needed, other, frequency and dose according to CIWA-Ar Scale assessments. Reassess CIWA in 1hour: DOSE REQUIRED 1-6 mg, Oral, As needed, other, according to CIWA-AR score See lorazepam 0.5 mg for dosing and frequency according to CIWA score. assessments. Reassess CIWA in 1hour DOSE REQUIRED 2-6 mg, Oral, As needed, other, according to CIWA-AR score. See lorazepam 0.5 mg for dosing and frequency according to CIWA score. assessments.reassess CIWA in 1hour: DOSE REQUIRED Page 4 of 5

5 [X] LORazepam (ATIVAN) injection 2 mg/ml mg, IntraVENous, As needed, other, frequency and dose according to CIWA-Ar scale Give if unable to take PO assessments. Reassess CIWA in 1 hour: DOSE REQUIRED Harrison Lorazepam prn dose based on CIWA-Ar [X] Lorazepam panel based upon CIWA-Ar [X] LORazepam (ATIVAN) injection 2 mg/ml "Or" Linked Panel mg, IntraVENous, As needed, other, frequency and dose according to CIWA-Ar scale If patient scores 0-7 for 48 hours, then assess every 8 hours or until discontinued by provider. No intervention CIWA score 8-16 Reassess in 2 hours. DOSE REQUIRED assessments. Reassess CIWA in 1 hour: DOSE REQUIRED Reassess CIWA in 30 minutes. DOSE REQUIRED Page 5 of 5

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