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PNEUMONIA ADMISSION

ORDERS - Adult Page 2 of 2

Allergy/Sensitivities and Reactions:

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plEASE UtilizE mEdicAtion rEconciliAtion form for EvAlUAtion of prE-AdmiSSion mEdicAtionS.

8. MEDICATIONS: IV access: T Saline lock unless otherwise stated. Other _____________________________________________

Antibiotics. Use pathogen-directed treatment when culture available.

Antibiotic started in ED (drug):

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ( t i m e ) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Empiric Antibiotic thErApy - GEnErAl mEdicAl Unit (including nursing home patients with suspected strep pneumonia) IV antibiotics will automatically be switched on day 3 to oral therapy. If on Day 3 of IV antibiotic therapy patient does not meet criteria for antibiotic switch, physician must re-write antibiotic orders. £ Ceftriaxone (Rocephin®)1gm IVPB every 24 hours x 3 doses plus Azithromycin 500 mg orally every 24 hours for 3 doses. Give both meds STAT if not started in ED. Then convert to Cefuroxime (Ceftin®) 500 mg orally every 12 hours.

OR If patient has a documented anaphylaxis to beta-lactam: £ Moxifloxacin (Avelox®) 400 mg IVPB every 24 hrs x 3 doses, then 400 mg orally every 24 hrs (ID consult required if allergy reaction not documented). Give STAT if not started in ED.

Empiric Antibiotic thErApy - Admit dirEctly to icU £ Ceftriaxone (Rocephin®) 1 gm IVPB every 24 hours plus Azithromycin 500 mg IVPB every 24 hours. Give STAT if not started in ED.

OR If patient has a cephalosprin allergy: £ Moxifloxacin (Avelox®) 400 mg IVPB every 24 hours (ID consult required if allergic reaction not documented) plus Aztreonam 1 gmIVPB every 8 hours x 3 doses. Doctor to reassess need for continuation of Aztreonam after 3 doses.

SUSpEctEd mUltiplE-rESiStAnt GrAm nEGAtivE orGAniSm(S)

£ Piperacillin/Tazobactam (Zosyn®) 4.5 Gm IVPB every 6 hours plus (choose one) Either £ Ciprofloxacin 400 mg IVPB every 12 hours

OR

£ Gentamicin

___mg IVPB loading dose (then Pharmacy to dose). Give STAT if not started in ED.

Smoking Cessation

£ Nicotine Patch ______mg (14 or 21 mg) apply topically daily £ _______________________________________________________ Other medications £ Albuterol updraft 2.5 mg every _____hours x 24 hours. Modify per local Respiratory therapy protocol.

£ as needed for cough _______________________________________ __________________________________ £ Milk of Magnesia 30ml orally daily as needed for constipation £ Acetaminophen 650 mg orally every 4 hours as needed for discomfort or fever greater than 101˚ F

£ _________________________________________HS as needed for sleep VTE prophylaxis - Use separate VTE Prophylaxis for Adult Patient Standing Orders Glycemic control - Use separate Adult Insulin Standing Orders

Phone order taken by and read back by:

Date/Time:

Transcriber's Signature:

Date/Time:

Prescriber's Printed Name:

Noting Nurse's Signature:

Date/Time:

Prescriber's Signature:

Pager Number/ID Number Date/Time:

Form transmitted to pharmacy: Date/Time:

P N E U M O N I A A D M I S S I O N O R D E R S A d u l t _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ B y : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

10-6000-221 Page 2 of 2 REV 2/3/09

Original - Chart

Copy - Fax or send to Pharmacy

Page 2 of 2

SO-019

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