What kind of ICU standing orders/protocols do you have?

I'm at a Level 1 / Teaching hospital, and we have virtually zero protocols. We have a DKA protocol with insulin gtt that includes lyte replacement...but that's the only one I can think of. If the patient gets put on insulin gtt but isn't DKA, no protocol. We have sedation vacation and SBT protocols as well. Other than that, none. The logic is that because we are a teaching facility, protocols would make it too easy on the interns / residents who actually need to be thinking situations through and making their own protocols in their heads.

I work in a 26 bed SICU of a teaching hospital. It sometimes seems we have standing order and protocols for everything. We don't have doctors in our unit except when they round in the AM and if they admit a patient or bring one out of surgery. They pretty much get them settled in and leave. Of course they are on call if needed and there is a surgical resident on call to cover the ICU all the time but calling them is seldom helpful.
Some I can think of:
Hypo tension
Hypertension
hypoglycemia
Hyperglycemia
A-Fib
Sepsis
Tachycardia
Bradycardia
Several other arrhythmias
HIT
DI
DKA
Increased ICPs surgery and trauma patients (
Neuro changes in neuro
Vent management
Extubation
Trach collar trials
Drop in urine output
Sliding scale replacement for:
Blood
Magnesium
Potassium
Calcium

There are others that I can't think of right now. For the first few years I worked there it seemed like every time I called a physician or PA about a problem all they would say is "did you initiate the protocol?".
Our unit has a large number of it's nurses accepted to CRNA school. I have often heard that one reason for that is that the schools in this state and surrounding states understand the very high degree of autonomy we work under.

We have some protocols, things like line inssertion, sedation vacation, foley placement/removal, and things like that, but most of our physicians have their own standing orders for individual disease processes...for example, if a patient is admitted to Dr X with CHF, we get on our in house computer program and print the sanding orders for that doc, and initiate those orders unless the physician writes anyting otherwise. It can be confusing at first, but once you know the docs, you know what they want, and what to do and not to do. Our sepsis protocol is standard across the board, as is the pneumonia orders.

I work at a small rural 6 Bed ICU. I have been working hard to get more protocols started here in our ICU also to make it easier for us and the MD's. I gathered a ton of protocols from another facility I work at in the "big city" to show and give some ideas. We finally have electrolyte replacement but most of the MD's refuse to let other protocols in. So what the quality dept did was come up with "order sets" that give the MD's some choices so they can feel they went to med school for something. I think that if they realized that protocols will help them sleep better at night with less interruptions from nursing staff they would be more apt to accept.

I work in a 26 bed MICU at a tertiary care, university, teaching hospital.

The protocols we have include:

*Electrolyte replacement- if the pt is >50 kg and does not have renal issues.
*Ventilator weaning
*AM dose optimization and weaning of sedative drips
*Insulin gtt

These are the main ones that I can think of- I know there are more that I can not think of right now.

The problem with our protocols is that our residents order the protocols. But, they do not know the details of the protocols. Therefore, they do not completely understand what is going on with their patients.

I work in an 8 bed community hospital ICU. We have ordersets for just about everything but they really aren't protocols it just like easy way for the MD to make sure they order everything pertinent for the dx. Protocol wise we have insulin gtt both dka and plan old hyperglycemia, sepsis, vent management(agian not really a do this if this so I'd say orderset). I think that's really about it.