Protocols

[Eirene, ASN, RN]

I work in the PCU. We have different protocols and standing orders.

For CP-- the usual cardiac enzymes, MONA, EKG. But then we are permitted to insert a foley if a patient hasn't voided for 8 hours and PRN adapt if the patient is taking PO fluids. We are also permitted to order ABGs if the patient falls into a certain category. We are also permitted to give xanax, ambien, etc. depending on the patient.

Is this usual for all floors? I know we are the only floor permitted to do this at my facility. I'm curious to how other hospitals work.

We are a 12-bed unit.

[TopazLover, BSN, RN]

We have protocols for many things in ER and Standing orders for alcohol withdrawal. MD needs only to cross out what does not want and sign. Can add everything else but saves time and is complete.I love the Withdrawal orders as they give the nurse lots of room for evaluating and medicating appropriately without having to call the MD for all changes. I think use of these decreases the negative feelings some people have about dealing with this disease.

We also have Comfort Care Standing Orders. These are complete and provide more end of life comfort than I have seen other places. Again, lots of latitude for nurse interventions.

[blondy2061h, MSN, RN]

We have an IV insulin protocol, and an electrolyte protocol we use regularly. We also have standing orders for labs based on day of the week that the RNs often order. All of our patients have standing blood product transfusion orders. Some have standing orders for FFP based on PT/INR. We'll also get standing orders commonly to pan cx and start IV abx in the case of a fever.

[al7139, ASN, RN]

Hi,

I work on a telemetry unit. We see lots of different diagnoses from CP, MI, CHF, COPD, Diabetes, to medical issues such as cellulitis, stroke, etc.

We do have protocols in place for certain situations. If a pt is on telemetry there is an order set that includes things like if there is chest pain, to give NTG x 3, EKG, and notify MD if the pain is unresolved or if you cannot give the NTG because of B/P being low. You can also give an initial dose of epi or atropine for brady arrhythmias.

We also have protocols for post cath pts with or without intervention, such as "Foley PRN" if the pt cannot void, and is on bedrest. This order allows us to suggest it to the pt as a temporary measure to alleviate the discomfort of urinating while lying down, or if the male pt has prostate issues (no straining and exacerbating the insertion site). The cath pt usually has orders for pain meds and other interventions.

We are not a PCU or ICU unit. As Telemetry we are considered med-surg. We can run basic cardiac drips or heparin for things like A-fib, or PE, or for post cath situations we may have integrilin or primacor, or lasix drips for CHF pts, but if they need to be titrated based on vitals, etc, they go to PCU or ICU.

Lots of PCU or ICU orders include electrolyte replacement orders based on labs, like if the pts K+ is 2.0 give K= 10 mEq/hrx4hrs then recheck K+ in 6hours (or whatever). WE do not do that on a "general unit." These pts are transferred to a unit where the pt-nurse ratio is low, and they can be closely monitored.

We NEVER give xanax or ambien without an order.

If the pt is doing poorly with O2 sats, we can call our Medical Response Team, which includes a RT who can do ABG's without an order based on their assessment.

Does this help?

Amy

[blondy2061h, MSN, RN]

I'm always kinda surprised at how strict our electrolyte protocols are. We give 40mEq of K+ for a K+ between 3.6-3.9 over 3 hrs. I find it kinda funny because I always considered those to be "good" numbers before. I've never once seen someone go hyperkalemic because of it, however, so I guess it works.