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

[leesespieces]

Hi everyone!

So I work in a 27 bed ICU (CCU/MICU/SICU) at a community hospital. I think we should have more standing orders in our ICU and more protocols to follow for certain types of patients. For example, we have standing orders for severe sepsis/septic shock, intensive insulin gtt therapy, acute CVA, and acute MI. The standing orders for HF, pneumonia, chest pain are ED orders and are not always initiated or used. As a matter of fact, our sepsis protocol is never used!

I think we should be using what we have and adding more! I know many ICU's have standing orders for electrolyte replacement and for all their drips etc.

So what kind of standing orders do you have in your units?!

[Be_Moore]

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.

[PMFB-RN, RN]

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.

[Mommy_of_3_in_AL..RN]

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.

[tazmantazb]

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.

[JJRBuckeyeRN]

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.

[APNgonnabe]

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.