Standing Orders
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New Admissions:
Continue all current medications from the hospital.
Please contact the person on call via secure messaging service with the patient’s name and room number on patient’s arrival.
Please continue all current medications as ordered on their discharge summary. No need to message/call all medications unless there is a concern regarding one of the meds.
Please Do Not message the patient’s entire med list. If there is a concern about a particular medication, please ask about that one.
For All patients that come in with controlled medication orders. Schedule III-V medications can be called in over the phone but Schedule II cannot be called in over the phone. It takes additional time to arrange Schedule II Narcotics (morphine, Norco, Dilaudid, Fentanyl Patch, Oxycodone, etc). Please confirm if the patient is/was using the scheduled medication during their hospital stay or if it was just available and not utilized.
Admission Labs:
CBC, CMP, Magnesium, Phosphorus, TSH, Lipid panel, A1C, blood cultures, Urine culture, and Chest Xray. Sputum culture will be obtained on trach patients.
Weekly Labs Short Term Patients:
All short term patients should be on weekly CBC, BMP on Sunday (unless admission labs were drawn in last 3 days)
All trach/vent patients should get a weekly Chest Xray on Sunday until order given to stop.
Please do not message regarding normal lab results/xray results. Place all lab results in the binder for Envoy Health which we will review next time we are there.
If the patient has a critical lab (except expected critical values like creatinine on dialysis patients) please message us on a secure messaging service regarding the labs and if no response then call.
Monthly Labs on Long Term Patients:
CBC, CMP, Magnesium level, phosphorus level, Vitamin D level
If they are on thyroid replacement, also order Free T3 and Free T4
Standing Medications:
Colace 100mg PO BID (hold if patient has diarrhea)
Tylenol 650mg PO/PEG q6hr PRN pain/fever (do not exceed 3gm of Tylenol daily or 2gm if patient has known liver issues)
PRN Medications:
Nausea:
Zofran 4mg IV/PO/PEG q6hr PRN nausea/vomiting
Phenergan 25mg IM/PO/PR q6hr PRN nausea/vomiting
GERD/Upset Stomach/Acid Reflux:
Tums 1gm PO q6hr PRN GERD/Acid reflux
Maalox 20ml PO q6hr PRN GERD/Acid reflux
Constipation:
Miralax 17gm PO daily PRN constipation
Senna 8.6mg PO daily PRN constipation
Lactulose 20gm PO daily PRN Constipation
Soapsuds enema daily PRN constipation
Gas Pain/Bloating:
Simethicone 125mg PO q6hr PRN gas pain/bloating
Itching/Allergic Reaction:
Benadryl 25mg PO q8hr PRN allergic reaction
Hydroxyzine 25mg PO q8hr PRN itching
Sliding Scale
Please use this sliding scale below as our standard sliding scale for all patients.
Shortness of Breath:
Duoneb (2.5/0.5mg) nebulized q6hr PRN shortness of breath/wheezing
Hypoglycemia: If glucose is <70 give oral replenishment, if <60 give D50 if available or glucagon AND given oral replenishment (juice, honey). Check blood sugar q1hr x4 hours and notify the provider on call. Hold all long acting insulin until further orders are received from the provider.
Bladder Training: For bladder training we will perform it for 2/3/5/7 days then remove the foley catheter. Clamp foley for 4 hours then unclamp for 15 minutes to allow patient to void. If patient voices urgency before 4 hours unclamp and allow patient to void. Once the foley catheter is removed, monitor urine output closely. If patient has not voided at least once every 6 hours, then perform an in and out catheterization. If more than 2 in and out catheterizations are required, replace the foley.
Wound Care: If patient is admitted with a stage II pressure ulcer or worse, please consult wound care (contact us for which physician to consult). Also if a patient had a wound care specialist seeing them in the hospital, please consult the same team for this admission. All patients will be referred to their original wound specialist. If the patient does not have an existing wound care specialist we will refer to Dr. Hernandez or Dr. Rodriguez.
Discharge Planning/DME:
We will write for home health, home PT/OT, and any necessary DME for the patient to go home on a case by case basis. Please contact us regarding any questions or concerns. Please place the appropriate forms in our folder and we will get them signed. Our preferred home health agency is Heavenly Home Health if their insurance is in network. If Heavenly is not in network please contact the provider seeing that patient for further clarification/options.
Please ensure that every patient has an appointment with their PCP for follow up before they are discharged.
Hospice/Palliative Care:
For any patients needing hospice care we refer to Allstate Hospice as our preferred partner. If the patient does not qualify for Hospice due to lack of payor/financial issues we will place them in Palliative Care under our staff and pursue comfort care only.
Dental Care:
For all patients enrolled in long term care please consult Nursing Home Dental Care for their dental care and evaluation.
Podiatry:
For all diabetic patients and any patients with nail/foot wounds that are long term, please consult in house podiatrist for evaluation if available.
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