Standing Orders

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‘S{aNDINE TRDERS FOR FLORIDA DETOX PROCEDURES PAGES T OFT

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TAT TLR TDhbec oT ened rate of 200 oat
“Verscd hg 1 redo elation, remedy afer TV innion verted

rte re Tong edicts oer wend, (ues: contrmdbeated or pent SPS)

KG and S207 mooring with aod preva and TET FAG Sy SS

Taos S008
Loire 4 ag OY a
Toradal oa TV

‘Desadron 10 mig

‘Neer patch pet Book

"To pack per

Tg fr pack pr ay

Ting fr gree T pack pet ay

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“Tak ad ited Glee eid 20 va gic abe, ath with 308e HOO and camp

Tlenine PENG

Zaqrena 20 8 NO

tooo 6 mig HC

‘Be 30 wa NG

Te inary tie

TF tar nr es Gees Fo 750 Sena oT onl afr enna

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ahrenene 200m NG smnctely wer Harn completed

‘ay Bares val ogni ery 15 mats ae Nabrencoe given abe

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REVISED; 142003 c

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POMAUCCE MARVIN L OR BS
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patient's plate in designated area below. 2. Send pharmacy copy to pharmacy afler me
gen sent 10 pharmacy. Inprint new set and place in chart. 4. All orders must include
Physician's Orders

STANDING ORDERS FOR FLORIDA DETOX PROC!

Admit to Dr. Sponaugle.
Obtain baseline vital signs: blood pressure, pulse, EKG rhythm strip,

IVF of LR 1000cc to IV reseal at a rate of 200cc/hour.
Versed 2-6mg IV titrated to sedation, immediately after IV infusion i:
Continuous EKG and SaO2 monitoring with blood pressure and respii

‘Administer the following medications after intubation, (unless contra
Zantac 50 mg IV
Zofran 4 mg IV
Toradol 60 mg IV

Decadron 10 mg 1V

Nicoderm patch if patient smokes:

7 mg for % pack per day

14 mg for %s-1 pack per day

21 mg for greater than | pack per day

‘After verification of nasogastric tube/oral gastric tube placement by ausc
intermittent suction, until gastric contents are emptied, then administer t
crushed and diluted in 60cc tepid H20 via gastric tube, flush with 30cc F
Clonidine mg NG

Zyprexa 20 mg NG

imodium 6 mg NG

Bentyl 20 mg NG

Ansert Urinary Catheter.

IVF bolus until diuresia. then decronce cate in 0 40S) Neevhaur tn TV reseal
SEAN IESE DOL §. Alt orders munt inchude date, time and physician’

Physician's Orders

STANDING ORDERS FOR FLORIDA DETOX PROCEDURES SAGEST OFT

‘Admit Dr. Sponaugle.

+

Obi baseline vial sig Sood pevare, phe, ERG ris sp, eaptiong, enpeamare

3a02

IVE of LR 1000cc 10 1V reseal at a rate of 200ecihour

Versed 2-Gmg IV tivated to sedation, immediately afer TV infusion is stated,

Continuous EKG and S202 monitoring with blood pressure and respiratory rate every § minutes

“Administer the following medications alle intubation, (unless contraindicated or patient is allergi)

Zantac 50 mg IV

Zofran 41mg lV

Toradol 60 ma IV

Decadron 10 mg IV

Nicoderm patch if patiemt smokes:

"Fmg for ¥ pack per day

14. g for 4-1 pack per day.

7 mig for greater than I pack per day

‘After verification of nasogastric tube/oral gastric tube placement by auscultation connect to low

Tntermitfent suction, until gasiric contents are emptied, then administer the following medications

crushed and diluted in 60ce tepid H20 via gastric tube, flush with 30ce 120 and clamp.
_ Clonidine mg NG |
‘Zyprexa 20 mg NG i
Tmodium 6 mg NG |
‘Bentyi 20 mg NG
T Insert Urinary Catheter.
is, then decrease rate to 2 '50-500ce/hour, to TV reseal after extubation.

IVF bolus until divresi

10.

sntain Diprivan git to tolerate BT tube @ lowest rate for satisfactory sedation.

Naltrexone 200mg NG immediately after Narcan is completed
3 afler Naltrexone is given, if stable,

12.

May decrease vital signs to every 15 minutes
ours after Naltrexone isgiven,
patient's plate m designated area below. 2. Send pharmacy copy to pharmacy after medication order wriven, 3. Rae off unomed

cen sc to phaymnsy,_Inprint new set and pla in chur 4. AMlorders must inclade date, hme and plysicina’s sigaature.
Paysician’s Orders |
in STANDING ORDERS FOR FLORIDA DETOX PROCEDURES PAGES20F2 |

Ta One hour before scheduled extubation ime administer.
Zofron 4 meV
Zantac 30 mg IV
TToradol 30 mg 1V
Robinul 0.4 mg IM
15 Extubete aRer ‘anvpm, and when extubation rere fa met
16, Discontinue Diprivan infusion 30 minutes before scheduled extubation time,
17. Discontinue orl gastric rube immediately prior to extubation, and nasogastric tbe after cubation
‘Fairway i stable
18 Versed 1-2 mg VP afer exubation Calewa

Table,
2. prin ate lg en ed “aWenderr must lus dns ne sna peat
top ban bem topes sera

Rule off wnsed

ae

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[ POST: PROCEDURE ORDERS FOR FLORIDA DETOX PROCEDURE PAGE TOF?
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i Wha signs @ 15 minutes x 4, hen routine as clinically indicated,
erat Way convert to Hep Lock when

aking ye TORS

‘Clear liquid dit ~ may begin when
Discontinue Foley when awake
‘Bed rest, bathroom privileges with asiseee

‘Onygen a8 2-3 Liminute vie nasal cannula, May Aiscontinue when maintaining room air safwation of
greater hen 9236,

ily swake. Advance diet as tolerated. (Sponaugle Died)

act

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“Ambien [C7 mg po. aths,
Tata aa Pou tae CORTE
‘Aran Tee ig 1 hor RD apo
im peat ag TV 1 hoy (pa Seen TV cote
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Sedat: ese de not appa ob se, pee ona be Psa.
Tait pai eaves spall cars by Phys bave at sign ANT
T-Pain be acarged espa «pry, MAW NOT DRIVE SELF HOME.

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Helen Ellis Memorial SESTERFIE
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PHYSICIAN'S ORDERS
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1 mg as pet deigaaned area tow. 2. Seat paemacy Sop to pharmacy Aer Medleaton order ia wrinen
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Toe Paysiean’s Orders

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PROCEDURE ORDERS FOR FLORIDA DETOX PROCEDURE, PAGES OFT

TW patiest vas way do s0 per Hespial protocol (LEAVE PATCH OWT)
Wave patient comple te “ RATING SCALES OF OPIATE WITHDRAWAL ™ quetionn
Reb recntare and bette decharge
‘Reap deol of bed devated 30 degrees
ie ah cap fer room ar a <5

REVISED: 62002
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‘Tarpon Springs, wR 4at754
PRYSICIAN'S SUSTERFIELD, JOUR sr

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PHYSICIAN'S ORDERS SPOMAUGLE,RARVIM LOR 13

12512 An 18 Sout Sie + Sepon Songs FLIAOEY + a7 OHS 198
FLORIDA Discharge Medication

DAIL:
# preseaibed i refills

“A, Nalrezone Sing tablet BVERY moming [Opiate Bioskes) $30 3 refill.
T stop taking without Doctors arder! Failure fo take Naltrexone ctu undo your procedurel*

©. nodium AD 2 Tablets EVERY 4-6 hours, a minimum of 4 tees daily OVER THE

(Got diamheal) No reseipion necessary. COUNTER

D, Berty 20mg (Dicycionsne) 1 tablet EVERY 6 hour, 3 ies daily #21 NONE
(Stomach cramping! Auti~distheal. Phe

Levins 0.375mg (vaseyaming} 2 capsules EVERY sxeeaig and evening #21 NONE
(Stemach cramping? Ant-darthai)

P, Prevcid 30mg (Lemsoprizole) tablet EVERY moming, FO Nowe

1 rovcribed pre-procedine, (Stomach acd)

SYMPTOMATIC: Woeeded_ -— CAE
~A. Cloniine0.2mg 1 ‘abet i ONLY Te SEEDED fee widneayal svapioms "#21 ~ NONE
‘c. Shaking, od sip seaomion,resticmne=, may we ep to Sublets pr day
Chev fr faster action. Side tists: weak muscles, Sy mou faigue
1B, Restoril 30mg (Temazepan) \ tablet at bedtime IF NEEDED for sleep. #7 NONE
€epiiny Shtt)ntatdin inde! ta Ht
D, Valium JOmg (Diazepam) ¥ito 1 wblet svery Shours HUNKEDED for amicty, AS NONE

E. Toradol 60mg (2ce) (Ketorolac) IM (Deltoid) evary 8 boots, LP NEEDED

for suuselejoict ache [Rey NONE
Tandeesting t jons. Iyill bein conmrul of all medications as directed by Dx, Sponang

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0415400150
WR 481754
RESTERFIELO, JOUW 53Y
BoB 1h/13/80 MALE

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