BIDMC Provider Order Entry - Order Setsmycourses.med.harvard.edu/ec_res/nt/EFB1265B-B911-4F95... ·...

BIDMC Provider Order Entry - Order Sets

General Design

Order sets are a list of suggested orders for a particular patient event (e.g. admit) or disease condition (heart failure). Most order sets fit one of the two basic templates listed below and are not designed as custom screens but run through a central screen driver. Each order on a set must be orderable as an individual order via the main POE system, although some parameters may be left blank on the set. The end user must click each order on a set to order it; there is no signoff on a group of orders with one click. When clicked on from the set, orders may branch to the main POE order screen with parameters from the set pre-filled. The user can add/edit/confirm data and also may see warnings that are specific to the patient/time of order. This design (reuse of main ordering screens) helps keep the order sets from falling out of sync with the evolving POE system.

Basic Templates

Procedure, Miscellaneous

o One time orders around a particular event that add to existing active order profile for the patient

o Sequence of orders specific to each set

Admit, Transfer, Postoperative

o Complete set of orders that will become the active order profile when signed

o Sequence of order categories is defined but some categories may be omitted

Service based (Cardiac Surgery, Psychiatry, OB/GYN etc)

Diagnosis/Procedure based (Heart Failure, Sepsis, Kidney Transplant, BMT, etc)

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Procedure/Miscellaneous Sets

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Admit/Transfer/Postoperative SetsHeart Failure

Heart Failure (cont)

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Admit/Transfer/Postoperative Sets

Popup for ARB meds:

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Admit/Transfer/Postoperative SetsHeart Failure (cont) Sample Med Pop-up Screen

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Admit/Transfer/Postoperative SetsSample weight-based heparin order screen

Sepsis

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Admit/Transfer/Postoperative SetsCardiac Medicine Interventional Service Admission

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Admit/Transfer/Postoperative SetsPsychiatry Admission

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Whipple Resection Postop Orders

Allergies Edit Delete

Postop orders: Admit to Surgery - Gold; Attending: SGP YETT,HARRIS; Condition: Good;

Vitals/Monitoring

click to Order

Vital signs: per routineI & O: YesIncentive spirometry: 10x per hrCall HO if: T>101.5 ; HR <60 or >110 ; SBP <80 or >160 ; DBP <60 or >90 ; RR <10 or >24 ; U/O <20 cc/hr ; GLU <80 or >500 ; O2 <91% ;

click to Order o2 Sats: AM POD 1 and POD 2

Activity click to Order

Bedrest tonight. OOB to chair POD 1.Ambulate starting POD 2.

Tubes/Drains click to Order

Closed suction drain Reconstitute and Record q Shift

click to Order

NGT low continuous suctionFlush q shift with 10 cc NS

click to Order Foley to gravity

Oxygen Therapy click to Order Oxygen Therapy: Nasal cannula 4 L/min D/C when sats > 91% by pulse oximetry

Nutrition click to Order Diet: NPO

click to Order Nutrition consult: Postop Whipple Resection

General Xray click to Order

Portable CXR to be done in PACURadiology General Xray

Other click to Order Accucheck on arrival to PACU - then QID

click to Order Thigh-high TED hose on at all times

click to Calf pneumatic boots on while in bed. D/C when ambulating.

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Admit/Transfer/Postoperative SetsOrder click to Order Pain control via Epidural or PCA as per APS.

click to Order Social Work consult for discharge planning on POD 1.

IV access click to Order IV access: Central Line

IV fluids

click to Order

1000 ml D5 1/2NSContinuous at 125 ml/hrfor 24 hrs postop. Then run at 75 ml/hr until D/C'd.

Medication Med Order Set click to Order Insulin

click to Order Pantoprazole 40 mg IV Q24H

click to Order Heparin 5000 UNIT SC Q12H

click to Order

If necessaryOctreotide Acetate 100 mcg SC Q8H

click to Order Acetaminophen 650 mg PO Q4-6H:PRN

click to Order Diphenhydramine HCl 25 mg PO/IV HS:PRN

click to Order Metoclopramide 10 mg PO QID Start: POD 5

click to Order Dolasetron Mesylate 12.5 mg IV Q8H:PRN

Lab click to Order

Blood, To be collected , in PACU: CBC; Sodium; Potassium; Chloride; Bicarbonate; Glucose; BUN; PT; Creatinine

click to Order

Blood, To be collected , IN AM POD 1: CBC; Sodium; Potassium; Chloride; Bicarbonate; Glucose; BUN; PT; Creatinine

click to Order

Blood, To be collected , IN AM POD 4: CBC; Sodium; Potassium; Chloride; Bicarbonate; Glucose; BUN; Creatinine

Done

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Laparoscopic Gastric Bypass Orders


Postop orders: Admit to Surgery - Purple; Attending: SGP YETT,HARRIS; Condition: Good;

Vitals/Monitoring

click to Order

Vital signs: per routineo2 Sats: with vitalsI & O: YesIncentive spirometry: 10x per hr

Activity click to Order Pneumatic boots

click to Order Activity: Ambulate tid

Wound Care

Therapeutic devices/DVT/Prophylaxis

Tubes/Drains click to Order Foley to gravity

click to Order G-tube to gravity

click to Order NGT low continuous suction

click to Order

Other JP drain to bulb suction



UGIS/SBFT in AMRadiology General Xray

Other click to Order Patient has a gallbladder.

click to Order Patient does not have a gallbladder.

IV access

IV fluids

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Admit/Transfer/Postoperative Setsclick to Order

1000 ml LRContinuous at 200 ml/hr

Medication Med Order Set click to Order Cefazolin 2 gm IV Q8H Duration: 24 Hours


click to Order Famotidine 20 mg IV Q12H

click to Order

Morphine Sulfate 1 mg IVPCA Lockout Interval: 6 minutes Basal Rate: 0 mg(s)/hour 1-hr Max Limit: 10 mg(s)

click to Order

Methylene Blue 1% 3 ml PO ONCE Duration: 1 Doses Start: @1800 on POD 0 Please dilute 3 ml in 27 ml water (30 ml total). Check JP output 1 hour later & contact HO ASAP if any blue is present.

click to Order Prochlorperazine 10 mg IV Q6H:PRN nausea

click to Order

Dolasetron Mesylate 12.5 mg IV ONCE for nausea not responsive to compazine Duration: 1 Doses

Lab click to Order Blood, To be collected NEXT ROUNDS: Hematocrit

click to Order Blood, To be collected MORNING OF : Hematocrit

Done

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Transplant Service

Hepatobiliary Post-op Orders

Kidney Transplant Post-op Orders

Orthotopic Liver Transplant Post-op Orders

Pancreas and Simultaneous Kidney/Pancreas Transplant Post-op Order

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Hepatobiliary Post-op Orders


Postop orders: Admit to Surgery - Blue; Attending: SGP YETT,HARRIS; Condition: Good;

Vitals/Monitoring

click to Order

Vital signs: per routineI & O: YesMonitor urine output: q2hIncentive spirometry: q2h while awake; turn side to side and cough q2hCall HO if: T>100.5 ; HR <60 or >110 ; SBP <100 or >160 ; DBP <50 or >100 ; RR <10 or >22 ; U/O <50 /hr ; O2 <93 ; Post-procedure vitals: q 1 hr for 2 hrs; q 2 hrs for 8 hrs; then: q4h


Activity: Out of bed to chair qidAmbulate qid with assistance until independent

Wound Care

click to Order

Wound care: Site: Incision Type: Surgical

click to Order

Wound care: Site: drain site Change dressing: qd



Foley to gravityTape foley to anterior thigh

click to Order

NGT low continuous suctionIrrigate w/ 10-20 ml normal saline PRN. Empty and record output q4h.

click to Order

T tube to gravity drain. Empty and record output q2h.

click to Order

Closed suction drain bulb suctionstrip q1-2h and PRN. Empty and record output q2h and PRN if necessary to maintain adequate suction.

Oxygen Therapy click to Order Oxygen Therapy: Nasal cannula

Nutrition

Other

IV access click to IV access: Central Line

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Admit/Transfer/Postoperative SetsOrder click to Order IV access: Peripheral saline lock

IV fluids click to Order

20 mEq KCL / 1000 mL D5 1/2NSContinuous

Medication Med Order Set click to Order Unasyn 3 gm IV Q6H

click to Order Morphine Sulfate 2-6 mg IV Q4H:PRN pain

click to Order Promethazine HCl 12.5 mg IV Q6H:PRN nausea

click to Order Promethazine HCl 12.5-25 mg PO Q6H:PRN nausea

click to Order Acetaminophen 325-650 mg PO/PR Q4-6H:PRN Temp above 101F


click to Order Famotidine (IV) 20 mg IV Q12H

click to Order Dolasetron Mesylate 12.5 mg IV Q8H:PRN nausea

Lab

Done

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Kidney Transplant Post-op Orders

Allergies Flomax

Edit Delete

Postop orders: Admit to Surgery - Transplant; Attending: SGP YETT,HARRIS; Condition: Good;

Vitals/Monitoring

click to Order

Vital signs: per routineWeight: qdI & O: YesMonitor urine output: q1hIncentive spirometry: with teachingCall HO if: HR <50 or >120 ; SBP <110 or >190 ; DBP <60 or >90 ; RR <10 or >22 ; U/O <1 ml/kg/hr ; GLU <70 or >200 ; O2 <93 ; Post-procedure vitals: q 15 min for 1 hrs; q 30 min for 2 hrs; q 1 hr for 4 hrs; then: q2h


Activity: Out of bed to chairPneumatic boots


Closed suction drain JP drains bulb suctionEmpty and record PRN.

click to Order Foley to gravity

Nutrition click to Order Diet: Clear liquids

Central TPN


Chest PORTABLE AP; schedule as STATRadiology General Xray


IV fluids

click to Order

1000 ml D5 1/2NSContinuous, Replacement Fluid: ml/ml replacement of urine output, not less than 50 ml/hr

click to Order

1000 ml 1/2NSContinuous, Replacement Fluid: ml/ml replacement of urine output, not less than 50 ml/hr

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Admit/Transfer/Postoperative SetsMedication Med Order Set click to Order Pamidronate 30 mg IV ONCE Duration: 1 Doses Start: POD #1

click to Order

Sulfameth/Trimethoprim SS 1 TAB PO DAILY * Drug-Allergy Warning *

click to Order Valganciclovir HCl 450 mg PO DAILY

click to Order Pantoprazole 40 mg PO Q24H Start: When patient taking PO

click to Order Nystatin Oral Susp. 5 ml PO BID Start: When tolerating PO

click to Order Docusate Sodium 100 mg PO BID

click to Order

Morphine Sulfate 1 mg IVPCA Lockout Interval: 15 minutes Basal Rate: 0 mg(s)/hour 1-hr Max Limit: 4 mg(s)

click to Order Acetaminophen 650 mg PO Q6H:PRN

click to Order Diphenhydramine HCl 25-50 mg PO Q12H OR QHS PRN sleep


click to Order Dolasetron Mesylate 12.5 mg IV Q8H:PRN nausea

Lab click to Order

Blood, To be collected NEXT ROUNDS: CBC; Sodium; Potassium; Chloride; Bicarbonate; Plt Count; Glucose; BUN; Creatinine; Phosphate; Magnesium

click to Order

Blood, To be collected MORNING OF : CBC; Sodium; Potassium; Chloride; Bicarbonate; Plt Count; Glucose; BUN; Creatinine; Phosphate; Magnesium; Cyclosporin; Tacrolimus

Done

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Orthotopic Liver Transplant Post-op Orders

Allergies

Edit Delete Postop orders: Admit to Surgery - Transplant; Attending: SGP YETT,HARRIS; Condition: Good;

Vitals/Monitoring

click to Order

Vital signs: per routineWeight: qdI & O: YesMonitor urine output: q1hIncentive spirometry: TCDB and incentive spirometer q2h after extubation, while awakeCall HO if: T>100.5 ; HR <60 or >120 ; SBP <100 or >180 ; DBP <50 or >100 ; RR <10 or >22 ; O2 <93 ; Post-procedure vitals: q 15 min for 1/2 hr; q 30 min for 4 hrs; then: q1h

Hemodynamic monitoring

click to Order PA line: in place, transduce Wedge: q4h Hemodynamic profile (CO,CI,SVR,PVR): q4h Cardiac output method: Thermodilution Flush w/: heparinized saline Other instructions CVP, PAP q1h

click to Order A line: in place,transduce Flush w/: heparinized saline Other instructions continuous SVO2 monitoring

click to Order CVL: tranduce CVP Other instructions Call HO for CVP > or CVP <

Activity

click to Order Activity: Bedrest with bed position Head of bed <30Pneumatic boots

Wound Care

click to Order

Wound care: Site: JP and T-tube Dressing: Gauze - dryComment: Change dressing QD and PRN

click to Order

Wound care: Site: Incision Type: SurgicalDressing: Gauze - dryComment: Change dressing prn

Tubes/Drains

click to Order Foley to gravityDo not irrigate unless plugged

click to Order NGT low continuous suctionOutput q4h

click to Order T tube to gravity, output q1h

click to Order Closed suction drain

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Admit/Transfer/Postoperative SetsStrip tubing q1-2h and PRN;Output q1h and PRN to maintain adequate suction;Clean connection with betadine before opening and closing

Mechanical Ventilation


Central TPN

General Xray

click to Order Chest Portable AP, schedule as STATRadiology General Xray

Other

click to Order If temp greater than 38 deg C (100.5F) orally, obtain blood cultures for aerobes, anaerobes and fungus if not sent in the last 24 hours. Check with MD whether sputum, urine and drain cultures are required.


IV fluids

click to Order 1000 ml D5 1/2NSContinuous at 125 ml/hr

Medication Med Order Set click to Order Valganciclovir HCl 450 mg PO DAILY click to Order Famotidine (IV) 20 mg IV Q12H click to Order Fluconazole 400 mg PO/NG Q24H

click to Order For Serum creatinine <3 mg/dLSulfameth/Trimethoprim DS 1 TAB PO/NG DAILY * Drug-Allergy Warning *

click to Order For Serum creatinine >3 mg/dLSulfameth/Trimethoprim DS 0.5 TAB PO DAILY * Drug-Allergy Warning *

click to Order Morphine Sulfate 2 mg IV Q1-2H:PRN click to Order Heparin 5000 UNIT SC Q8H click to Order Unasyn 1.5 gm IV Q6H Duration: 8 Doses

Lab

click to Order Blood Gases - Arterial, To be collected 03/10/03, on admission to SICU and q8h x 24hrs, process STAT: ABG (1 of 4)

click to Order Blood Gases - Arterial, To be collected , second draw, process STAT: ABG (2 of 4) click to Order Blood Gases - Arterial, To be collected , third draw, process STAT: ABG (3 of 4) click to Order Blood Gases - Arterial, To be collected , fourth draw, process STAT: ABG (4 of 4) click to Order Blood, To be collected , on admission to SICU: CBC; Sodium; ALT; Potassium; AST;

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Admit/Transfer/Postoperative SetsChloride; Alk Phos; Bicarbonate; Total Bili; Glucose; BUN; PT; Creatinine; Amylase; PTT; Calcium; Phosphate; Fibrinogen; Magnesium; Bilirubin, Direct

click to Order Blood, To be collected , 8 hrs after SICU admission labs: CBC; Sodium; ALT; Potassium; AST; Chloride; Alk Phos; Bicarbonate; Total Bili; Glucose; BUN; PT; Creatinine; PTT; Fibrinogen; Bilirubin, Direct

click to Order Blood, To be collected , 8 hrs after 2nd draw: CBC; Sodium; ALT; Potassium; AST; Chloride; Alk Phos; Bicarbonate; Total Bili; Glucose; BUN; PT; Creatinine; PTT; Fibrinogen; Bilirubin, Direct

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Pancreas and Simultaneous Kidney/Pancreas and Transplant Post-op Orders


Postop orders: Admit to Surgery - Transplant; Attending: SGP YETT,HARRIS; Condition: Good;

Vitals/Monitoring

click to Order

Vital signs: per routineo2 Sats: continuousWeight: qdI & O: YesFingerstick: q 1hr X4, then q 2hrs while in SICUCall HO if: HR <50 or >120 ; SBP <110 or >190 ; GLU <70 or >200 ; O2 <93 ; CVP <4 or >20; HCT <24 ;

Hemodynamic monitoring click to Order CVL: tranduce CVP

Activity click to Order Activity: Out of bed to chair

Tubes/Drains click to Order Foley to gravity

click to Order

NGT low continuous suctionAbsolutely nothing per NG tube

click to Order

Closed suction drain bulb suctionempty and record PRN

Nutrition click to Order Diet: NPO Absolutely nothing by mouth

Central TPN


Chest Portable AP; schedule as STATRadiology General Xray

IV access

IV fluids

click to Order

1000 ml D5 1/2NSContinuous, Replacement Fluid: ml/ml of urine output, not less than 125 ml/hrSimultaneous kidney/pancreas transplant

click to 1000 ml D5 1/2NS

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Order Continuous at 50 ml/hrPancreas transplant

Medication Med Order Set click to Order Pamidronate 30 mg IV ONCE Duration: 1 Doses Start: POD #1

click to Order

Heparin IV Start: 4 - 6 hrs post-operatively No Initial BolusInitial Infusion Rate: 200 units/hr

click to Order Unasyn 3 gm IV Q8H Duration: 6 Doses

click to Order Fluconazole 400 mg IV Q24H

click to Order Valganciclovir HCl 450 mg PO DAILY Start: POD #5

click to Order

Famotidine (IV) 20 mg IV Q12H until tolerating PO, then DC

click to Order Pantoprazole 40 mg PO Q24H Start: when tolerating PO

click to Order Octreotide Acetate 100 mcg SC Q8H

Lab click to Order

Blood, To be collected , on arrival to SICU: CBC; Sodium; Potassium; Chloride; Hematocrit; Bicarbonate; Plt Count; Glucose; BUN; Creatinine; Amylase; Lipase

click to Order Blood, To be collected , 6 hrs after first draw: Hematocrit

click to Order

Blood, To be collected , 12 hrs after first draw : CBC; Sodium; Potassium; Chloride; Hematocrit; Bicarbonate; Plt Count; BUN; Creatinine; Amylase; Lipase

click to Order Blood, To be collected , 18 hrs after first draw: Hematocrit

Done

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Labor and Delivery Orders

Allergies Edit Delete Admit to Obstetrics - L & D; Attending: SGP YETT,HARRIS; Condition: Good;

Vitals/Monitoring

click to Order

Vital signs: BP, HR: q2h; Temp q4hI & O: YesCall HO if: T>100.4 ; HR <60 or >130 ; SBP <90 or >160 ; DBP <60 or >90 ; RR <10 or >22 ; U/O <30 cc/hr ; O2 <93% RA ;

click to Order Vital signs: per Preeclampsia Magnesium Protocol

click to Order Vital signs: per Preterm Magnesium Protocol

OB click to Order OB Fetal monitoring

Activity click to Order Activity: Activity as tolerated

Nutrition click to Order Diet: Clear liquids, low fat 40 gm until active labor established

click to Order Diet: NPO , may take ice chips

Other click to Order Foley to gravity.

IV access click to Order IV access: Peripheral

IV fluids

click to Order

1000 ml LRContinuous at 125 ml/hrAdjust rate as needed

Medication Med Order Set click to Order

Penicillin G Potassium 4 MU IV ONCE Duration: 1 Doses LOADING DOSE

click to Order Penicillin G Potassium 2 MU IV Q4H

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Admit/Transfer/Postoperative SetsOrder click to Order Ampicillin 2 gm IV Q6H

click to Order

Gentamicin 120 mg IV ONCE Duration: 1 Doses LOADING DOSE

click to Order Gentamicin 80 mg IV Q8H

click to Order

Misoprostol 25 mcg VG Q4-6H:PRN Duration: 3 Doses For induction of labor as per protocol.

click to Order

Magnesium Sulfate (L&D) 4 gm IV BOLUS ONCE Duration: 1 Doses Bolus: 4 gm over 20 minutes

click to Order

Magnesium Sulfate (L&D) 2 gm/hr IV DRIP INFUSION Start: After completion of bolus dose

click to Order

Terbutaline Sulfate 0.25 mg SC MR Q20MIN X3 Hold for MHR>120

click to Order

Terbutaline Sulfate 5 mg PO TID Hold for MHR>120

click to Order Hydralazine HCl 5 mg IV ONCE Duration: 1 Doses

click to Order Methylergonovine Maleate 0.2 mg IM ONCE Duration: 1 Doses

click to Order Nalbuphine HCl 10 mg IM ONCE Duration: 1 Doses

click to Order

Nalbuphine HCl 10 mg IV ONCE Duration: 1 Doses IV dose must follow IM dose

click to Order

Oxytocin 2 MILLI UNITS/MIN IV DRIP INFUSION Increase by ___ mu/min every ___ min until contractions are q2-3min apart or to a maximum of ___ mu/min. Discontinue for hyperstimulation and/or a non-reassuring FHR pattern.

click to Order Betamethasone Sodium Phos/Acet 12 mg IM Q24H Duration: 2 Doses

click to Order Erythromycin 250 mg PO Q6H Duration: 7 Days

click to Order

Labetalol HCl 100 mg PO BID Hold for Maternal SBP <100 and/or MHR <50

click to Order

Labetalol HCl 10 mg IV ONCE Duration: 1 Doses Hold for Maternal SBP <100 and/or MHR <50

click to Order Dexamethasone 6 mg IM Q12H Duration: 4 Doses

click to Order

Sodium Citrate 30 ml PO ONCE:PRN epidural or c-section Administer within 15 minutes of procedure

Lab click to Order Blood, To be collected STAT: CBC

click to Order Urine, To be collected STAT: UA dipstick only

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LABS for patients with preeclampsiaBlood, To be collected STAT: CBC; ALT; Plt Count; Creatinine; Uric Acid

Blood tests

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Antepartum Orders

Allergies Edit Delete Admit to Obstetrics - Antepartum; Attending: SGP YETT,HARRIS; Condition: Good;

Vitals/Monitoring

click to Order

Vital signs: BP, T, P, R qshiftWeight: weeklyCall HO if: T>100.4 ; HR <60 or >130 ; SBP <90 or >160 ; DBP <60 or >90 ; RR <10 or >22 ; U/O <30 cc/hr ; O2 <93% RA ;

click to Order Fingerstick: 2 hrs after every meal

click to Order DTR/Clonus: q4

click to Order Vital signs: per Preeclampsia Magnesium Protocol

click to Order Vital signs: per Preterm Magnesium Protocol

OB click to Order OB Fetal monitoring

click to Order OB ATU

click to Order Check FHR Qshift;

click to Order Check Active Fetal Movement Qshift;


click to Order Activity: Bedrest with bathroom privileges

Nutrition click to Order Nutrition consult: Initial patient assessment

click to Order Diet: House diet

Consults click to Order Consults Physical Therapy

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Admit/Transfer/Postoperative SetsOther click to Order NICU Consult - MD must call to arrange.

click to Order UA dipstick only Q Tuesday.

click to Order Joslin Consult. MD must call to arrange.

IV access

IV fluids Medication Med Order Set click to Order Docusate Sodium 100 mg PO BID:PRN


click to Order Oxazepam 15-30 mg PO HS:PRN insomnia

click to Order Calcium Carbonate 500 mg PO QID:PRN

click to Order Milk of Magnesia 15-30 ml PO Q6H:PRN

click to Order Nephrocaps 1 CAP PO DAILY

click to Order Clindamycin 600 mg IV Q8H

click to Order Ampicillin 2 gm IV Q6H

click to Order

Gentamicin 120 mg IV ONCE Duration: 1 Doses LOADING DOSE

click to Order Gentamicin 80 mg IV Q8H

click to Order

Magnesium Sulfate (L&D) 4 gm IV BOLUS ONCE Duration: 1 Doses Bolus: 4 gm over 20 minutes

click to Order

Magnesium Sulfate (L&D) 2 gm/hr IV DRIP INFUSION Start: After completion of bolus dose

click to Order Hydralazine HCl 5 mg IV ONCE Duration: 1 Doses

click to Order Methylergonovine Maleate 0.2 mg IM ONCE Duration: 1 Doses

click to Order Erythromycin 250 mg PO Q6H Duration: 7 Days

click to Order

Labetalol HCl 100 mg PO BID Hold for Maternal SBP <100 and/or MHR <50

click to Order

Labetalol HCl 10 mg IV ONCE Duration: 1 Doses Hold for Maternal SBP <100 and/or MHR <50

click to Bisacodyl 10 mg PR DAILY:PRN

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Admit/Transfer/Postoperative SetsOrder

Lab click to Order Blood, To be collected NEXT ROUNDS: CBC; ALT; Creatinine; Uric Acid

click to Order Urine, To be collected ROUTINE: Protein, total; Creatinine

Blood tests

Done

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Admit/Transfer/Postoperative SetsPostpartum Orders

Allergies Edit Delete Transfer to Obstetrics - Postpartum; Attending: SGP YETT,HARRIS; Condition: Good;

Vitals/Monitoring

click to Order

Vital signs: BP, T, P, R qshiftCall HO if: T>100.4 ; HR <60 or >130 ; SBP <90 or >160 ; DBP <60 or >90 ; RR <10 or >22 ; U/O <30 cc/hr ; O2 <93% RA ;

OB

Activity click to Order Activity: Ambulate

Nutrition click to Order Diet: House diet

Other click to Order RhoGAM if indicated.

click to Order D/C IV fluids when tolerating adequate POs.

click to Order D/C Foley in 12-24 hours if u/o >30 cc per hour

click to Order

Ice to perineum first 12-24hours prn.Sitz baths prn.

click to Order

May shower.Heating pad prn.If unable to void, follow protocol for management of postpartum bladder distention.

click to Order If patient on WIC, obtain HCT first postpartum day.

IV access

IV fluids Medication Med Order Set click to Order Docusate Sodium 100 mg PO BID:PRN

click to Order Oxycodone-Acetaminophen 1-2 TAB PO Q4-6H:PRN

click to Order Ibuprofen 600 mg PO Q6H:PRN

click to Order Codeine Sulfate 30-60 mg PO Q4-6H:PRN

click to Acetaminophen 500-1000 mg PO Q4-6H:PRN

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Admit/Transfer/Postoperative SetsOrder click to Order Bisacodyl 10 mg PR DAILY:PRN

click to Order Milk of Magnesia 30 ml PO HS:PRN

click to Order

Dibucaine 1 Appl TP PRN to perineum

click to Order Simethicone 80 mg PO QID:PRN

click to Order Calcium Carbonate 500 mg PO QID:PRN

Lab click to Order

LABS for patients with preeclampsiaBlood, To be collected , routine: CBC; ALT; Plt Count; Creatinine; Uric Acid

Blood tests

Done

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GYN Postop Orders

Allergies Edit Delete Postop orders: Admit to GYN; Attending: SGP YETT,HARRIS; Condition: Good;

Vitals/Monitoring

click to Order

Vital signs: q4o2 Sats: with vitalsIncentive spirometry: 10x per hrCall HO if: T>100.4 ; U/O <30cc x 2h ;


Activity: Ambulate tidPneumatic boots

Wound Care


Foley to gravityDC in am

Nutrition click to Order Diet: House diet Advance diet as tolerated

Other click to Order RhoGAM if indicated.

IV access click to Order IV access: Peripheral

IV fluids

click to Order

1000 ml LRContinuous at 125 ml/hrChange to peripheral lock when taking POs

Medication Med Order Set click to Order Meperidine 50-100 mg IM Q3-4H:PRN Duration: 2 Days

click to Order Ibuprofen 600 mg PO Q6H:PRN

click to Order Oxycodone-Acetaminophen 1-2 TAB PO Q4-6H:PRN

click to Order Ketorolac 15-30 mg IV Q6H:PRN Duration: 3 Days

click to Hydroxyzine HCl 25 mg IM Q3-4H:PRN

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Admit/Transfer/Postoperative SetsOrder

Lab

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Cardiac Surgery Post-op Orders


Postop orders: Admit to Surgery - Cardiac; Attending: SGP YETT,HARRIS; Condition: Good;

Vitals/Monitoring

click to Order

Vital signs: per protocolI & O: YesMonitor urine output: q1h

Hemodynamic monitoring click to Order

PA line: in place, transduce Other instructions cardiac output/index q1hr until C.I.>2.0, then q4hr

Cardiac monitoring


Activity: Activity as toleratedAdvance per cardiac rehabilitation

Wound Care

click to Order

Wound care: Site: operative leg Type: SurgicalComment: keep ace wraps on from ankle to thigh x 72 hrs. May change prn.



Chest tube to suction 20 cmRecord chest tube output hourly.

click to Order

NGT low continuous suctionRemove when extubated.

Oxygen Therapy click to Order Oxygen Therapy: After extubation, titrate O2 to keep saturation >92%

Mechanical Ventilation

click to Order

Mechanical Ventilation: SIMV (Volume Targeted) w/ PS & w/o PSTidal volume (mechanical): 700 cc Respiratory rate: 10 Pressure support level: 5 cm/h2o PEEP: 5 cm/h2o FIO2: 100 % Wean per Cardiac Surgery Fast Track Protocol.

Weaning

Nutrition click to Order Diet: Start: when extubated Clear liquids

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Admit/Transfer/Postoperative SetsCardiology click to Order Cardiology ECG


CXR upon admission to CSRURadiology General Xray


Other click to Order Soft protective devices on wrists as needed per protocol.

click to Order Please D/C CVL prior to transfer to floor after peripheral IV access established.

click to Order D/C Foley catheter on POD #2

IV access

IV fluids

click to Order

1000ml LRContinuous for 1000 mlUp to 1 liter to maintain C.I. >2.0, then call HO.

Medication Med Order Set

click to Order

Propofol 20-50 mcg/kg/min IV DRIP TITRATE TO sedation DC prior to extubation Patient must have adequate airway support prior to administration of dose.

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Nitroglycerin 0.25-0.6 MCG/KG/MIN IV DRIP TITRATE TO to keep MAP < 90, or at 0.5 mcg/kg/min if radial artery graft

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Nitroprusside Sodium 0.25-1 MCG/KG/MIN IV DRIP TITRATE TO maintain MAP < 90

click to Order Phenylephrine HCl 0.5-5 MCG/KG/MIN IV DRIP TITRATE TO to keep MAP > 60

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Glycopyrrolate 0.6 mg IV ONCE:PRN to reverse neuromuscular blockade, if T >36C. May combine with neostigmine in syringe

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Neostigmine 3 mg IV ONCE:PRN to reverse neuromuscular blockade, if T>36C. May combine with glycopyrrolate in syringe.

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Potassium Chloride 20 mEq / 50 ml SW IV PRN K<4.4 and CR<2.0 ** Concentrated KCL must be given via central line only **

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Calcium Gluconate 2 gm / 100 ml D5W IV PRN Free Cal <1.12 to run over 1 hr.

click to Magnesium Sulfate 2 gm / 100 ml D5W IV PRN mg <2.0

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Admit/Transfer/Postoperative SetsOrder click to Order

Meperidine 12.5 mg IV PRN shivering May repeat X1.

click to Order Morphine Sulfate 0.5-4 mg IV Q2H:PRN pain

click to Order Metoclopramide 10 mg IV Q6H:PRN nausea/vomiting

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Cefazolin 2 gm IV Q8H Duration: 4 Doses if patient is POA

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Vancomycin HCl 1000 mg IV Q12H Duration: 4 Doses if patient was in hospital pre-operatively

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Ketorolac 30 mg IM ONCE Duration: 1 Doses hold if Creat>1.2 or >70 years of age

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Ketorolac 15 mg IM Q6H Duration: 4 Doses Hold if creat >1.2 or >70 years of age

click to Order Oxycodone-Acetaminophen 1-2 TAB PO Q4H:PRN pain

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Sucralfate 1 gm NG Q6H Duration: 4 Doses DC after 4 doses or removal of GT

click to Order Acetaminophen 650 mg PO/PR Q4H:PRN temperature >38.0

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Clopidogrel Bisulfate 300 MG PO/NG ONCE Duration: 1 Doses Start: 4 hrs postop for off-pump CABG if CT output <200 ml over 4 hrs.

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Clopidogrel Bisulfate 75 MG PO/NG DAILY Duration: 3 Months Start: POD #1 for off-pump CABG

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Isosorbide Mononitrate 60 mg PO DAILY Start: POD #1 for patients with radial artery graft if NGT discontinued.

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Aspirin EC 81 mg PO DAILY Start: POD #1 if extubated

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Aspirin 81 mg NG DAILY Start: POD #1 if intubated. DC when NGT removed.

click to Order Ranitidine 150 mg PO BID

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Ranitidine 150 mg NG BID DC when NGT removed.


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Docusate Sodium (Liquid) 100 mg NG BID DC when NGT removed.

click to Order Insulin

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Sodium Chloride 0.9% Flush 3 ml IV DAILY:PRN Peripheral IV - Inspect site every shift

Lab click to Blood, To be collected , upon arrival to CSRU, process STAT: Chloride; Bicarbonate;

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Admit/Transfer/Postoperative SetsOrder BUN; Creatinine

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Blood Gases, To be collected , upon arrival to CSRU, process STAT: ABG; Sodium, Whole Blood; Potassium, Whole Blood; Glucose, Whole Blood; Ionized Calcium

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Blood, To be collected MORNING OF : CBC; Sodium; Potassium; Chloride; Bicarbonate; Glucose; BUN; Creatinine; to be done morning of postop day #1

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Cardiac Surgery Transfer OrdersAllergies Flomax

Edit Delete Transfer to Surgery - Cardiac; Attending: SGP YETT,HARRIS; Condition: Good;

Vitals/Monitoring

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Vital signs: Q 4 hours X 24 hours then Q 8 hours if stableo2 Sats: Daily and PRNTelemetry: YesWeight: qdI & O: YesFingerstick: Q AC and QHSIncentive spirometry: Q 2 hours while awake

Activity click to Order Progress activity per cardiac rehabilitation guidelines.

Wound Care


Tubes/Drains click to Order Chest tube to suction 20 cm

Oxygen Therapy click to Order Oxygen Therapy: Wean o2 keeping saturation >92%

Nutrition click to Order Diet: Diabetic/Consistent Carbohydrate, Cardiac/Heart healthy (3-4 gm NA)


Other

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Temporary Cardiac Pacing:Electronically isolate pacing wires when not in use.Patient to remain in bed for 1 hr after wires removed.Document BP after wire removal.Observe for a minimum of 2 hrs prior to discharge.

click to Order DC Central venous line on POD #2.

click to Order DC Foley catheter on POD #2.

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Admit/Transfer/Postoperative SetsIV access

IV fluids Medication Med Order Set click to Order Metoprolol 25 mg PO BID

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Furosemide 20 mg PO Q12H * Drug-Allergy Warning *

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Furosemide 20 mg IV Q12H * Drug-Allergy Warning *

click to Order Potassium Chloride 20 mEq PO Q12H



click to Order Aspirin EC 81 mg PO DAILY

click to Order Warfarin MD to order daily dose PO DAILY

click to Order Insulin


click to Order Oxycodone-Acetaminophen 1-2 TAB PO Q4H:PRN pain

click to Order Morphine Sulfate 1-5 mg SC/IM Q3-4H:PRN pain

click to Order Milk Of Magnesia 30 ml PO HS:PRN constipation

click to Order Bisacodyl 10 mg PR DAILY:PRN constipation

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Clopidogrel Bisulfate 75 MG PO DAILY for off-pump CABG patients x 3 mos. total

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Isosorbide Mononitrate 60 mg PO DAILY for patients with radial artery graft

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Cefazolin 2 gm IV Q8H Duration: 4 Doses if patient is POA. 4 doses total Postop - check MAR for dose given in ICU.

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Vancomycin HCl 1000 mg IV Q12H Duration: 4 Doses if patient inhouse preop. 4 doses total Postop - check MAR for dose given in ICU.

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Sodium Chloride 0.9% Flush 3 ml IV DAILY:PRN Peripheral IV - Inspect site every shift

click to Order Atorvastatin 10 mg PO DAILY

Lab click to Blood, To be collected MORNING OF , process STAT: CBC; Sodium; Potassium;

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Admit/Transfer/Postoperative SetsOrder Chloride; Bicarbonate; Glucose; BUN; Creatinine click to Order

Daily PT/INR if on WarfarinBlood, To be collected MORNING OF : PT

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Biologics/Oncology Sample

Concurrent biochemotherapy in melanoma (off study)

High Dose IL-2 Off Protocol

*Low Dose IL-2 Off Protocol

Maintenance Biotherapy for Metastatic Melanoma

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Low Dose IL-2 Off Protocol


Admit to Medicine - Biologics/Oncology; Attending: SGP YETT,HARRIS; Condition: Good;

Vitals/Monitoring

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Vital signs: q4I & O: YesCall HO if: T>104 ; severe N/V/D, Dyspnea, confusion, or chest pain ;


Nutrition click to Order Diet: House diet

General Xray

Consults

Other click to Order Target SBP >= ___________.

click to Order Weigh Q AM.

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BC x 2 for T >101.5 after Day 3.PIV x 2 upon admission.NO STEROIDS.Cardiac monitor for all patients while on vasopressors.Patients should D/C all antihypertensive meds at least 24 hours before admission unless otherwise specified.

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Transfuse 1-2 units PRBC's over 1-3 hrs each unit for hgb<9.Transfuse 1 bag plts over 30 min for plt ct<10K.

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Labs:Day 1,3,5: CBC with platelets, NA, K, CL, CO2, Ca, Mg, Phos, Glucose, BUN/Creat, ALT, AST, Alk Phos, Total Bili, LDDay 2,4,6: NA, K, CL, C02, BUN/Creat, CK

Hold IL-2 for bicarb < 18; see toxicity management/lytes replacement guidelines. click to Order

Hypotension Guidelines:If SBP < target:1) Give 250cc NS IV over 15 min, may repeat x 2 (total 3 boluses)*.2) If SBP remains < target, start Dopamine at 4 mcg/kg/min, ** then call covering NP/MD for further instructions.3) Adjust dopamine and/or add Neosynephrine per Biologics dosing chart.4) D/C fluid bolus order for weight gain > 5% over baseline.

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Admit/Transfer/Postoperative SetsSee Toxicity Management Guidelines*Fluid bolus order may be repeated at each hypotensive episode until weight gain exceeds guideline above.** Use admission weight to calculate dosage.

IV access

IV fluids

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250 ml NS Bolus 250 ml Over 15 minsFor SBP < target. May repeat x2 for a total of 3 boluses. D/C this order for weight gain > 5% over baseline.

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50 mEq Sodium Bicarbonate/1000 ml D5 1/2 NSContinuous at 75 ml/hrBicarb replacement: If serum bicarb >=18 and <=20, change IVF to this solution. Once serum bicarb >=21, discontinue IVF. If bicarb <18 and >=16, give 100 mEq IVB and recheck in 1 hr and if < 16, call HO.

Medication Med Order Set click to Order Indomethacin 25 mg PO Q6H

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Acetaminophen 650 mg PO Q4H Start at 1pm on Day 1


click to Order Lorazepam 1-2 mg PO/IV Q4-6H:PRN nausea or anxiety

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Meperidine 25-50 mg IV Q2H:PRN rigors in 50 ml D5W over 15 min

click to Order Diphenhydramine HCl 25-50 mg PO/IV Q6H:PRN pruritis

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Oxazepam 15-30 mg PO HS:PRN insomnia May repeat X1.

click to Order Prochlorperazine 10 mg PO/IV Q6H:PRN nausea

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Diphenoxylate-Atropine 1 TAB PO PRN diarrhea One tab after each loose stool. Max 8 tabs per day.

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DopAmine 4 mcg/kg/min IV DRIP TITRATE TO keep SBP >= target PRN hypotension that is refractory to fluid boluses. Cardiac monitor while on medication.

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Phenylephrine HCl 1 mcg/kg/min IV DRIP TITRATE TO keep SBP >= target. PRN if target SBP not met while pt on maximum dopamine dose. Cardiac monitor while on medication.

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Potassium Chloride PO Sliding Scale Notify HO if K < 3.0

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Potassium Chloride IV Sliding Scale Notify HO if K < 3.0

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Calcium Replacement (Oncology) IV Sliding Scale Notify HO if Corrected Calcium < = 7.0

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Magnesium Sulfate IV Sliding Scale Notify HO if Magnesium <1.2

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Potassium Phosphate 15 mmol / 250 ml NS IV PRN for serum phosphate >= 1.5 and <2.4 Infuse over 5 hours If serum phosphate <1.5, call HO.

Lab

Blood tests

Done

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Admit/Transfer/Postoperative SetsOncology Bone Marrow Transplant

Auto Acute Leuk BMT

*Conventional Allo: Busulfan/Cytoxan

Conventional Allo: Cytoxan/TBI

General Auto BMT Orders

Non-ECOG Multiple Myeloma

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Conventional Allo: Busulfan/Cytoxan

Allergies

Edit Delete Admit to Medicine - Hematology/ BMT; Attending: SGP YETT,HARRIS; Condition: Good; BMT protocol: prot name

General Ordersclick to Order Diet: Low bacteria TPN when caloric intake decreases

click to Order Vital signs: q4I & O: YesCall HO if: SBP <100 or >150 ; DBP>90 ;

click to Order Record height on admission.Weigh (kg) daily by 7 AM.

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Private room, door closed, required due to prolonged neutropenia.Before entering room: Put on mask, wash hands, wear gloves. Equipment in room for patient only.Incentive spirometer in room.

click to Order Consults Physical Therapy click to Order Nutrition consult: BMT admission Labs

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Blood, To be collected , on afternoon of admission: Sodium; ALT; CBC/DIFF; Potassium; AST; Chloride; Alk Phos; Bicarbonate; Total Bili; Plt Count; Glucose; LD; BUN; Albumin; PT; Creatinine; PTT; Calcium; Phosphate; Magnesium; Bilirubin, Direct; Protein, Total

click to Order To be collected NEXT ROUNDS: Hold Specimen click to Order Urine, To be collected , on afternoon of admission: UA complete w/reflex click to Order Radiology General Xray click to Order EKG to be done on afternoon of admission

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Ongoing labs:1. Q day: CBC, diff, plts, BUN, creatinine, electrolytes, Ca, phos, Mg2. Q Mon, Wed, Fri: AST, bili T/D, uric acid, glucose, albumin, LD, alk phos3. Q Tues: PT, reticulocyte count, albumin, total protein4. Q weekly, beginning Day +14 through Day +100: Cytomegalovirus (CMV) Viral Load testing if patient or donor CMV positive. 5. Day 0, then Mon Wed, Fri: Cyclosporine levels from peripheral blood draw. 6. Additional labsClot to blood bank q3d.For 1st T >100.5 per day, culture blood from all central line & from a peripheral stick. Call HO.Day -3,-2,-1, then PRN: EKGDay -4 through Day 0: Urine Complete w/ reflex.7.Before Discharge Obtain:CBC, diff, plts, BUN, creat, electroytes, Mg, Ca, phos, PFT's if plt> 50,000

RBC and Platelet Transfusionsclick to Order Irradiate, WBC-poor at collection or by filtration all blood products (except marrow

or stem cells) before administration.

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Admit/Transfer/Postoperative SetsPacked RBC’S for HCT <25Platelets: If a.m. (or any other) plt count: <20,000/ul: Recheck plts at 5 PM <10,000/ul: give one bag plt product. Check post platelet count. If <10,000, repeat procedure above until plts >10,000

click to Order Acetaminophen 650 mg PO PRN Premedicate before all blood products No acetaminophen during chemotherapy.

click to Order Diphenhydramine HCl 25-50 mg PO/IV PRN only if history of hives with all blood products

click to Order Meperidine 25-50 mg IV PRN rigors after blood products Hold if SBP <90

Bone Marrow and Peripheral Blood Stem Cell Reinfusion

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Bone Marrow and/or Peripheral Blood Stem Cell Reinfusions: Call transplant nurse to arrange time when marrow/ stem cells will be availablePlease send STAT type & screen in morning before reinfusion.Do not radiate or filter marrow or stem cells.Reinfuse stored marrow and/or peripheral blood stem cellsEKG, crash cart on floor.

click to Order Acetaminophen 650 mg PO PRN premedicate before BM/PBPC reinfusions

click to Order Diphenhydramine HCl 25-50 mg PO/IV PRN premedicate before BM/PBPC reinfusions

click to Order Lorazepam 0.5-1 mg PO/IV PRN premedicate before BM/PBPC reinfusions PRN and then q3-4h PRN with BM/PBPC reinfusions

click to Order 50 mEq Sodium Bicarb + 20 mEq Potassium Chl / 1000 mL D5 1/2 NSContinuous at 350 ml/hr for 1000 mlfor 2-3 hrs prior to BM/PBPC reinfusion

click to Order 50 mEq Sodium Bicarb + 20 mEq Potassium Chl / 1000 mL D5 1/2 NSContinuous at 200 ml/hrbetween BM/PBPC reinfusions

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50 mEq Sodium Bicarb + 20 mEq Potassium Chl / 1000 mL D5 1/2 NSContinuous at 350 ml/hr for 1000 mlover 2-3 hours after last BM/PBPC reinfusion. Then revert back to pre-infusion hydration order.

Antiemetics

click to Order Dolasetron Mesylate 100 mg IV PRN 30 mins prior to chemotherapy then QD for 3 days.

click to Order Lorazepam 1 mg IV PRN prior to each dose of busulfan click to Order Lorazepam 1-2 mg IV Q4-6H:PRN after busulfan Supportive Careclick to Order Oxazepam 15-30 mg PO HS:PRN click to Order Aluminum Hydroxide Suspension 30 ml PO Q4H:PRN

click to Order Loperamide HCl 2 mg PO PRN after each loose stool. For 3 or more loose stools/day. Not to exceed 16 mg per day. Call HO prior to administering for the 1st time.

click to Order Multivitamins 1 CAP PO DAILY click to Order Folic Acid 1 mg PO DAILY click to Order BID sitz bath for perianal irritation.

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Admit/Transfer/Postoperative SetsElectrolyte Replacement

click to Order When giving electrolyte replacement, repeat level approximately 2 hrs after supplementation.

click to Order Potassium Chloride PO Sliding Scale Call HO for K <3.0

click to Order Potassium Chloride IV Sliding Scale Notify MD if K < 3.0

click to Order Magnesium Sulfate IV Sliding Scale Call HO for MG <1.2

click to Order Potassium Phosphate 15 mmol / 250 ml NS IV PRN if serum phosphate >=1.5 and <2.4 Infuse over 5 hours. If serum phosphate <1.5, call HO.

click to Order Calcium Replacement (Oncology) IV Sliding Scale Notify HO if corrected CA <7.0

Antibioticsclick to Order

Except for dosage adjustment, BMT MD on call should approve all changes in antibiotic regimen.

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Acyclovir 400 mg IV Q8H Day minus 2 until discharge. Hold if creatinine >1.5 (See also PO order)

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Acyclovir 400 mg PO Q8H Day minus 2 until discharge. Hold if creatinine >1.5 (See also IV order).

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Sulfameth/Trimethoprim DS 1 TAB PO BID Start on admission and discontinue on day -3. * Drug-Allergy Warning *

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Levofloxacin 500 mg PO DAILY Day -2 until 1st neutropenic spike >=100.5

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Fluconazole 200 mg PO BID Start Day -2

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Nystatin Oral Suspension 10 ml PO QID swish and swallow

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During Neutropenia (PMN<500) for first T>100.5: Repeat T in 15 minutes. If T >100.5 clearly unassociated with blood product or growth factor administration.

Culture blood from each central access catheter and one peripheral stick. Culture stool, sputum & urine. Portable PA CXR.

click to Order Clotrimazole 1 TROC PO 5X/D

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Sodium Fluoride (Dental Gel) 1 Appl TP HS to be brushed with toothettes HS

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Bacitracin 500 mg PO TID Give with nystatin & polymyxin Start 4 days prior to admission and continue until engraftment.

click to Order Chlorhexidine Gluconate 15 ml PO BID

click to Polymyxin B Sulfate 1,000,000 UNIT PO TID of 63


Order Give with nystatin and bacitracin. Start 4 days prior to admission and continue until engraftment.

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Nystatin 4 TAB PO TID Give with polymyxin & bacitracin. Start 4 days prior to admission and continue until engraftment.

Hydration/Chemotherapy

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20 mEq Potassium Chloride / 1000 mL D5 1/2 NSContinuous at 100 ml/hrBegin on admission. 6 hrs prior to beginning cyclophosphamide, change rate to 200 cc/hr (see additional order).

click to Order 20 mEq Potassium Chloride / 1000 mL D5 1/2 NSContinuous at 200 ml/hr Start: 6 hrs prior to beginning cyclophosphamideContinue for 24 hours after cyclophosphamide administration.

click to Order Use oncology guideline on med screen for dose & frequencyUrsodiol PO Day -2 until discharge

click to Order Glutamine 10 gm PO TID Day 0 until discharge. Mixed in a slurry of any PO liquid

click to Order CycloSPORINE (Continuous Infusion for BMT) IV DRIP INFUSION Start Day -1 in the morning. Continuous Infusion over 24 hours. Adjust dose per blood levels.

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Cyclosporin levels:Monitor CSA levels by peripheral blood draw.Start Day 0, then Mon, Wed, Fri.Target CSA level is 475-525 mg/mL.With any dose changes, CSA levels should be re-checked >=24 hrs following dose change, per BMT MD.Repeat levels when there is a change in LFTs or changing renal function, per BMT MD.

Chemotherapy

click to Order ALL CHEMOTHERAPY MEDICATIONS ARE ON PAPER AND MUST BE WRITTEN OR COSIGNED BY AN ONCOLOGY ATTENDING.

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Calculate BSA based on Ht and Wt at admission.Use corrected IBW. See appendix on paper protocol for formula.Call BMT MD if there is a difference of > 5% from BSA used on orders.

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BIDMC Provider Order Entry - Order Setsmycourses.med.harvard.edu/ec_res/nt/EFB1265B-B911-4F95... ·...

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