Stroke and Neurosurgery Order Set Updates

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LIVE 9/10

As part of periodic review, updates have been made to many of the stroke and neurosurgery order sets. Below is a summary of the key changes – please use critical eyes when using them for the first time, and keep in mind any saved personalized versions may need updating to reselect your preferences.  There were a few requested prechecks we could not do as they would impact multiple other order sets, but providers can save a personal version with the items prechecked if they want.

Stroke/TIA Admission to Tele/SD and Stroke Orders for Critical Care:

  • Renaming to include “Ischemic” in title
  • Preselecting cardiac monitoring with indication of “stroke” or “critical care”
  • Changing maintain BP parameters to be free-text required (***) instead of a standard default value
  • Clearer direction about when NIH Stroke Scale needs to be done
  • Adding options for consults to Cardiology, PMR
  • Adding carotid ultrasound, TTE options with guidance on appropriate use
  • Expanding the options and guidance on use of atorvastatin

Acute Stroke post tPA for Critical Care:

  • Clearer direction about when NIH Stroke Scale needs to be done
  • Antihypertensive drip titration directions altered to include pre and during/post tPA goals for BP in sync with ED orders

Alteplase for Ischemic Stroke:

  • Direction to providers prior to initiating tPA (matches ED content)
  • Antihypertensive drip titration directions altered to include pre and during/post tPA goals for BP in sync with ED orders

Craniotomy Post-Op:

  •  Precheck of admit to ICU
  • Updated VS frequencies immediately postop with coordinating neuro checks on same schedule
  • Addition of multiple prechecks for commonly ordered items
  • Changing Maintain BP parameters to free-text required values instead of standard default value
  • Expanded ventriculostomy orders with differentiation for continuous draining vs. intermittent draining
  • Addition of hypertonic saline orders
  • Replacement of antihypertensives with the Neuro preferred agents/dosing
  • Addition of other anticonvulsants with PO/IV dosing options 

NCICU Admission:

  • Correction of typos only

 

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