Approved Formulary
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Description: A collection of common PharmNet™ Order comments fragments - copy from here and paste into your orders as needed.
Directions: click within any dotted-line box to copy the contents of the box to the Clipboard.
ceFAZolin preop doses
Dose: Per Weight
Order Comments:
vancomycin preop doses
Dose: Per Weight
Order Comments:
NTG SL order comments:
Placeholder Orders
Order Comments:
Med Rec Range Orders
Order Comments:
Therapeutic Substitution
Order Comments:
SMOG Enema (NF)
Order Comments:
Dose: Per Weight
Order Comments:
***ON CALL*** 2 gm for weight less than 120 kg (264 lbs) or 3 gm for weight 120 kg or more
vancomycin preop doses
Dose: Per Weight
Order Comments:
***ON CALL*** Give vancomycin 1 gm for weight less than 80 kg (176 lbs) or 1.5 gm for weight 80 kg or more. Give in Holding Room.
NTG SL order comments:
Times 3 doses PRN chest pain, EKG.
Notify physician after 3rd dose of NTG.
Notify physician after 3rd dose of NTG.
Placeholder Orders
Order Comments:
This order signifies that dosing for this medication is being managed via pharmacy protocol. There are no scheduled doses, future doses will be determined by serum levels.
Med Rec Range Orders
Order Comments:
May repeat x 1 if first dose not effective.
Therapeutic Substitution
Order Comments:
Use for … per IMH substitution policy.
SMOG Enema (NF)
Order Comments:
• Sorbitol 25 mL
• Milk of Magnesia 25 mL
• Mineral Oil 25 mL
• Glycerin 25 mL
• Milk of Magnesia 25 mL
• Mineral Oil 25 mL
• Glycerin 25 mL
LOW DOSE SCALE - CORRECTION INSULIN
MEDIUM DOSE SCALE-CORRECTION INSULIN
HIGH DOSE SCALE - CORRECTION INSULIN
Insulin Pump orders
Dose: as directed
Route of administration: Subcutaneous
Frequency: As Directed
PRN reason: Blood Glucose
Order Comments:
☑ Patient's own med
Copy Order Comments (hidden):
LOW DOSE SCALE - CORRECTION INSULIN
Comment - for thin, elderly, or renal patients, using < 40 units/day)
• Do not hold Correction Insulin if NPO.
• If HS dose has been ordered and is being given, begin correction when blood glucose 200 mg/dl or above and give half (½) the correctional dose scale.
• If two consecutive scheduled blood glucose are greater than 180 mg/dl, increase to next Correction Insulin Scale up and treat blood glucose on new scale.
BS < 70 - Initiate Hypoglycemia Order Set
BS 70-150 None
BS 151-199 2 units.
BS 200-249 2 units.
BS 250-299 4 units.
BS 300-349 6 units.
BS 350-400 8 units.
BS > 400 10 units.
Note: If > 400 mg/dl recheck blood glucose in 4 hours, if still > 400 mg/dl notify MD.
Comment - for thin, elderly, or renal patients, using < 40 units/day)
• Do not hold Correction Insulin if NPO.
• If HS dose has been ordered and is being given, begin correction when blood glucose 200 mg/dl or above and give half (½) the correctional dose scale.
• If two consecutive scheduled blood glucose are greater than 180 mg/dl, increase to next Correction Insulin Scale up and treat blood glucose on new scale.
BS < 70 - Initiate Hypoglycemia Order Set
BS 70-150 None
BS 151-199 2 units.
BS 200-249 2 units.
BS 250-299 4 units.
BS 300-349 6 units.
BS 350-400 8 units.
BS > 400 10 units.
Note: If > 400 mg/dl recheck blood glucose in 4 hours, if still > 400 mg/dl notify MD.
MEDIUM DOSE SCALE-CORRECTION INSULIN
Copy Order Comments (hidden):
MEDIUM DOSE SCALE - CORRECTION INSULIN
Comment - average-sized patients, using 40‑80 units/day)
• Do not hold Correction Insulin if NPO.
• If HS dose has been ordered and is being given, begin correction when blood glucose 200 mg/dl or above and give half (½) the correctional dose scale.
• If two consecutive scheduled blood glucose are greater than 180 mg/dl, increase to next Correction Insulin Scale up and treat blood glucose on new scale.
• If two consecutive scheduled blood glucose are less than 90 mg/dl, decrease to next Correction Insulin Scale down and treat blood glucose on new scale.
BS < 70 - Initiate Hypoglycemia Order Set
BS 70-150 None
BS 151-199 4 units.
BS 200-249 6 units.
BS 250-299 8 units.
BS 300-349 10 units.
BS 350-400 12 units.
BS > 400 14 units.
Note: If > 400 mg/dl recheck blood glucose in 4 hours, if still > 400 mg/dl notify MD.
Comment - average-sized patients, using 40‑80 units/day)
• Do not hold Correction Insulin if NPO.
• If HS dose has been ordered and is being given, begin correction when blood glucose 200 mg/dl or above and give half (½) the correctional dose scale.
• If two consecutive scheduled blood glucose are greater than 180 mg/dl, increase to next Correction Insulin Scale up and treat blood glucose on new scale.
• If two consecutive scheduled blood glucose are less than 90 mg/dl, decrease to next Correction Insulin Scale down and treat blood glucose on new scale.
BS < 70 - Initiate Hypoglycemia Order Set
BS 70-150 None
BS 151-199 4 units.
BS 200-249 6 units.
BS 250-299 8 units.
BS 300-349 10 units.
BS 350-400 12 units.
BS > 400 14 units.
Note: If > 400 mg/dl recheck blood glucose in 4 hours, if still > 400 mg/dl notify MD.
HIGH DOSE SCALE - CORRECTION INSULIN
Copy Order Comments (hidden):
HIGH DOSE SCALE - CORRECTION INSULIN
Comment - obese, infected or on steroids, using > 80 units/day
• Do not hold Correction Insulin if NPO.
• If HS dose has been ordered and is being given, begin correction when blood glucose 200 mg/dl or above and give half (½) the correctional dose scale.
• If two consecutive scheduled blood glucose are greater than 180 mg/dl, notify provider and consider adjusting/adding nutritional or basal insulin to provide adequate coverage.
• If two consecutive scheduled blood glucose are less than 90 mg/dl, decrease to next Correction Insulin Scale down and treat blood glucose on new scale.
BS < 70 - Initiate Hypoglycemia Order Set
BS 70-150 None
BS 151-199 4 units.
BS 200-249 6 units.
BS 250-299 10 units.
BS 300-349 12 units.
BS 350-400 16 units.
BS > 400 18 units.
Note: If > 400 mg/dl recheck blood glucose in 4 hours, if still > 400 mg/dl notify MD.
Comment - obese, infected or on steroids, using > 80 units/day
• Do not hold Correction Insulin if NPO.
• If HS dose has been ordered and is being given, begin correction when blood glucose 200 mg/dl or above and give half (½) the correctional dose scale.
• If two consecutive scheduled blood glucose are greater than 180 mg/dl, notify provider and consider adjusting/adding nutritional or basal insulin to provide adequate coverage.
• If two consecutive scheduled blood glucose are less than 90 mg/dl, decrease to next Correction Insulin Scale down and treat blood glucose on new scale.
BS < 70 - Initiate Hypoglycemia Order Set
BS 70-150 None
BS 151-199 4 units.
BS 200-249 6 units.
BS 250-299 10 units.
BS 300-349 12 units.
BS 350-400 16 units.
BS > 400 18 units.
Note: If > 400 mg/dl recheck blood glucose in 4 hours, if still > 400 mg/dl notify MD.
Insulin Pump orders
Dose: as directed
Route of administration: Subcutaneous
Frequency: As Directed
PRN reason: Blood Glucose
Order Comments:
Continuous subcutaneous infusion via pump per MD order. Pump to be managed by patient.
Product Notes: delete existing info.☑ Patient's own med
Pediatric PRN Pain/temperature Protocol Orders
Neonatal/Pediatric IV label comments
ibuprofen pediatric orders:
Maximum pediatric dose: 400 mg
Age 6 months or older: 10 mg/kg PO Q6H PRN
pain or temperature > 100.1°F
Age 13 or above: 400 mg PO Q4H PRN
pain or temperature > 100.1°F
Maximum pediatric dose: 400 mg
Age 6 months or older: 10 mg/kg PO Q6H PRN
pain or temperature > 100.1°F
Age 13 or above: 400 mg PO Q4H PRN
pain or temperature > 100.1°F
acetaminophen pediatric orders:
Maximum pediatric dose: 650 mg
Age 12 or younger: 15 mg/kg PO Q4H PRN
pain or temperature > 100.1°F
Age 13 or above: 650 mg PO Q4H PRN
pain or temperature > 100.1°F
Maximum pediatric dose: 650 mg
Age 12 or younger: 15 mg/kg PO Q4H PRN
pain or temperature > 100.1°F
Age 13 or above: 650 mg PO Q4H PRN
pain or temperature > 100.1°F
Neonatal/Pediatric IV label comments
**Neonatal syringe**
**Pediatric syringe**
**Pediatric bag**