Common Inpatient Admissions (Peds) - Revision history

JenniferH: /* Seizures */

2020-11-21T15:15:55Z

Seizures

← Older revision		Revision as of 15:15, 21 November 2020
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	===Seizures===		===Seizures===
	see [[Pediatric Seizures YKHC Wiki Page]] for more details		see [[Pediatric Seizures\|Pediatric Seizures YKHC Wiki Page]] for more details

	Occasionally seizure patients are admitted for monitoring. (see [[media:Seizure_evaluation_peds.pdf\|Seizure Evaluation (Pediatrics) YKHC Clinical Guideline]] and [[media:Seizure_treatment_peds.pdf\|Seizure Treatment (Pediatrics) YKHC Clinical Guideline]]). This may be for reassurance and education, for starting or re-starting medications or to rule out meningitis or another concerning cause. If the patient experienced status, had a focal seizure or has had more than one seizure in 24 hours, then transfer to ANMC should be strongly considered for further evaluation and treatment. For any post seizure admission, make sure the patient has an IV (if possible) and order prn anti-seizure medications for IV and non-IV administration. The Peds Pyxis includes a '''[[Pharmacy Things to Know#Pediatric Seizure Kit\|Pediatric Seizure Kit]]''' for quick access to urgent/emergent anti-seizure medications.		Occasionally seizure patients are admitted for monitoring. (see [[media:Seizure_evaluation_peds.pdf\|Seizure Evaluation (Pediatrics) YKHC Clinical Guideline]] and [[media:Seizure_treatment_peds.pdf\|Seizure Treatment (Pediatrics) YKHC Clinical Guideline]]). This may be for reassurance and education, for starting or re-starting medications or to rule out meningitis or another concerning cause. If the patient experienced status, had a focal seizure or has had more than one seizure in 24 hours, then transfer to ANMC should be strongly considered for further evaluation and treatment. For any post seizure admission, make sure the patient has an IV (if possible) and order prn anti-seizure medications for IV and non-IV administration. The Peds Pyxis includes a '''[[Pharmacy Things to Know#Pediatric Seizure Kit\|Pediatric Seizure Kit]]''' for quick access to urgent/emergent anti-seizure medications.

JenniferH: /* Seizures */

2020-11-21T15:15:40Z

Seizures

← Older revision		Revision as of 15:15, 21 November 2020
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	see [[Pediatric Seizures YKHC Wiki Page]] for more details		see [[Pediatric Seizures YKHC Wiki Page]] for more details

	Occasionally seizure patients are admitted for monitoring. (see [[media:Seizure_evaluation_peds.pdf\|Seizure Evaluation (Pediatrics) YKHC Clinical Guideline]] and [[media:Seizure_treatment_peds.pdf\|Seizure Treatment (Pediatrics) YKHC Clinical Guideline]]). This may be for reassurance and education, for starting or re-starting medications or to rule out meningitis or another concerning cause. If the patient experienced status, had a focal seizure or has had more than one seizure in 24 hours, then transfer to ANMC should be strongly considered for further evaluation and treatment. For any post seizure admission, make sure the patient has an IV (if possible) and order prn anti-seizure medications for IV and non-IV administration. The Peds Pyxis includes a '''[[Pharmacy Things to Know#Pediatric Seizure Kit\|Pediatric Seizure Kit]]''' for quick access to urgent/emergent anti-seizure medications. Referrals made for an EEG and MRI if indicated usually take weeks to months to get completed as an outpatient. This is because these referrals are considered non urgent and the patient must have or obtain their tribal card and have Denali Kid care or pay for their travel. The appts then often get missed because of weather or family responsibilities etc. It is therefore best to transfer seizure patients, that need more urgent work up, to Anchorage. When you discharge a patient > 6 months of age at risk for seizures—please make sure they go home with rectal diastat (ordered [[Pharmacy Things to Know#"As Indicated" On Presciptions\|"As Indicated"]]) with refills and a peds discharge handout for seizures.		Occasionally seizure patients are admitted for monitoring. (see [[media:Seizure_evaluation_peds.pdf\|Seizure Evaluation (Pediatrics) YKHC Clinical Guideline]] and [[media:Seizure_treatment_peds.pdf\|Seizure Treatment (Pediatrics) YKHC Clinical Guideline]]). This may be for reassurance and education, for starting or re-starting medications or to rule out meningitis or another concerning cause. If the patient experienced status, had a focal seizure or has had more than one seizure in 24 hours, then transfer to ANMC should be strongly considered for further evaluation and treatment. For any post seizure admission, make sure the patient has an IV (if possible) and order prn anti-seizure medications for IV and non-IV administration. The Peds Pyxis includes a '''[[Pharmacy Things to Know#Pediatric Seizure Kit\|Pediatric Seizure Kit]]''' for quick access to urgent/emergent anti-seizure medications.

			Referrals made for an EEG and MRI if indicated usually take weeks to months to get completed as an outpatient. This is because these referrals are considered non urgent and the patient must have or obtain their tribal card and have Denali Kid care or pay for their travel. The appts then often get missed because of weather or family responsibilities etc. It is therefore best to transfer seizure patients, that need more urgent work up, to Anchorage. When you discharge a patient > 6 months of age at risk for seizures—please make sure they go home with rectal diastat (ordered [[Pharmacy Things to Know#"As Indicated" On Presciptions\|"As Indicated"]]) with refills and a peds discharge handout for seizures.

	===Patients Requiring Infusions===		===Patients Requiring Infusions===

JenniferH: /* Seizures */

2020-11-21T15:14:51Z

Seizures

← Older revision		Revision as of 15:14, 21 November 2020
Line 46:		Line 46:

	===Seizures===		===Seizures===
	see [[Pediatric Seizures]] for more details		see [[Pediatric Seizures YKHC Wiki Page]] for more details

	Occasionally seizure patients are admitted for monitoring. (see [[media:Seizure_evaluation_peds.pdf\|Seizure Evaluation (Pediatrics) YKHC Clinical Guideline]] and [[media:Seizure_treatment_peds.pdf\|Seizure Treatment (Pediatrics) YKHC Clinical Guideline]]). This may be for reassurance and education, for starting or re-starting medications or to rule out meningitis or another concerning cause. If the patient experienced status, had a focal seizure or has had more than one seizure in 24 hours, then transfer to ANMC should be strongly considered for further evaluation and treatment. For any post seizure admission, make sure the patient has an IV (if possible) and order prn anti-seizure medications for IV and non-IV administration. The Peds Pyxis includes a '''[[Pharmacy Things to Know#Pediatric Seizure Kit\|Pediatric Seizure Kit]]''' for quick access to urgent/emergent anti-seizure medications. Referrals made for an EEG and MRI if indicated usually take weeks to months to get completed as an outpatient. This is because these referrals are considered non urgent and the patient must have or obtain their tribal card and have Denali Kid care or pay for their travel. The appts then often get missed because of weather or family responsibilities etc. It is therefore best to transfer seizure patients, that need more urgent work up, to Anchorage. When you discharge a patient > 6 months of age at risk for seizures—please make sure they go home with rectal diastat (ordered [[Pharmacy Things to Know#"As Indicated" On Presciptions\|"As Indicated"]]) with refills and a peds discharge handout for seizures.		Occasionally seizure patients are admitted for monitoring. (see [[media:Seizure_evaluation_peds.pdf\|Seizure Evaluation (Pediatrics) YKHC Clinical Guideline]] and [[media:Seizure_treatment_peds.pdf\|Seizure Treatment (Pediatrics) YKHC Clinical Guideline]]). This may be for reassurance and education, for starting or re-starting medications or to rule out meningitis or another concerning cause. If the patient experienced status, had a focal seizure or has had more than one seizure in 24 hours, then transfer to ANMC should be strongly considered for further evaluation and treatment. For any post seizure admission, make sure the patient has an IV (if possible) and order prn anti-seizure medications for IV and non-IV administration. The Peds Pyxis includes a '''[[Pharmacy Things to Know#Pediatric Seizure Kit\|Pediatric Seizure Kit]]''' for quick access to urgent/emergent anti-seizure medications. Referrals made for an EEG and MRI if indicated usually take weeks to months to get completed as an outpatient. This is because these referrals are considered non urgent and the patient must have or obtain their tribal card and have Denali Kid care or pay for their travel. The appts then often get missed because of weather or family responsibilities etc. It is therefore best to transfer seizure patients, that need more urgent work up, to Anchorage. When you discharge a patient > 6 months of age at risk for seizures—please make sure they go home with rectal diastat (ordered [[Pharmacy Things to Know#"As Indicated" On Presciptions\|"As Indicated"]]) with refills and a peds discharge handout for seizures.

JenniferH: /* Seizures */

2020-11-21T15:14:32Z

Seizures

← Older revision		Revision as of 15:14, 21 November 2020
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	Generally low risk BRUE events do not need work up and admission, but occasionally these patients are admitted for observation for 12-24 hours, with close monitoring, to reassure parents and caretakers that the event does not repeat and to further evaluate other possible etiologies such as reflux, aspiration, seizure, RSV in a less than 2 month old, meningitis, etc		Generally low risk BRUE events do not need work up and admission, but occasionally these patients are admitted for observation for 12-24 hours, with close monitoring, to reassure parents and caretakers that the event does not repeat and to further evaluate other possible etiologies such as reflux, aspiration, seizure, RSV in a less than 2 month old, meningitis, etc

	===[[~~Seizure Evaluation –~~ Pediatric\|Seizures]]~~===~~		===Seizures===
			see [[Pediatric Seizures]] for more details

	Occasionally seizure patients are admitted for monitoring. (see [[media:Seizure_evaluation_peds.pdf\|Seizure Evaluation (Pediatrics) YKHC Clinical Guideline]] and [[media:Seizure_treatment_peds.pdf\|Seizure Treatment (Pediatrics) YKHC Clinical Guideline]]). This may be for reassurance and education, for starting or re-starting medications or to rule out meningitis or another concerning cause. If the patient experienced status, had a focal seizure or has had more than one seizure in 24 hours, then transfer to ANMC should be strongly considered for further evaluation and treatment. For any post seizure admission, make sure the patient has an IV (if possible) and order prn anti-seizure medications for IV and non-IV administration. The Peds Pyxis includes a '''[[Pharmacy Things to Know#Pediatric Seizure Kit\|Pediatric Seizure Kit]]''' for quick access to urgent/emergent anti-seizure medications. Referrals made for an EEG and MRI if indicated usually take weeks to months to get completed as an outpatient. This is because these referrals are considered non urgent and the patient must have or obtain their tribal card and have Denali Kid care or pay for their travel. The appts then often get missed because of weather or family responsibilities etc. It is therefore best to transfer seizure patients, that need more urgent work up, to Anchorage. When you discharge a patient > 6 months of age at risk for seizures—please make sure they go home with rectal diastat (ordered [[Pharmacy Things to Know#"As Indicated" On Presciptions\|"As Indicated"]]) with refills and a peds discharge handout for seizures.		Occasionally seizure patients are admitted for monitoring. (see [[media:Seizure_evaluation_peds.pdf\|Seizure Evaluation (Pediatrics) YKHC Clinical Guideline]] and [[media:Seizure_treatment_peds.pdf\|Seizure Treatment (Pediatrics) YKHC Clinical Guideline]]). This may be for reassurance and education, for starting or re-starting medications or to rule out meningitis or another concerning cause. If the patient experienced status, had a focal seizure or has had more than one seizure in 24 hours, then transfer to ANMC should be strongly considered for further evaluation and treatment. For any post seizure admission, make sure the patient has an IV (if possible) and order prn anti-seizure medications for IV and non-IV administration. The Peds Pyxis includes a '''[[Pharmacy Things to Know#Pediatric Seizure Kit\|Pediatric Seizure Kit]]''' for quick access to urgent/emergent anti-seizure medications. Referrals made for an EEG and MRI if indicated usually take weeks to months to get completed as an outpatient. This is because these referrals are considered non urgent and the patient must have or obtain their tribal card and have Denali Kid care or pay for their travel. The appts then often get missed because of weather or family responsibilities etc. It is therefore best to transfer seizure patients, that need more urgent work up, to Anchorage. When you discharge a patient > 6 months of age at risk for seizures—please make sure they go home with rectal diastat (ordered [[Pharmacy Things to Know#"As Indicated" On Presciptions\|"As Indicated"]]) with refills and a peds discharge handout for seizures.

JenniferH: /* Pneumonia / Bronchiolitis */

2020-11-11T19:46:35Z

Pneumonia / Bronchiolitis

← Older revision		Revision as of 19:46, 11 November 2020
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	===[[Pneumonia – Pediatric More Than 3 Months\|Pneumonia]] / [[Bronchiolitis / Wheezing – 3-24 Months\|Bronchiolitis]]===		===[[Pneumonia – Pediatric More Than 3 Months\|Pneumonia]] / [[Bronchiolitis / Wheezing – 3-24 Months\|Bronchiolitis]]===

	Use the ~~‘Community Acquired~~ Pneumonia and Wheezing ~~Guidelines’ '''*link here'''~~ to direct care plus the additional powerplan labeled PED Respiratory Infection that has preselected and other choices to help with these admissions. Note: if a patient is requiring q 2 nebs, more than 2L O2 or our RTs and nurses are uncomfortable with a patient’s clinical status, it is time to consider transferring the patient.		Use the [[media:Pneumonia_peds.pdf\|Pneumonia (Pediatric > 3 months) YKHC Clinical Guideline]] and [[media:Bronchiolitis_wheezing.pdf\|Bronchiolitis/Wheezing (3-24 months) YKHC Clinical Guideline]] to direct care plus the additional powerplan labeled PED Respiratory Infection that has preselected and other choices to help with these admissions. Note: if a patient is requiring q 2 nebs, more than 2L O2 or our RTs and nurses are uncomfortable with a patient’s clinical status, it is time to consider transferring the patient.

	===TB Screening Admission===		===TB Screening Admission===

JenniferH: /* Skin and Soft Tissue Infection */

2020-11-11T19:45:53Z

Skin and Soft Tissue Infection

← Older revision		Revision as of 19:45, 11 November 2020
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	===[[Skin and Soft Tissue Infection]]===		===[[Skin and Soft Tissue Infection]]===

	Use the Skin and Soft Tissue Infection Guideline ~~'''*link here'''~~ to direct care. Admit using pediatric admission order plus the sub powerplan labeled PED Abcess/Cellulitis that has preselected and other choices to help with these admissions. Consider using dilute bleach baths with these patients as well.		Use the [[media:SSTI.pdf\|Skin and Soft Tissue Infection YKHC Clinical Guideline]] to direct care. Admit using pediatric admission order plus the sub powerplan labeled PED Abcess/Cellulitis that has preselected and other choices to help with these admissions. Consider using dilute bleach baths with these patients as well.

	===[[Pneumonia – Pediatric More Than 3 Months\|Pneumonia]] / [[Bronchiolitis / Wheezing – 3-24 Months\|Bronchiolitis]]===		===[[Pneumonia – Pediatric More Than 3 Months\|Pneumonia]] / [[Bronchiolitis / Wheezing – 3-24 Months\|Bronchiolitis]]===

JenniferH: /* Hyperbilirubinemia */

2020-11-11T19:19:25Z

Hyperbilirubinemia

← Older revision		Revision as of 19:19, 11 November 2020
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	===[[Jaundice – Neonatal Evaluation & Treatment\|Hyperbilirubinemia]]===		===[[Jaundice – Neonatal Evaluation & Treatment\|Hyperbilirubinemia]]===

	Infants are admitted per our ~~Hyperbilirubinemia Guideline’ '''*link here'''~~ for phototherapy. At the top of the general peds admission orders there is an additional powerplan labeled PED Phototherapy that has preselected and selectable choices to help with these admissions.		Infants are admitted per our [[media:Jaundice_neonatal.pdf\|Neonatal Jaundice YKHC Clinical Guideline]] for phototherapy. At the top of the general peds admission orders there is an additional powerplan labeled PED Phototherapy that has preselected and selectable choices to help with these admissions.

	===[[Skin and Soft Tissue Infection]]===		===[[Skin and Soft Tissue Infection]]===

JenniferH: /* Neonatal Fever */

2020-11-11T19:18:55Z

Neonatal Fever

← Older revision		Revision as of 19:18, 11 November 2020
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	===[[Fever – Infants 0-90 days\|Neonatal Fever]]===		===[[Fever – Infants 0-90 days\|Neonatal Fever]]===

	Infants under 90 days of age with fever who meet admission criteria per the ‘0-90 ~~Day Infant Fever Guideline’ '''*link here'''~~ are admitted after an initial work up, on or off antibiotics, as indicated. Use the PEDS Admission power plan plus the admit subphase PED Infant 0-90 Day Old orders that have preselected and other order choices to help with these admissions.		Infants under 90 days of age with fever who meet admission criteria per the [[media:Fever_less_than_90_days.pdf\|Fever (Infant 0-90 days) YKHC Clinical Guideline]] are admitted after an initial work up, on or off antibiotics, as indicated. Use the PEDS Admission power plan plus the admit subphase PED Infant 0-90 Day Old orders that have preselected and other order choices to help with these admissions.

	Infants who were pre-treated in the village and/or those patients where a tap was not obtainable in the ER present a challenge for management and treatment. Your options are to try to:		Infants who were pre-treated in the village and/or those patients where a tap was not obtainable in the ER present a challenge for management and treatment. Your options are to try to:

JenniferH: /* Seizures */

2020-11-11T19:13:43Z

Seizures

← Older revision		Revision as of 19:13, 11 November 2020
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	===[[Seizure Evaluation – Pediatric\|Seizures]]===		===[[Seizure Evaluation – Pediatric\|Seizures]]===

	Occasionally seizure patients are admitted for monitoring. ~~'''~~see [[media:Seizure_evaluation_peds.pdf\|Seizure Evaluation (Pediatrics) YKHC Clinical Guideline]] and [[media:Seizure_treatment_peds.pdf\|Seizure Treatment (Pediatrics) YKHC Clinical Guideline]]~~'''~~ . This may be for reassurance and education, for starting or re-starting medications or to rule out meningitis or another concerning cause. If the patient experienced status, had a focal seizure or has had more than one seizure in 24 hours, then transfer to ANMC should be strongly considered for further evaluation and treatment. For any post seizure admission, make sure the patient has an IV (if possible) and order prn anti-seizure medications for IV and non-IV administration. The Peds Pyxis includes a '''[[Pharmacy Things to Know#Pediatric Seizure Kit\|Pediatric Seizure Kit]]''' for quick access to urgent/emergent anti-seizure medications. Referrals made for an EEG and MRI if indicated usually take weeks to months to get completed as an outpatient. This is because these referrals are considered non urgent and the patient must have or obtain their tribal card and have Denali Kid care or pay for their travel. The appts then often get missed because of weather or family responsibilities etc. It is therefore best to transfer seizure patients, that need more urgent work up, to Anchorage. When you discharge a patient > 6 months of age at risk for seizures—please make sure they go home with rectal diastat (ordered [[Pharmacy Things to Know#"As Indicated" On Presciptions\|"As Indicated"]]) with refills and a peds discharge handout for seizures.		Occasionally seizure patients are admitted for monitoring. (see [[media:Seizure_evaluation_peds.pdf\|Seizure Evaluation (Pediatrics) YKHC Clinical Guideline]] and [[media:Seizure_treatment_peds.pdf\|Seizure Treatment (Pediatrics) YKHC Clinical Guideline]]). This may be for reassurance and education, for starting or re-starting medications or to rule out meningitis or another concerning cause. If the patient experienced status, had a focal seizure or has had more than one seizure in 24 hours, then transfer to ANMC should be strongly considered for further evaluation and treatment. For any post seizure admission, make sure the patient has an IV (if possible) and order prn anti-seizure medications for IV and non-IV administration. The Peds Pyxis includes a '''[[Pharmacy Things to Know#Pediatric Seizure Kit\|Pediatric Seizure Kit]]''' for quick access to urgent/emergent anti-seizure medications. Referrals made for an EEG and MRI if indicated usually take weeks to months to get completed as an outpatient. This is because these referrals are considered non urgent and the patient must have or obtain their tribal card and have Denali Kid care or pay for their travel. The appts then often get missed because of weather or family responsibilities etc. It is therefore best to transfer seizure patients, that need more urgent work up, to Anchorage. When you discharge a patient > 6 months of age at risk for seizures—please make sure they go home with rectal diastat (ordered [[Pharmacy Things to Know#"As Indicated" On Presciptions\|"As Indicated"]]) with refills and a peds discharge handout for seizures.

	===Patients Requiring Infusions===		===Patients Requiring Infusions===

JenniferH: /* Seizures */

2020-11-11T19:13:01Z

Seizures

← Older revision		Revision as of 19:13, 11 November 2020
Line 47:		Line 47:
	===[[Seizure Evaluation – Pediatric\|Seizures]]===		===[[Seizure Evaluation – Pediatric\|Seizures]]===

	Occasionally seizure patients are admitted for monitoring. '''see [[media:Seizure_evaluation_peds.pdf\|Seizure Evaluation (Pediatrics) YKHC Clinical Guideline]] and [[media:Seizure_treatment_peds.pdf\|Seizure Treatment (Pediatrics) YKHC Clinical Guideline]]''' . This may be for reassurance and education, for starting or re-starting medications or to rule out meningitis or another concerning cause. If the patient experienced status, had a focal seizure or has had more than one seizure in 24 hours, then transfer to ANMC should be strongly considered for further evaluation and treatment. For any post seizure admission, make sure the patient has an IV (if possible) and order prn anti-seizure medications for IV and non-IV administration. The Peds Pyxis includes a '''[[Pharmacy Things to Know#Pediatric Seizure Kit\|Pediatric Seizure Kit]]''' for quick access to urgent/emergent anti-seizure medications. Referrals made for an EEG and MRI if indicated usually take weeks to months to get completed as an outpatient. This is because these referrals are considered non urgent and the patient must have or obtain their tribal card and have Denali Kid care or pay for their travel. The appts then often get missed because of weather or family responsibilities etc. It is therefore best to transfer seizure patients, that need more urgent work up, to Anchorage. When you discharge a patient > 6 months of age at risk for seizures—please make sure they go home with rectal diastat with refills and a peds discharge handout for seizures.		Occasionally seizure patients are admitted for monitoring. '''see [[media:Seizure_evaluation_peds.pdf\|Seizure Evaluation (Pediatrics) YKHC Clinical Guideline]] and [[media:Seizure_treatment_peds.pdf\|Seizure Treatment (Pediatrics) YKHC Clinical Guideline]]''' . This may be for reassurance and education, for starting or re-starting medications or to rule out meningitis or another concerning cause. If the patient experienced status, had a focal seizure or has had more than one seizure in 24 hours, then transfer to ANMC should be strongly considered for further evaluation and treatment. For any post seizure admission, make sure the patient has an IV (if possible) and order prn anti-seizure medications for IV and non-IV administration. The Peds Pyxis includes a '''[[Pharmacy Things to Know#Pediatric Seizure Kit\|Pediatric Seizure Kit]]''' for quick access to urgent/emergent anti-seizure medications. Referrals made for an EEG and MRI if indicated usually take weeks to months to get completed as an outpatient. This is because these referrals are considered non urgent and the patient must have or obtain their tribal card and have Denali Kid care or pay for their travel. The appts then often get missed because of weather or family responsibilities etc. It is therefore best to transfer seizure patients, that need more urgent work up, to Anchorage. When you discharge a patient > 6 months of age at risk for seizures—please make sure they go home with rectal diastat (ordered [[Pharmacy Things to Know#"As Indicated" On Presciptions\|"As Indicated"]]) with refills and a peds discharge handout for seizures.

	===Patients Requiring Infusions===		===Patients Requiring Infusions===