Zembles, Shawn

Subject: FW: Code Ice

From: Zembles, Shawn Sent: Wednesday, January 05, 2011 5:19 PM To: Battles, Andrew; McGinnis, Terisa; Carter, Melinda; Baker, Julie; Blair, Karen; Beilsmith, Ellen Cc: Ohnoutka, Deb; Millard, Thomas; Joe Ramsey (joearamsey@gmail.com); Stoops MD, Stephen; Pharr, Faith; Peters, Cynthia Subject: Code Ice Hi all, Ive spoken with both Dr. Dunker and Dr. Ramsey who have approved the attached Code ICE standing order to be used immediately. In the standing order, Dr. Millards request for the order to separate the ED and inpatient responsibilities have been addressed and Ive confirmed with Terisa the change. Although I do not have an email address for Dr. Millard, both Terisa and I are confident the changes made are what he wants to see. Ive received recommendations from Mindy regarding the fentanyl discussion and direction from Dr. Stoops- based on Mindys research, the changes have been made. Dr. Dunker wants to see an echo ordered if the patients SBP remains < 80 or MAP < 65 despite a fluid challenge of 500 cc NS- this has been added. Dr. Dunker will discuss the changes with Dr. Blick upon his return. Dr. Dunker has two hard copies of the standing order for himself and Dr. Blick as I do not have email addresses for either of them. All other issues that were brought up at MedCep have been addressed. Faith has eyes on the standing order, has reviewed, and given format recommendations that have been addressed. Attached is the most current standing order that I will be sending to Karen and Ellen to make available on CNET for use ASAP. I will ask them to look at trouble shooting why the SMMC logo and the references on page 5 will not print out on a printer. We will continue to work towards a combined CH standing order as our goal. Thank you to everyone who put in a lot of hard work on getting this standing order addressed so that SMMC is consistent with best practice in the area of protective hypothermia. Shawn Zembles, DNP, RN, CCRN, ACNS-BC Clinical Nurse Specialist, Critical Care St. Mary's Medical Center 201 NW R.D. Mize Road Blue Springs, MO 64014 Office: 816-655-5409 Pager: 816-440-1803 Fax: 816-655-5456 Mobile: 816-507-2414