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​For OSUWMC USE ONLY.  To license, please contact the OSU Technology Commercialization Office at https://tco.osu.edu

Abdominal Pain Syndromes: Evaluation and Management

Click here for OSUWMC Guideline

DATE: January 2018 EDITION: 1st

​The purpose of this guideline is to provide standardization of care for patients with "Functional Abdominal Care" to improve morbidity, mortality, resource utilization and efficiency of care.

Accidental Hypothermia

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DATE: February 2018 EDITION: 2nd

The aim of the guideline is to provide recommendations on the management of the profoundly hypothermic patient. Specifically, guidance is provided to help facilitate aggressive resuscitation and the implementation of ECMO when clinically indicated.

Acute Coronary Syndrome

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DATE: February 2018 EDITION: 5th

Acute coronary syndrome (ACS) is a life-threatening form of coronary heart disease (CHD) that develops as a result of the heart muscle failing to receive an adequate amount of oxygenated blood. This guideline presents a clinical algorithm for evaluation and management of patients presenting with symptoms of acute coronary syndrome (ACS).

Alcohol Withdrawal

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DATE: October 2018 EDITION: 2nd

Alcohol withdrawal syndrome (AWS) is a potentially life-threatening condition that can occur in individuals who have been consuming large amounts of alcohol for weeks, months, or years and then either abruptly stop or significantly reduce their alcohol intake. This guideline  provides recommendations on how to recognize as well as treat alcohol withdrawal.

Anticoagulation Recommendations Post-Valve Replacement

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DATE: January 2017 EDITION: 3rd

This guideline provides recommendations for  the proper coagulation management of patients following the replacement of any of the following valves: mechanical AVR, bioprosthetic AVR, mechanical MVR, and bioprosthetic MVR. It is imperative to consider relative risk of bleeding versus thrombosis given the patient’s current clinical status when initiating or continuing anticoagulant therapy.

Anticoagulation Reversal: Factor Xa Inhibitors -Rivaroxaban (Xarelto®), Apixaban (Eliquis®), Betrixaban (Bevyxxa®), Edoxaban (Savaysa®)

Click here for OSUWMC Guideline

DATE: May 2018 EDITION: 3rd

The guideline aims to provide recommendations for managing minor, major, and life-threatening bleeds in patients on factor Xa inhibitors. There is no pharmacologic antidote for factor Xa inhibitors, and treatment of bleeding remains empirical.

Tools

National Guidelines and References

Policies and Procedures

Anticoagulation Reversal: Dabigatran (Pradaxa ®)

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DATE: February 2019 EDITION: 4th

The guideline provides recommendations for the proper management of minor, major, and life-threatening bleeds among patients taking Dabigatran (Pradaxa®). 

Anticoagulation Reversal: Unfractionated Heparin (UHF) and Low Molecular Weight Heparin (LMWH)

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DATE: November 2017 EDITION: 2nd

The guideline aims to provide recommendations for managing major and life-threatening bleeds among patients taking unfractionated heparin (UFH) or low molecular weight heparin (LMWH).

Anticoagulation Reversal: Warfarin Management of Elevated INR and Reversal

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DATE: October 2018 EDITION: 3rd

The guideline aims to provide recommendations for managing patients on warfarin suffering from an elevated INR or non-life threatening bleed. This guideline is applicable for the most common INR goal of 2-3. Therapeutic INR goals should be confirmed before reversal and adjusted according to warfarin indication.

Antiplatelet and Anticoagulant Therapy Management Surrounding Regional Anesthesia

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DATE: February 2018 EDITION: 1st

​This guideline provides clinicians with recommendations on how to prevent neuraxial complications for preoperative patients on antiplatelet or anticoagulant medications.  This does not apply to patients with perineural catheter placement.

Tools

National Guidelines and References

Policies and Procedures

Antiplatelet Therapy Management in Patients with Arterial Stents

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DATE: March 2019 EDITION: 4th

Inappropriate discontinuation of antiplatelet therapy in a patient with an arterial stent can lead to catastrophic repercussions. This guideline discusses how to appropriately manage antiplatelet therapy among patients with intravascular stents around the time of surgeries and procedures.

Asthma: Outpatient Management

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DATE: February 2017 EDITION: 4th

This guideline describes how to properly assess asthma control as well as effectively adjust pharmacological therapy when deemed appropriate. Further insight is provided on the management of asthma exacerbations.

Blood Culture Indications

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DATE: November 2017 EDITION: First

​The guideline provides general indications/criteria for drawing blood cultures and potentially reduce unnecessary cultures.  Unnecessary cultures contribute to increased length of stay, costs and laboratory turnaround time to provide results.

Brain Death in Adults: Establishing the Diagnosis

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DATE: November 2017 EDITION: 7th

This guideline describes brain death in adults which is defined as the irreversible loss of function of the brain, including the brain stem. It is important to note that the determination of brain death may ONLY be made by an attending physician who is a neurologist, neurosurgeon, or critical care specialist.

Burn Care Management

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DATE: February 2019 EDITION: 6th

The treatment of burns often requires a multidisciplinary approach along with continuous therapy. This guideline focuses on the treatment of burns starting with the primary A-B-C-D-E survey. The guideline then proceeds to provide recommendations for appropriate fluid resuscitation and use of pharmacologic agents based on the total body surface area (TBSA) impacted by the burn.

Candidemia: Confirmed

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DATE: May 2018 EDITION: 6th

This guideline describes the diagnosis of Candidemia via a blood culture and presents the clinical pathway for treatment once the Candida species has been identified. The guideline touches on Child-Pugh classification for severe hepatic dysfunction as well.  

Tools

National Guidelines and References

Policies and Procedures

Central Line-Associated Bloodstream Infection (CLABSI)

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DATE: January 2018 EDITION: 2nd

A Central Line-Associated Bloodstream Infection (CLABSI) represents a surveillance term used to describe a patient with a central line in place, who has a laboratory-confirmed bloodstream infection (BSI) that is not related to an infection of another site.  CLABSIs result in thousands of deaths each year and billions of dollars in added costs to the U.S. health care system.  This guideline focuses on prevention of CLABSIs in patients with central venous catheters in place.

 

 

 

 

Cervical Spine Trauma

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DATE: January 2017 EDITION: 4th

This guideline addresses the process for c-spine clearance of both evaluable patients as well as non-evaluable patients. It is important to note all blunt trauma patients should be considered as having a cervical spine injury until proven otherwise.

Clostridium difficile in Hospitalized Patients

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DATE: July 2018 EDITION: 5th

C. difficile is a spore-forming, gram-positive, anaerobic bacillus that produces toxins. It accounts for up to 25% of episodes of antibiotic-associated diarrhea and is the most common cause of healthcare-associated diarrhea. This guideline specifically references the transmission, diagnosis, treatment, and prevention of C. difficile.

Contrast Induced Nephropathy (CIN) and Iodinated Contrast Media-Induced Toxicity

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DATE: February 2017 EDITION: 4th

This guideline was developed for both emergent and non-emergent studies.  Due to the urgent need for clinical insight from imaging, further communication between the requesting clinician and procedural attending physician may be required.  For emergent cases, consider post-procedure fluid resuscitation.

COPD: Inpatient Exacerbations

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DATE: October 2017 EDITION: 3rd

Chronic obstructive pulmonary disease (COPD) is a slowly progressing disease that results in airflow obstruction. Exacerbations are generally triggered by infections but may also result from non infectious etiologies. This guideline describes the diagnosis and the treatment of chronic obstructive pulmonary disease exacerbations among inpatients.           

Cystic Fibrosis: Inpatient Management Pulmonary Exacerbation

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DATE: February 2019 EDITION: 1st

​This guideline provides clinical guidance for inpatient management of cystic fibrosis pulmonary exacerbations to improve outcomes through collaborative, multidisciplinary, team-based care.

Tools

National Guidelines and References

Policies and Procedures

Deep Venous Thrombosis (DVT): Initial ED Management

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DATE: March 2019 EDITION: 2nd

​This guideline provides recommendations on the initial management of Deep Venous Thrombosis (DVT) in the emergency department setting. Guidance is also provided on how to properly risk stratify patients, the use of anticoagulants as well as proper hypercoagulability work-up.

Deep Venous Thrombosis (DVT): Prevention​

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DATE: January 2018 EDITION: 4th

The guideline presents the process of risk assessment for deep venous thrombosis (DVT) and venous thromboembolism (VTE) in various patient populations. Further recommendations are provided on mechanical prophylaxis and pharmacologic prophylaxis approaches to reduce the occurrence of DVT and VTE.

Delirium: Management of ICU Patients

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DATE: September 2018 EDITION: 3rd

Delirium is an acute confusional state, with acute changes in attention, cognition, and awareness. It often has a sudden onset and a waxing and waning course. The guideline reviews the diagnosis of delirium through the use of the CAM-ICU assessment as well as the RASS. Based on the findings of either assessment, further guidance is provided on non-pharmacological and pharmacological therapies. It is important to note delirium prevention begins with non-pharmacological measures

Delirium: Management of Non-ICU Patients

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DATE: September 2018 EDITION: 3rd

Delirium is an acute confusional state, with acute changes in attention, cognition, and awareness. It often has a sudden onset and a waxing and waning course. Delirium can occur in patients of all ages, is a common geriatric syndrome, and can cause severe complications and increased risk of mortality. The guideline discusses precipitating factors and the evaluation of non-ICU inpatients with suspected delirium. Further guidance is provided on non-pharmacologic and pharmacologic therapies. It is important to note delirium prevention begins with non-pharmacologic measures.

Depression Management

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DATE: August 2016 EDITION: 4th

This guideline addresses the acute, continuation, and maintenance phases of major depressive disorder through standardized processes of screening, diagnosis, and symptom management. Unipolar depression with psychosis and bipolar depression are not addressed in this guideline.

Diabetes: Foot Burn

Click here for OSUWMC Guideline

DATE: March 2017 EDITION: 3rd

This guideline presents the key aspects of care pertaining to diabetic foot burns. Key aspects of care discussed include assessment of diabetic control per HgA1c, optimization of glycemic/metabolic control, and optimization of burn wound management. The prime component of the guideline is the use of TCOM Levels / Hyperbaric Oxygen (HBO) therapy as it is a procedure proven to improve patient condition

Diabetes: Hypoglycemia Treatment in Non-Pregnant Adults

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DATE: August 2018 EDITION: 3rd

Hypoglycemia has been linked to increased mortality yet over treatment of this condition can induce hyperglycemia, which has equally been associated with poor outcomes. This guideline is designed to treat events of hypoglycemia, either spontaneous or insulin-induced, and to decrease glycemic variability associated with treatment of hypoglycemia.

Diabetes: In Pregnancy - Inpatient Management

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DATE: January 2016 EDITION: 3rd

Pregnant women who have never had diabetes before but who develop high blood glucose during pregnancy are said to have gestational diabetes. ​​This guideline discusses the diagnosis and management of diabetes during pregnancy. Key aspects of care presented in the guideline include identification of pregnant women with diabetes mellitus, the optimization of glycemic control, and patient education. Information is presented for gestational diabetes and pregestational diabetes

Diabetes: Non-Pregnant Adults - Inpatient Management

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DATE: March 2017 EDITION: 5th

​This guideline presents a comprehensive approach to the diagnosis and management of diabetes among adult inpatients.

Diabetes: Outpatient Management

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DATE: February 2018 EDITION: 5th

This guideline presents diagnostic criteria for diabetics as well as pre-diabetics.  Further recommendations are provided on the proper management of patients with type 1 diabetes and patients with type 2 diabetes. Additional information is provided on the proper management of diabetics with other clinical ailments such as hypertension, retinopathy, and nephropathy. 

Diabetes: Periop/Periprocedure Glucose Management

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DATE: August 2018 EDITION: 8th

This guideline presents procedures for perioperative/periprocedural glucose management in diabetics. Guidance is provided for both the intraoperative/intraprocedure phase as well as for the postoperative/postprocedure phase. The guideline also includes a section on inpatient and outpatient management recommendations.

Diabetes: Type 1 Diabetes Mellitus (T1DM) and Diabetic Ketoacidosis (DKA)

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DATE: February 2018 EDITION: 8th

This guideline addresses the medical management of diabetic ketoacidosis (DKA) and type 1 diabetes mellitus. The guideline includes aspects of continuing management, DKA resolution, and patient education as a part of discharge planning. The guideline also contains specific recommendations for clinical as well as laboratory evaluation along with medical management. A table is included to provide guidance on appropriate IV insulin infusion rates based on the patient's change in glucose measurements.

Diabetes: Type 2 Diabetes Mellitus (T2DM) and Other Non-Diabetes-Associated Hyperglycemia (i.e., Stress Induced)

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DATE: February 2018 EDITION: 7th

This guideline  does NOT apply to patients with type 1 diabetes or diabetic ketoacidosis (DKA). Moreover, this guideline does NOT apply to post-cardiac surgery patients on 4 Ross Heart Hospital. Rather, the purpose of the guideline is to provide recommendations for IV insulin infusion treatment in patients with type 2 diabetes mellitus and other non-diabetes associated episodes of hyperglycemia.

Diagnostic Imaging During Pregnancy

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DATE: February 2019 EDITION: 3rd

While most diagnostic radiologic procedures are associated with little, if any, known significant fetal risks, this guideline is intended to provide recommendations for the use of diagnostic imaging during pregnancy.

Extracorporeal Life Support (ECLS)

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DATE: June 2018 EDITION: 3rd

Extracorporeal life support (ECLS) and extracorporeal membrane oxygenation (ECMO) are strategies that can be employed in critically ill adults. The guideline aids medical professionals in identifying patients who may benefit from VV-ECLS or VA-ECLS. This guideline is NOT intended for the post-cardiotomy patient who should be treated at the discretion of the attending cardiac surgeon.

Tools

National Guidelines and References

Policies and Procedures

Febrile Neutropenia

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DATE: August 2016 EDITION: 6th

Febrile neutropenia is defined as a single oral temperature > 38.0° C (100.4°F) and ANC < 500, or < 1000, with an expected decline to < 500. Chemotherapy-induced neutropenia, specifically, remains the major predisposing factor to infection in cancer patients. This guideline presents a clinical algorithm for the evaluation and treatment of febrile neutropenia. Criteria for recognition of sepsis as well as recommendations for duration of antibiotic use are included.

Fecal Microbiota Transplant (FMT) for the Treatment of Clostridium Difficile Infection

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DATE: June 2018 EDITION: 3rd

Clostridium difficile is the most common cause of healthcare-associated diarrhea and recurs in anywhere from 12 to 64% of patients. C. difficile infection (CDI) is usually managed with antibiotics; however, severe disease may be refractory to medication therapy. Fecal microbiota transplant (FMT) has been evaluated as an alternative treatment modality in the management of severe medication-refractory and recurrent CDI (RCDI). The guideline outlines steps necessary to ensure that the process of FMT is both safe and efficient for patients at OSUWMC. 

Fragility Fracture: Inpatient Management

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DATE: June 2017 EDITION: 1st

Fragility fracture patients seldom receive adequate treatment for osteoporosis who have high rate of 2" fractures within 2 years.  This guideline aims to improve early treatment and reduce the risk of secondary fracture.​

Gadolinium-Induced Toxicity in Adults

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DATE: September 2017 EDITION: 4th

Gadolinium-based contrast (GBC) agents are safe and toxicity is exceedingly rare. This guideline outlines pregnancy risks associated with GBC use, reviews gadolinium allergies along with nephrogenic systemic fibrosis (NSF), and describes agent-specific indications for gadolinium use. This guideline was developed primarily for non-emergent imaging studies. Emergency study indications may fall outside of this guideline and thus, further communication between the requestor and the radiology attending is indicated.

Headache: Acute

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DATE: February 2016 EDITION: 3rd

This guideline describes the diagnosis, management, and follow-up procedures for patients with acute headaches. It is important to note that this guideline does NOT pertain to patients that present with symptoms suggestive of a life-threatening headache etiology.

Heart Failure

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DATE: August 2017 EDITION: 6th

This guideline describes the management and treatment of patients presenting with symptoms consistent with heart failure. Specific recommendations are provided on the management of acute decompensated heart failure (HF) with reduced ejection fraction, systolic heart failure, and the use of ultrafiltration to remove fluid in patients with acute decompensated heart failure (ADHF).

Heparin-Induced Thrombocytopenia (HIT)

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DATE: November 2016 EDITION: 4th

Heparin-induced thrombocytopenia (HIT) is an immune-mediated reaction to heparin and platelet factor 4 (PF4) complexes resulting in a hypercoagulable state of platelet activation and thrombin generation. If left untreated, HIT carries a 30 – 50 % risk of life or limb-threatening thromboembolic complications. This guideline describes the development of heparin-induced thrombocytopenia along with several treatment options. A diagnostic algorithm is provided to aid in the diagnosis of the condition. 

Hepatorenal Syndrome

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DATE: May 2018 EDITION: 4th

Nearly 40% of nonazotemic cirrhotic patients will develop hepatorenal syndrome (HRS) within 5 years. Moreover, there is a 20% incidence in patients with severe acute liver injury and fulminant hepatic failure. This guideline addresses the diagnosis of hepatorenal syndrome along with management strategies.

Idiopathic Intracranial Hypertension (Pseudotumor Cerebri) Management

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DATE: November 2017 EDITION: 2nd

​Idiopathic Intracranial Hypertension (IIH), also known as pseudotumor cerebri, is a neurological disorder attributable to elevated intracranial pressure. If not properly diagnosed and/or managed, IIH may lead to progressive – and possibly permanent – loss of vision. In addition, patients may be exposed to excessive radiation and/or may make frequent emergency department visits. The goal of this guideline is to provide recommendations for the treatment of IIH in order to increase the likelihood of vision preservation, treatment of co-morbid conditions (i.e., weight management), and symptom alleviation.

Infective Endocarditis

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DATE: April 2016 EDITION: 4th

Infective endocarditis (IE) is an infection of the endocardial surface of the heart that previously prompted  widespread use of antimicrobial prophylaxis. However, existing evidence does not support the extensive use of antibiotic prophylaxis as it may lead to an increased risk of the development of multi-drug-resistant organisms, anaphylaxis, side effects of unnecessary antibiotic administration, and excessive costs to the health care system.  This guideline provides information on conditions and procedures for when antibiotic prophylaxis is appropriate. 

Tools

National Guidelines and References

Policies and Procedures

Inflammatory Bowel Disease Severe Colitis

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DATE: April 2018 EDITION: 2nd

The guideline provides direction on the inpatient management of IBD related severe colitis, the identification of patients who may require rescue therapy, and treatment options to minimize associated complications while easing the patient through the transition of inpatient to outpatient care.

Intracerebral Hemorrhage (ICH)/ Intraparenchymal Hemorrhage (IPH) Management

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DATE: January 2018 EDITION: 8th

This guideline provides guidance on the diagnosis and treatment of intracerebral hemorrhage (ICH)/ intraparenchymal hemorrhage (IPH). The treatment options discussed include both pharmacological and surgical means

Ischemic Stroke

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DATE: May 2018 EDITION: 7th

This guideline addresses the diagnosis and treatment of a patient presenting with symptoms of an ischemic stroke.  Varying diagnostic plans are outlined dependent on the age of the patient. The guideline also includes recommendations pertaining to pharmacological treatment, endovascular care, surgical care, and discharge planning. 

Liver Failure: Management of Acute Failure and Pre-Transplant Steps

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DATE: May 2018 EDITION: 6th

This guideline is designed to aid in rapid identification of patients with possible acute liver failure and to identify a core group of consultants with expertise in transplantation and complications of liver disease.  The guideline further outlines the management and daily care of patients with acute liver failure.

Lower GI Bleeding

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DATE: October 2018 EDITION: 1st

​This guideline will standardize care, especially for high risk hospitalized populations such as those with multiple co-morbidities and the elderly.

Tools

National Guidelines and References

Policies and Procedures

Lung Resection: Lobectomy, Segmentectomy, Wedge Resection

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DATE: January 2018 EDITION: 5th

Lung resection is the surgical removal of all or part of the lung due to the development of lung cancer or other lung diseases. This guideline presents information on patient assessment, consults, nutrition and activity requirements, respiratory requirements, patient education, and discharge planning.  The three lung resection procedures discussed include:

  • Lobectomy removes one lobe of the lung
  • Segmentectomy removes areas of the lung along with their veins, arteries, and airways
  • Wedge resection removes an area of the lung that includes part of one or more lobes

 

 

Lung Volume Reduction Surgery

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DATE: July 2018 EDITION: 5th

The Ohio State University Wexner Medical Center is certified by The Joint Commission as one of the locations in the United States able to perform lung volume reduction surgery (LVRS). This surgery reduces the size of the lungs damaged by emphysema by removing some of the most diseased parts of the lungs. Having LVRS will allow the remaining lung to function more normally. This guideline presents the protocol for lung volume reduction surgery including labs and imaging, post-operative care, and patient discharge.   

Non-Invasive Mechanical Ventilation in Respiratory Failure

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DATE: April 2018 EDITION: 1st

This guideline is intended for acutely decompensating patients requiring short-term (hours to days) therapy of mechanical ventilation.  It standardizes initiation, maintenance and discontinuation of non-invasive mechanical ventilation (NIMV) and helps guide clinicians in recognizing inadequate responses to NIMV and initiating escalation of care.  This guideline does not apply to patients already on NIMV being downgraded or transferred from a higher level of care.

Tools

National Guidelines and References

Policies and Procedures

Obesity: Outpatient Weight Screening and Management in Adults

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DATE: March 2019 EDITION: 1st

​Obesity is a complex condition that occurs when a person carries excess weight or body fat that can increase risk for heart disease, diabetes and high blood pressure.  This guideline aims to provide recommendations for weight management for patients with BMI >25.  ​

Tools

National Guidelines and References

Policies and Procedures

Obstetrical Issues

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DATE: September 2017 EDITION: 4th

This guideline describes the management of some of the most common obstetrical issues. Specifically, some of the topics include the prevention of neonatal sepsis, the use of antenatal corticosteroids for fetal maturation, scheduled as well as elective deliveries, and induction/augmentation of labor. Moreover, information on the use of episiotomies and the proper management of postpartum depression is included.

Obstructive Sleep Apnea

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DATE: April 2018 EDITION: 5th

Obstructive sleep apnea (OSA) is a common and potentially life-threatening medical disorder that prevents proper airflow when a patient is asleep. This guideline addresses preoperative/pre-procedure screening of patients who may have obstructive sleep apnea or have previously been diagnosed with obstructive sleep apnea.  The guideline further addresses post-operative and post-procedural care for these patients.

Opioid Abuse and Diversion Potential - Inpatient Management

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DATE: August 2018 EDITION: 4th

The guideline aims to standardize patient care and empower the healthcare team in situations involving aberrant medication behaviors. Risk factors for aberrant behaviors are outlined along with preventative interventions to be used at clinician discretion or by RN per protocol.

Orthopedic Clinical Pathway: Total Shoulder Replacement

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DATE: September 2017 EDITION: 2nd

The pathway describes the care of a patient undergoing a total shoulder replacement from the time of pre-procedure to post-operative day 3. Areas of care include desired patient outcomes, assessments, consults/tests, medications/IV therapy, nutrition, activity, interventions, education, and discharge planning.

Tools

National Guidelines and References

Policies and Procedures

Palliative Ventilator Withdrawal

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DATE: April 2017 EDITION: 5th

This guideline focuses on the process of palliative ventilator withdrawal (PVW) once the decision to withdraw Life-Prolonging Treatment (LPT) has been made. Patient assessment and practical procedures for ventilator withdrawal are presented along with symptom management, treatment recommendations, and precautions.  Ultimately, the decision to withdraw LPT is complex and should be individualized.

Pancreatitis: Acute

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DATE: February 2019 EDITION: 4th

Acute pancreatitis is an inflammatory condition of the pancreas resulting in severe abdominal pain. This guideline addresses recognition, assessment, and management of acute pancreatitis. Pancreatic necrosis is also discussed in the guideline.

Paracentesis

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DATE: August 2017 EDITION: 1st

Paracentesis is a procedure to take out fluid that has collected in the abdominal ​(peritoneal) cavity.  This buildup of fluid is called ascites.  Ascites may be caused by infection, inflammation, an injury or other conditions, such as cirrhosis or cancer.  The fluid is removed using a long, thin needle put through the abdomen.

Tools

National Guidelines and References

Policies and Procedures

Pneumonia: Community Acquired (CAP)

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DATE: April 2016 EDITION: 6th

Almost all major decisions in the management of Community-Acquired Pneumonia (CAP) depend on initial assessment of severity. This guideline presents the protocol for the evaluation and management of community-acquired pneumonia (CAP) through the use of prognostic models such as the CURB-65. 
 

Pneumonia: Hospital-Acquired and Ventilator-Associated (HAP/VAP)

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DATE: April 2018 EDITION: 1st

​This guideline assists clinicians in treating patients with hospital-acquired pneumonia (HAP or VAP) to determine appropriate diagnostic workup, initial antibiotic selection and follow-up treatment.  This guideline does not apply to patients with healthcare-associated infection such as those transferred from nursing and long term care facilities.

Tools

National Guidelines and References

Policies and Procedures

Post Fall Assessment

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DATE: October 2017 EDITION: 2nd

The guideline aims to standardize patient care and reduce variation in practice post fall. The guideline includes an algorithm that details the sequential steps in the treatment of a patient following a witnessed or suspected fall. Further recommendations include the use of an ISBAR communication, potential imaging options, and risk factors for various complications as well as how to mitigate those risk factors. 

Postpartum Hemorrhage

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DATE: May 2017 EDITION: 3rd

Postpartum hemorrhage (PPH) is an obstetric emergency that requires a prompt response. Fortunately, most women with PPH are quickly identified and can be treated satisfactorily without the need for intensive care. Whether in simple or advanced refractory cases, it is critical to maintain a team approach with nursing, physicians, and blood bank to optimize outcome. This guideline addresses the diagnosis, management, and treatment of postpartum hemorrhage. Risk factors and causes of postpartum hemorrhage are further discussed. 

Preoperative Testing and Medication Management

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DATE: June 2017 EDITION: 2nd

This guideline was developed with the purpose of preventing unnecessary preoperative testing as well as OR cancellations due to inadequate patient preparation. The guideline includes recommendations on preoperative evaluation and testing in patients scheduled to undergo non-cardiac procedures. The guideline also includes recommendations for medication management prior to procedures. Decisions for individual medication therapies should be evaluated based upon the patient’s medication allergies and prior adverse reactions, medical problems/comorbidities, and the specific surgery being performed/need for neuraxial anesthesia.

Pulmonary Hypertension

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DATE: February 2018 EDITION: 3rd

Pulmonary hypertension (PH) is a complex lung disorder that  if left untreated can result in damage to the right side of the heart. This guideline addresses the diagnosis, and treatment of both acute pulmonary hypertension as well as chronic pulmonary hypertension.

Pyelonephritis Management

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DATE: October 2018 EDITION: 5th

This guideline addresses the diagnosis and management of acute pyelonephritis. Moreover, specific guidance is provided on the antibiotics of choice for acute uncomplicated pyelonephritis and acute complicated pyelonephritis. NOTE: This guideline does not apply to chronic or recurrent pyelonephritis.

QTc Prolongation and Prevention of TdP

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DATE: February 2019 EDITION: 2nd

​Torsades de Pointes (TdP) is a ventricular tachycardia characterized by a twisting of the peaks of the QRS complex across the isoelectric line and is associated with a long QT or QTc.  TdP is often associated with prolonged corrected QT intervals (QTc).  This guideline was developed to help standardize treatment as well as prevent under- and over-monitoring QTc intervals.

Tools

National Guidelines and References

Policies and Procedures

Refractory Hypoxemia

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DATE: April 2018 EDITION: 3rd

Acute respiratory failure attributable to either severe acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) is a challenging medical condition that requires the rapid escalation of medical therapy. The guideline discusses various interventions and procedures that can be utilized to treat refractory hypoxemia such as prone ventilation, inhaled vasodilators, high-frequency ventilation (HFOV), and extra-corporeal membrane oxygenation (ECMO).The guideline also provides a decision tree, that when implemented, provides the highest likelihood of eliminating refractory hypoxemia by the most efficient means possible.

Sepsis: Initial Management

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DATE: October 2017 EDITION: 4th

This guideline provides guidance on important components of managing patients with severe sepsis including how to RECOGNIZE the severity of the infection, RESUSCITATE all patients with shock or high lactate, REASSESS treatment effectiveness, and PREVENT complications.

Sickle Cell Anemia: Acute Pain Crisis

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DATE: April 2018 EDITION: 6th

The guideline describes the initial assessment and diagnosis of a patient presenting with acute pain associated with sickle cell anemia. Pain management as well as other treatment and intervention options are discussed in combination with patient education prior to discharge.

Staphylococcus aureus Bacteremia in Adults: Diagnosis and Management

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DATE: May 2017 EDITION: 3rd

Staphylococcus aureus bacteremia is associated with high morbidity, mortality, and healthcare costs. The guideline contents include an algorithm for diagnosis and management of S. aureus bacteremia in adult patients, guidance on antimicrobial agents of choice and dosing recommendations, and related protocols.  

Status Epilepticus (SE): Management

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DATE: January 2018 EDITION: 2nd

 

Patients suffering from status epilepticus (SE) require emergent, targeted treatment. The guideline ultimately aims to standardize the process to achieve rapid seizure control and provide guidance on the appropriate use of multimodal monitoring. Specifically, the guideline provides recommendations for diagnosing, monitoring, managing, and providing continued care to SE patients.

 

Steven Johnson Syndrome (SJS)/Toxic Epidermal Necrolysis (TEN)

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DATE: November 2017 EDITION: 5th

Steven Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are rare, acute, life-threatening dermatological diseases characterized by diffuse superficial sloughing of the epidermis (< 20% sloughing in patients with SJS, and > 40% sloughing in patients with TEN). Approximately 95% of TEN cases and 50% of SJS cases are reported to be drug related. This guideline addresses the diagnosis, and management of Steven Johnson Syndrome(SJS) and Toxic Epidermal Necrolysis (TEN). 

Subarachnoid Hemorrhage: Management

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DATE: March 2019 EDITION: 6th

Aneurysmal Subarachnoid Hemorrhage (SAH) is a medical emergency that is frequently misdiagnosed. This guideline focuses on the assessment, confirmatory diagnosis, and treatment of SAH. Further information is provided on possible complications that may arise among this population.

Surgical Management of Obesity

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DATE: April 2017 EDITION: 4th

This guideline presents modalities that can be utilized to surgically manage obesity. The procedures discussed include Laparoscopic Adjustable Gastric Banding (LAGB); Sleeve Gastrectomy; Roux-en-Y Gastric Bypass (RNYGB and Intra-gastric Balloons

Surgical Site Infections (SSIs): Prevention

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DATE: April 2018 EDITION: 3rd

Surgical site infections (SSIs) represent a significant portion of healthcare-associated infections in the United States every year. The majority of SSIs are largely preventable and thus this guideline addresses various preoperative, intraoperative, and postoperative measures that can be taken to help reduce the risk of surgical site infections among patients. 

Syncope: Evaluation and Disposition

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DATE: October 2018 EDITION: 3rd

Syncope is a transient, self-limited loss of consciousness associated with an inability to maintain postural tone that spontaneously resolves. It is distinct from seizures, coma, shock, or other states of altered consciousness. The most common possible cause of syncope is a transient fall of systemic arterial pressure to a level below the minimum needed to sustain cerebral blood flow. The guideline provides recommendations on examinations that may be helpful in diagnosing the patient along with proper management. 

Targeted Temperature Management (Induced Hypothermia )

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DATE: September 2018 EDITION: 5th

Use of induced hypothermia has been shown to decrease the severity of ischemic brain damage for improved neurological outcomes at 6 months after cardiac arrest. Induced hypothermia has also been shown to be effective for refractory intracranial pressure (ICP) elevations. This guideline describes the use of hypothermia in patients following cardiac arrest in order to decrease the likelihood of ischemic brain damage and to increase the chance for favorable neurological outcomes.

Testicular Pain

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DATE: November 2017 EDITION: 4th

This guideline addresses the management of testicular pain in the adult population. Overall, the guideline provides recommendations for symptom management depending on whether the patient is deemed to be at low or high risk for testicular torsion.  

Tools

National Guidelines and References

Policies and Procedures

Thoracolumbar Spine Trauma

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DATE: January 2017 EDITION: 4th

This guideline addresses the process of thoracolumbar-spine trauma clearance of both evaluable patients as well as non-evaluable patients. It is important to note all blunt trauma patients should be considered as having a TL spine injury until proven otherwise.

Tobacco Cessation: Inpatient Clinical Protocol

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DATE: May 2016 EDITION: 3rd

The aim of this guideline is to provide recommendations for the treatment of nicotine dependent inpatients in an attempt to improve their hospital stay and overall quality of life. This guideline discusses tobacco cessation among patients through use of the “5As” model and various pharmacotherapies that target nicotine dependency.

Transfusion Therapy: Indications for Ordering

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DATE: January 2018 EDITION: 5th

This guideline is NOT applicable to situations requiring massive transfusion of blood products. Rather, this guideline addresses the various indications for ordering transfusion therapy for patients along with the various forms of therapies that can be used.  Transfusion components discussed include PRBCs, platelets, FFP, thawed plasma, cryoprecipitate, therapeutic plasma exchange (TPE), irradiated blood products, and cytomegalovirus negative blood products (CMV).

Transient Ischemic Attack (TIA)

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DATE: May 2018 EDITION: 3rd

The guideline provides information on diagnostic confirmation of transient ischemic attack (TIA) as well as appropriate patient care for those admitted versus those seen in the CDU. The guideline also includes information on managing risk factors associated with TIA, and treatment recommendations.

Upper GI Bleeding

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DATE: August 2017 EDITION: 5th

This guideline describes the symptoms of possible upper GI bleed and ultimately the diagnosis of an upper GI bleed through focused assessment with initial labs. Steps in management of high-risk and low-risk patients are also discussed. The first priority is to ensure that the patient is hemodynamically stable, which often requires admission to the ICU for monitoring and fluid resuscitation.

Urinary Tract Infection in Adult Patients: CAUTI Prevention

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DATE: August 2017 EDITION: 4th

Catheter-associated UTIs account for the highest number of healthcare-associated infections. This guideline discusses the considerations for catheter use, proper insertion techniques, and catheter maintenance.

Urinary Tract Infection in Adult Patients: Diagnosis and Management

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DATE: April 2018 EDITION: 3rd

Urinary tract infections (UTIs) are among the most common bacterial infections. The aim of this guideline is to simplify UTI workup so that there is a reflex to urine culture ONLY when the urinalysis has significant findings and to standardize treatment of patients with confirmed UTIs. The guideline provides direction on treatment considerations for patients with symptoms and a positive urinalysis. A table is included to direct providers on the proper empiric treatment to use based on UTI severity and renal function.

Ventricular Assist Devices

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DATE: January 2018 EDITION: 7th

Ventricular assist devices (VAD) are mechanical pumps that can be used to support heart function and blood flow in patients with weakened hearts. This guideline discusses the risks and benefits of using a ventricular assist device.

Wound Care Management

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DATE: September 2017 EDITION: 3rd

Wound care requires diagnosis and management by a wound care specialist. Proper treatment of skin impairments can improve patient outcomes while saving both time and money. However, when interventions for cutaneous compromise are not diagnosed and/or not managed appropriately, limbs as well as lives are lost. Inappropriate interventions can lead integumentary morbidities to become chronic, expensive, and debilitating. This guideline reviews the diagnosis and subsequent treatment of wounds. 

 

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