Long Island Jewish Medical Center
ADULT CYSTIC FIBROSIS
ADMISSION CHECK LIST
(ORDERS MUST BE ENTERED INTO SUNRISE)
Follow the ABCD’s THEN see below for more instructions
A. Airway: Call respiratory
B. Bacteria: Order antibiotics
C. Calories: Order double portion diet, including diabetic patients
D. Admit to Dr. Rubin Cohen AND contact pulmonary fellow or Dr. Cohen to
review orders
S. Self-Administration: evaluate patient and obtain consent as applicable
A. RESPIRATORY THERAPY
▪ Must Call 11885 Or Page 25-06517 or 25-00077 to do the following:
- To administer FIRST respiratory treatment
 Short Acting Beta Agonist (SABA) MUST be ordered as NOW (Unless the patient states that
he or she does not need a treatment) AND Routine
- TO supply nebulizers for self-administration upon admission, if patient will self-administer
- TO supply VEST or other methods of airway clearance upon admission
- TO assess the need for oxygen therapy
AIRWAY CLEARANCE THERAPY (Choose one) This is provided by RT on admission
- Vest therapy 30 minutes four times per day
- Acapella at bedside
MEDICATIONS
- Patient may self administer ANY of the medications below
- When ordering ensure that the “Care giver / Patient May Administer” box is checked off if the
patient is willing and able to self-administer, please see below for self-administration instructions
- Albuterol (Proventil®) MDI 90 micrograms / actuation or 2.5 mg / 3 mL in normal saline via medication
nebulizer
 usually ordered standing at least every 6 hours during waking hours
- Levalbuterol (Xopenex®) 0.63% Or 1.25% in normal saline via medication nebulizer
 usually should be ordered standing at least every 6 hours during waking hours
 non-formulary and should only be used in select patients who cannot tolerate Albuterol
- Fluticasone / Salmeterol (Advair® Diskus) ___ micrograms fluticasone / 50 micrograms salmeterol
 order 1 puff 2 times per day
- Dornase alfa (Pulmozyme®) 2.5 mg / 2.5 mL in normal saline via medication nebulizer
 order either once or twice daily
Mucolytic
- Hypertonic saline (Hyper-sal®) 3% (15 mL) OR 7% (4 mL) via medication nebulizer
 order either once or twice daily based on patient tolerability
Inhaled
- Tobramycin (TOBI®) 300 mg / 5 mL sterile water via medication nebulizer
antibiotic.
 check with pulmonary whether to continue and order twice daily
Usually
- Colistimethate (Colymycin®) 150 mg in 2 mL sterile water via medication nebulizer 2 times per
not
day
needed if
on IV
- Aztreonam (Cayston®) 75 mg 3 times daily via medication nebulizer
 pharmacy may not have it in stock, patient may bring and use own
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Long Island Jewish Medical Center
ADULT CYSTIC FIBROSIS
ADMISSION CHECK LIST
(ORDERS MUST BE ENTERED INTO SUNRISE)
B. INTRAVENOUS ANTIBIOTICS
- Check Allergies
- Infectious diseases drug approval is REQUIRED for restricted antimicrobials.
 Page 25-06619 on weekdays between 9:00 to 18:00, or the on-call ID fellows on the weekends
- ORDER FIRST IV ANTIBIOTIC DOSE STAT
Doses provided for patients with normal renal function
Treatment of pulmonary exacerbation - Amikacin* ______ mg (18 mg / kg ) IV once daily
in CF patients requires the use of
- Aztreonam (Azactam®) 2 g IV every 8 hours
multiple antibiotics. Choices of
- Cefepime (Maxipime®) 2 g IV every 8 hours
antibiotics is aimed at targeting the
- Ciprofloxacin (Cipro®) 400 mg IV every 8 hours
most common pathogens, Pseudomonas
- Colitimethate (Coly-Mycin® M) 150 mg IV q12 hours **
aeruginosa, Burkholderia cepacia,
- Imipenem/cilastatin (Primaxin®) 500 mg IV every 6 hours
Stenotrophamonas maltophilia,
®
staphylococcus aureus. Patient specific - Linezolid (Zyvox ) 600 mg PO every 12 hours
- Linezolid (Zyvox®) 600 mg IV every 12 hours
choices are based on sputum cultures
- Meropenem (Merrem®) 2 g IV every 8 hours
and previous antibiotic use and not
based on CAP or HCAP guidelines.
- Tobramycin* ____ mg (10 mg / kg ) IV once daily
- Piperacillin/tazobactam (Zosyn®) 4.5 g IV every 6 hours
- Vancomycin* 1 g IV every 12 hours
* Check trough before the fourth dose
**
Monitor for renal impairment, check creatinine twice weekly
C. NUTRITIONAL SERVICES
- Regular, double portions (including for diabetic patients)
- Order Weight on admission and every Monday, Wednesday, Friday
- MUST ORDER Nutrition consult
Dietary Supplement
- Ensure Plus (specify number of cans per meal) (May use other supplement)
D. ADMIT TO DR. RUBIN COHEN AND CONTACT PULMONARY FELLOW OR DR. COHEN TO
REVIEW ORDERS
S. SELF ADMINISTRATION
- Evaluate if the patient is able to self administer their routine medications while in the hospital
- Obtain consent from the patient if he or she is willing to participate in the self-administration program
 consent form is available on 5 North nurses station in a wall file by the computers
- Once consent is obtained indicate all medications allowed for self administration, see above for
respiratory medication and below for all others
MEDICATION ORDERS
Please ensure that the “Care giver / Patient May Administer” box is checked off if the patient is willing
and able to self-administer
- CF patients may, if they so choose, self administer SABA, LABA, ICS, nebulized dornase alfa,
hypertonic saline, nebulized antibiotics (see above) as well as medications noted below
-
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Long Island Jewish Medical Center
ADULT CYSTIC FIBROSIS
ADMISSION CHECK LIST
(ORDERS MUST BE ENTERED INTO SUNRISE)
PANCREATIC ENZYMES REPLACEMENT THERAPY (PERT) : Patients Usually Self-Administer Pert
- PERT available in Electronic Orders: Creon, Pancreaze, Zenpep
For the above agent specify number of capsules WITH MEALS AND WITH SNACKS, orders must be separate . For
example: 4 capsules with meals and _2 capsules with snacks
VITAMINS:
- AquaADEK ____ tablet (s) PO once daily (May Self-Administer)
ANTI-INFLAMMATORY:
- Prednisone ____ mg PO once daily (if needed)
- Azithromycin (Zithromax®) 500 mg three times weekly (if patient is taking at home)
OTHER ORDERS
- Sputum for C & S (or ask patient about their last culture)
- Vital Signs every 8 hours
- U/A and UCx
- Activities: out of bed as tolerated
- Blood cultures X 2, if temperature is greater than 38.5
- Isolation Precautions
degrees centigrade
- CBC, CMP on admission and twice weekly
- HgbA1C should be sent on all diabetic patients
- Chest X-ray: PA and Lateral
- IV Access
- Use existing PICC line Or long term central venous catheter
- Insert Peripheral IV , if no PICC or Port
- PICC line placement Through Interventional Radiology
(order if patient does not have or needs replacement of permanent IV access)
Questions? Please contact any one of the following persons:
Name
Phone
Dr. Rubin Cohen
516-395-0166
LIJMC Pulmonary Fellow on call
Call Operator
5North Nurse Manager (Sarah Karshigeyeva)
Spectralink - 11556
Dietitian (Geralyn LaVecchia)
25-06010
Pharmacist (Magda Fulman)
Spectralink - 11601
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