Clinical Pathways & Guidelines

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ADHD (Attention-Deficit/Hyperactivity Disorder) 

(See under "Mental Health")

Albumin Use

• Guidelines
• Albumin Ordering Changes in Sunrise (Jun 09)
• Albumin Guidelines from Med Assets

Alzheimer's Disease

(See under "Dementia")

Aminoglycoside Dosing Guidelines

(See under "Antibiotics")

Angina (chronic, stable)

(See under "Cardiology")

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Antibiotics

• Aminoglycoside Dosing Guidelines for Adults (for Pediatric dosing see under "Pediatrics")
• Antibiograms,  Inpatient and Outpatient
• Antibiotic and Ethanol Lock Protocol
• Criteria for Use of Restricted Antimicrobials
• Linezolid Guidelines for Use
• Macrolide Guidelines for Use
• Neonatal Sepsis Antibiotic Guideline (See under "Neonatology")
• Pocket Guides (Antibiotics, Antifungals, Antiretrovirals)
• Treatment of Clostridium Difficile Clinical Pathway
• Vancomycin Dosing Guidelines for Adults  (For Pediatric dosing see under "Pediatrics")

Anticoagulation

Drug Guidelines

Adult

• Adult Impella Catheter Unfractionated Heparin Infusion Protocol (See under "Cardiology")
• Apixaban (Guidelines for Use, Restricted to use according to these algorithms: Non-valvular Afib Algorithm, VTE Algorithm)
• Argatroban Dosing Protocol
• Bridging- Management of Anticoagulation in the Peri-Procedural Period
• DVT Prophylaxis Guidelines (see under VTE below)
• ECMO Protocols (See "ECMO")
• Enoxaparin, Dalteparin and Fondaparinux for Treatment (Dosing and Monitoring Guideline)
• Enoxaparin AntiXa Monitoring Dose Adjustment Table
• Fondaparinux
• Kcentra® (for the treatment of life threatening bleed in patients on warfarin/apixaban/rivaroxaban, see under "Bleeding Disorders")
• Oral Anticoagulant Pocket Card Reference
• Oral Anticoagulation Reversal Algorithm (See under "Bleeding Disorders")
• Praxbind® ( for patients on dabigatran who are bleeding or in need of emergent surgery, see under "Bleeding Disorders")
• Regional Anesthesia During Antithrombotic Therapy
• Rivaroxaban (Guidelines for Use, Restricted to use according to these algorithms: Non-valvular Afib Algorithm, VTE Algorithm)
• Thrombate III Algorithm for Use in Cardiopulmonary Bypass
• Transitioning Between Anticoagulants Reference Table
• Treatment of Hemorrhage in Patients with an elevated INR (See under "Bleeding Disorders")
• Unfractionated Heparin
  • Heparin Infusion Protocol VTE/Afib/ACS
  • High Bleed Risk Heparin VTE Protocol (Trauma/Vascular ICU Patients)
  • Subcutaneous Heparin for Treatment Drug Information
• VTE Prophylaxis Guidelines
• VTE Treatment Duration Algorithm
• Warfarin-Anticoagulation Therapy Guideline (Inpatient and Outpatient)

Pediatric

• ECMO Protocols (See "ECMO") 
• Enoxaparin Pediatric Dosing and Monitoring Protocol
• Heparin Infusion in the Neonate/Pediatric Cardiac Post-Surgical or Post-Transcatheter Intervention Population Guideline
• Unfractionated Heparin (Treatment Dose) Pediatric Infusion Protocol
• Warfarin Pediatric Protocol

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Lectures, Articles, Formulary Flashes, Memos

• APTT, heparin, HIT and direct thrombin inhibitors (Memo from Dr. John Olson, UHS Lab Director)
• Anticoagulation Safety Initiatives (Formulary Flash to education staff on the UHS Anticoagulation Program and JC requirements)
• Anticoagulants: New and Old and what lies beneath (Ted Arevalo, MD, Hospital Medicine, Grand Rounds October 2015)
• Antithrombotic Guidelines for VTE CHEST 2016
• Heparin Induced Thrombocytopenia (Formulary Flash to help increase awareness)
• Heparin Induced Thrombocytopenia (Formulary Flash to help optimize diagnosis and treatment)
• Heparin vs LMWHs vs Fondaparinux (Formulary Flash comparing parenteral anticoagulants)
• Heparin Assay Faculty Memo (Dr. Higgins, Hematology Lab Director)
• Heparin Monitoring Change (Formulary Flash from May 2009 describing assay change by the Lab)
• Oral Anticoagulant Considerations (Formulary Flash comparing the novel oral anticoagulants to warfarin)

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Patient Education

• Dalteparin Patient Ed Brochure (English and Spanish)
• Enoxaparin Patient Ed Brochure (English and Spanish)
• Enoxaparin 60mg Syringe Teaching Template (English and Spanish)
• Enoxaparin 80mg Syringe Teaching Template (English and Spanish)
• Enoxaparin 100mg Syringe Teaching Template (English and Spanish)
• Enoxaparin 120mg Syringe Teaching Template (English and Spanish)
• Enoxaparin 150mg Syringe Teaching Template (English and Spanish)
• Fondaparinux Patient Ed Brochure (English and Spanish)
• Vitamin K Content Handout (English and Spanish)
• Warfarin Patient Ed Brochure (English and Spanish)

Policies

• Inpatient Anticoagulation Stewardship Program
• Inpatient Warfarin INR Monitoring Policy
• Outpatient Anticoagulation Management Protocol
• Outpatient Anticoagulation Clinic Lab Requirements
• Pediatric Enoxaparin Dispensing Policy
• Warfarin Unit-Dose Dispensing Policy

Argatroban Use

(See under "Anticoagulation")

Asthma or COPD Management (Outpatient)

• UHS Chronic Outpatient Pharmacologic Management of Asthma (2008)
• General Information (NIH website: National Heart Lung & Blood Institute)
• Homepage for the Global Initiative for Asthma (GINA)
• Homepage for the Global Initiative for Chronic Obstructive Lung Disease (GOLD)
• Omalizumab (Xolair)
• RAMP Algorithm (Respiratory Assessment and Management Protocol) (See under "Pediatrics")

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Atrial Tachyarrhythmias

(see "Cardiology")

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Benign Prostatic Hyperplasia (BPH)

• UHS Guidelines
• National Guidelines

Bleeding Disorders

• Clotting Factor Reference table for UHS
• Guideline for Reversal of Antithrombotics in Intracranial Hemorrhage NCCS/SCCM 2015
• Hemophilia - Algorithm for the Management of Bleeding in Hemophilia
• Hemophilia Emergency Center Pathways
  
  • CNS Injury Hemophilia Pathway
  • Fever CVAD Hemophilia Pathway
  • Hemlibra Hemophilia Pathway
  • Hematuria Hemophilia Pathway
  • Non-CNS Bleed Hemophilia Pathway
• Kcentra (See the "Oral Anticoagulation Reversal Algorithm" below)
• Oral Anticoagulation Reversal Algorithm (for patients on warfarin, rivaroxaban, apixaban, and dabigatran who are bleeding or in need of emergent surgery)
• Praxbind (See the "Oral Anticoagulation Reversal Algorithm")
• Tranexamic Acid (TXA) for Traumatic Hemorrhage Clinical Pathway

Breast and Cervical Cancer

• Department of State Health Services Breast and Cervical Cancer Information

Cardiology

• Acute Coronary Syndrome (ACS)
  • Angina (Chronic, Stable)
    • Algorithm
    • Critical Pathway
    • References
  • Antiplatelet Therapy Algorithm for ACS
  • NSTE-ACS
    • Non-ST-elevation acute coronary syndromes AHA/ACC 2014
• Adult Impella Catheter Unfractionated Heparin Infusion Protocol
• Atrial Tachyarrhythmias
  • Risk Stratification for Arrhythmic Events in Asymptomatic Pre-Excitation: Systematic Review of SVT Guidelines
  • Supraventricular Tachycardia Guidelines ACC AHA HRS 2015
  • Tachyarrhythmias with Pulse Algorithm 2015
• Congestive Heart failure (Acute and Chronic)
  • ACE Inhibitor Intolerance
  • Aldosterone Antagonist Use in CHF
  • Beta-blocker Use in CHF
  • Corlanor Algorithm (Outpatient CHF Clinics only)
  • Diuresis Algorithm
  • Diuretic Use in Acute CHF
  • Entresto Algorithm (Outpatient CHF Clinics only)
  • Heart Failure Guidelines ACCF/AHA 2013
  • Nesiritide (Natrecor) Position Statement (December, 2003)
• Dofetilide Initiation and Monitoring Guideline
• GP IIb/IIIa Adult Cardiology Treatment Dosing and Monitoring Guidelines
• Guidelines for the Prevention of CVD in Women - Evidence-Based AHA Guidelines
• Hyperlipidemia Guidelines 2016 (See "Hyperlipidemia")
• Sotalol Initiation and Dosage Titration Guideline

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Cervical Cancer

(See "Breast and Cervical Cancer")

Cholesterol

(See "Hyperlipidemia")

Cilostazol

• Guidelines for Use with PAD-Induced Claudication

Clostridium difficile

• Clinical Practice Guidelines 2010 from IDSA SHEA
• Treatment Guidelines

Code Blue Drugs and Guidelines

• Pocket Guidelines (March 2013)
• Protocol for tPA Use in Adult Cardiac Arrest

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Community Acquired Pneumonia

(See Under "Infectious Diseases")

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Constipation

(See Under "GI Disorders")

Contraceptives

• Emergency Contraception Algorithm
• U.S. Medical Eligibility for Contraceptive Use, 2010 from the CDC

Critical Care

• Analgesia and Sedation Protocols for the Mechanically Ventilated Patient
  • Adult Weight-Based Dosing Protocol
  • STICU Protocol
• Electrolyte Replacement Protocol- Oral and Enteral Routes of Administration
• Inhaled Epoprostenol (Flolan) Administration Guideline for Patients with ARDS
• Ketamine Continuous Infusion for Pain Management in the STICU (For other Ketamine guidelines see "Neurocritical Care")
• Protocol for tPA Use in Adult Cardiac Arrest

CroFab

(See "Snakebites")

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CVA

(See "Stroke")

Darbepoetin Alfa Guidelines

• Use with Chemotherapy
• Use in CRF

Dementia

• Dementia and Cognitive Impairment Guidelines 2012
• Dementia Clinical Pathways

Depression

(See "Mental Health")

Diabetes

• Diabetic Neuropathy Guidelines AAN 2011
• Inpatient Glycemic Control - AACE-ADA Consensus Statement May 2009
• UHS Outpatient Glycemic Control Algorithm for Adults with Type 2 Diabetes
• UHS Pharmacological Algorithm for the Management of Painful Diabetic Neuropathy
• Metformin Guidelines
• New-Onset Diabetes After Transplantation - 2003 Consensus Guidelines
• New-Onset Diabetes After Transplantation - Addendum to 2003 Guidelines
• Pioglitazon Guidance to UHS Providers

DVT Prophylaxis

(see "Anticoagulation")

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Epilepsy

• Antiepileptic Therapy Guidelines
  • Generalized Seizures
  • Partial Seizures
• Pediatric guidelines (See "Pediatrics")
• Status Epilepticus in the Neuro ICU (See "Neurocritical Care")

Exposure Pathways

• CDC Emergency Needlestick Information

ECMO-Extracorporeal Membrane Oxygenation

• ECMO Circuit Prime and Electrolyte Correction Protocol
• ECMO Unfractionated Heparin Management Protocol

Factor VII/NovoSeven

(See Hemophilia Algorithm under "Bleeding Disorders")

Factor IX Complex Concentration (Profilnine)

(See Treatment of Hemorrhage in Patients with an Elevated INR under "Bleeding Disorders")

FEIBA

(See Hemophilia Algorithm under "Bleeding Disorders")

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Fentanyl

• Comparison of Fentanyl with Morphine

Fomepizole Use

• Clinical Pathway

Genital Warts

• Pathway

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GI Disorders

• Constipation- Opioid Induced Constipation
• GERD (Gastroesophageal Reflux Disease)
  • AGA Position Statement on GERD 2008
  • Metoclopramide Issues
  • FDA Alert Regarding Metoclopramide
• Nausea and Vomiting
  • Scopolamine Transdermal Patch Algorithm

Hemophilia

(See under "Bleeding Disorders". A clotting factor reference table is also available in this section.)

Heparin-Induced Thrombocytopenia

(See under "Anticoagulation")

Hepatitis B

(See under "Infectious Diseases")

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Hepatitis C

(See under "Infectious Diseases")

HIV Disease

(See under "Infectious Diseases")

Hyperalimentation Orders

(See "Parenteral Nutrition Orders")

Hyperlipidemia

• Hyperlipidemia Guidelines 2016
• Dyslipidemias Guidelines Summary 2014 ACC/AHA

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Hypertonic Saline Use

• Hypertonic Saline for Symptomatic Hypotonic Hyponatremia (See under "Nephrology")
• Neurocrtical Care Protocol for Hypertonic Saline Bolus and Continuous Infusion (See under "Neurocrtical Care")
• Neurosurgery Hypertonic Saline Weaning Protocol (See under "Neurocrtical Care")

Infectious Diseases

• Community Acquired Pneumonia
  • IDSA-ATS Guidelines for the Management of Community-Acquired Pneumonia in Adults
  • UHS Guidelines -- Antibiotic Therapy for Community-Acquired Pneumonia
  • Procalcitonin Algorithm for Pneumonia
• Bacteremia
  • Staph Aureus Bacteremia Treatment Algorithm
• HIV Diseases
  • Link to Guidelines for Prevention & Treatment of Opportunistic Infections
  • Link to Guidelines for use of Antiretroviral Agents
• Hepatitis B
  • Chronic Hepatitis B - Update 2009
• Hepatitis C
  • HCV Testing, Managing, and Treatment  IDSA/AASLD 2015
• Malaria
  • Malaria Treatment Algorithm for Adults
• MRSA Eradication Protocol
• Scabies
  • Guidelines
  • Safety of Topical Lindane Products
• Tuberculosis
  • Care Path

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Iron Guidelines

• Iron Sucrose Guidelines for Use

Kcentra®

(for patients on warfarin/apixaban/rivaroxaban with life threatening bleeds or need for emergent surgery, see "Bleeding Disorders")

Ketamine

(See various guidelines posted under "Critical Care" and "Neurocritical Care")

Linezolid Use

(See under "Antibiotics")

Macrolide Use

(See under "Antibiotics")

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Malaria

(See under "Infectious Diseases")

Mental Health

ADHD

• UHS Guidelines
• ADHD National Guidelines from American Academy of Child & Adolescent Psychiatry 2003
• ADHD National Guidelines from American Academy of Pediatrics 2011
• Teacher Evaluation (before patient is on medication)
• Teacher Evaluation (after patient is on medication)        

Bipolar Disease Pathways

• Bipolar Disease Treatment Guidelines - American Psychiatric Association (APA)
• TDMHMR Psychotropic Drug Maximum Dosage Guidelines

Depression Pathways

• Ketamine Administration for Depression (Algorithm, Guideline)
• Major Depressive Disorder Treatment Guidelines - American Psychiatric Association (APA)
• TDMHMR Psychotropic Drug Maximum Dosage Guidelines
• Patient Information Sheet (Tricyclics)
• Patient Information Sheet (SSRI's)
• Patient Information Sheet (Atypicals)
• Patient Information Sheet (MAO Inhibitors)
• Hamilton Depression Scale (Page 1)
• Hamilton Depression Scale (Page 2)

Schizophrenia Pathways

• Schizophrenia Patient Outcomes Research Team (PORT) Treatment Recommendations
• TDMHMR Psychotropic Drug Maximum Dosage Guidelines
• Schizophrenia Disease Management Program
• Schizophrenia Rating Scale
• Reference Guide for Schizophrenia Rating Scale
• Antipsychotic Medication Dosing and Side Effects Tables
• Antipsychotic Medication Side Effects Management Algorithm
• Drug Information Sheet (Typical Neuroleptics)
• Drug Information Sheet (Atypical Neuroleptics)
• Drug Information Sheet (Clozaril)
• Drug Information Sheet ("Depot" Injectable Typical Neuroleptics)
• Clozapine Registry Information for Providers
• Clozapine Requirements for Pharmacists
• Non-formulary Depot Atypical Antipsychotics-Procedures for Administration, Psychotropic Subcommittee Report

Methadone Use

• Guidelines for Methadone Use

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Migraine

• Algorithm for Outpatient Treatment of Acute Migraine Headaches
• Algorithm for Outpatient Prevention of Migraine Headaches

Neonatology

• Erythropoietin Usage Guidelines in Anemia of Prematurity
• Neonatal Abstinence Syndrome (NAS) Guideline
  • Modified Finnegan's Neonatal Abstinence Scoring Tool
• Neonatal Sepsis Antibiotic Guideline
• Neonatal Trace Element Guideline for Parenteral Nutrition
• RSV Prophylaxis Guidelines
• NICU Ethanol Lock Protocol
• Guideline for the Treatment and Care of Peripheral Intravenous Extravasations Infiltration in Neonates

• Rocuronium for Neonatal Intubation

Nephrology

• Hyperphosphatemia in CKD- Algorithm
• Hypertonic Saline for Symptomatic Hypotonic Hyponatremia
• Secondary Hyperparathyroidism Related to CKD- Algorithm 

Neurocritical Care

• Anti-Shivering Protocol for neurosurgery
• Neurocritical Care Protocol for Hypertonic Saline Bolus and Continuous Infusion
• Hypertonic Saline Guidelines for Use in Pediatrics (See "Pediatrics")
• Ketamine for Analgesia in the Neuro-ICU
• Ketamine for ICP Control in adults
• Neuro ICU Normothermia Protocol
  
• Neurosurgery Hypertonic Saline Weaning Protocol
• Opioid Induced Constipation (See "GI Disorders")
• Subarachnoid Hemorrhage Guideline
• Severe Traumatic Brain Injury Protocol

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Neurology

• Algorithm for the Treatment of Relapsing Multiple Sclerosis
• Glatiramer acetate (Copaxone®) Algorithm in Multiple Sclerosis
• Natalizumab (Tysabri®) Algorithm in Multiple Sclerosis
• Tocilizumab (Actemra® Algorithm in Neuromyelitis Optica and NMO Spectrum Disorders

Occupational Exposure

(See "Exposure Pathways")

Ophthalmology

• Ophthalmology Guidelines for Use of Aflibercept

Osteoarthritis

• Guidelines
• GI Assessment Tool

Osteoporosis

• National Osteoporosis Foundation Clinician's Guide to Prevention and Treatment of Osteoporosis
• Treatment of Low Bone Density or Osteoporosis to Prevent Fractures - A Clinical Practice Guideline from the American College of Physicians
• WHO Fracture Risk Assessment Tool

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Pain Management

• Guidelines for Opioids in Chronic Noncancer Pain Feb 2009
• Sub dissociative Ketamine for Adult Patient Analgesia in the Emergency Department
• Tramadol Guidelines
• UHS Pain Management Pocket Reference (updated 2013)

Pap Smear

(See under "Breast and Cervical Cancer")

Parenteral Nutrition Orders

• Guidelines for Creating TPN Orders
• Neonatal Trace Element Guideline for Parenteral Nutrition (See under "Neonatology" )

Pediatrics

• Aminoglycoside Dosing for Pediatrics
• Anticoagulation Guidelines (See "Pediatric Anticoagulation Drug Guidelines")
• Antiepileptic Therapy for Traumatic Brain Injury Protocol in Pediatrics(Algorithm)
• Antiepileptic Therapy for Traumatic Brain Injury Protocol in Pediatrics (Discussion and References)
• Code Blue Medication Pocket Guideline (March 2013) - See page 2 for Pedi
• Dexmedetomidine Pediatric Critical Care Guideline
• ECMO Protocols (See "ECMO")
• Electrolyte Replacement Infusions in Pediatrics
• Hypertonic Saline Guidelines for Use in the Pediatric Intensive Care Unit
• Neonatal Sepsis Antibiotic Guideline (See under "Neonatology")
• RAMP Algorithm (Respiratory Assessment and Management Protocol)
• RSV Prophylaxis (See under "Neonatology")
• Vancomycin Dosing for Pediatrics

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Pharyngitis

• Guidelines
• Algorithm

Praxbind®

 (for patients on dabigatran with life threatening bleeds or need for emergent surgery, see "Bleeding Disorders")

Prostate Cancer

• Guidelines for the Management of Clinically Localized Prostate Cancer

Psoriasis

• Algorithm

Pulmonary Hypertension

• Pulmonary Hypertension Treatment Algorithm
• Flolan Guidelines
• Guidelines for Patient Care during Flolan Infusion

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Quinolone Use

(See under "Antibiotics")

Respiratory Infections

• Respiratory Tract Infections Adult Treatment Recommendations
• Respiratory Tract Infections Pediatric Treatment Recommendations

Scabies

(See under "Infectious Diseases")

Seizures

(See under "Epilepsy")

Snakebites

• CroFab - Snakebite Severity Score Flowsheet and Treatment Algorithm

Stroke

• Acute Stroke Protocol – Emergency Center
• Acute Stroke Protocol - Inpatient
• Guideline for Reversal of Antithrombotics in Intracranial Hemorrhage NCCS/SCCM 2015
• Management of Hypertension in Acute Ischemic Stroke
• Management of Intracranial Hemorrhage During and After t-PA Infusion
• Management of Angioedema During and After t-PA infusion
• Intracranial Hemorrhage Protocol
• NIH Stroke Scale
• Algorithm for Secondary Stroke Prevention
• Management of Stroke in Infants and Children

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Subarachnoid Hemorrhage

• Aneurysmal Subarachnoid Hemorrhage Guidelines AHA/ASA 2012

• Subarachnoid Hemorrhage Guideline (See under "Neurocritical Care")

Thrombate III Algorithm for use in CPB

(See under "Anticoagulation")

Total Parenteral Nutrition Orders

(See "Parenteral Nutrition Orders")

Tramadol

(See under "Pain Management")

Tranexamic Acid (TXA)

(See under "Bleeding Disorders")

Tuberculosis

(See under "Infectious Diseases")

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Urinary Incontinence

• Algorithm
• Tables

Vaccine Information

• CDC MMWR website
• Vaccine Information Statements
• CDC General Informations on Vaccines & Immunizations
• San Antonio Metropolitan Health District Vaccine Database (Contact Vivian Flores at 207-2868 if you don't have a password)

Wound Care

• Guidelines

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