Active Protocols
Respiratory
Nutrition
Other
Protocol Compliance: 85%
ELGAN 24-28 week pathway (Day 16)
RESPIRATORY GOALS
2/3
Wean FiO2 ? Protocol ✓ Compliant
Protocol-Driven: Based on SpO2 > 92% consistently over 12h
FiO2
35%
→
30%
NICSTEM: Most infants at 26wk tolerate weaning to 25-30% within 48h
Last updated: 2 hours ago
Wean PIP ? Caution ⚠️ Caution
Protocol-Driven: Based on pCO2 < 50 for 24h
PIP
22 cmH2O
→
20 cmH2O
Last ABG: 6 hours ago
Maintain vent rate ? Protocol ✓ Compliant
Protocol-Driven: Based on WOB assessment and blood gas
Rate
40/min
→
40/min
Last updated: 12 hours ago
NUTRITION GOALS
1/1
Advance feeds ? Protocol ✓ Compliant
Protocol-Driven: ELGAN feeding advancement schedule, DOL 16
Volume
2ml q3h
→
4ml q3h
NICSTEM: Feeding tolerance excellent, can consider faster advancement
Last feed: 1 hour ago
OTHER CLINICAL GOALS
3/3
D/C antibiotics ? Protocol ✓ Compliant
Protocol-Driven: 7-day course completion with negative cultures
Status
Day 7/7
→
Discontinue
Final dose: 20:00 today
Monitor PDA ? Protocol ✓ Compliant
Protocol-Driven: Echo follow-up for hemodynamically significant PDA
Action
Observe
→
Echo in 3d
Last echo: 3 days ago
Monitor IVH ? Protocol ✓ Compliant
Protocol-Driven: Weekly HUS for Grade II IVH
Action
Grade II
→
HUS in 7d
Last HUS: 5 days ago
🧠
Neurological System (Warning)
🫁
Respiratory System (Critical)
❤️
Cardiovascular System (Warning)
🍽️
Gastrointestinal System (Normal)
🎋
Renal System (Normal)
🧬
Integumentary System (Warning)
🦠
Infectious Disease (Normal)
⚗️
Endocrine System (Normal)
FiO2 35% ↓ to 30% (SpO2 92-95%)
Grade II IVH: Stable
📝
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History
PROGRESS NOTE - PROTOCOL-DRIVEN
Patient: Serize, Baby Arturo | MRN: 1001236
DOB: 04/10/2025 | GA: 24 1/7 weeks (Corrected: 26 3/7)
DOL: 16 | Weight: 810g (+19.1% from birth)
DOB: 04/10/2025 | GA: 24 1/7 weeks (Corrected: 26 3/7)
DOL: 16 | Weight: 810g (+19.1% from birth)
Auto-generated from EHR data • Click to edit
24 HOUR EVENTS
• Desaturations: 2 significant (SpO2 <85% >20 seconds), self-resolved
• Bradycardia: None
• Apnea: None
• Afebrile
• Blood culture (48h): No growth to date
• Bradycardia: None
• Apnea: None
• Afebrile
• Blood culture (48h): No growth to date
Auto-generated from nursing flowsheets • Click to edit
RESPIRATORY
• Current Support: Conventional ventilation (Rate 40, PIP 22, PEEP 6, FiO2 35% → Target: 30%)
• Blood Gas (6hrs ago): pH 7.29, pCO2 49, pO2 64, HCO3 22, BE -3
• Work of Breathing: Minimal retractions, comfortable on current settings
• Lung Exam: Symmetric breath sounds, scattered fine crackles bilaterally
• Secretions: Thin, minimal
• CXR (2 days ago): Improved aeration, persistent hazy opacities, no focal consolidation
• Stable SpO2 92-95% on current settings
• Protocol Status: ELGAN Respiratory Pathway - FiO2 and Rate compliant
• Blood Gas (6hrs ago): pH 7.29, pCO2 49, pO2 64, HCO3 22, BE -3
• Work of Breathing: Minimal retractions, comfortable on current settings
• Lung Exam: Symmetric breath sounds, scattered fine crackles bilaterally
• Secretions: Thin, minimal
• CXR (2 days ago): Improved aeration, persistent hazy opacities, no focal consolidation
• Stable SpO2 92-95% on current settings
• Protocol Status: ELGAN Respiratory Pathway - FiO2 and Rate compliant
Generated from respiratory assessment • Protocol compliance noted • Click to edit
CARDIOVASCULAR
• HR 150-165, regular
• BP 55/32 (mean 40)
• Capillary refill <3 seconds
• Echo (3 days ago): Moderate PDA with L→R shunt, good ventricular function
• Protocol Status: PDA Monitoring Protocol - Compliant (scheduled follow-up echo in 3d)
• BP 55/32 (mean 40)
• Capillary refill <3 seconds
• Echo (3 days ago): Moderate PDA with L→R shunt, good ventricular function
• Protocol Status: PDA Monitoring Protocol - Compliant (scheduled follow-up echo in 3d)
Generated from cardiac assessment • Click to edit
GASTROINTESTINAL
• Current Feeds: Breastmilk 2ml q3h (trophic) → Target: 4ml q3h
• TPN Day 16
• Feeding Tolerance: No emesis, minimal residuals (<20% of feeds)
• Abdomen: Soft, non-distended, no discoloration
• Bowel Sounds: Present in all quadrants
• Stool: Small, soft yellow x2 in past 24 hours
• Protocol Status: ELGAN Feeding Protocol - Compliant with advancement schedule
• TPN Day 16
• Feeding Tolerance: No emesis, minimal residuals (<20% of feeds)
• Abdomen: Soft, non-distended, no discoloration
• Bowel Sounds: Present in all quadrants
• Stool: Small, soft yellow x2 in past 24 hours
• Protocol Status: ELGAN Feeding Protocol - Compliant with advancement schedule
Generated from GI assessment • Protocol compliance noted • Click to edit
INFECTIOUS DISEASE
• Day 7 of 7 of ampicillin/gentamicin
• Blood Culture (48h): No growth to date
• WBC 10.2 (normal, improved from 12.8 two days ago)
• Afebrile, no signs of infection
• Protocol Status: Antimicrobial Stewardship Protocol - Compliant (discontinuing after 7-day course)
• Blood Culture (48h): No growth to date
• WBC 10.2 (normal, improved from 12.8 two days ago)
• Afebrile, no signs of infection
• Protocol Status: Antimicrobial Stewardship Protocol - Compliant (discontinuing after 7-day course)
Generated from infectious disease data • Protocol compliance noted • Click to edit
NEUROLOGY
• Activity: Appropriate for gestational age
• Tone: Mild hypotonia, appropriate for gestational age
• Head Ultrasound (5 days ago): Grade II IVH, stable from previous
• Protocol Status: IVH Monitoring Protocol - Compliant (weekly HUS scheduled)
• Tone: Mild hypotonia, appropriate for gestational age
• Head Ultrasound (5 days ago): Grade II IVH, stable from previous
• Protocol Status: IVH Monitoring Protocol - Compliant (weekly HUS scheduled)
Generated from neurological assessment • Protocol compliance noted • Click to edit
ASSESSMENT & PLAN
1. RESPIRATORY: Wean ventilator support per ELGAN protocol
• Decrease FiO2 from 35% to 33% → reassess → if SpO2 consistently >92%, further reduce to 30%
• Continue current PIP, PEEP, and rate settings
• Obtain blood gas in 12 hours after FiO2 change to assess ventilation status
• Protocol compliance: 85% (2/3 goals met - FiO2 and Rate compliant, PIP weaning cautioned)
2. NUTRITION: Advance enteral feeding per ELGAN protocol
• Increase feeds from current 2ml q3h to 3ml q3h today
• If tolerated with minimal residuals, increase to 4ml q3h tomorrow
• Continue current TPN; adjust fluid composition based on electrolytes
• Protocol compliance: 100% (feeding advancement on track)
3. INFECTIOUS DISEASE: Complete antibiotic course per protocol
• Complete 7-day course of ampicillin today (final dose at 20:00)
• Complete 7-day course of gentamicin today (final dose at 20:00)
• Discontinue antibiotics if blood culture remains negative at 48 hours
• Protocol compliance: 100% (course completion on track)
4. NEUROLOGY: Continue IVH monitoring per protocol
• Continue current neurological assessments
• Schedule follow-up head ultrasound in 7 days per IVH monitoring protocol
• Protocol compliance: 100% (monitoring schedule on track)
5. CARDIOVASCULAR: PDA monitoring per protocol
• Continue hemodynamic monitoring
• Schedule follow-up echo in 3 days per protocol
• Protocol compliance: 100% (monitoring schedule on track)
• Decrease FiO2 from 35% to 33% → reassess → if SpO2 consistently >92%, further reduce to 30%
• Continue current PIP, PEEP, and rate settings
• Obtain blood gas in 12 hours after FiO2 change to assess ventilation status
• Protocol compliance: 85% (2/3 goals met - FiO2 and Rate compliant, PIP weaning cautioned)
2. NUTRITION: Advance enteral feeding per ELGAN protocol
• Increase feeds from current 2ml q3h to 3ml q3h today
• If tolerated with minimal residuals, increase to 4ml q3h tomorrow
• Continue current TPN; adjust fluid composition based on electrolytes
• Protocol compliance: 100% (feeding advancement on track)
3. INFECTIOUS DISEASE: Complete antibiotic course per protocol
• Complete 7-day course of ampicillin today (final dose at 20:00)
• Complete 7-day course of gentamicin today (final dose at 20:00)
• Discontinue antibiotics if blood culture remains negative at 48 hours
• Protocol compliance: 100% (course completion on track)
4. NEUROLOGY: Continue IVH monitoring per protocol
• Continue current neurological assessments
• Schedule follow-up head ultrasound in 7 days per IVH monitoring protocol
• Protocol compliance: 100% (monitoring schedule on track)
5. CARDIOVASCULAR: PDA monitoring per protocol
• Continue hemodynamic monitoring
• Schedule follow-up echo in 3 days per protocol
• Protocol compliance: 100% (monitoring schedule on track)
Generated based on selected protocol-driven goals • Click to edit
TEMPLATE LIBRARY
Progress Note Template
Admission Note Template
Discharge Note Template
Procedure Note Template
Consultation Note Template
Progress Note
Today, 07:30
Progress Note
Yesterday, 08:15
Consultant Note - Cardiology
3 days ago, 15:45
Progress Note
4 days ago, 08:30
Procedure Note - PICC Line
7 days ago, 11:20
Admission Note
DOL 0, 14:10