Order Set: General Medicine Admit Orders - MethodistMD

1 Attach patient label herePhysician Orders ADULT Order Set: General Medicine Admit Orders [R] = will be ordered T= Today; N = Now (date and time ordered)Height: _____cm Weight: _____kgAllergies:[ ] No known allergies[ ]Medication allergy(s):_____[ ] Latex allergy [ ]Other:_____[ ] Admit Patient to Dr. _____Admit Status: [ ] Inpatient [ ] Outpatient [ ] ObservationBed Type: [ ] Med/Surg [ ] Critical Care [ ] Stepdown [ ] Telemetry; Specific Unit Location: _____[ ]Notify physician onceT;N, of room number on arrival to unitPrimary Diagnosis: _____Secondary Diagnosis: _____[ ]Vital SignsT;N, Monitor and Record T,P,R,BP, q4h(std), For 24 hr, then, qshift[ ]Vital SignsT;N, Monitor and Record T,P,R,BP, q8h(std)[ ]Out Of Bed (Activity As Tolerated)T;N[ ]BedrestT.

2 NAdmission/Transfer/DischargeVital SignsActivityNOTE to MD: Inpatient - hospital stay for medically necessary services, includes both severity of illness and intensity of service that require acute care and cannot be safely provided in a lower level of care Outpatient - short term (usually less than 6 hrs) evaluation, treatment, or service in an outpatient area of the hospital such as emergency room, ambulatory surgery, radiology or other ancillary areaObservation - short term (usually less than 24 hrs) stay in the hospital for evaluation, treatment, assessment, and reassessment to determine need for progression to inpatient admission vs discharge to outpatient follow-up [][ ]NPOS tart at: T;N[ ]American Heart Association Diet (Wise Diet)Start at: T;N[ ]1800 Calorie ADA Diet[ ]Dysphagia DietStart at: T;N[ ]Nasal Cannula (O2-BNC)T;N PRN, 2 L/min L/min, Special Instructions: for shortness of breath[ ]Dextrose 5% with NaCl (D51/2NS)1,000 mL, IV, Routine, 75 mL/hr, T;N[ ]potassium chloride (D51/2 NS KCl 20 mEq)1,000 mL, IV, Routine, 75 mL/hr, T.

3 N[ ]potassium chloride (D51/2 NS KCl 40 mEq)1,000 mL, IV, Routine, 75 mL/hr, T;N[ ]Sodium Chloride (NS)1,000 mL, IV, Routine, 75 mL/hr, T;N[ ]Sodium Chloride (1/2 NaCl)1,000 mL, IV, Routine, 75 mL/hr, T;N*111*Food/NutritionPatient CareRespiratory CareContinuous InfusionsMED General Medication Admit - 20901-QM1108 Ver4 071211 Page 1 of 3 attach patient label herePhysician Orders ADULT Order Set: General Medicine Admit Orders [R] = will be ordered T= Today; N = Now (date and time ordered)[ ]acetaminophen650 mg,Tab,PO,q6h,PRN Pain, Mild (1-3),Routine,T;N[ ]acetaminophen-HYDRO codone 325 mg-5 mg oral tablet1 tab, Tab, PO, q6h, PRN Pain, Moderate (4-7), Routine, T;NLaxative of Choice Orders below:[ ]magnesium hydroxide (Milk of Magnesia)30mL, Liq, PO, Daily, PRN Constipation, Routine, T;N[ ]bisacodyl5 mg, EC Tablet, PO, Daily, PRN Constipation, Rouinte, T;N[ ]Al hydroxide/Mg hydroxide/simethicone (Maalox Max)15 mL, Oral Susp, PO, q6h, PRN Gas, Routine, T;N[ ]prochlorperazaine5 mg, Injection, IM, q4h, PRN Nausea, Routine, Comment: If unable to take PO.

4 [ ] mg,Tab,PO,q4h,PRN Nausea,Routine,T;N[ ]ondansetron4 mg, Injection, IV Push, q8h, PRN Nausea/Vomiting, Routine[ ]temazepam15 mg, Cap, PO, hs, PRN Sleep, Routine[ ]zolpidem5 mg, Tab, PO, hs, PRN Insomnia, Routine[ ]diphenhydrAMINE25 mg, Cap, PO, tid, PRN Itching, Routine[ ]nitroglycerin (nitroglycerin sublingual) mg, Tab, SL, prn, PRN Chest Pain, Routine[ ] mg, Tab, PO, tid, PRN Anxiety, Routine[ ]esomeprazole40 mg, Tab, PO, acb, Routine[ ]esomeprazole40 mg, Injection, IV Push, q24h, Routine[ ]famotidine20 mg, Injection, IV Push, q12h, RoutineVTE Prophylaxis (MEDICAL) OrdersMedications VTE Prophylaxis (MEDICAL)

5 OrdersDiarrhea OrdersNausea Vomiting OrdersPain Management OrdersRoutine Diagnostic OrdersRoutine AM Diagnostic OrdersSTAT Diagnostic Orders (STAT Lab Orders )[ ]CT Brain/Head WO ContT;N, Routine, Stretcher[ ]US Retroperitoneal B Scan/Real Time Comp (Renal Ultrasound)T;N, Routine, StretcherNote: BUN and Creatinine lab Orders are required if they have not been performed within the last 30 days.[ ]CreatinineT;N,Routine,once,Type: Blood[ ]BUNT;N,Routine,once,Type: Blood[ ]diatrizoate (CT oral contrast (diatrizoate))15 mL, PO, OnCall, Routine, Oral Contrast for CT Abdomen, Comment: RAD BILL ONLY[ ]CT Thorax W ContT;N[ ]CT Abdomen W/WO ContT;N[ ]CT Pelvis W/WO Cont T;N[ ]CT Abdomen & Pelvis W/WO Cont T;NLaboratoryDiagnostic TestsCT Diagnostic MED General Medication Admit - 20901-QM1108 Ver4 071211 Page 2 of 3 attach patient label herePhysician Orders ADULT Order Set: General Medicine Admit Orders [R] = will be ordered T= Today.

6 N = Now (date and time ordered)[ ]US Abd Comp[ ]Delay DietStart at: T;2359, Delay diet for US Abd Comp[ ]US Abd Ltd Sing Organ/FU[ ]Delay DietStart at: T;2359, Delay diet for US Abd Ltd Sing Organ/FU[ ]US Ext Lower Ven Doppler W Compress BilT;N, Reason for Exam: Other, Enter in Comments, Routine[ ]Notify Physician of Chest PainT;N, Notify for chest pain unrelieved by nitroglycerin[ ]Physician ConsultT;N[ ]Physician ConsultT;N[ ]Physician Group ConsultT;N_____ _____ _____ _____Date Time Physician's Signature MD Number Consults/NotificationsAbd Ltd Sing Organ/FU w/delay diet (US Abd Ltd Sing Organ/FU w/delay diet)Abd Comp US w/delay diet (US Abd Comp w/delay diet)

7 CT Diagnostic continued MED General Medication Admit - 20901-QM1108 Ver4 071211 Page 3 of 3 Attached patient label herePhysician Orders - ADULT[R] = will be ordered Physician Orders -ADULTVTE Medical Prophylaxis OrdersT= Today; N = Now (date and time ordered)Height: _____cm Weight: _____kgAllergies:[ ]Medication allergy(s):_____[ ] Latex allergy [ ]Other:_____[ ]Sequential Compression Device Apply T;N, Apply To: Lower Extremities, Comment: Bleeding Risks Present[ ]heparin 5,000 units,Injection, subcutaneous, q12h, Routine, T;N, Comment: Pharmacist may adjust administration times after first dose.

8 [ ]heparin 5,000 units,Injection, subcutaneous, q8h, Routine, T;N, Comment: Pharmacist may adjust administration times after first dose.[ ]enoxaparin40 mg, Injection, Subcutaneous, Qday, Routine, T;N, If CrCl less than 30 mL/min, pharmacy to adjust dose to 30mg SQ Qday. Pharmacist may adjust administration times after first dose.[ ]CBC w/o Diff RoutineRoutine,T;N, once, Type: Blood, [ ]CBC w/o Diff Time StudyRoutine,T+2;0400, QODay, Type: BloodIf NO Bleeding Risk Present, place ONE Heparin or Enoxaparin Order below and place both CBC Orders :ORNOTE: Medical Risk Factor Assessment, Bleeding Risk Factor Assessment and Mechanical Device (SCD) Contraindication Assessment criteria is listed below VTE Bleeding Risk is Present, place SCD Order below:VTE ORDERSAND BOTH CBCs:Do Not Administer VTE Prophylaxis: [ ]Contraindication-VTE ProphylaxisT;N, Reason: Patient has bleeding risk for anticoagulants, and SCDs are early ambulation.

9 [ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]*111*Do Not Administer VTE Prophylaxis:MEDICAL RISK FACTOR ASSESSMENT: This is a partial list of medical risk factors. Clinicians are advised to consider other risk factors or conditions that may predispose patients to DVT/PE. Check all that may apply:Prolonged immobilization, paralysis, or bed rest orderedICU patient Sepsis diagnosis or Active Infection Active inflammatory bowel diseaseCancer and/or presence of malignancyHeart FailureRespiratory Disease (COPD or Pneumonia)Ischemic Stroke (non-hemorrhagic) Prior history of VTE or Pulmonary EmbolismAge greater than 45 Morbid Obesity (BMI greater than 35) Central Line or PICC LineCurrent treatment with estrogens (Oral contraceptives.)

10 Hormone Replacement Therapy) Hereditary clotting disorderPregnancy with diagnosed clotting disorder or Antiphospholipid Syndrom diagnosisNephrotic SyndromeNo medical risk factors existVTE MEDICAL PROPHYLAXIS-22225-QM-1008 Ver 4 032911 Page 1 of 2 Attached patient label herePhysician Orders - ADULT[R] = will be ordered Physician Orders -ADULTVTE Medical Prophylaxis OrdersT= Today; N = Now (date and time ordered)[ ][ ]Active bleeding[ ]INR greater than and patient NOT on warfarin therapy[ ]INR greater than 2 and patient ON warfarin therapy[ ]Transplant patients with platelet count less than 100,000[ ]Platelet count less than 50,000 (applies to patients with no history of transplant procedures)