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;NAdmission/Transfer/DischargeV ital 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.

2 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;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.

3 [ ] 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) 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.

4 [ ]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; 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.

5 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)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.

6 [ ]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.

7 [ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]*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; 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.

8 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) [ ]Solid organ transplant during this episode of careOR within 30 days of admission[ ]Documented bleeding or Coagulopathy disorder[ ]Hemorrhagic Stroke within 6 weeks of admission [ ]Severe Uncontrolled Hypertension[ ]Recent Intraocular or Intracranial surgery[ ]Vascular Access or Biopsy sites inaccessible to hemostatic control [ ]Recent Spinal Surgery[ ]Epidural or Spinal Catheter[ ]Pregnancy, Possible Pregnancy or Postpartum (to include up to 6 weeks post partum)[ ]Heparin Induced Thrombocytopenia (HIT)[ ][ ]No Bleeding Risk Factors exists[]KtddithbilbliMECHANICAL DEVICE (SCD) CONTRAINDICATION ASSESSMENTBLEEDING RISK FACTOR ASSESSMENT: This is a partial list of bleeding risk factors.

9 Clinicians are advised to consider other risk factors or conditions that may predispose patients to DVT/PE. Check all that may apply:Patient already receiving anticoagulation therapy with warfarin, heparin, fondaparinux, enoxaparin or other anticoagulation therapyHeparin allergy or pork allergy [ ]Known or suspected deep vein thrombosis or pulmonary embolism[ ]Acute stages of inflammatory phlebitis process[ ]Disruptions in lower extremity skin integrity ( surgical incision, recent skin graft, dermatitis, etc. )[ ]Arterial occlusion[ ]Instances where increased venous or lymphatic return is undesirable[ ]Massive lower extremity edema[ ]Unable to place device_____ _____ _____ _____Date Time Physician's Signature MD Number VTE MEDICAL PROPHYLAXIS-22225-QM- Ver 4 032911 Page 2 of 2