ID

10682

Description

Routine documentation of university hospital muenster. This form serves the purpose of documenting and ordering medications and syringe pumps in a specific pediatric ICU.

Keywords

  1. 6/8/15 6/8/15 - Julian Varghese
Uploaded on

June 8, 2015

DOI

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License

Creative Commons BY-NC 3.0 Legacy

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Order form pediatric intensive care unit UKM

Order form pediatric intensive care unit UKM- Physician's order

Patient Information
Description

Patient Information

Alias
UMLS CUI-1
C1955348
Name of the Patient:
Description

Patient's name

Data type

text

Alias
UMLS CUI-1
C1299487
Date of birth:
Description

Date of birth

Data type

date

Alias
UMLS CUI-1
C0421451
Please enter the weight of the patient:
Description

Weight

Data type

float

Alias
UMLS CUI-1
C0005910
Please enter the height of the patient:
Description

Height

Data type

float

Alias
UMLS CUI-1
C0005890
Please enter the body surface area of the patient:
Description

Body surface area

Data type

float

Alias
UMLS CUI-1
C0005902
Date of entry:
Description

Date

Data type

date

Alias
UMLS CUI-1
C0807937
Parameters to be monitored, please include the measuring intervals and threshholds for the respective parameters
Description

Parameters to be monitored, please include the measuring intervals and threshholds for the respective parameters

Alias
UMLS CUI-1
C0449381
Blood pressure (RR)/ Mean arterial pressure (MAP):
Description

Blood pressure

Data type

text

Alias
UMLS CUI-1
C0005823
Central venous pressure (CVP):
Description

Central venous pressure

Data type

text

Alias
UMLS CUI-1
C0428640
Pulmonary arterial pressure (PAP)/ Left atrial pressure (LAP):
Description

Pulmonary arterial pressure

Data type

text

Alias
UMLS CUI-1
C1168098
Transcutaneous carbon dioxide (TcPCO2):
Description

Transcutaneous carbon dioxide

Data type

text

Oxygen saturation (SaO2):
Description

Oxygen saturation

Data type

text

Alias
UMLS CUI-1
C0237753
Weight
Description

Weigh

Data type

float

Alias
UMLS CUI-1
C0005910
Electrolyte Balance
Description

Electroylte balance

Data type

text

Alias
UMLS CUI-1
C0013831
Neurological monitoring:
Description

Neurological monitoring

Data type

text

Alias
UMLS CUI-1
C0150281
Special positioning of the patient:
Description

Special positioning

Data type

text

Alias
UMLS CUI-1
C1561964
Physiotherapy:
Description

Physiotherapy

Data type

text

Alias
UMLS CUI-1
C0949766
Aspiration:
Description

Aspiration

Data type

text

Alias
UMLS CUI-1
C0349707
Special needs or comments::
Description

Special needs or comments

Data type

text

Alias
UMLS CUI-1
C0947611
Record of liquid and nutrition of the patient:
Description

Record of liquid and nutrition of the patient:

Patient's total body liquid volume (ml/ 24h):
Description

Total body liquid volume

Data type

float

Please input the patient's liquid record from the previous day as follow- Intake, Excretion, Perspiration, balance and diuresis (all in ml/ kg/ h):
Description

Previous day liquid measurement

Data type

text

Alias
UMLS CUI-1
C0025102
Enteral nutrition (kcal/ 100 ml):
Description

Enteral nutrition

Data type

float

Alias
UMLS CUI-1
C0014327
Please mention the nutrition record as follow when applicable- Total amount, Enteral, Parenteral (all in kcal/ kg)
Description

Nutrition

Data type

text

Alias
UMLS CUI-1
C2596652
Please enter the liquid measurement as follow when applicable- Total, Enteral, Parenteral (all in ml/ kg):
Description

Liquid measurement

Data type

text

Medication
Description

Medication

Alias
UMLS CUI-1
C0013227
Name of the medication:
Description

Medication name

Data type

text

Alias
UMLS CUI-1
C2360065
Dose:
Description

Dose

Data type

text

Alias
UMLS CUI-1
C3174092
Drug administration route:
Description

Drug administration route

Data type

text

Alias
UMLS CUI-1
C0013153
Time of drug administration:
Description

Time

Data type

time

Alias
UMLS CUI-1
C0040223
Drug administration accomplished?
Description

Task accomplishment

Data type

text

Name of the physician:
Description

Physician's name

Data type

text

Syringe pumps
Description

Syringe pumps

Alias
UMLS CUI-1
C0181332
Name of the drug:
Description

Drug name

Data type

text

Alias
UMLS CUI-1
C2360065
Dose:
Description

Dose

Data type

text

Alias
UMLS CUI-1
C3174092
Dilution:
Description

Dilution

Data type

text

Alias
UMLS CUI-1
C1504362
Other related informations:
Description

Related informations

Data type

text

Therapy instructions
Description

Therapy instructions

Alias
UMLS CUI-1
C0087111
Type of therapy:
Description

Therapy type

Data type

text

Alias
UMLS CUI-1
C1514463
UMLS CUI-2
C1516607
UMLS CUI-3
C0805701
UMLS CUI-4
C1527021
Time:
Description

Time

Data type

time

Alias
UMLS CUI-1
C0040223
Name of the physician:
Description

Physician's name

Data type

text

Name of the nurse:
Description

Nurse's name

Data type

text

Diagnosis order
Description

Diagnosis order

Alias
UMLS CUI-1
C0011900
Diagnosis
Description

Diagnosis

Data type

text

Alias
UMLS CUI-1
C0011900
Time:
Description

Time

Data type

time

Alias
UMLS CUI-1
C0040223
Name of the physician:
Description

Physician's name

Data type

text

Name of the nurse:
Description

Nurse's name

Data type

text

Laboratory tests and examination
Description

Laboratory tests and examination

Alias
UMLS CUI-1
C0022885
UMLS CUI-2
C0260877
Laboratory tests:
Description

Laboratory tests

Data type

text

Alias
UMLS CUI-1
C0022885
Examination:
Description

Examination:

Data type

text

Alias
UMLS CUI-1
C0260877

Similar models

Order form pediatric intensive care unit UKM- Physician's order

Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Patient Information
C1955348 (UMLS CUI-1)
Patient's name
Item
Name of the Patient:
text
C1299487 (UMLS CUI-1)
Date of birth
Item
Date of birth:
date
C0421451 (UMLS CUI-1)
Weight
Item
Please enter the weight of the patient:
float
C0005910 (UMLS CUI-1)
Height
Item
Please enter the height of the patient:
float
C0005890 (UMLS CUI-1)
Body surface area
Item
Please enter the body surface area of the patient:
float
C0005902 (UMLS CUI-1)
Date
Item
Date of entry:
date
C0807937 (UMLS CUI-1)
Item Group
Parameters to be monitored, please include the measuring intervals and threshholds for the respective parameters
C0449381 (UMLS CUI-1)
Blood pressure
Item
Blood pressure (RR)/ Mean arterial pressure (MAP):
text
C0005823 (UMLS CUI-1)
Central venous pressure
Item
Central venous pressure (CVP):
text
C0428640 (UMLS CUI-1)
Pulmonary arterial pressure
Item
Pulmonary arterial pressure (PAP)/ Left atrial pressure (LAP):
text
C1168098 (UMLS CUI-1)
Transcutaneous carbon dioxide
Item
Transcutaneous carbon dioxide (TcPCO2):
text
Oxygen saturation
Item
Oxygen saturation (SaO2):
text
C0237753 (UMLS CUI-1)
Weight
Item
Weight
float
C0005910 (UMLS CUI-1)
Electrolyte Balance
Item
Electrolyte Balance
text
C0013831 (UMLS CUI-1)
Neurological monitoring
Item
Neurological monitoring:
text
C0150281 (UMLS CUI-1)
Special positioning
Item
Special positioning of the patient:
text
C1561964 (UMLS CUI-1)
Physiotherapy
Item
Physiotherapy:
text
C0949766 (UMLS CUI-1)
Aspiration
Item
Aspiration:
text
C0349707 (UMLS CUI-1)
Special needs or comments
Item
Special needs or comments::
text
C0947611 (UMLS CUI-1)
Item Group
Record of liquid and nutrition of the patient:
Total body liquid volume
Item
Patient's total body liquid volume (ml/ 24h):
float
Previous day liquid measurement
Item
Please input the patient's liquid record from the previous day as follow- Intake, Excretion, Perspiration, balance and diuresis (all in ml/ kg/ h):
text
C0025102 (UMLS CUI-1)
Enteral nutrition
Item
Enteral nutrition (kcal/ 100 ml):
float
C0014327 (UMLS CUI-1)
Nutrition
Item
Please mention the nutrition record as follow when applicable- Total amount, Enteral, Parenteral (all in kcal/ kg)
text
C2596652 (UMLS CUI-1)
Liquid measurement
Item
Please enter the liquid measurement as follow when applicable- Total, Enteral, Parenteral (all in ml/ kg):
text
Item Group
Medication
C0013227 (UMLS CUI-1)
Medication name
Item
Name of the medication:
text
C2360065 (UMLS CUI-1)
Dose
Item
Dose:
text
C3174092 (UMLS CUI-1)
Drug administration route
Item
Drug administration route:
text
C0013153 (UMLS CUI-1)
Time
Item
Time of drug administration:
time
C0040223 (UMLS CUI-1)
Item
Drug administration accomplished?
text
Code List
Drug administration accomplished?
CL Item
Yes (1)
CL Item
No (2)
Physician's name
Item
Name of the physician:
text
Item Group
Syringe pumps
C0181332 (UMLS CUI-1)
Drug name
Item
Name of the drug:
text
C2360065 (UMLS CUI-1)
Dose
Item
Dose:
text
C3174092 (UMLS CUI-1)
Dilution
Item
Dilution:
text
C1504362 (UMLS CUI-1)
Related informations
Item
Other related informations:
text
Item Group
Therapy instructions
C0087111 (UMLS CUI-1)
Therapy type
Item
Type of therapy:
text
C1514463 (UMLS CUI-1)
C1516607 (UMLS CUI-2)
C0805701 (UMLS CUI-3)
C1527021 (UMLS CUI-4)
Time
Item
Time:
time
C0040223 (UMLS CUI-1)
Physician's name
Item
Name of the physician:
text
Nurse's name
Item
Name of the nurse:
text
Item Group
Diagnosis order
C0011900 (UMLS CUI-1)
Diagnosis
Item
Diagnosis
text
C0011900 (UMLS CUI-1)
Time
Item
Time:
time
C0040223 (UMLS CUI-1)
Physician's name
Item
Name of the physician:
text
Nurse's name
Item
Name of the nurse:
text
Item Group
Laboratory tests and examination
C0022885 (UMLS CUI-1)
C0260877 (UMLS CUI-2)
Laboratory tests
Item
Laboratory tests:
text
C0022885 (UMLS CUI-1)
Examination:
Item
Examination:
text
C0260877 (UMLS CUI-1)

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