ID

16000

Description

AAFP: Congestive Heart Failure Admission Order, Standardizes Admission Orders, Author: Robert M. Wiprud, MD The primary purpose of these Ordersets is to decrease unnecessary variability and to improve quality through standardized Admission Orders. Developed by the Scott & White Clinic at College Station, Texas. Copyright © 2006 American Academy of Family Physicians. Physicians may photocopy or adapt for use in their own practices; all other rights reserved. Wiprud RM. Providing consistent care with standardized admission orders. Fam Pract Manag. September 2006: 49-52 See http://www.aafp.org/fpm/2006/0900/p49.html This ODM Form includes the sixth section ("Congestive Heart Failure Admission Order").

Link

http://www.aafp.org/fpm/2006/0900/p49.html

Keywords

  1. 6/26/16 6/26/16 -
Uploaded on

June 26, 2016

DOI

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License

Creative Commons BY-NC 3.0

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AAFP: Congestive Heart Failure Admission Order

AAFP: Congestive Heart Failure Admission Order

Default Itemgroup
Description

Default Itemgroup

Name
Description

Name

Data type

text

Age
Description

Age

Data type

integer

Date of Birth
Description

Date of Birth

Data type

date

Medical Record
Description

Medical Record

Data type

integer

Status
Description

Status

Status
Description

Status

Data type

text

Attending
Description

Attending

Name of attending physician
Description

Name

Data type

text

Phone number of attending physician
Description

Phone number

Data type

integer

Admitting Diagnosis
Description

Admitting Diagnosis

Congestive Heart Failure Associated Diagnoses
Description

Admitting Diagnosis

Data type

text

Condition
Description

Condition

Condition
Description

Condition

Data type

text

Code Status
Description

Code Status

Data type

text

Allergies
Description

Allergies

Allergies
Description

Allergies

Data type

text

Diet
Description

Diet

NPO
Description

Diet

Data type

boolean

Clear liquid
Description

Diet

Data type

boolean

AHA step 2
Description

Diet

Data type

boolean

ADA__calories
Description

Diet

Data type

boolean

Fluid restriction: 2000mL/24 hrs or __mL/24hrs
Description

Diet

Data type

boolean

If diet according to ADA please specify amount of calories
Description

ADA specification

Data type

integer

If fluid restriction, please specify amount per 24 hrs
Description

Fluid restriction specification

Data type

integer

Activity
Description

Activity

Bed rest
Description

Activity

Data type

boolean

Bed rest with bathroom privileges
Description

Activity

Data type

boolean

Up with assistance
Description

Activity

Data type

boolean

Other
Description

Acitivity

Data type

boolean

If Other, please specify
Description

Specification of Other

Data type

text

Nursing
Description

Nursing

Vital signs every 4 hrs or per unit routine
Description

Nursing

Data type

boolean

Notify MD for: increasing dyspnea; chest pain; BP < 90/60 or > 180/110; P < 60 or > 120 bpm
Description

Nursing

Data type

boolean

Daily weights
Description

Nursing

Data type

boolean

Strict I&O
Description

Nursing

Data type

boolean

O2 via NP @2,3 or 4 L/min
Description

Nursing

Data type

boolean

Pulse ox check every 4 hrs and titrate O2 to keep pulse ox > 92%
Description

Nursing

Data type

boolean

Continuous cardiac monitoring
Description

Nursing

Data type

boolean

Medications
Description

Medications

ASA__mg PO every morning
Description

Medications

Data type

boolean

Clopidogrel 75mg PO every morning
Description

Medications

Data type

boolean

ACE inhibitor:____
Description

Medications

Data type

boolean

Lasix __ mg IVP every __hrs
Description

Medications

Data type

boolean

NTG paste ___inch(es) every__hrs
Description

Medications

Data type

boolean

Betablocker:____
Description

Medications

Data type

boolean

Digoxin (NYHA class III/IV): ___mg PO daily
Description

Medications

Data type

boolean

Spironolactone__mg PO bid
Description

Medications

Data type

boolean

Tylenol 650mg PO every 4-6 hrs prn pain
Description

Medications

Data type

boolean

MOM 30 mL PO every 12 hrs prn constipation
Description

Medications

Data type

boolean

Ambien 10 mg PO at bedtime prn for insomnia
Description

Medications

Data type

boolean

If ASA, please specify amount of ASA every morning
Description

ASA specification

Data type

integer

Measurement units
  • mg
mg
If ACE inhibitor, please specify
Description

ACE specification

Data type

text

If Lasix, please specify amount
Description

Lasix specification

Data type

float

Measurement units
  • mg
mg
If Lasix, please specify frequency
Description

Lasix specification

Data type

integer

Measurement units
  • hrs
hrs
If NTG paste, please specify amount
Description

NTG paste specification

Data type

float

Measurement units
  • inch(es)
inch(es)
If NTG paste, please specify frequency
Description

NTG paste specification

Data type

float

Measurement units
  • hrs
hrs
If Betablocker, please specify
Description

Betablocker specification

Data type

text

If Digoxin please specify amount
Description

Digoxin specification

Data type

integer

Measurement units
  • mg
mg
If Spironolactone, please specify amount
Description

Spironolactone specification

Data type

integer

Measurement units
  • mg
mg
IV
Description

IV

IV
Description

IV

Data type

text

Lab
Description

Lab

CBC, BNP, CK, CK-MB, Troponin I, MG+, TSH, UA on admission
Description

Lab

Data type

text

Repeat CK, CK-MB, Troponin I in 8 hrs
Description

Lab

Data type

boolean

Daily basal metabolic profile
Description

Lab

Data type

boolean

Other
Description

Lab

Data type

boolean

If Other, please specify
Description

Specification of Other

Data type

text

Diagnostic Studies
Description

Diagnostic Studies

Echocardiogram - to be read by___
Description

Diagnostic Studies

Data type

boolean

ECG if not done in ER
Description

Diagnostic Studies

Data type

boolean

CXR:__Portable__PA/Lat, Reason: CHF
Description

Diagnostic Studies

Data type

boolean

If CXR:__, please specify
Description

CXR specification

Data type

integer

If CXR, please specify Portable__PA/Lat
Description

CXR specification

Data type

integer

Consult
Description

Consult

Consult
Description

Consult

Data type

text

Patient Education
Description

Patient Education

Begin CHF patient education.
Description

Patient Education

Data type

text

Other Order
Description

Other Order

Other Orders
Description

Other Orders

Data type

text

Signature
Description

Signature

Data type

text

Name
Description

Name

Data type

text

Date and Time
Description

Date and Time

Data type

datetime

Similar models

AAFP: Congestive Heart Failure Admission Order

Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Name
Item
Name
text
Age
Item
Age
integer
Date of Birth
Item
Date of Birth
date
Medical Record
Item
Medical Record
integer
Item Group
Status
Item
Status
text
Code List
Status
CL Item
Observation (1)
CL Item
Admission (2)
CL Item
Medical Floor (3)
CL Item
Monitored Bed (4)
Item Group
Attending
Name
Item
Name of attending physician
text
Phone number
Item
Phone number of attending physician
integer
Item Group
Admitting Diagnosis
Admitting Diagnosis
Item
Congestive Heart Failure Associated Diagnoses
text
Item Group
Condition
Item
Condition
text
Code List
Condition
CL Item
Stable (1)
CL Item
Fair (2)
CL Item
Serious (3)
CL Item
Critical (4)
Item
Code Status
text
Code List
Code Status
CL Item
Full Code (1)
CL Item
DNR (2)
Item Group
Allergies
Allergies
Item
Allergies
text
Item Group
Diet
Diet
Item
NPO
boolean
Diet
Item
Clear liquid
boolean
Diet
Item
AHA step 2
boolean
Diet
Item
ADA__calories
boolean
Diet
Item
Fluid restriction: 2000mL/24 hrs or __mL/24hrs
boolean
ADA specification
Item
If diet according to ADA please specify amount of calories
integer
Fluid restriction specification
Item
If fluid restriction, please specify amount per 24 hrs
integer
Item Group
Activity
Activity
Item
Bed rest
boolean
Activity
Item
Bed rest with bathroom privileges
boolean
Activity
Item
Up with assistance
boolean
Acitivity
Item
Other
boolean
Specification of Other
Item
If Other, please specify
text
Item Group
Nursing
Nursing
Item
Vital signs every 4 hrs or per unit routine
boolean
Nursing
Item
Notify MD for: increasing dyspnea; chest pain; BP < 90/60 or > 180/110; P < 60 or > 120 bpm
boolean
Nursing
Item
Daily weights
boolean
Nursing
Item
Strict I&O
boolean
Nursing
Item
O2 via NP @2,3 or 4 L/min
boolean
Nursing
Item
Pulse ox check every 4 hrs and titrate O2 to keep pulse ox > 92%
boolean
Nursing
Item
Continuous cardiac monitoring
boolean
Item Group
Medications
Medications
Item
ASA__mg PO every morning
boolean
Medications
Item
Clopidogrel 75mg PO every morning
boolean
Medications
Item
ACE inhibitor:____
boolean
Medications
Item
Lasix __ mg IVP every __hrs
boolean
Medications
Item
NTG paste ___inch(es) every__hrs
boolean
Medications
Item
Betablocker:____
boolean
Medications
Item
Digoxin (NYHA class III/IV): ___mg PO daily
boolean
Medications
Item
Spironolactone__mg PO bid
boolean
Medications
Item
Tylenol 650mg PO every 4-6 hrs prn pain
boolean
Medications
Item
MOM 30 mL PO every 12 hrs prn constipation
boolean
Medications
Item
Ambien 10 mg PO at bedtime prn for insomnia
boolean
ASA specification
Item
If ASA, please specify amount of ASA every morning
integer
ACE specification
Item
If ACE inhibitor, please specify
text
Lasix specification
Item
If Lasix, please specify amount
float
Lasix specification
Item
If Lasix, please specify frequency
integer
NTG paste specification
Item
If NTG paste, please specify amount
float
NTG paste specification
Item
If NTG paste, please specify frequency
float
Betablocker specification
Item
If Betablocker, please specify
text
Digoxin specification
Item
If Digoxin please specify amount
integer
Spironolactone specification
Item
If Spironolactone, please specify amount
integer
Item Group
IV
Item
IV
text
Code List
IV
CL Item
IV lock; flush per routine (1)
Item Group
Lab
Item
CBC, BNP, CK, CK-MB, Troponin I, MG+, TSH, UA on admission
text
Code List
CBC, BNP, CK, CK-MB, Troponin I, MG+, TSH, UA on admission
Lab
Item
Repeat CK, CK-MB, Troponin I in 8 hrs
boolean
Lab
Item
Daily basal metabolic profile
boolean
Lab
Item
Other
boolean
Specification of Other
Item
If Other, please specify
text
Item Group
Diagnostic Studies
Diagnostic Studies
Item
Echocardiogram - to be read by___
boolean
Diagnostic Studies
Item
ECG if not done in ER
boolean
Diagnostic Studies
Item
CXR:__Portable__PA/Lat, Reason: CHF
boolean
CXR specification
Item
If CXR:__, please specify
integer
CXR specification
Item
If CXR, please specify Portable__PA/Lat
integer
Item Group
Consult
Consult
Item
Consult
text
Item Group
Patient Education
Patient Education
Item
Begin CHF patient education.
text
Item Group
Other Order
Other Orders
Item
Other Orders
text
Signature
Item
Signature
text
Name
Item
Name
text
Date and Time
Item
Date and Time
datetime

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