ID

16207

Description

AAFP: Pelvic Inflammatory Disease 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 twenty-sixth section ("AAFP: Pelvic Inflammatory Disease Admission Order")

Link

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

Keywords

Versions (3)
  1. 7/5/16 7/5/16 -
  2. 7/24/16 7/24/16 -
  3. 9/17/21 9/17/21 -
Uploaded on

July 5, 2016

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License

Creative Commons BY-NC 3.0
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AAFP: Pelvic Inflammatory Disease Admission Order

English

AAFP: Pelvic Inflammatory Disease Admission Order

1 forms  
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 number
Description

Medical record number

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

Data type

integer

Admitting Diagnosis
Description

Admitting Diagnosis

Pelvic Inflammatory Disease Associated Diagnoses
Description

Admitting Diagnosis

Data type

text

Condition
Description

Condition

Condition
Description

Condition

Data type

text

Allergies
Description

Allergies

Allergies
Description

Allergies

Data type

text

Diet
Description

Diet

Routine as tolerated
Description

Diet

Data type

boolean

Activity
Description

Activity

Bed rest with bathroom privileges
Description

Activity

Data type

boolean

Nursing
Description

Nursing

Vital signs: every shift
Description

Nursing

Data type

boolean

Notify MD for: T > 102.5; P > 120 and < 60; BP < 90/60 and > 180/110
Description

Nursing

Data type

boolean

Medications
Description

Medications

Medications
Description

Medications

Data type

text

Vicodin 1-2 PO every 6-8 hrs prn pain
Description

Medications

Data type

boolean

Ambien 10 mg PO @ bedtime prn insomnia
Description

Medications

Data type

boolean

Phenergan 12.5-25 mg SIVP every 6-8 hrs prn nausea/ vomiting
Description

Medications

Data type

boolean

Tylenol 500 mg 1-2 every 6-8 hrs prn fever or pain
Description

Medications

Data type

boolean

MOM 30 mL PO every 12 hrs prn constipation
Description

Medications

Data type

boolean

Other
Description

Medications

Data type

boolean

If Other, please specify
Description

Medications

Data type

text

IV
Description

IV

Dextrose 5% in 1/2 normal saline @ 125 mL/hr
Description

IV

Data type

boolean

Lab
Description

Lab

CBC, UA, urine HCG, basal metabolic profile
Description

Lab

Data type

boolean

Gentamicin level 6-14 hrs after initial infusion if using once a day
Description

Lab

Data type

boolean

Gentamicin dosing
Description

Lab

Data type

boolean

Cervical swab for GC/Chlaydia
Description

Lab

Data type

boolean

Hemogram daily in a.m.
Description

Lab

Data type

boolean

Signature
Description

Signature

Data type

text

Print Name
Description

Print Name

Data type

text

Date and Time
Description

Date and Time

Data type

datetime

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Similar models

AAFP: Pelvic Inflammatory Disease Admission Order

1 forms
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 number
Item
Medical record number
integer
Item Group
Status
Item
Status
text
Status
Code List
Status
CL Item
Observation (1)
CL Item
Admission (2)
CL Item
Medical Floor (3)
Item Group
Attending
Name
Item
Name of attending physician
text
Phone
Item
Phone number of attending physician
integer
Item Group
Admitting Diagnosis
Admitting Diagnosis
Item
Pelvic Inflammatory Disease Associated Diagnoses
text
Item Group
Condition
Item
Condition
text
Condition
Code List
Condition
CL Item
Stable (1)
CL Item
Fair (2)
CL Item
Serious (3)
CL Item
Critical (4)
Item Group
Allergies
Allergies
Item
Allergies
text
Item Group
Diet
Diet
Item
Routine as tolerated
boolean
Item Group
Activity
Activity
Item
Bed rest with bathroom privileges
boolean
Item Group
Nursing
Nursing
Item
Vital signs: every shift
boolean
Nursing
Item
Notify MD for: T > 102.5; P > 120 and < 60; BP < 90/60 and > 180/110
boolean
Item Group
Medications
Item
Medications
text
Medications
Code List
Medications
CL Item
Cefotetan 2gm IVPB every 23 hrs OR (1)
CL Item
Cefoxitin 2 gm IVPB every 6 hrs plus doxycycline 100 mg IV/PO every 12 hrs OR (2)
CL Item
Clindamycin 900 mg IVPB every 8 hrs plus Gentamycin 7 mg/kg IVPB over 1 hr per day (adjust dose according to normagram) OR (3)
CL Item
Unasyn 3 grams IVPB every 6 hrs plus Doxycycline 100 mg IV/PO every 12 hrs (4)
Medications
Item
Vicodin 1-2 PO every 6-8 hrs prn pain
boolean
Medications
Item
Ambien 10 mg PO @ bedtime prn insomnia
boolean
Medications
Item
Phenergan 12.5-25 mg SIVP every 6-8 hrs prn nausea/ vomiting
boolean
Medications
Item
Tylenol 500 mg 1-2 every 6-8 hrs prn fever or pain
boolean
Medications
Item
MOM 30 mL PO every 12 hrs prn constipation
boolean
Medications
Item
Other
boolean
Medications
Item
If Other, please specify
text
Item Group
IV
IV
Item
Dextrose 5% in 1/2 normal saline @ 125 mL/hr
boolean
Item Group
Lab
Lab
Item
CBC, UA, urine HCG, basal metabolic profile
boolean
Lab
Item
Gentamicin level 6-14 hrs after initial infusion if using once a day
boolean
Lab
Item
Gentamicin dosing
boolean
Lab
Item
Cervical swab for GC/Chlaydia
boolean
Lab
Item
Hemogram daily in a.m.
boolean
Signature
Item
Signature
text
Print Name
Item
Print Name
text
Date and Time
Item
Date and Time
datetime
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