ID

16211

Description

AAFP: Upper GI Bleed 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-ninth section ("AAFP: Upper GI Bleed Admission Order")

Link

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

Keywords

Versions (2)
  1. 7/5/16 7/5/16 -
  2. 7/25/16 7/25/16 -
Uploaded on

July 5, 2016

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License

Creative Commons BY-NC 3.0
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AAFP: Upper GI Bleed Admission Order

English

AAFP: Upper GI Bleed 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

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

Upper Gl Bleed Contributing 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

NPO except meds
Description

Diet

Data type

boolean

NPO including meds
Description

Diet

Data type

boolean

Activity
Description

Activity

Bed rest with bedside commode
Description

Activity

Data type

boolean

Bathroom privileges with assistance
Description

Activity

Data type

boolean

Nursing
Description

Nursing

ICU: per routine
Description

Nursing

Data type

boolean

Telemetry or medical: every 1 hr until stable X4, then every 2 hrs until stable X4, then every 4 hrs
Description

Nursing

Data type

boolean

Notify MD for: BP < 90/60 or > 170/110, P < 60 or > 120, Urine output < 30 cc/hr over 4 hrs, all H/H results
Description

Nursing

Data type

boolean

If NG to suction, replace NG fluid cc for cc with NG with 20 mEq KCl every 12 hrs
Description

Nursing

Data type

boolean

Medications
Description

Medications

Protonix 40 mg PO/IV every 12 hrs
Description

Medications

Data type

boolean

Other
Description

Medications

Data type

boolean

If Other, please specify
Description

Medications

Data type

text

IV
Description

IV

Bolus normal saline___cc over__
Description

IV

Data type

boolean

If Bolus normal saline, please specify amount
Description

IV

Data type

integer

If Bolus normal saline, please specify duration
Description

IV

Data type

text

Dextrose 5% normal saline with 20 mEq KCl/l @___mL/hr total
Description

IV

Data type

boolean

If Dextrose 5% normal saline, please specify amount
Description

IV

Data type

integer

Measurement units
  • mL/hr total
mL/hr total
Lab
Description

Lab

Hemogram, comp met profile, PT/PTT/INR on admission
Description

Lab

Data type

boolean

HH every 4 hrs X3
Description

Lab

Data type

boolean

Type and screen for __units PRBC
Description

Lab

Data type

boolean

If type and screen, please specify amount of units PRBC
Description

Lab

Data type

integer

Consult
Description

Consult

Consult
Description

Consult

Data type

text

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: Upper GI Bleed 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
integer
Item Group
Status
Item
Status
text
Status
Code List
Status
CL Item
Observation (1)
CL Item
Admission (2)
CL Item
Medical floor (3)
CL Item
Telemetry (4)
CL Item
ICU (5)
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
Upper Gl Bleed Contributing 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
NPO except meds
boolean
Diet
Item
NPO including meds
boolean
Item Group
Activity
Activity
Item
Bed rest with bedside commode
boolean
Activity
Item
Bathroom privileges with assistance
boolean
Item Group
Nursing
Nursing
Item
ICU: per routine
boolean
Nursing
Item
Telemetry or medical: every 1 hr until stable X4, then every 2 hrs until stable X4, then every 4 hrs
boolean
Nursing
Item
Notify MD for: BP < 90/60 or > 170/110, P < 60 or > 120, Urine output < 30 cc/hr over 4 hrs, all H/H results
boolean
Nursing
Item
If NG to suction, replace NG fluid cc for cc with NG with 20 mEq KCl every 12 hrs
boolean
Item Group
Medications
Medications
Item
Protonix 40 mg PO/IV every 12 hrs
boolean
Medications
Item
Other
boolean
Medications
Item
If Other, please specify
text
Item Group
IV
IV
Item
Bolus normal saline___cc over__
boolean
IV
Item
If Bolus normal saline, please specify amount
integer
IV
Item
If Bolus normal saline, please specify duration
text
IV
Item
Dextrose 5% normal saline with 20 mEq KCl/l @___mL/hr total
boolean
IV
Item
If Dextrose 5% normal saline, please specify amount
integer
Item Group
Lab
Lab
Item
Hemogram, comp met profile, PT/PTT/INR on admission
boolean
Lab
Item
HH every 4 hrs X3
boolean
Lab
Item
Type and screen for __units PRBC
boolean
Lab
Item
If type and screen, please specify amount of units PRBC
integer
Item Group
Consult
Consult
Item
Consult
text
Signature
Item
Signature
text
Print Name
Item
Print Name
text
Date and Time
Item
Date and Time
datetime
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