Admission Orders

Writing Admission Orders
This item includes 4 components:

p
General comments about writing admission
orders
A template for admission orders
Examples for each part of the template
An example of a complete set of orders
This is meant to be a guide but you will need a lot

of practice and feedback to master this skill
skill.
Writing Admission Orders

This item includes 4 components:
p
General comments about writing admission
orders
A template for admission orders
Examples for each part of the template
An example of a complete set of orders
This is meant to be a guide but you will need a lot

of practice and feedback to master this skill
skill.
General Comments
Order writing is complicated: ask for help, practice
it often
ft
The EMR complicates it a bit, but if you know how
t write
to
it orders,
d
you will
ill b
be able
bl tto fifigure outt th
the
EMR
Do not rely on templates and order sets: they will
not always be available, and they may not be
complete
Order writing and patient management are
inseparable.
p
YOU MUST learn this if yyou want
to be able to care for patients.
ADMISSION ORDERS TEMPLATE

One of the mnemonic devices that you can use
to help you remember the information to be
included in all admission orders is the
acronym:
ADA-Vitamin L

A: Admit to: (name of admitting doctor and unit)
D: Diagnosis
A: Allergies
V: Vital Signs
I : Ins (diet,
(
ivf)
f)
T: Telemetry or other monitoring
A: Activityy
M: Meds
I: Is and Os
N: Nursing
L: Labs

A: Admit to: (name of admitting doctor and
unit)

A: Admit to: (name of admitting doctor and
unit)
E
Examples:
l
Admit to ICU, Dr. Crandall

Admit to 4N, Dr. Schindler

D: Diagnosis

D: DiagnosisDiagnosis Examples
Abdominal Pain
S/P appendectomy

D: Diagnosis
A: Allergies

D: Diagnosis
A: Allergies
p
Examples:
NKDA (No known drug allergies)

Allergies: Sulfa drugs,
drugs IV contrast

D: Diagnosis
A: Allergies
V: Vital Signs

D: Diagnosis
A: Allergies
V: Vital Signs-
Vital signs q one hour (in ICU)
VS typically includes temperature, blood

pressure, heart rate and respiratory rate. If you
want any additional vital signs,
signs they should be
ordered specifically
Example:
Monitor CVP q one hour

Monitor pulse ox q 4 hours

D: Diagnosis
A: Allergies
V: Vital Signs
I : Ins (diet, ivf)

D: Diagnosis
A: Allergies
V: Vital Signs
I : Ins (diet, ivf)

All patients should have a diet order
Examples:
NPO
General Diet
1800 call ADA diet
di
Clear liquids

D: Diagnosis
A: Allergies
V: Vital Signs
I : Ins (diet, ivf)- Maintenance IVF

IVF should be ordered if needed
All IVF orders need the type of fluid, any
additives,, and the rate. Examples:
p
D5.45NS with 20 KCl at 100cc per hour
LR at 85 cc p
per hour
.9NS at TKO (to keep open rate)
Heplock IV (this means the IV is capped off and no
fluids)

D: Diagnosis
A: Allergies
V: Vital Signs
This is also an appropriate area to order

bl d products
blood
d
if needed,
d d ffor example:
l
Transfuse one unit PRBC over 2 hours

D: Diagnosis
A: Allergies
V: Vital Signs

Type of fluid
Typical is D5.45 with 20KCl
Consider changing if diabetic, renal failure, electrolyte
abnormalities, etc.
Also consider alternative fluids (colloid, blood, LR) if
resuscitation or replacement is needed in addition to
maintenance

D: Diagnosis
A: Allergies
V: Vital Signs

Rate
Formula for maintenance rate:
First
s 10
0 K: 4cc/K/hour
cc/ / ou
Second 10 K: 2cc/K/hour
Remaining K: 1cc/K/hour
Example: 70K person: 40 + 20 + 50 = 110cc/hour

D: Diagnosis
A: Allergies
V: Vital Signs
I : Ins (diet, ivf)
T: Telemetry
T l
t or other
th monitoring
it i

D: Diagnosis
A: Allergies
V: Vital Signs
I : Ins (diet, ivf)
T: Telemetry
T l
t or other
th monitoring
it i
Order telemetry if needed.
Any other invasive monitoring: a-line, CVP,
pulse ox, swan ganz

D: Diagnosis
g
A: Allergies
V: Vital Signs
I : Ins (diet, ivf)
A: Activity

D: Diagnosis
g
A: Allergies
V: Vital Signs
I : Ins (diet, ivf)
A: Activity
Examples:
As tolerated
bed rest
no weight bearing to right foot
ambulate with assist only

D: Diagnosis
A: Allergies
V: Vital Signs
I : Ins (diet, ivf)
A: Activity
M: Meds

D: Diagnosis
A: Allergies
V: Vital Signs
I : Ins (diet, ivf)
A: Activity
M: Meds
For everyy patient
p
consider the following
g categories
g
and
if they are indicated for your patient (not all are needed
in all patients):
Pain meds
Antibiotics
DVT prophylaxis (may not be a med)
Ulcer prophylaxis
P i
Previous
meds
d

D: Diagnosis
A: Allergies
V: Vital Signs
I : Ins (diet, ivf)
A: Activity
M: Meds
I: Is and Outs

D: Diagnosis
A: Allergies
V: Vital Signs
I : Ins (diet, ivf)
A: Activity
M: Meds
I: Is and Outs
For most patients strict Is and Os
Consider how frequently you want UO checked:
UO q one hour (typical for ICU pt with foley)
UO q shift

D: Diagnosis
A: Allergies
V: Vital Signs
I : Ins (diet, ivf)
A: Activity
M: Meds
I: Is and Outs
N: Nursing

D: Diagnosis
A: Allergies
V: Vital Signs
I : Ins (diet, ivf)
A: Activity
M: Meds
I: Is and Outs
N: Nursing - Can include many things.

Examples:
Call HO for BP>170/90
BP>170/90, <90/60,
<90/60 HR>120<60,
HR>120<60 RR>30<12
RR>30<12, T>38
T>38,
UO<30cc/hour or 200/shift, Glucose >200<70
Dressing changes: wet to dry to right leg wound tid
Keep leg elevated
Call HO for any change in mental status
Check and record pedal dopplers q 4 hours
JP to bulb suction
F l to
Foley
t gravity
it
Incentive spirometer q one hour while awake
Teds and boots at all times unless ambulating

D: Diagnosis
A: Allergies
V: Vital
V
Vit l Si
Signs
I : Ins (diet, ivf)
A: Activity
M: Meds
I: Is and Outs
N: Nursing
L: Labs
Orders must include the specific test, when you
want it done,
done and how often if it is to be
repeated. Avoid open ended orders that have
no stop
p date ((such as cbc q d).
)

D: Diagnosis
A: Allergies
V: Vital
V
Vit l Si
Signs
I : Ins (diet, ivf)
A: Activity
M: Meds
I: Is and Outs
N: Nursing
L: Labs
It is not adequate to order electrolytes

D: Diagnosis
A: Allergies
V: Vital
V
Vit l Si
Signs
I : Ins (diet, ivf)
A: Activity
M: Meds
I: Is and Outs
N: Nursing
L: Labs
Be aware that in the EMR you may be asked to
link orders to a specific diagnosis or indication
Example: venous duplex, diagnosis: edema

D: Diagnosis
A: Allergies
V: Vital
V
Vit l Si
Signs
I : Ins (diet, ivf)
A: Activity
M: Meds
I: Is and Outs
N: Nursing
L: Labs
Examples of correctly written labs:
CBC now and

d iin AM
Chem 7 (names are different at different institutions) q am for 3
days
Chem sticks ac and hs q d
CXR stat
Venous duplex
p
right
g leg
g today
y

D: Diagnosis
A: Allergies
V: Vital Signs
I : Ins (diet, ivf)
A: Activity
M: Meds
I: Is and Os
N: Nursing
L: Labs
Example of a complete set of

Orders
Admit to 4NS: Dr. Schindler

Dx: S/P carotid
endarterectomy
NKDA
Vital signs q 4hours, please
include neuro checks and
check incision for hematoma
Ins: Clear liquid diet
45NS with 20KCl at 85cc/hour
until tolerating PO then
heplock
Telemetry not needed
Activity as tolerated
M d
Meds:
ASA 325mg PO q d
Atenolol 50mg po q d
Tylenol 650 po q 4 hours prn
pain
Kefzol 1g q 8 hours x 2 doses
Strict Is and Os
N i
Nursing:
Teds and boots at all times
unless walking
Call HO for BP>170/90,
<90/60,
90/60 HR>120<60,
HR 120 60
RR>30<12, T>38,
UO<30cc/hour or 200/shift,
Glucose >200<70
L b
Labs:
Chem stick ac and hs

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Writing Admission Orders

This item includes 4 components:

This is meant to be a guide but you will need a lot

Writing Admission Orders

This is meant to be a guide but you will need a lot

ADMISSION ORDERS TEMPLATE

ADMISSION ORDERS TEMPLATE

ADMISSION ORDERS TEMPLATE

ADMISSION ORDERS TEMPLATE

Admit to ICU, Dr. Crandall

ADMISSION ORDERS TEMPLATE

ADMISSION ORDERS TEMPLATE

ADMISSION ORDERS TEMPLATE

ADMISSION ORDERS TEMPLATE

NKDA (No known drug allergies)

ADMISSION ORDERS TEMPLATE

ADMISSION ORDERS TEMPLATE

Vital signs q one hour (in ICU)

VS typically includes temperature, blood

Monitor CVP q one hour

ADMISSION ORDERS TEMPLATE

I : Ins (diet, ivf)

ADMISSION ORDERS TEMPLATE

I : Ins (diet, ivf)

ADMISSION ORDERS TEMPLATE

I : Ins (diet, ivf)- Maintenance IVF

ADMISSION ORDERS TEMPLATE

I : Ins (diet, ivf)- Maintenance IVF

This is also an appropriate area to order

ADMISSION ORDERS TEMPLATE

I : Ins (diet, ivf)- Maintenance IVF

ADMISSION ORDERS TEMPLATE

I : Ins (diet, ivf)- Maintenance IVF

ADMISSION ORDERS TEMPLATE

I : Ins (diet, ivf)

ADMISSION ORDERS TEMPLATE

I : Ins (diet, ivf)

ADMISSION ORDERS TEMPLATE

ADMISSION ORDERS TEMPLATE

ADMISSION ORDERS TEMPLATE

ADMISSION ORDERS TEMPLATE

ADMISSION ORDERS TEMPLATE

ADMISSION ORDERS TEMPLATE

ADMISSION ORDERS TEMPLATE

ADMISSION ORDERS TEMPLATE

N: Nursing - Can include many things.

ADMISSION ORDERS TEMPLATE

ADMISSION ORDERS TEMPLATE

ADMISSION ORDERS TEMPLATE

ADMISSION ORDERS TEMPLATE

Examples of correctly written labs:

CBC now and

ADMISSION ORDERS TEMPLATE

Example of a complete set of

Admit to 4NS: Dr. Schindler

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