1. Order Writing

2. Essentials: Clarity Date, Time, Signature Appropriate Rank Re-evaluate
ADC VAAN DISML
Essentials:
Clarity
Date, Time, Signature
Appropriate Rank
Re-evaluate

3. Order Writing ADC VAAN DISML Admit Order Location Attending Physician
“Admit Mr. Jones to 6B, monitored bed, for Dr. Frank”

4. Order Writing ADC VAAN DISML Diagnosis
Chief complaint or problem(s)
“Diagnosis: Acute Coronary Syndrome”

5. Order Writing ADC VAAN DISML = Condition
Good
Fair
Poor
Guarded
Critical
No anticipated complications; pt. Stable Pt. Is ill, may have complications Very ill pt., chronically or terminally ill, not very stable Very ill pt., clinical outcome not predictable Desperately ill, unstable patient
“Condition: Stable”

6. Order Writing ADC VAAN DISML = Vital Signs (T, P, R, BP)
Patient’s condition dictates frequency
Special variables need orders
orthostatics, neuro status, pulse oximetry
Review daily
“Call” orders
“Vital signs q 4 hours. Call if P>100 or< 60, SBP>150 or<90”

7. Order Writing ADC VAAN DISML = Activity Restricted/Encouraged Bed rest
Bed rest with bathroom privileges/bedside commode
Up in chair/hall
Walk with assistance - how often
Up ad lib
“Bed rest. Up to bathroom with assistance”

8. Order Writing ADC VAAN DISML
Allergies
Include what they are allergic to and what reaction they get
“Allergies: Penicillin - Hives and Wheezing”

9. Order Writing ADC VAAN DISML= Nursing Instructions
Intake and Output
Daily weights
Patient positioning/turning
Wound care
Foley catheter, nasogastric tube
“Call” orders - e. g. pain, urine output
“1. Intake and Output
2. If patient develops chest pain, give 0.4 mg nitroglycerin s.l.,
obtain 12-lead EKG and call me stat on pager 1234”

10. Order Writing ADC VAAN DISML=Diet/Nutrition
Oral Nutrition - restricted or normal diet
diabetes, renal or liver disease
NPO for altered mental status, pre- surgical patients, some abdominal problems
If NPO, need order for alternative hydration and nutrition
“Two gram sodium diet today, then n.p.o. after midnight”

11. ADC VAAN DISML = Diet/Nutrition
Short term intravenous therapy
Electrolyte solutions
Long term intravenous therapy
parenteral or enteral nutrition

12. Order Writing ADC VAAN DISML=Intravenous Fluids
Be specific about composition, rate of administration and quantity
D5W - 5 % Dextrose in Water
D5½NS - 5% Dextrose in half normal saline
NS - Normal Saline
LR - Lactated Ringers solution
Example: “Infuse one liter of NS at 500cc/hour, then saline lock”
Request pumps when indicated
“Place saline lock”

13. Order Writing ADC VAAN DISML=Special Studies and Consults
Imaging studies - X-ray, sonograms, CT’s
Cardiovascular Studies - EKGs, echocardiograms, dopplers
Neurologic studies - EMGs, EEGs
Provide explanations when appropriate
Communicate directly with consulting physician when possible, always in stat situations
“1. Portable Chest X-ray
2. EKG, stat
3. Consult Dr. Stuart Frank regarding Acute Coronary Syndrome- I have notified him”

14. Order Writing ADC VAAN DISML = Medications
Dosage
Route of Administration
Be specific with prn orders
Review medications daily
Be specific when making changes. Cancel previous orders
If stat, communicate directly with nurse
Order Writing ADC VAAN DISML = Medications

15. ADC VAAN DISML = Medications
“1. ASA 325 mg., p.o. now x 1 dose 2. Start intravenous nitroglycerin drip at 10 micrograms/min. Increase rate by 5 micrograms/min every 15 minutes until systolic BP is 110, or until chest pain is relieved. Call me if rate of 30 micrograms/min is reached, or if chest pain is not relieved 3. Infuse heparin bolus 5000 units intravenously and follow by heparin drip at 1000 units/hour 4. Metoprolol 50 mg. p.o. BID”

16. Type and Crossmatch Orders
Be specific about blood product desired
packed cells, whole blood, platelets, cryoprecipitate
Clearly state how many units desired
Clearly state what you want done
Type and Cross order should precede transfuse order
“Type and Cross 4 units of PRBCs. Transfuse two units now, each over 4 hours; Hold two units in blood bank”

17. Order Writing ADC VAAN DISML = Laboratory Studies
Avoid orders for daily blood work
phlebotomy associated anemia not uncommon
Timing important for fasting levels, some drug levels
Order Writing ADC VAAN DISML = Laboratory Studies
“1. CBC, Cardiac Enzymes, Troponin I, BMP, PT, INR, PTT stat
2. Repeat Cardiac enzymes and troponin q 6 hours x3
3. Repeat EKG q 6 hours x3
4. PTT 4 hours after heparin is started”

18. THANK YOU, Jane Jones, MSIII

19. Don’t forget to date and time all orders and notes!

20. Prescription Writing Patient’s full name and DOB Date Rx
Drug Name…generic or trade name acceptable
Dosage
Quantity to be dispensed
Directions to patient
how many, how often, what route
how long? With meals?
Avoid “as directed”

21. Prescription Writing Number of refills May substitute?
consider whether acute or chronic illness,
abuse potential of drug, possibility of overdose
May substitute?
Generics are cheaper
Signature. DEA number for schedule II drugs.

22. Avoid the Following AbbreviationsIU
Mistaken as "IV" (intravenous) or 10 (ten).
Write international unit(s)
MgSO4
Misinterpreted as morphine sulfate, resulting in the wrong medication being administered.
Write magnesium sulfate
MS / MSO4 / MSO4
Misinterpreted as magnesium sulfate, resulting in the wrong medication being administered.
Write morphine
Q.D. / QD / q.d. / qd
Mistaken for Q.O.D./ qod, resulting in an inappropriate dosing schedule.
Write daily
Q.O.D. / QOD / q.o.d. / qod
Mistaken for Q.D./qd, resulting in an inappropriate dosing schedule.
Write every other day
T I W
Misinterpreted as "three times a day" or "twice a week."
Specify days of the week
U / u
Mistaken as a zero or a four (4), resulting in overdose. Also mistaken for "cc" (cubic centimeters) when poorly written.
Write unit(s) µg
Mistaken for "mg" (milligrams) when written, resulting in an overdose.
Write microgram(s) or mcg