How to Write Orders

1. How to Write Orders Shruti Kant, MD Sonya Aikels, DO Pediatric Chief Residents July 2, 2008

2. Admission Orders • ADC VANDALISM • Admit to peds service under Dr. ___ and residents (inpatient/observation) • Diagnosis • Condition – good/fair/critical • Vitals – q ___ hours • Allergies • Nursing – I/O, daily wt, suctioning, neurochecks, reflux precautions, sz precautions etc

3. Admit Orders (cont) • Diet • Activity – bed rest, out of bed to chair etc • Labs/imaging • IV fluids • Medications • Consults • Instructions

4. Medication Orders • Write pt’s wt and allergies on order sheet • Amount and route of administration • Frequency of administration • Always check dosing!!! • Use LexiComp or Harriet Lane only to check dosage • Write dosage (mg/kg/dose or day) for every order

5. Medication Orders (cont) • Always have a calculator!! • Must write PRN for as needed medications • Qualify PRN orders • No trailing zeroes (eg 1.0mg) • Always write preceding zeroes (eg 0.1mg) • Be specific with what you want done • If in doubt call the pharmacist or the nurse!

6. Medication Orders (examples) • Tylenol 50mg q4 hrs prn (15mg/kg/dose) • Route not given • Prn specification • Ceftriaxone 100mg IV q day • Dosage not written • Novolog 5.0 units SQ q am • Trailing zero

7. Abbreviations • Examples • QID/TID/QD • Cc • MS/MSO4 • U • Look at list on order sheets • If in doubt, write it out!!

8. Discharge Orders • D/C all lines • Discharge home with _____ • Discharge diagnosis • Condition • Activity • Diet • Medications • Follow up – PCP and specialists • Special instructions for parents

9. Thank You!!

10. Scenarios • 14 d/o female with temp 100.8 ® • 6mo male with dehydration due to AGE • 12 y/o male, known asthmatic s/p acute exacerbation to go home on albuterol and pulmicort