ADC VANDALISM – admission orders

HOSPITAL MEDICINE, MNEMONICS

There are several mnemonics to help you remember how to write admission orders. The one i like to use is :

Admit & D/C VANDALISM (i.e. ADC VANDALISM)
Here’s the general idea:

  • Admit to Med/Surg; Tele;  Intermediate (PCU);  ICU. Select/Write Attending Physician’s Name. Also write service and co-residents if applicable.
  • Diagnosis: list in order of priority. Break them into two groups. First, New/Acute Problems. Second, Chronic Problems.
  • Condition: stable, good, fair, guarded, critical, etc.
  • Vitals: routine, q shift (aka every 8 hours), q4hours; Parameters for notifying physician e.g. SBP <90 or >150; HR < 60, RR <10, T > 38.3 degrees
  • Activity: ad lib, bed rest / bathroom privileges (BRP), out of bed (OOB) ad lib / bedside commode / up in chair as tolerated, up to chair, ambulate TID, etc.
  • Nursing Instructions:
    • Strict I/O’s, daily weights, Foley to gravity, O2 requirement; 1:1 Observation, Neurocheck q4h
    • Wound care: Dressing changes, DVT stockings, etc;
    • Respiratory care: updrafts, endotracheal suctioning, spirometry, incentive spirometer, etc.
    • Precautions: Aspiration precautions, fall precaution, seizure precautions
    • Protocols: Hypoglycemia protocol, bedsore prevention, incentive spirometer.
  • Diet: regular, ADA (diabetic), low sodium, NPO/NPO except ice chips/meds, clear liquid as tol,  advance as tol,  regular / 4 g Na / diabetic (1800, 2000, 2400)
  • Allergies (to food & Meds): No food allergies, NKDA, or name allergy AND reaction (e.g., hives, anaphylaxis)
  • Labs, studies, radiology or imaging: CBC, Chemistries, X-rays, MRI/CT, ECG, Pulse ox, Ca, Mg, Phos, etc.
  • IV Fluids: D5NS to run at 120cc/hr or NS at 100 cc/hr etc
  • Specialists or consults
  • Medications and Monitoring.
    • Sedatives, analgesics, and prn meds
    • Antibiotics & Meds that treat the new diagnoses
    • Reconcile home medications and choose those to d/c or cont.
    • Write med name, dose, route, and schedule

Bowel Protocol
– Docusate Na 100 mg PO BID
– Bisacodyl 5 mg PO or 10 mg PR QHS PRN no BM for 24°
– MOM 30 mL PO QHS PRN no BM for 48°

Pain Management
– Ketorolac 30 mg IVP q6° PRN pain (Not to exceed 12o mg / day)
– Hydrocodone 5-10 mg / APAP 500 mg PO q4° PRN
– Ibuprofen 400-600 mg PO q6° schd ×48° then PRN
– APAP 650 mg PO q4° PRN fever/pain

DVT Prophylaxis
– Enoxaparin 30-40 mg SUBQ q12°-24°
– PCDs / SCDs – Pneumatic compression devices / Sequencial compression devices

GI Prophylaxis
– Protonix

Antiemetic
– Ondansetron 4 mg IV ×1 MRP ×1 PRN N/V
– Prochlorperazine 10 mg IV q6° PRN N/V
– Promethazine 25 mg PR q4° PRN N/V

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