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General medical adm icu v8[1]

General  Medical  Adm  ICU  v8  

Diagnosis
¨ Primary Diagnosis____________________________________________________________
¨ Secondary Diagnosis__________________________________________________________
Service Designation
¨ Attending: Dr. _____________________________________________________________
¨ Hospitalist: Dr. _____________________________________________________________
¨ Date: ____________________________________________
¨ Time: ____________________
Hospital Status
¨ Inpatient
Hospital Location
x ICU
¨ Neg pressure room ________________________________________________________
Allergies
¨ Update Allergies with Reactions: ______________________________________________
VTE PE Prophylaxis Medical Evidence
¨ Heparin 5000 unit subcutaneously every 12 hours
¨ Heparin 5000 unit subcutaneously every 8 hours
¨ enoxaparin (Lovenox) 30 milligram subcutaneously every 24 hours
¨ enoxaparin (Lovenox) 40 milligram subcutaneously every 24 hours
l Consider platelet monitoring when initiating and treating heparin or lovenox
¨ Platelet count routine or __________(stat, urgent, daily)
¨ Reason for no chemical prophylaxis
- CIRCLE ONE:
     Physician  Signature:  __________________________________   PATIENT  STICKER  
     Date  /  Time:  ________________________________________   General  Medical  Adm  ICU  v8  


l Sequential Compression Devices are only recommended for medical patients at high risk for
¨ Sequential Compression Device Left Calf ¨ Sequential Compression Device Right Calf ¨ Sequential Compression Device Left Foot ¨ Sequential Compression Device Right Foot ¨ Reason for no SCD's - CIRCLE ONE: Bil traum amp legs w comp Bil traum amp legs wo com Sensory neuropathy
l If patient already on Coumadin, baseline PT/INR before resuming Coumadin
¨ warfarin (Coumadin) _________ milligram orally daily at 1700
VTE PE Prophylaxis Reminders
l For hospitalized acutely ill general medical patients who have a contraindication to anticoagulation,
IPC or graduated ES should be used Evidence l For hospitalized acutely ill general medical patients without contraindications who are confined to bed and have additional risk factors for VTE, DVT prophylaxis with LDUH, an LMWH, or a factor Xa inhibitor should be used Evidence l Individualized therapy based on the type of agent used, comorbidities, risk factors, and/or type of      Physician  Signature:  __________________________________   PATIENT  STICKER  
     Date  /  Time:  ________________________________________   General  Medical  Adm  ICU  v8  

Medications
Analgesics
¨ HYDROcodone-acetaminophen 7.5 mg-325 mg tab (Lortab 7.5) 1 tablet orally every 4 hours
¨ HYDROcodone-acetaminophen 7.5 mg-325 mg tab (Lortab 7.5) 2 tablet orally every 6 hours ¨ HYDROmorphone (Dilaudid) 0.5 milligram intravenously every 4 hours ¨ HYDROmorphone (Dilaudid) 0.5 milligram intravenously every 2 hours ¨ HYDROmorphone (Dilaudid) 1 milligram intravenously every 4 hours ¨ HYDROmorphone (Dilaudid) 1 milligram intravenously every 2 hours ¨ ibuprofen 400 milligram orally 3 times a day as needed for pain scale 1-5 ¨ ibuprofen 600 milligram orally 4 times a day as needed for pain scale 6-10 ¨ ketorolac (Toradol) 10 milligram orally every 6 hours for 5 day as needed for pain scale 1-5 ¨ ketorol

Source: https://bmhsc.org/Resources/15194/FileRepository/ContentDocuments/General-Medical-Adm-ICU-v8.pdf

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The following is a list of the most commonly prescribed drugs. It representsan abbreviated version of the drug list (formulary) that is at the core of yourprescription-drug benefit plan. The list is not all-inclusive and does notguarantee coverage. In addition to using this list, you are encouraged to askyour doctor to prescribe generic drugs whenever appropriate. 2012 Express Scripts Medicare

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