Medicine Revised 6/16/2013
Admit Orders to the Hospital:
ADCVANDIMLS-CC
A: Admit to (service: Medicine, Pediatrics, Surgery, ENT, Neurosurgery, etc.)
List Your name and Pager number
List Admitting Intern and Pager number
List Admitting Resident and pager number
List Admitting Attending
D: Diagnosis
List the main diagnosis and any other that are pertinent to the care of the patient
C: Condition
This indicates to the nursing staff and PR folks how sick the patient is
Serious, Guarded, Critical, Stable, not to be released etc.
V: Vitals
This is how frequently YOU want vital signs checked.
This can be every 15 minutes, hourly, every 4 hours, every 12 hours, daily or
whatever you choose. If you put per routine know what that means for the
service you are on.
A: Activity
This refers to limitations on activity
Bed rest, bed rest with bathroom privileges, fall precautions, ad lib, no
restrictions this directs many of the cares that the patient will receive.
N: Nursing
What you want the nurses to routinely do
Accurate input and output values, daily weight, calorie counts, CR
(cardiorespiratory) monitor, pulse oxymetry, wound care/dressing
changes, etc.
D: Diet
What you want the patient to eat
NPO (nothing per os NO eating or drinking), NPO except medications,
2000 calorie ADA (American dietary association), no added salt,
whatever the special food that the parents are using etc.
I: IVF (intravenous fluids)
The patient may not need an IV, but if they do this line dictates what fluid to hang.
You should indicate the fluid, the rate that it is to run, how much or how long
it is to be ran.
i.e. D5 0.5 NS + 20 mEq/L of KCl at 75 ml/hr
YOU SHOULD KNOW WHY YOU ARE USING THIS FLUID AND
HOW TO CALCULATE EVERY ASPECT OF THE ORDER
Medicine Revised 6/16/2013
M: Medications
These are the medications the patient will be receiving
Include the name, dose, route and frequency
Oxygen is a medication! If you want the patient on oxygen list it here and how
you want it delivered (mask, nasal cannula etc.).
PRN (as needed) medications need specific indications for why they are to be
given. i.e. Morphine 4mg IV push q4 hour PRN for severe pain
L and S: Labs and Studies
These are the labs that need to be drawn now and those that need to be obtained routinely. You
should only order labs whose abnormal or normal results will change your treatment plan.
Ordering a lab just because you want to see the result is poor form AND you may get an
abnormal result and now YOU must explain why the result is abnormal.
You can also order other ancillary studies under this heading such as x-rays, ECG, EEG, etc.
Whenever you order one of these studies you need to write down in the order sheet the
indication for the study. Do not put because I want it or "because my attending/resident
wants it".
Call HO:
This section should be filled out on ALL patients and alerts the nursing staff to things that
you really want to know about. The nurses are your eyes and ears while you are busy
working up other patients, eating or sleeping. The nurses and ancillary personal should
always be treated with the utmost respect.
THEY DO NOT WORK FOR YOU!
Temperature: > 38.5 C this varies by service and patient.
Respiratory Rate: If the patient is not admitted with respiratory distress than any sustained rate
(for > 5 minutes) that is over the upper limit of normal should be concerning. If the
patient is admitted with respiratory distress, than you need to decide at what rate you
would change your management plan. You will always want to be called if the rate is <
10/minute.
Oxygen Saturation: If your patient is on a pulse ox, you want to know if the
saturation is < 88%. You also want to know if any increases in oxygen flow are made.
An increase in need for supplemental oxygen is a sign of alveolar disease and need to be
addressed immediately.
Heart Rate: You will want to be notified when the heart rate is sustained above a
normal rate or above the patients normal rate. You always want to know if the heart rate
is < 60/minute.
Blood Pressure: This is dependent on the reason for admission and baseline for the patient.
You need to consider systolic and diastolic pressures. Here again choose a number
that is abnormal for your patient (if they are admitted for hypertension then you will
constantly be called if you want to be notified if the SBP is above the upper limit of
normal). You can give both a high and low pressure trigger.
Code Status: Every patient, critically ill or not, needs this listed. (Full Code, DNR, DNI, DNR/DNI, etc.)
Always put down as the last line Please call with any questions or concerns
Sign your orders LEGIBLY and put your pager number after your signature.
