Mercy-Orders-Signature-Template.txt Mercy Hospital of Pittsburgh Standing Orders: Signature Block Template Change List The Owner of this Standing Order is Bruce MacLeod, M.D., Chair, Mercy Department of Emergency Medicine Suggestions for changes should be emailed to Dr. MacLeod's delegate for this Standing Order Template: Keith Conover, M.D. Change List started 11/25/06 Version 2.1 changes: - moved "Print Last Name:" fillin ABOVE written-signature fillin. REASON: people tend to sign something as their last action on a form. People tended to not print their name in the "Print Last Name:" fillin as they signed the form and then ignored everything below the signature. GLOBAL CHANGE: changed in master Signature Block and for all orders. - changed the name of the DEM attending emergency physician signature block to deal with the following issues, and to be consistent between internal DEM orders (e.g., Brain Attack, Restraint) and those used both in the DEM and on the floor (e.g., DEM Transition Admission Orders and other admission orders completed by a physician in the DEM) a) an attending cosignature is NOT required for residents signing hospital admitting orders such as Chest Pain Admission orders or DEM Transition Admission Orders b) an inpatient attending cosignature is required for ALL admitting orders written in the DEM c) it is possible that a non-emergency physician might need to sign these orders; for example, a neurologist or neurosurgeon in the ED might have primary responsibility for a patient, and fill out the Brain Attack and ICH orders. Therefore, the text on the dual-signature-block internal DEM orders will now read: "Resident/PA/CRNP:" and "ED Attending physician (required):" and text on the triple-signature-block admitting orders will now read: "PA* CRNP* Resident (*PA/CRNP signature requires attending cosignature.)" and "ED attending physician (not required for resident signature)" and "Inpatient attending verifies (required)." Note that have gone back and forth many times considering different terms, and the term "ED Attending Physician" could be an emergency physician OR a neurologist/neurosurgeon (or other specialist or primary care physician). And the only good way we've found to unambiguously term the admitting attending of record is "Inpatient attending." (Note that saying the full "Inpatient attending physician" would require enough room that it would require that the triple signature block take even more room than it does now, and "inpatient attending" was thought to be understandable as is.) - found we didn't leave enough room for the Date block so increased the size. - Added a second page with a triple-signature box for the DEM Transition orders, which unlike the internal DEM Standing Orders, need to have a third signature block for the verifying inpatient attending. Modified this triple signature block in line with the above principles. With three signature blocks, had to decrease the Time: fillin to make some room for the Date: fillin. Version 1.0 changes: - Decided, to avoid confusion with "verifying attending signature" where that is of a private attending verifying DEM Transition Orders, now the bottom block will say "Attending Co-Signature." On the standard DEM order sheet, it says "DEM Attending Physician" for the signature block, however, I could see Dr. Baker or Dr. Bursick in the ED signing these orders if they happen to be there and caring for a patient as opposed to a DEM attending, so have left off the "DEM." Later, decided that uniformity among the DEM Standing Orders was more important, and left it at "Attending emergency physician" on all the DEM Standing Orders. Thought it unlikely that a neurosurgeon or neurologist would need to sign these orders and that they would understand to sign in the "Attending emergency physician" fillin. - Decided that the word "signature" doesn't need to be in the header for a signature block, and instead, put the imperative "Sign:" inside the signature block instead. - When standing _admitting_ orders are required by hospital policy, as for those admitted with a diagnosis of chest pain or community- acquired pneumonia, they say "Mandatory" in the top left block; we decided to include this for BAPET orders as we want any and every BAPET patient to have these orders on the chart. - The signature block will have to appear on every page. Even if the orders are printed front and back with a printer that supports duplex printing, a signature block must appear on each and every page. This is to ensure that, if the pages are photocopied single-sided, a signature box appears on each and every page. - MEDICAL STUDENTS may sign admitting orders (though the DEM has decided not to allow); however, these signatures must be cosigned by a resident or attending. - RESIDENTS may sign admitting orders; they do not require attending cosignature. - PAs AND CRNPs may sign orders; these DO require an attending cosignature. Admitting orders signed by a DEM CRNP or PA DO could potentially be cosigned by the admitting attending of record. However the DEM prefers that such admitting orders be cosigned by a DEM attanding as well as the admitting attending of record. - DEM-SIGNED ADMITTING ORDERS: Admitting orders signed by a DEM attending or resident must either be verified by the inpatient attending of record or a covering inpatient attending by 9 AM. Originally a statement to this effect appeared at the beginning of the DEM Transition Orders. However, we moved this down to just above the signature block and this appears to work much better than have it at the beginning of the orders.