Mercy-Orders-DEM-Transition.txt Mercy Hospital of Pittsburgh DEM Transition Orders Change List The Owner of this Standing Order is Bruce MacLeod, M.D., Chair, DEM. Suggestions for changes should be emailed to Dr. MacLeod's Delegate for this Standing Order: Keith Conover, M.D. See also Mercy-Orders-Template.txt and Mercy-Orders-DEM-Signature- Template.txt for additional notes of changes that apply to all orders. Proposed changes to version 2.1 - changed the triple signature box at the bottom as per Mercy-Orders-DEM-Signature-Template.txt - added a "NPO p midnight" diet order as we often have to write this. - Added to the "Notify Physician" section: "if Panic lab value." - Discussed the idea of replacing "Acetaminophen 650 mg PO Q4H PRN pain" with " ...PO/PR PRN pain" but then we got bogged down in a discussion of what dose of rectal acetaminophen is needed to be effective for pain, and even generalizing from the studies regarding rectal acetaminophen for fever, we couldn't reach a consensus, so we left it as is. - the Routine Adult Subcutaneous Insulin Orders and Adult Sliding Scale Subcutaneous Insulin Orders were combined to produce OS-322 Subcutaneous Insulin Order, and the DEM Transition Orders were modified to reflect this. We did NOT add a checkbox for the Critcal Care Insulin Infusion Orders as emergency physicians are NOT to write orders for critical care patients. We also did not add a checkbox for the DKA orders as these are to be used INSTEAD of the DEM Transition Admission Orders for DKA patients. - added to the list of "notify physician if": "If panic lab value" - after discussion at several department meetings based on input from Medicine regarding the need for DVT prophylaxis, and in general emergency physicians' (appropriate, given how far it is from "emergency medicine") unfamiliarity with DVT prophylaxis, added prompts for DVT prophylaxis. We were going to add "Intermittent pneumatic compression devices" rather than the different flavors of heparin for prophylaxis, however were told that these should be ordered using the "DVT Risk Assessment/Orders for Prophylaxis" so added a checkbox to indicate that these are attached. Also added a checkbox "Contact inpatient attending in AM for DVT Prophylaxis orders" which will help make sure these orders are completed, without demanding that an emergency physician complete them, nor demanding that the emergency physician remember to discuss this when contacting an inpatient attending about an admission, or having to call the inpatient attending back (possibly in the middle of the night) to discuss these options. - MEDICATIONS: changes to the orders, including a larger signature block at the bottom, cut the amount of room on the orders, unless we go to two pages; we elected to cut the medications block down, and added a note that "Other critical medications (routine dailymedications go on regular order sheet)." If an emergency physician offers, as a courtesy, to write some or all of the patient's daily medications, these should go on a separate order sheet; but as per policy, this is neither expected nor required. As per Donna Gurcak's suggestion, added a vertical line in the middle of the medication fillin box, to make it easier to fill in and read if one wants to add more than three medications here. However, it's a pale gray line so people may easily write across it if they wish. ******* Previous and current version is 2.0, dated 7/31/05