Acute Care Elderly (ACE) Admission Order Set [2060]

THE CHRIST HOSPITAL

CINCINNATI, OHIO 45219

Pre-Printed Physician Orders Sheet Instruction:

To be used during Epic downtime, a replication of the electronic

order set

Review: Review pre-selected orders (X)

Cancel: To cancel pre-selected orders, place a line through the order

Add: To initiate non-selected orders, place an "X" in front of the

order(s)

Sign: Place full signature, date, and time at the bottom of each page

FORM TITLE ACUTE CARE ELDERLY ADMISSION ORDERS

D- 2060 New/Rev Date 3/3/15

Page 1 of 9

Place Patient Label Here

THE FOLLOWING ABBREVIATIONS ARE NOT PERMITTED FOR USE: IU,U (Units), QD (Daily), QOD (Every other day), 1.0 (1), .5 (0.5), MS, MSO4, MgSO4 (morphine sulfate, magnesium sulfate) S= Today, S+1 = Tomorrow or POD1, S+2 = POD2, etc.

HEIGHT:

WEIGHT:

ALLERGIES:

DIAGNOSIS:

Acute Care Elderly (ACE) Admission Order Set [2060]

Acute Care for Elders Units: Practical Considerations for Optimizing Health Outcomes. Robert M. Palmer; Steven R. Counsell; and S Health Outcomes 2003; 11 (8): 507-517

American Geriatrics Society Updated Beers Criteria for

URL: ".

Potentially Inappropriate Medication Use in Older Adults. The aspx?sourcedoc=/Forms/Ordersets/2060%20Reference%20

American Geriatrics Society 2012 Beers Criteria Update Expert for%20ACE%20Admission%20Order%20Set%20Beers%20

Panel

Criteria.pdf&action=default"

Status Order

Status Order (Single Response) ( ) Admit to Inpatient

( ) Refer to Observation

Code Status

Code Status (Single Response) ( ) Full Code ( ) Do not resuscitate ( ) Partial Code

Routine, ONE TIME Admission Service: Admission Level of Care: Admission Diagnosis: Admitting Physician: Comments: Starting Routine, ONE TIME Admission Service: Admission Level of Care: Admission Diagnosis: Attending Physician: Comments: Informational: Observation orders require a documented Plan of Care from the ordering practitioner Starting:

Routine, CONTINUOUS Routine, CONTINUOUS Routine, CONTINUOUS Resuscitation Restrictions:

Physician Signature ___________________________________ Date/Time: ____________

*D2060*

*D2060*

THE CHRIST HOSPITAL

CINCINNATI, OHIO 45219

Pre-Printed Physician Orders Sheet Instruction:

To be used during Epic downtime, a replication of the electronic

order set

Review: Review pre-selected orders (X)

Cancel: To cancel pre-selected orders, place a line through the order

Add: To initiate non-selected orders, place an "X" in front of the

order(s)

Sign: Place full signature, date, and time at the bottom of each page

FORM TITLE ACUTE CARE ELDERLY ADMISSION ORDERS

D- 2060 New/Rev Date 3/3/15

Page 2 of 9

Place Patient Label Here

THE FOLLOWING ABBREVIATIONS ARE NOT PERMITTED FOR USE: IU,U (Units), QD (Daily), QOD (Every other day), 1.0 (1), .5 (0.5), MS, MSO4, MgSO4 (morphine sulfate, magnesium sulfate) S= Today, S+1 = Tomorrow or POD1, S+2 = POD2, etc.

Consults [X]Inpatient consult to Social Work [X]PT eval and treat [X]OT eval and treat [ ] Speech/Language/Cognition eval and treat [ ] Speech dysphagia/swallowing eval & treat [ ] DIAG-modified barium swallow [ ] Nutrition consult [ ] Inpatient consult to wound care nurse [ ] Inpatient consult to Palliative Care

[ ] Inpatient Consult to Pastoral Services [ ] Inpatient consult to Pharmacy-General [ ] Inpatient consult to Psychiatry

Routine, ONE TIME Reason for Consult: Patient/ACE consult Starting S, For -1

Routine, UNTIL DISCONTINUED Reason for PT? ACE patient Starting S, For -1

Routine, UNTIL DISCONTINUED Reason for OT? ACE patient Starting S, For -1

Routine, ONE TIME Reason for SLP? ACE consult Starting S, For 1 Occurrences

Routine, ONE TIME Reason for swallow evaluation? Starting S, For 1 Occurrences

Routine, 1 TIME IMAGING Reason for exam: For 1

Routine, ONE TIME Reason for Consult: Patient/ACE Consult Starting S, For -1

Routine, ONE TIME Reason for consult: Starting S, For -1

Routine, ONE TIME Reason for Consult: Consulting provider/group contacted? Starting S, For -1

Routine, ONE TIME Reason for Consult? Starting S, For -1

Routine, ONE TIME Reason for consult: Starting S, For 1 Occurrences

Routine, ONE TIME Did you place a call to Behavioral Health Intake at 5-1894: Reason for consult: Consulting provider/group contacted? Starting S, For 1 Occurrences

Physician Signature ___________________________________ Date/Time: ____________

THE CHRIST HOSPITAL

CINCINNATI, OHIO 45219

Pre-Printed Physician Orders Sheet Instruction:

To be used during Epic downtime, a replication of the electronic

order set

Review: Review pre-selected orders (X)

Cancel: To cancel pre-selected orders, place a line through the order

Add: To initiate non-selected orders, place an "X" in front of the

order(s)

Sign: Place full signature, date, and time at the bottom of each page

FORM TITLE ACUTE CARE ELDERLY ADMISSION ORDERS

D- 2060 New/Rev Date 3/3/15

Page 3 of 9

Place Patient Label Here

THE FOLLOWING ABBREVIATIONS ARE NOT PERMITTED FOR USE: IU,U (Units), QD (Daily), QOD (Every other day), 1.0 (1), .5 (0.5), MS, MSO4, MgSO4 (morphine sulfate, magnesium sulfate) S= Today, S+1 = Tomorrow or POD1, S+2 = POD2, etc.

Vitals Signs

Vital Signs [ ] Vital Signs [ ] Notify MD or NP - vital signs (specify)

[ ] Telemetry Observational Monitoring [ ] Telemetry Observational Monitoring [ ] Notify MD to determine if ongoing telemetry is needed

Routine, EVERY 8 HOURS, While Awake, Starting S with First Occu Routine, ONE TIME Systolic BP less than: Systolic BP greater than: Diastolic BP less than: Diastolic BP greater than: Pulse greater than: For -1

Routine, ONE TIME, Remote telemetry monitoring, Starting S, For 1 Routine, ONE TIME, 48 hours after admit to telemetry, Starting S+2 a

Nursing Orders

Isolation Orders

[ ] Isolation Orders [ ] Contact isolation [ ] Contact plus isolation [ ] Contact and respiratory isolation [ ] Contact and airborne isolation [ ] Airborne Isolation (Negative Air Pressure)

Routine, UNTIL DISCONTINUED, Starting S at 12:00 AM Routine, UNTIL DISCONTINUED, Starting S at 12:00 AM Routine, UNTIL DISCONTINUED, Starting S at 12:00 AM Routine, UNTIL DISCONTINUED, Starting S at 12:00 AM Routine, UNTIL DISCONTINUED, Starting S at 12:00 AM

Precaution Orders

[ ] Precaution Orders [ ] Aspiration precautions [ ] Fall precautions [ ] Neutropenic precautions [ ] Seizure precautions [ ] Precaution- specify in comments

Routine, CONTINUOUS Routine, CONTINUOUS Routine, CONTINUOUS Routine, CONTINUOUS Routine, CONTINUOUS

Physician Signature ___________________________________ Date/Time: ____________

THE CHRIST HOSPITAL

CINCINNATI, OHIO 45219

Pre-Printed Physician Orders Sheet Instruction:

To be used during Epic downtime, a replication of the electronic

order set

Review: Review pre-selected orders (X)

Cancel: To cancel pre-selected orders, place a line through the order

Add: To initiate non-selected orders, place an "X" in front of the

order(s)

Sign: Place full signature, date, and time at the bottom of each page

FORM TITLE ACUTE CARE ELDERLY ADMISSION ORDERS

D- 2060 New/Rev Date 3/3/15

Page 4 of 9

Place Patient Label Here

THE FOLLOWING ABBREVIATIONS ARE NOT PERMITTED FOR USE: IU,U (Units), QD (Daily), QOD (Every other day), 1.0 (1), .5 (0.5), MS, MSO4, MgSO4 (morphine sulfate, magnesium sulfate) S= Today, S+1 = Tomorrow or POD1, S+2 = POD2, etc.

Nursing Orders Delirium Care & Prevention Orders

[ ] Non-Pharmacologic Delirium Care/Prevention Standards of Care

Routine, ONE TIME, 1. When appropriate, ask family to bring in patie 2. During the day, keep window shades up to allow natural lighting 3. Consider turning bed to face outside during daytime 4. At night, low level indirect lighting, low volume 5. Encourage family to attend to patient and instruct them in specifics 6. Patient at risk for delirium; call MD with any change in patient base 7. Encourage wakefulness during the day so patient inclined to sleep

Starting S

Nursing Orders Bowel/Bladder A review of laxative therapies for treatment of chronic constipation in older adults, Fleming V; Wade WE; American Journal of Geriatr 8 (6).

[ ] If no BM reported in 3+ days, RN to assess for fecal impaction Routine, ONE TIME, Starting S, For -1

& disimpact if indicated

[ ] Discontinue foley catheter

Routine, ONE TIME, Starting S, For 1 Occurrences

Nursing Orders Sleep [X]Sleep/Insomnia Standards of Care

Routine, ONE TIME, 1. Avoid all caffeine beverages after noon 2. If routine diuretics or laxatives are scheduled after 1700, contact p administration time 3. Before offering medications for insomnia, offer patient a choice of 4. Offer patient a back rub at bedtime 5. Offer patient disposable earplugs to promote rest Starting S

Diet /Nutrition

Supplements [ ] ENSURE ORAL SUPPLEMENT

Routine, Diet Q Day

Flavor:

[ ] ENSURE CLEAR ORAL SUPPLEMENT

Routine, Diet Q Day

Ensure Clear Flavor:

[ ] ENSURE PUDDING ORAL SUPPLEMENT

Routine, Diet Q Day

Flavor:

[ ] GLUCERNA ORAL SUPPLEMENT

Routine, Diet Q Day

Flavor:

[ ] NEPRO ORAL SUPPLEMENT

Routine, Diet Q Day

Flavor:

[ ] MAGIC CUP ORAL SUPPLEMENT

Routine, Diet Q Day

Flavor:

Physician Signature ___________________________________ Date/Time: ____________

THE CHRIST HOSPITAL

CINCINNATI, OHIO 45219

Pre-Printed Physician Orders Sheet Instruction:

To be used during Epic downtime, a replication of the electronic

order set

Review: Review pre-selected orders (X)

Cancel: To cancel pre-selected orders, place a line through the order

Add: To initiate non-selected orders, place an "X" in front of the

order(s)

Sign: Place full signature, date, and time at the bottom of each page

FORM TITLE ACUTE CARE ELDERLY ADMISSION ORDERS

D- 2060 New/Rev Date 3/3/15

Page 5 of 9

Place Patient Label Here

THE FOLLOWING ABBREVIATIONS ARE NOT PERMITTED FOR USE: IU,U (Units), QD (Daily), QOD (Every other day), 1.0 (1), .5 (0.5), MS, MSO4, MgSO4 (morphine sulfate, magnesium sulfate) S= Today, S+1 = Tomorrow or POD1, S+2 = POD2, etc.

[ ] NUTRASHAKE ORAL SUPPLEMENT

[ ] TWOCAL ORAL SUPPLEMENT [ ] SUPLENA ORAL SUPPLEMENT [ ] JUVEN ORAL SUPPLEMENT

[ ] BENEPROTEIN POWDER ORAL SUPPLEMENT [ ] HEALTHY SHOT 12 ORAL SUPPLEMENT [ ] HEALTHY SHOT 24 ORAL SUPPLEMENT [ ] ALCOHOLIC BEVERAGE ORAL SUPPLEMENT

Routine, Diet Q Day Flavor: Routine, Diet Q Day Routine, Diet Q Day Routine, Dietary every 12 hours Flavor: Routine, Diet Q Day Routine, Diet Q Day Routine, Diet Q Day Routine, ONE TIME

Diets

[ ] NPO DIET

Routine, Diet Q Day NPO restrictions: NPO Starting S with First Occurrence Include Now

[ ] NPO After Midnight

Routine, After Midnight NPO restrictions: NPO after midnight Starting S

[ ] REGULAR DIET

Routine, Dietary TID Regular Restrictions: Diet type restriction: Liquid restrictions: Fluid amount restriction: Mineral Restrictions: Starting S with First Occurrence Include Now

[ ] CARDIAC DIET

Routine, Dietary TID Cardiac Restrictions: Diet type restriction: Fluid amount restriction: Mineral Restrictions: Starting S with First Occurrence Include Now

[ ] LIQUID DIET

Routine, Dietary TID Liquid restrictions: Color/Temperature Restrictions: Fluid amount restriction: Mineral Restrictions: Diet type restriction: Starting S with First Occurrence Include Now

[ ] LOW SODIUM DIET

Routine, Dietary TID Sodium restrictions: Diet type restriction: Fluid amount restriction: Mineral Restrictions: Carbohydrate controlled: Starting S with First Occurrence Include Now

Physician Signature ___________________________________ Date/Time: ____________

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