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Updated 5/5/11

DISCHARGE ORDERS to SNF/NF/HOME HEALTH
(Suggestions: write orders on hospital order sheet, use this format as reminder)

A-dmit to:..list: □ facility and □ physician who will follow.
D-iagnosis:..list: □ the hospital generated diagnosis,
  (do this only if a DC summary will not accompany patient) Goal is to send all patients with DC summary when possible
C-ondition &
 C-ode status		 if known (If a DC summary will not accompany patient:list status at discharge of problems treated in hospital.)
 
A-llergies... □ give adverse reaction if known
   
V-ital signs.. □ VS & weights (frequency) □ sit-stand BP's (if pertinent)
  □ Sao2? □ criteria for calling & who to call
  (NH's usually have a routine of VS frequency such as weekly or monthly
A-ctivity level. □ activities orders □ PT?  □ OT?
  (write orders for rehab, orders should list: reasons for therapy and goal.) e.g. Gait/Balance & restrengthening  for post-hip fx to regain independent ambulation.
N-ursing orders:. e.g. skin care orders, ambulation, etc.
D-iet:... □ diet (consistency, type) (note many NH residents need only regular diets)
  □ feeding instructions for swallowing disorders
  □ Speech therapy consults (if swallowing disorders are suspected.)
   □ include daily fluid by shift (po or IV) if pertinent.
I-V fluids........ write only if needed, be sure receiving facility
can do IV's.

□ Fluid goals (oral) □ I & O's needed?
M-eds............. □ try to write for q day or bid dosing when possible, crushed? liquids?
  □ provide indications for each med. e.g. metoprolol (CHF)
  □ write # days for antibiotics □ remember any respiratory meds
  For narcotics or continuous meds, fax the orders in advance to the facility to avoid interruptions in therapy.
  □ eye drops? □ skin care?
L-abs.............. □ write indications for labs. (Most NH's have routine lab days, if not critical write " next lab day" or in generalities such as "1-2 weeks". Avoid labs on Fridays & weekends if possible.
  □ write "who to call" with results or where to send results.
S-pecifics:...... □ Respiratory therapy? □ O2? □ Nebs?
  □ F/U appointments, who and when?
  □ If NH Re-admit: Resume: previous lab or therapies?
  □ Accuchecks □ SSI? □ renew previous meds?
Website: http://geriatrics.unmc.edu/  


 

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