Admitting a Patient

Honestly, your PHYSICIANS should have a protocol or something that reminds them to order what they need to order when they admit a patient. It's pitiful that you have to ask for a whole bunch of basic things, but even the best physicians miss stuff.

Things I think about:

- Either an order for VTE prophylaxis or a communication order stating why they don't have VTE prophylaxis ordered

- Stress ulcer prophylaxis, esp. if patient on vent/BiPAP, high INR/PTT, or history of GERD

- Labs... particularly blood cultures if the patient is presenting with possible infection, preferably before first antibiotic is hung

- Insulin/BG checks if diabetic

- A diet order of some kind, even if just NPO

- An activity level order

- A foley order if they have a foley

- A tele order if they are on tele

- Home meds re-ordered if applicable

- Something for nausea

- Several somethings for pain, with built-in pain level parameters (i.e. Tylenol for pain 1-3, Norco for 4-6, and IV morphine for 7-10) so we're not "practicing outside our scope" when we medicate the patient

That last one sounds ridiculous, but is actually something Joint Commission just audited at my facility, because apparently morphine was being given for low pain levels but people were giving a Norco for 10/10 pain, so every pain medicine is supposed to have what levels it's appropriate to give the medicine for built into the order now. I'll tell you our physicians are really loving being called about that one when we tell them just ordering something for pain isn't good enough.

Everything else I just look at on a case by case basis. I hope this helps!

I make a cheat list before I call, but it's specific to the patient. I can't imagine there's a "one size fits all" list that wouldn't be excessively long (and therefore useless). If I'm dealing with something relatively unfamiliar, I might run my list by a co-worker or charge nurse and ask them if they think I'm missing anything important. Maybe something like that would work for you.

The main question I ask is when they're going to be here to admit their patient. It doesn't alway work out like that and tying up loose ends is unavoidable, over time you'll end up remembering things on the first call to the Doc, but there's no real expectation that you'll be able to do that right off the bat.

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- Several somethings for pain, with built-in pain level parameters (i.e. Tylenol for pain 1-3, Norco for 4-6, and IV morphine for 7-10) so we're not "practicing outside our scope" when we medicate the patient

That last one sounds ridiculous, but is actually something Joint Commission just audited at my facility, because apparently morphine was being given for low pain levels but people were giving a Norco for 10/10 pain, so every pain medicine is supposed to have what levels it's appropriate to give the medicine for built into the order now. I'll tell you our physicians are really loving being called about that one when we tell them just ordering something for pain isn't good enough.

Everything else I just look at on a case by case basis. I hope this helps!

The JC doesn't actually require standardized prn orders based on a numerical pain scale, they actually discourage that based on professional practice recommendations that forbid that method of prescribing prn's, they do unfortunately accept that as a method for meeting their requirements on prn orders which is that they must be understood similarly by both the prescriber and the nurse.

The JC still allows nurses to use nursing judgement based on established pain management practices, but that requires the facility to show how they evaluate this competency. Just saying pain level 5=norco requires no nursing judgement and therefore less hassle for the facility.