Community acquired pneumonia care plan: medical admission orders James Campbell MD Demonstrate to HL7 workgroups Admission order set for hospital medical/surgical unit for adult patient with community acquired pneumonia The primary care physician sees a patient in clinic for cough, fever and dyspnea. Physical examination and chest xray document a lobar pneumonia. The patient is quite ill and Pneumonia Severity Score support the need for inpatient care. The physician employs this order set to prepare and transmit admission orders to the hospital. Admission / Discharge / Transfer Admit to hospital Admission status: Urgent Admitting physician: James Campbell James Campbell Referring physician: Craig Parker Craig Parker Prognosis: Admitting diagnosis: community acquired pneumonia Code status: Use this order set for adult patients being admitted for pneumonia Consults Bedside Nicotine Program Test alert text Respiratory therapy consult Infectious disease consult Pulmonary medicine consult Social service consult Vital signs and Assessments Vital signs per unit protocol Weigh patient daily for two days test Intake and output daily for two days Electrocardiographic telemetry continuously Pulse oximetry continuously Monitor and record Relative perceived dyspnea Diet Encourage oral fluid intake Goal: body weight at prescribed weight by discharge Laboratory and Testing Arterial blood gases, one time, STAT <entry typeCode="COMP"> <procedureRequest classCode="PROC" moodCode="RQO"> <id assigningAuthorityName="University of Nebraska" root="2.16.840.1.113883.3.7.98" extension="E00014"/> <code code="24323-8" codeSystem="2.16.840.1.113883.11.16492" codeSystemName="LOINC" displayName="Comprehensive metabolic HCFA 2000 Panel"/> <text>Compehensive metabolic panel; 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one time; routine</text> <!--AEG changed statusCode to priorityCode --> <priorityCode code="routine"/> <trigger typeCode="TRIG"> <selectionStatus classCode="VERIF" moodCode="EVN"> <code code="64100000" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="false (qualifier)"/> </selectionStatus> </trigger> </procedureRequest> </entry> <entry typeCode="COMP"> <procedureRequest classCode="PROC" moodCode="RQO"> <id assigningAuthorityName="University of Nebraska" root="2.16.840.1.113883.3.7.98" extension="E00017"/> <code code="34529-8" codeSystem="2.16.840.1.113883.11.16492" codeSystemName="LOINC" displayName="PT and PTT"/> <text>Protime and PTT; one time; routine</text> <trigger typeCode="TRIG"> <selectionStatus classCode="VERIF" moodCode="EVN"> <code code="64100000" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="false (qualifier)"/> </selectionStatus> </trigger> </procedureRequest> </entry> <entry typeCode="COMP"> <procedureRequest classCode="SPECCOLLECT" moodCode="RQO"> <id assigningAuthorityName="University of Nebraska" root="2.16.840.1.113883.3.7.98" extension="E00018"/> <code/> <text>Blood culture aerobic and anaerobic; one time; STAT prior to antibiotic</text> <!--AEG changed statusCode to priorityCode --> <priorityCode code="stat"/> <!-- AEG stregthOfRecommendation typeCode="EVID"> <orderItemAlert classCode="ALRT" moodCode="EVN"> <text >"Prior to antibiotic"</text> </orderItemAlert> </stregthOfRecommendation --> <trigger typeCode="TRIG"> <selectionStatus classCode="VERIF" moodCode="EVN"> <code code="31874001" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="true (qualifier)"/> </selectionStatus> </trigger> </procedureRequest> </entry> </orderSetSection> </component> </orderSetSection> </component> <component typeCode="COMP"> <conjunctionCode code="or"/> <orderSetSection classCode="ORGANIZER" moodCode="DEF"> <id assigningAuthorityName="University of Nebraska" root="2.16.840.1.113883.3.7.97" extension="S00006"/> <title>Treatments Oxygen by nasal cannula to maintain saturations above 90% Oxygen by mask to maintain saturations above 90% Turn cough and deep breathe per protocol Test alert code Medications Administer antibiotics within four hours of admission Fluoroquinolone OR (Extended cephalosporin or beta lactam) plus a macrolide for uncomplicated case Moxifloxacin 400mg IV daily Moxifloxacin 400mg per 250ml (product) <component typeCode="ARR"> <conjunctionCode code="xor"/> <orderSetSection classCode="ORGANIZER" moodCode="DEF"> <id assigningAuthorityName="University of Nebraska" displayable="true" root="2.16.840.1.113883.3.7.98" extension="00080"/> <title>Extended cephalosporin or beta lactam Ceftriaxone 1 gram IV daily Ceftriaxone 1gram per 50 ml (product Ampicillin Sulbactam 3 grams IVPB q6h Ampicillin 2gram Sulbactam 1gram (product) Macrolide Clarithromycin 500mg PO BID for 10 days Clarithromycin 500mg oral (product Azithromycin 500mg IV for 3 days Azithromycin 500mg oral (product) Suspected aspiration: Fuoroquinolone plus Clindamycin or Flagyl OR Penicillin beta lactam inhibitor Piperacillin / tazobactam 4.5 grams IV q4hours Piperacillin / tazobactam test this Ambulatory within 36 hours again <entry typeCode="COMP"> <substanceAdministrationRequest classCode="SBADM" moodCode="RQO"> <id assigningAuthorityName="University of Nebraska" displayable="true" root="2.16.840.1.113883.3.7.98" extension="E00097"/> <code code="18629005" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="administration of medication"/> <text>Moxifloxacin 400mg IV daily</text> <!-- AEG: changed statusCode to priorityCode --> <effectiveTime/> <priorityCode code="routine"/> <routeCode code="47625008" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Intravenous route (qualifier)"/> <doseQuantity value="400" unit="mg"/> <product typeCode="PRD"> <manufacturedProduct classCode="MANU"> <manufacturedLabeledDrug classCode="CER" determinerCode="KIND"> <name>Moxifloxacin injection</name> <!--code code="384944008" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Moxifloxacin injection"/--> </manufacturedLabeledDrug> </manufacturedProduct> </product> <trigger typeCode="TRIG"> <selectionStatus classCode="VERIF" moodCode="EVN"> <code code="64100000" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="false (qualifier)"/> </selectionStatus> </trigger> </substanceAdministrationRequest> </entry> <component typeCode="COMP"> <conjunctionCode code="xor"/> <orderSetSection classCode="ORGANIZER" moodCode="DEF"> <id assigningAuthorityName="Univesity of Nebraska" displayable="true" root="2.16.840.1.113883.3.7.97" extension="S00011"/> <title>Anaerobic coverage: Clindamycin or Flagyl Clindamycin 300mg IV q6hours Clindamycin injection Metronidazole 7.5 mg/kg IV q6hours Metronidazole 500mg IV injection