University of Iowa
Department
of Family Medicine
FPInfo: Resources to support patient care
DFM Info
Inpatient Home Orders for Oxygen / IV Antibiotics / Enteral Feeds
Home Oxygen - Diagnosis - # Liters Per Minute via Nasal Canula, Continuous / With Activity -- Examples: 2 LPM via NC continuous vs. 3 LPM via NC with activity) - Sign and print physician name
IV Antibiotics On first script: - Drug name, dose, and frequency - Diagnosis - Duration of therapy (include stop date) - Staff doctor to follow (usually a doctor from infectious disease) - Sign and print physician name
If lab draws are needed, include a second script: Weekly lab draws - Which labs to draw - Please fax results to Dr. *** at phone number, ***-***-***. - Sign and print physician name
Enteral Feeds - Diagnosis - Type of delivery (Ex: NG, NJ, PEG) - Type of formula (Ex: Jevity, Osmolite 1.2) - Indicate if feeds are bloused or cycled. -- If cycled, indicate rate of cc/hr over how many hours (Ex: 70 cc/hr for 12 hours) - Indicate if sole or primary source of food - Sign and print physician name