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