CARDIOLOGY HEART FAILURE ADMISSION ORDER SET [592] Origination: 07/28/08 Released: ORDERS

Transcription

1 CARDIOLOGY HEART FAILURE ADMISSION ORDER SET [592] Origination: 07/28/08 Released: ORDERS ADMISSION (Single Response) ( ) ADMIT AS INPATIENT (AH) Dx: Admitting Department: AH BED PLANNING Estimated length of stay: Certification: I certify that inpatient services are expected to be medically necessary for greater than two midnights. Please see H&P and MD Progress Notes for additional information about the patients course of treatment. ( ) ADMIT AS INPATIENT (AMC) Dx: Admitting Department: AMC BED PLANNING Estimated length of stay: Certification: I certify that inpatient services are expected to be medically necessary for greater than two midnights. Please see H&P and MD Progress Notes for additional information about the patients course of treatment. ( ) ADMIT AS INPATIENT (GSH) Dx: Admitting Department: GSH BED PLANNING Estimated length of stay: Certification: I certify that inpatient services are expected to be medically necessary for greater than two midnights. Please see H&P and MD Progress Notes for additional information about the patients course of treatment. ( ) ADMIT AS INPATIENT (TG) Dx: Admitting Department: TG BED PLANNING Estimated length of stay: Certification: I certify that inpatient services are expected to be medically necessary for greater than two midnights. Please see H&P and MD Progress Notes for additional information about the patients course of treatment. ( ) ADMIT AS OBSERVATION (AH) Reason for observation? Dx: Admitting Department: AH BED PLANNING ( ) ADMIT AS OBSERVATION (AMC) Reason for observation? Dx: Admitting Department: AMC BED PLANNING ( ) ADMIT AS OBSERVATION (GSH) Reason for observation? Dx: Admitting Department: GSH BED PLANNING ( ) ADMIT AS OBSERVATION (TG) Reason for observation? Dx: Admitting Department: TG BED PLANNING CARDIAC MONITORING (Single Response) (X) CARDIAC MONITOR (TELE) [ ] CODE STATUS (Single Response) For Until specified, Notify provider of significant arrhythmias and/or ST changes. (X) CODE STATUS - FULL CODE Details ( ) CODE STATUS - DNAR Details ( ) CODE STATUS - PARTIAL CODE- SPECIFY Details ( ) COMFORT MEASURES ONLY CONDITION (Single Response) ( ) CONDITION OF PATIENT - Stable Condition of patient on admission: STABLE

2 ( ) CONDITION OF PATIENT - Guarded Condition of patient on admission: GUARDED ( ) CONDITION OF PATIENT - Critical Condition of patient on admission: CRITICAL ISOLATION/PRECAUTIONS ISOLATION PRECAUTIONS [ ] CONTACT PRECAUTIONS ISOLATION PANEL - (MRSA, VRE, MDRO'S, SCABIES, ETC. ) [ ] CONTACT PRECAUTIONS (MRSA, MDRO's, SCABIES, Routine ETC.) [ ] CART ISOLATION Qty-1, Routine [ ] CONTACT ENTERIC PRECAUTIONS ISOLATION PANEL - (C.DIFF, NOROVIRUS, DIARRHEA) [ ] CONTACT ENTERIC (C. DIFF, NOROVIRUS, Routine DIARRHEA) [ ] CART ISOLATION Qty-1, Routine [ ] DROPLET PRECAUTIONS ISOLATION PANEL - (PERTUSSIS, INFLUENZA, URI/LRI, ETC.) [ ] DROPLET (PERTUSSIS,URI/LRI, ETC.) Routine [ ] CART ISOLATION Qty-1, Routine [ ] AIRBORNE CONTACT PRECAUTIONS ISOLATION PANEL - (CHICKENPOX, MEASLES, DISSEM SHINGLES) [ ] AIRBORNE CONTACT(CHKNPOX,MEASLES,DISSEM Routine SHINGLES) [ ] CART ISOLATION Qty-1, Routine [ ] AIRBORNE RESPIRATOR ISOLATION PANEL - (TB, SARS, SMALLPOX) [ ] AIRBORNE RESPIRATOR(TB,SARS,SMALLPOX) Routine [ ] CART PAPR (TUBERCULOSIS) Qty-1, Routine VITAL SIGNS VITALS [X] VITAL SIGNS - per unit standard [X] HEIGHT/WEIGHT ON ADMISSION [X] WEIGHT - Daily Routine, PER UNIT STANDARD, Starting today On admission only: Including respiratory rate and oxygen saturation every 15 minutes while titrating vasoactive infusions and at least hourly while infusions continue. Routine, ONCE, Starting today For 1 Occurrences Routine, DAILY, Starting tomorrow with First Occurrence As Scheduled For Until specified SHIFT: ACTIVITY ACTIVITY [ ] BEDREST Bedrest - other: Nurse assistance only? [ ] BEDREST WITH BSC Routine, QSHIFT, Starting today Nurse assistance only? [ ] UP IN CHAIR Routine, QSHIFT, Starting today Nurse assistance only? 3 times daily

3 [X] AMBULATE NURSING ASSESSMENTS [X] INTAKE AND OUTPUT Routine, QSHIFT, Starting today Advance: With: With mask: Nurse assistance only? Encourage ambulation. Routine, PER UNIT STANDARD, Starting today Strict? CARDIAC MONITORING [MOVED UNDER ADMISSION SECTION] [X] CARDIAC MONITOR For Until specified, Notify provider of significant arrhythmias and/or ST changes. CONTINGENCY [X] NOTIFY PROVIDER FOR B/P PARAMETERS [X] NOTIFY PROVIDER OF ELEVATED TEMP [X] NOTIFY PROVIDER (ONGOING) - abnormal results - POCT [X] NOTIFY PROVIDER (ONGOING) - heart rate [X] NOTIFY PROVIDER (ONGOING) - respiratory distress [X] NOTIFY PROVIDER (ONGOING) - abnormal resultslabs or symptoms [X] NOTIFY PROVIDER (ONGOING) - low urine output For Until specified, Systolic BP over 160 or under 90 For Until specified, Greater than 101F For Until specified Provider contact number: POCT glucose less than 70 mg/dl or greater than 200 mg/dl For Until specified Provider contact number: Greater than 120 or less than 50 For Until specified Provider contact number: Over 30 or under 12 or oxygen saturation less than 90% For Until specified Provider contact number: Critical Lab or significant change in symptoms. Provider contact number: Less than 400mL in 24 hours - notify after 0700 INTERVENTIONS [X] ELEVATE HOB - 30 degrees [ ] ELEVATE - legs Extremity: HOB(degrees): [ ] ORDER SEQL COMP DEVICE SCD Routine, ONCE, Starting today Type of SCD: [ ] MEDICAL RECORDS - to unit Routine, ONCE, Starting today For 1 Occurrences, Obtain old records URINARY CATHETER INSERT / MAINTENANCE [ ] INSERT URINARY CATHETER Routine, PER UNIT STANDARD, Starting today Clinical Indication for Continued use: [ ] INSERT STRAIGHT URINARY CATHETER Routine, ONCE, Starting today For 1 Occurrences [ ] URINARY CATHETER MAINTENANCE Routine, PER UNIT STANDARD, Starting today [ ] DISCONTINUE FOLEY CATHETER Routine, ONCE, Starting today For 1 Occurrences IV INSERT / MAINTENANCE IV INSERT / MAINTENANCE [X] IV INSERT / MAINTENANCE [X] INSERT IV [X] IV MAINTENANCE Routine, ONCE, Starting today

4 [ ] INSERT SALINE LOCK Routine, ONCE, Starting today [ ] SALINE LOCK MAINTENANCE [X] saline flush (NS) 0.9% NaCl inj 1-20 ml, Intravenous, Q8H RESPIRATORY RESPIRATORY [X] OXYGEN ENTER OXYGEN L/m: SELECT DEVICE TO DELIVER OXYGEN: To keep oxygen sats greate than 92% with activity. [X] STANDARD PULSE OXIMETRY Routine, QSHIFT, Starting today With vital signs? With Cardiopulmonary monitoring? While: Titrate Fi02 to keep SaO2 between: With exercise? And PRN. [X] SMOKING CESSATION Routine, ONCE, Starting today For 1 Occurrences, Pt education for smoking cessation on admission if patient has smoked in past 12 months. [ ] INCENTIVE SPIROMETER Routine, PRN, Starting today, Every 2 hours while awake [ ] ARTERIAL BLOOD GAS Routine, PRN INFORMATIONAL, Starting today, If unable to maintain 90% or basline oxygen saturation [ ] RT - PT EDUCATION - Incentive Spirometry Routine, ONCE, Starting today, Pt Education - Incentive Spirometry on admission. [ ] RT - PT EDUCATION - TCDB Routine, ONCE, Starting today, On admit for deep breathing and coughing exercises [ ] RT - PT EDUCATION - MDI Routine, ONCE, Starting today, On admit, for metered-dose inhaler for phase 2 and 3 patients. NUTRITION DIET (Single Response) ( ) DIET NOTHING BY MOUTH Routine, START NOW, Starting today For Until specified Base Diet Type? NPO ( ) DIET NOTHING BY MOUTH - After midnight Routine, START NOW, Starting tomorrow at 12:01 AM For Until specified Base Diet Type? NPO ( ) DIET GENERAL / AGE APPROPRIATE Routine, START NOW, Starting today For Until specified Calorie Limit per day? None Water restriction? ( ) DIET CARB CONTROL - STANDARD Routine, START NOW, Starting today Base Diet Type? Carb Control - Standard ( ) DIET CARB CONTROL - HIGH Routine, START NOW, Starting today Base Diet Type? Carb Control - High ( ) DIET CARB CONTROL - LOW Routine, START NOW, Starting today Base Diet Type? Carb Control - Low ( ) DIET LOW SODIUM (Less than 2000 mg sodium) [ ] Routine, START NOW, Starting today Base Diet Type? Low Sodium

5 ( ) DIET CARDIAC (Less than 3000 mg sodium & Low Fat) Routine, START NOW, Starting today Base Diet Type? Cardiac ( ) DIET CLEAR LIQUID Routine, START NOW, Starting today For Until specified Base Diet Type? Clear Liquid ( ) DIET DYSPHAGIA ADVANCED Routine, START NOW, Starting today Base Diet Type? Dysphagia Advanced Liquid Consistency? ( ) DIET DYSPHAGIA MECHANICAL ALTERED Routine, START NOW, Starting today Base Diet Type? Dysphagia Mechanical Altered Liquid Consistency? ( ) DIET DYSPHAGIA PUREED Routine, START NOW, Starting today Base Diet Type? Dysphagia Pureed Liquid Consistency? ( ) DIET RENAL DIALYSIS Routine, START NOW, Starting today Base Diet Type? Renal Dialysis ( ) DIET RENAL NO DIALYIS Routine, START NOW, Starting today Base Diet Type? Renal No Dialysis DIET INSTRUCTIONS (Single Response) (X) DIET FLUID RESTRICTION IV + PO =: ( ) ICE CHIPS ONLY For Until specified ( ) SIPS OR ICE CHIPS For Until specified ( ) ADVANCE DIET AS TOLERATED For Until specified IV FLUIDS IV FLUIDS [ ] 0.45 % NaCl (1/2 NS) infusion soln Intravenous, CONTINUOUS [ ] D5 1/2 NS infusion soln Intravenous, CONTINUOUS [ ] 0.9 % NaCl (NS) infusion soln Intravenous, CONTINUOUS MEDICATONS ANGIOTENSIN-CONVERTING ENZYME (ACE) INHIBITORS (Single Response) ACE inhibitors are the first line treatment and the cornerstone of heart failure therapy with proven improved survival for all patients with an LV EF LESS THAN 40% in the absence of known contraindications (including GFR < 30 ml/min). The risk of hypotension is increased with hypovolemia, consider decreasing or titrating diuretics accordingly. If the contraindication is persistent across encounters, please document in the Allergies/Contraindication activity. If the contraindication is persistent across encounters, please document in the Allergies/Contraindication Activity in addition to the Core Measure section below.

6 MHS HF Management Guidelines: ACE Inhibitors URL: " s/order%20set%20linked%20documents/ace%20inhibit ors%20heart%20failure%20management%20guidelines. pdf" ( ) captopril (CAPOTEN) tab 6.25 mg, Oral, Q8H (remove dose and leave blank for provider to indicate) ( ) enalapril (VASOTEC) tab 2.5 mg, Oral, BID ( ) lisinopril (PRINIVIL, ZESTRIL) tab 2.5 mg, Oral, DAILY ( ) CONTRAINDICATION TO ACE INHIBITOR OR ARB Routine, ONGOING, Starting today ANGIOTENSIN RECEPTOR BLOCKERS (ARB) (Single Response) ARB agents are second line when ACE inhibitors are not tolerated. If ARB is contraindicated for this hospitalization only select order to document. If the contraindication is persistent across encounters, please document in the Allergies/Contraindication activity. If the contraindication is persistent across encounters, please document in the Allergies/Contraindication Activity in addition to the Core Measure section below. MHS HF Management Guidelines: Angiotensin Receptor Blockers URL: " s/order%20set%20linked%20documents/ace%20altern ative%201%20angiotensin%20receptor%20blockers%20 ARBs%20Heart%20Failure%20Management%20Guidelin es.pdf" ( ) losartan (COZAAR) tablet 50 mg, Oral, DAILY ( ) CONTRAINDICATION TO ACE INHIBITOR OR ARB Routine, ONGOING, Starting today BETA BLOCKERS (Single Response) Please order beta blockers on all patients or document contraindication. If BETA BLOCKER is contraindicated for this hospitalization only select order to document. If the contraindication is persistent across encounters, please document on the Allergies/Contraindication activity as well. If the contraindication is persistent across encounters, please document in the Allergies/Contraindication Activity in addition to the Core Measure section below. MHS HF Management Guidelines: Beta Blockers URL: " s/order%20set%20linked%20documents/beta%20block ers%20%20heart%20failure%20management%20guideli nes.pdf" ( ) carvedilol (COREG) tab mg, Oral, BID CC ( ) metoprolol (LOPRESSOR) tab 25 mg, Oral, BID ( ) metoprolol (TOPROL XL) tab SR 24 hr 25 mg, Oral, DAILY ( ) CONTRAINDICATION TO BETA BLOCKER Routine, ONGOING, Starting today ALDOSTERONE ANTAGONISTS (Single Response) ( ) spironolactone (ALDACTONE) tab 25 mg, Oral, DAILY LIPID LOWERING AGENT (Single Response) If HMG-CoA reductase inhibitor is contraindicated for this hospitalization only select order to document. If the contraindication is persistent across encounters, please document in the Allergies/Contraindication activity as well. If the contraindication is persistent across encounters, please document in the Allergies/Contraindication Activity in addition to the Core Measure section below. ( ) atorvastatin (LIPITOR) tablet 10 mg, Oral, BEDTIME

7 ( ) CONTRAINDICATION TO HMG-CoA Reductase Inhibitors Routine, ONGOING, Starting today INOTROPIC AGENTS [ ] DOBUTamine in D5W (Single Strength) IV infusion 2-20 mcg/kg/min, Intravenous, TITRATE [ ] DOPamine in D5W (Single Strength) IV infusion 2-20 mcg/kg/min, Intravenous, TITRATE [ ] milrinone (PRIMACOR) 1 mg/ml bolus 50 mcg/kg/dose, Intravenous, ONCE, Starting today [ ] milrinone (PRIMACOR) IV infusion 0.5 mcg/kg/min, Intravenous, TITRATE NITRATES [ ] isosorbide dinitrate (ISORDIL) tab 10 mg, Oral, TID NTG [ ] nitroglycerin (NITROSTAT) 0.4 mg sublingual tab 0.4 mg, Sublingual, Q5MIN PRN chest pain For 3 Doses [ ] nitroglycerin (NITRO-BID) 2 % topical ointment 1 Inch, External, Q6H [ ] nitroglycerin 50 mg in 500 ml D5W infusion (Single mcg/min, Intravenous, TITRATE Strength) DIURETICS (Single Response) Consider potassium supplementation as necessary for patient ( ) bumetanide (BUMEX) inj Intravenous ( ) Torsemide (DEMADEX) tab ORAL ( ) bumetanide (BUMEX) tab 0.5 mg, Oral, QAM CC ( ) furosemide (LASIX) inj Intravenous ( ) furosemide (LASIX) tab 20 mg, Oral, QAM CC ( ) metolazone (ZAROXOLYN) tab 2.5 mg, Oral, DAILY POTASSIUM ORAL SUPPLEMENTS (Single Response) ( ) potassium chloride (K-DUR) tab CR 10 meq, Oral, DAILY CARDIAC GLYCOSIDES [ ] digoxin (LANOXIN) tab mg, Oral, DAILY [ ] digoxin 0.25 mg/ml inj loading dose 0.5 mg, Intravenous, ONCE, Starting today For 1 Doses [ ] digoxin 0.25 mg/ml inj mg, Intravenous, DAILY [ ] digoxin 0.25 mg/ml inj 0.25 mg, Intravenous, DAILY PLATELET INHIBITORS (Single Response) ( ) aspirin 81 mg chew tab 81 mg, Oral, DAILY ( ) aspirin 325 mg tablet 325 mg, Oral, DAILY Create a new VTE Prophylaxis group LINK VTE GUIDLINE (TAKE FROM OS 600) Summary of Risk Factors for VTE and suggested prophylaxis options for each level of risk DVT PROPHYLAXIS (Single Response) Use enoxaparin with caution in patients with severe renal impairement (CrCl < 30mL/min) and not recommended for ESRD (CrCL < 10mL/min). Consider using unfractionated heparin. If enoxaparin is to be used in severe renal impairment (CrCl ml/min), then consider 30 mg SUBCUT DAILY (40 mg SUBCUT DAILY for BMI > 40) and monitor closely for signs and symptoms of bleeding. ( ) enoxaparin 40 mg DAILY (CrCl >= 30 ml/min) 40 mg, Subcutaneous, DAILY ( ) enoxaparin 40 mg BID (for patients with BMI > 40 and 40 mg, Subcutaneous, BID CrCl >= 30 ml/min) ( ) heparin (PF) 5000 UNIT/0.5ML inj 5,000 Units, Subcutaneous, Q12H MECHANICAL DEVICE VTE PROPHYLAXIS (TAKE FROM OS 600) [ ] ORDER SEQL COMP DEVICE (IPC) Knee High [ ] ORDER SEQL COM DEVICE (IPC) Thigh High CONTRAINDICATION VTE MEDICATION PROPHYLAXIS

8 [ ] CONTRAINDICATION VTE PROPHYLAXIS Routine, ONGOING, Starting today [ ] COMFORT MEASURES ONLY LABORATORY HEMATOLOGY [ ] CBC WITH DIFF STAT, ONCE, Starting today NOW For 1 Occurrences [ ] CBC WITH DIFF Routine, ONCE, Starting 0700 For 1 Occurrences COAGULATION [ ] PROTHROMBIN (PT) Routine, ONCE, Starting tomorrow at 7:00 AM For 1 Occurrences CHEMISTRY [X] MAGNESIUM Routine, ONCE, Starting tomorrow at 7:00 AM For 1 Occurrences [ ] BNP (B NATRIURETIC PEPTIDE) - on admit Routine, ONCE, Starting today, Do not draw if patient receiving nesiritide [ ] BNP (B NATRIURETIC PEPTIDE) - on discharge Routine, ONCE, Starting today, Do not draw if patient receiving nesiritide. [X] BASIC METABOLIC PANEL Routine, ONCE, Starting tomorrow at 7:00 AM For 1 Occurrences [ ] HEPATIC FUNCTION PANEL (LFT) Routine, ONCE, Starting today [ ] LIPID PANEL - fasting Routine, ONCE, Starting today [ ] HEMOGLOBIN A1C Routine, ONCE, Starting today [ ] TSH 3RD GENERATION (THYROID STIMULATING Routine, ONCE, Starting today HORMONE) [ ] TSH REFLEX FT4 Routine, ONCE, Starting today [ ] IRON/TIBC Routine, ONCE, Starting today [ ] FERRITIN Routine, ONCE, Starting today [ ] TROPONIN Routine, Q3S, Starting today For 3 Occurrences URINE TESTING [ ] UA CULTURE IF INDICATED Routine, ONCE, Starting today [ ] URINALYSIS (UA) (NO CULTURE) Routine, ONCE, Starting today For 1 Occurrences [ ] DRUG ABUSE SCREEN URINE Routine, ONCE, Starting today IMAGING IMAGING [ ] CHEST 1 VIEW X-RAY Routine, ONCE, Starting today For 1 Occurrences [ ] CHEST 2 VIEW X-RAY Routine, ONCE, Starting today For 1 Occurrences [ ] CT ANGIO CARDIAC W/ CALCIUM SCORE Routine, ONCE, Starting today For 1 Occurrences [ ] NM STRESS TEST TREADMILL Routine, ONCE, Starting today For 1 Occurrences [ ] NM STRESS TEST ADENOSINE/LEXISCAN Routine, ONCE, Starting today For 1 Occurrences CARDIAC STUDIES CARDIAC STUDIES [ ] EKG - on admit Routine, ONCE, Starting today For 1 Occurrences Reason for test? Congestive Heart Failure NOS Which group? Which group? (AMC ONLY): Once, on Admission. [ ] ECHO LIMITED Routine, ONCE, Starting today [ ] ECHO COMPLETE - TTE Routine, ONCE, Starting today For 1 Occurrences CONSULTS

9 CONSULTATION ANCILLARY [X] CONSULT/ASSESSMENT TO NUTRITION SVCS Routine, ONCE, Starting today Reason for Nutrition Consult: Education (Specify) For disease or condition: Provider Specialty: Department Specialty: Reason for consult: Low Salt Diet, Low Fat Diet Low Salt Diet Low Fat Diet [X] CONSULT TO SOCIAL SVCS STAT, ONCE, Starting today For 1 Occurrences Reason for consult: DRUG/ETOH ABUSE/REQUEST FOR TX For disease or condition: Please assess this heart failure patient for barriers to care including financial, transportation, pt/family coping/support and/or other resource needs. [ ] CONSULT TO PALLATIVE CARE STAT, ONCE, Starting today For 1 Occurrences Reason for consult: HEART FAILURE For disease or condition: [ ] CONSULT TO DIABETIC EDUCATOR Routine, ONCE, Starting today Diabetes Type: Visit Type: Outpatient Group Consult Preferred? Content (can choose multiple options): [ ] CONSULT TO PREVENTIVE CARDIOLOGY (IP CARDIAC REHAB) Routine, ONCE, Starting today Reason for consult: For disease or condition: Provider Specialty: Department Specialty: [ ] ST EVAL AND TREAT PANEL - swallow eval and treat and diet recomendations [ ] ST EVAL Routine, ONCE, Starting today Type of Evaluation? [ ] ST TREAT [ ] PT EVAL AND TREAT PANEL [ ] PT EVAL Routine, ONCE, Starting today [ ] PT TREAT [ ] OT EVAL AND TREAT PANEL [ ] OT EVAL Routine, ONCE, Starting today [ ] OT TREAT CONSULT PHYSICIAN [ ] IP CONSULT AND TREAT - Cardiology Routine, ONCE, Starting today For 1 Occurrences Requested Group: Reason for consult: Has consultant been notified? Cardiology consultation is RECOMMENDED for patients with EF less than or equal to 40%, ongoing symptoms, volume overload, complicated medical regimen or unclear diagnostic evaluation. PATIENT EDUCATION / REMINDERS [X] REFERRAL MULTICARE HEART FAILURE CLINIC Referral Specialty - Cardiology, Referral for 3 visits (expires (GSH ONLY) on 7/15/14), Qty-1, Referral - Internal, Routine [ ] CARDIO - AMC CARDIAC REHAB - CONSTX Referral Dept - AMC CARDIAC REHAB, Referral Dept Specialty - Cardiac Rehab, Referral for 3 visits (expires on 7/15/14), Qty-1, Referral - Internal, Routine [ ] CARDIO - CARDIAC REHAB SO HILL Referral Specialty - Cardiology, Referral for 6 visits (expires on 7/15/14), Qty-1, Referral - Internal, Routine

10 [ ] CARDIAC REHAB PHASE 2 - TG PREV CARDIO Referral Specialty - Cardiology, Referral for 3 visits (expires on 7/15/14), Qty-1, Referral - Internal, Routine ADDITIONAL DIAGNOSTIC REFERRAL Consider Evaluation for Obstructive Sleep Apnea, if the patient has a history of Snoring, Witnessed Apnea, Disrupted Sleep, and/or Daytime Fatigue. Evaluation is especially important if the following co-morbid conditions are present: Hypertension (especially if more than one drug required to manage), Diabetes Mellitus, Cardiovascular Disease, Atrial Fibrillation, or other Dysrhythmia, Stroke, Depression, and/or Obesity. An In-Lab, Overnight Polysomnogram is strongly encouraged as the diagnostic tool of choice for Heart Failure patients, as they have an increased risk of Central Sleep Apnea or Cheynes-Stokes respirations, as well as Obstructive Sleep Apnea. Home sleep tests are relatively contraindicated in Heart Failure patients for this reason. [ ] **O SLEEP STUDY - AMC Referral Specialty - Sleep Disorders, Referral Dept - AMC SLEEP DISORDERS CENTER, Referral Dept Specialty - Sleep Disorder, Referral for 3 visits (expires on 7/15/14), Qty- 1, Sleep Center Managed Care, Routine [ ] **O SLEEP STUDY - GOOD SAM Referral Specialty - Sleep Disorders, Referral for 3 visits (expires on 7/15/14), Qty-1, Sleep Center Managed Care, Routine [ ] **O SLEEP STUDY TG/MB/COV/GH Referral Specialty - Sleep Disorders, Referral Dept Specialty - Sleep Disorder, Referral for 3 visits, Qty-1, Sleep Center Managed Care, Routine CORE MEASURES CONTRAINDICATIONS [ ] CONTRAINDICATION ACE INHIBITOR OR ARB Routine, ONGOING, Starting today [ ] CONTRAINDICATION ANTICOAGULATION Routine, ONGOING, Starting today [ ] CONTRAINDICATION ANTITHROMBOTIC Routine, ONGOING, Starting today [ ] CONTRAINDICATION ASPIRIN Routine, ONGOING, Starting today [ ] CONTRAINDICATION BETA BLOCKER Routine, ONGOING, Starting today [ ] CONTRAINDICATION STATIN Routine, ONGOING, Starting today