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Medication	Dose / Route	Frequency	Ordered By	Start / End	Action
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➕ New Medication Order

Medication Name *

Generic Name

Dose *

Route *

Frequency *

Administration Instructions

Hold if Systolic BP <

Hold if Diastolic BP <

Hold if Pulse <

Hold if Pulse >

Prescribing Physician *

Start Date

End Date (optional)

Mark as PRN Controlled Substance (Schedule II) Hospice Comfort Kit Medication

🧰 Hospice Comfort Kit

Standard comfort medications. Select any to pre-fill the order form. Verify dose with physician order.

🔄 Medication Reconciliation

Complete medication reconciliation at each visit. Verify all medications against the current order list.

Reconciliation Date

Reconciled By

Discrepancies / Changes

All medications verified — list matches

⚠️ High-Alert Medication Reminders

💉 Insulin — verify blood glucose before giving. Double-check dose and units.

🩸 Warfarin/Coumadin — check INR. Hold if INR > 3.5 unless ordered otherwise.

❤️ Digoxin — hold if HR < 60 or > 100. Check potassium level.

😮 Opioids — assess pain score before and 30–60 min after. Monitor respirations.

😴 Benzodiazepines — fall precautions. Monitor sedation level.

💧 Diuretics — monitor I&O, weight, electrolytes.

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