Which of these orders is sign-able?

Post-op day 1 cholecystectomy, mild incisional pain.

tylenol 2 tabs prn pain

• Safe — sign it.
• Unsafe — missing dose in mg, route, frequency, max/24h.
• Safe if pharmacy clarifies.
• Unsafe — only because it uses a brand name.

T2DM admitted for cellulitis, NPO overnight.

Insulin reg 4 u sc qid

• Unsafe — 'u' is on the ISMP do-not-use list; sliding scale not specified.
• Safe — standard insulin order.
• Unsafe — wrong frequency only.
• Safe if you add hold parameters.

65 yo with CAP, PSI Class IV, normal renal function.

Ceftriaxone 1 g IV Q24H, indication: CAP, duration: 5 days; + azithromycin 500 mg IV Q24H per protocol

• Unsafe — no indication.
• Safe — drug, dose, units, route, frequency, indication, duration all present.
• Unsafe — should be PO.
• Unsafe — needs renal adjustment.

Initiating warfarin in a 72 yo with new AF, baseline INR 1.1, no bleeding.

Warfarin .5 mg PO daily

• Unsafe — missing leading zero; should be 0.5 mg (else risk of reading as 5 mg).
• Safe — small starting dose is reasonable.
• Unsafe — should be 5 mg.
• Unsafe — only because indication is missing.

Acute PE confirmed by CTPA, 92 kg patient, normal renal function.

start heparin drip

• Safe — RN will call back for parameters.
• Unsafe — no bolus, no infusion rate, no monitoring plan, no protocol.
• Safe — institutional default will apply.
• Unsafe — heparin is contraindicated.

Inpatient with renal CrCl of 25, ordered routine vancomycin.

Vancomycin 1 g IV Q8H, indication: HCAP

• Safe — standard vancomycin dose.
• Unsafe — needs renal-dose adjustment and trough monitoring plan; consider weight-based dose.
• Unsafe — wrong indication only.
• Safe if you add a stop date.