CCS Guide
Step 3 CCS Orders Checklist
Most CCS scores improve when you stop improvising and start running a repeatable checklist. This page gives you a starter bundle plus the highest-yield adjustments for unstable ED cases, inpatient admissions, and outpatient follow-up.
The short answer
Use a “starter bundle,” then delete anything that isn’t standard-of-care for the presentation. Front-load stabilization + key diagnostics, then close the loop with reassessment and disposition.
Starter bundle (safe defaults)
Always consider
- Vital signs, pulse oximetry; telemetry if cardiac/unstable
- Focused physical exam (don’t freeze—click what matters)
- CBC, BMP/CMP (as appropriate)
- Urinalysis (common and often helpful)
- Pregnancy test when applicable
- Pain control + antiemetic if symptomatic
ED/unstable add-ons
- IV access + fluids if hypotensive/dehydrated
- ECG for chest pain/syncope/SOB with concern
- Point-of-care glucose for AMS, weakness, diaphoresis
- Blood cultures before antibiotics if septic
- Oxygen if SpO2 < 94%
Inpatient admission checklist (easy points)
- DVT prophylaxis (unless contraindicated)
- Diet + activity orders
- Strict I/O or daily weights when relevant (CHF, renal)
- Repeat labs after treatment (e.g., BMP after insulin/K replacement)
- Consults when indicated (surgery for acute abdomen, cardiology for STEMI, etc.)
Outpatient / chronic case checklist
- Start appropriate first-line therapy
- Schedule follow-up (timeframe matters)
- Order targeted screening labs (not a fishing expedition)
- Counseling: smoking, diet, exercise, return precautions
FAQ
Is there a universal starter order set for CCS?
Yes—but it must be adjusted to the setting. Start with vitals/monitoring, focused diagnostics, and immediate stabilization. Avoid ordering invasive procedures or broad panels unless the case calls for it.
What are the most common “easy points” people miss?
Disposition (admit/discharge), follow-up plan, counseling (smoking/diet/exercise), DVT prophylaxis on admitted patients, and repeating critical labs after treatment (e.g., potassium in DKA/hyperkalemia).
Do I need to order a pregnancy test?
In most female patients of childbearing potential, yes—pregnancy status changes imaging, meds, and disposition and is commonly rewarded in scoring.