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Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Delegation/Practice Protocols,Inpatient Delegation Protocols,Related

Ventricular Assist Device - Adult - Postoperative

Ventricular Assist Device - Adult - Postoperative - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Inpatient Delegation Protocols, Related


IP - Ventricular Assist Device - Adult - Postoperative [3194]
Intended for Adult Patients Only
Admission Status
Patient needs to be admitted on Cardiac transplant service if they have a Abiomed, Thoratec, HeartMate, or CentriMag
VAD.
Admission Status [97509]
Admit To Inpatient [ADT0001] Attending:
Admitting Resident:
Requested Floor: B4/5
Service:
Rationale for LOS greater than 2 midnights:
Post-Op/Phase II
Isolation Status
Isolation Status [97372]
Isolation - Enhanced Contact - Clostridium Difficile
[ISO0010]
CONTINUOUS, Separate order must be placed for isolation
cart., Pre-Op Day Of Procedure
Isolation - Contact - MRSA [ISO0039] CONTINUOUS, Separate order must be placed for isolation
cart., Pre-Op Day Of Procedure
Isolation - Contact - VRE [ISO0051] CONTINUOUS, Separate order must be placed for isolation
cart., Pre-Op Day Of Procedure
Isolation - Protective Precautions - Panel [116356]
Protective Precautions [ISO0001] CONTINUOUS
Reason for Protective Precautions:
Pre-Op Day Of Procedure
Protective - Positive Pressure Room [NURCOM0109] CONTINUOUS, Pre-Op Day Of Procedure
Isolation - Airborne - TB-Pulmonary Confirmed/Suspect
[ISO0003]
CONTINUOUS, Separate order must be placed for isolation
cart., Pre-Op Day Of Procedure
Isolation - Contact - Multidrug Resistant Organism -
Panel [116335]
Isolation - Contact - Multidrug Resistant Organism
(MDR) [ISO0006]
CONTINUOUS, Pre-Op Day Of Procedure
Isolation Cart [EQP0016] CONTINUOUS, Routine, Pre-Op Day Of Procedure
Isolation - Contact - Extensively Resistant Organism
(XDR) - Panel [ISO0616]
Panel
Isolation - Contact - Extensively Resistant Organism
(XDR) [ISO0320]
CONTINUOUS
Isolation Cart [EQP0016] CONTINUOUS, Routine
Venous Thromboembolism (VTE) Prophylaxis
Refer to In-patient Order Set 4999 - Ventricular Assist Device Heparin Anticoagulation
VTE Prophylaxis (Single Response) [144115]
Caprini VTE Risk Assessment URL: https://uconnect.wisc.edu/servlet/Satellite?
cid=1126666624583&pagename=B_EXTRANET_UWH_HOME%
2FFlexMemberFile%2FLoad_File&c=FlexMemberFile
High VTE Risk with Low Bleed Risk [130117]
enoxaparin (LOVENOX) injection [800040] 40 mg, Subcutaneous, EVERY 24 HOURS
heparin PF 5000 UNIT/0.5ML injection [156571] 5,000 units, Subcutaneous, EVERY 12 HOURS
heparin PF 5000 UNIT/0.5ML injection [156571] 5,000 units, Subcutaneous, EVERY 8 HOURS Starting
tomorrow at 6:00 AM
Begin Postoperative Day 1
Sequential Compression Device (SCD) / Foot Pump
[EQP0023]
CONTINUOUS, Routine
Left/Right/Bilateral? Bilateral
Type: Knee High
Apply and Maintain Anti-Embolism Stocking
[NURTRT0039]
CONTINUOUS, Routine
Does this need to be inserted/placed?
Left/Right/Bilateral? Bilateral
Type: Knee high
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Copyright © 2014 University of Wisconsin Hospital and Clinics Authority


High VTE Risk with High Bleed Risk (Single Response)
[129757]
Sequential Compression Device (SCD) / Foot Pump
[EQP0023]
CONTINUOUS, Routine
Left/Right/Bilateral? Bilateral
Type: Knee High
Post-Op/Phase II
Apply and Maintain Anti-Embolism Stocking
[NURTRT0039]
CONTINUOUS, Routine
Does this need to be inserted/placed?
Left/Right/Bilateral? Bilateral
Type: Knee high
Post-Op/Phase II
No VTE Prophylaxis [130084]
VTE Prophylaxis - Reason Not Ordered [COR0008] ONCE, Routine
Reason Not Ordered:
Patient Care Orders
Vital Signs [87678]
Vital Signs [NURMON0013] SEE COMMENTS, Starting today, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Every 15 minutes times 4, then every 30 minutes times 4,
then every hour., Post-Op/Phase II
Patient Monitoring [89873]
Measure Arterial Line - Continuous [NURMON0019] CONTINUOUS, Starting today, Routine
BP Source: Invasive
BP Location:
BP Position:
BP Restrictions:
Post-Op/Phase II
Measure Central Venous Pressure - Continuous
[NURMON0002]
CONTINUOUS, Starting today, Routine, Post-Op/Phase II
Measure Pulmonary Artery Pressure - Continuous
[NURMON0023]
CONTINUOUS, Starting today, Routine
Pulmonary Artery Systolic Pressure (mmHg): Other
(Comment)
Pulmonary Artery Diastolic Pressure (mmHg): Other
(Comment)
Pulmonary Artery Mean Pressure (mmHg): Other (Comment)
Pulmonary Artery Wedge Pressure (mmHg):
Central Venous Pressure (mmHg):
Central Venous Pressure (mmH2O):
Cardiac Output:
Cardiac Output Method:
Cardiac Index:
Systemic Vascular Resistance:
Pulmonary Vascular Resistance:
Pulmonary Vascular Resistance Index:
Stroke Volume (mL/beat):
Stroke Volume Index:
Systemic Vascular Resistance Index:
Left Cardiac Work Index:
Right Cardiac Work Index:
Left Ventricular Stroke Work Index:
Right Ventricular Stroke Work Index:
Pulmonary Capillary Wedge Pressure (mmHg):
Measure with FloTrac? No
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Copyright © 2014 University of Wisconsin Hospital and Clinics Authority


Continuous, Post-Op/Phase II
Measure Hemodynamic Parameters - Every 4 Hours
[NURMON0023]
ONCE, Starting today For 1 Occurrences, Routine
Pulmonary Artery Systolic Pressure (mmHg):
Pulmonary Artery Diastolic Pressure (mmHg):
Pulmonary Artery Mean Pressure (mmHg):
Pulmonary Artery Wedge Pressure (mmHg):
Central Venous Pressure (mmHg):
Central Venous Pressure (mmH2O):
Cardiac Output: Q4 Hours
Cardiac Output Method: Thermodilution
Cardiac Index: Q4 Hours
Systemic Vascular Resistance: Q4 Hours
Pulmonary Vascular Resistance: Q4 Hours
Pulmonary Vascular Resistance Index:
Stroke Volume (mL/beat):
Stroke Volume Index:
Systemic Vascular Resistance Index:
Left Cardiac Work Index:
Right Cardiac Work Index:
Left Ventricular Stroke Work Index:
Right Ventricular Stroke Work Index:
Pulmonary Capillary Wedge Pressure (mmHg):
Measure with FloTrac? No
Measure cardiac output, cardiac index, systemic vascular
resistance, and pulmonary vascular resistance every 4
hours., Post-Op/Phase II
Neurovascular Checks [NURMON0045] EVERY 2 HOURS, Starting today, Routine, Until awake,
Post-Op/Phase II
Assess Neurologic Status [NURMON0006] EVERY 2 HOURS, Starting today, Routine, Until awake,
Post-Op/Phase II
Cardiac Rhythm Monitoring - Adult [NURMON0010] CONTINUOUS, Starting today, Routine
Notify Provider: Symptomatic Change in Rhythm
Functional Cardiac Defibrillator Present:
Activity [125668]
Activity Bedrest While Intubated [NURACT0008] SEE COMMENTS, Starting today For 1 Weeks, Routine
AD LIB:
AMBULATE:
CHAIR:
DANGLE:
BEDREST: strict bedrest
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Increase activity to dangle once patient is extubated., Post-
Op/Phase II
Elevate Head Of Bed Unless Chest Is Open
[NURACT0002]
Equal to (degrees): 30
Greater than (degrees):
Less than (degrees):
Other options:
Routine, CONTINUOUS, Starting today, Post-Op/Phase II
High Fowler's Position During Weaning [NURACT0011] CONTINUOUS, Starting today, Post-Op/Phase II
Dangle With Leg Extension Exercises After Extubation
[NURACT0008]
CONTINUOUS, Starting today, Routine
AD LIB:
AMBULATE:
CHAIR:
DANGLE: 3x daily
BEDREST:
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Copyright © 2014 University of Wisconsin Hospital and Clinics Authority


RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Once extubated, increase activity to dangle., Post-Op/Phase
II
Activity Chair [NURACT0008] CONTINUOUS, Routine
AD LIB:
AMBULATE:
CHAIR: 3x daily
DANGLE:
BEDREST:
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
To chair if tolerate dangling, Post-Op/Phase II
Activity Ambulate [NURACT0008] CONTINUOUS, Routine
AD LIB:
AMBULATE: 4x daily
CHAIR:
DANGLE:
BEDREST:
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Once pulmonary catheter is removed, Post-Op/Phase II
Reposition Patient [NURACT0005] Type:
Routine, SEE COMMENTS, Starting today, Every 2 hours.,
Post-Op/Phase II
Sternal Precautions [PRECAU0010] CONTINUOUS, Starting today, Routine, Sternal Precautions:
No lifting greater than 8 pounds.
No pushing/pulling with arms during transfers.
No shoulder elevation past 90 degrees., Post-Op/Phase II
Nutrition [89875]
NPO Except Medications & Fluid Restriction [NUT0001] EFFECTIVE NOW, Starting today, Routine
General Diet:
Diabetic Diet:
NPO (If patient receiving tube feeding see question 25): NPO
EXCEPT MEDICATIONS
Liquids & Modified Consistency (If Dysphagia Protocol see
questions 21-24):
Fiber:
Renal & Dialysis Multi-Nutrient Restriction:
Lactose Restricted:
Protein:
Fat:
Sodium:
Potassium:
Phosphorus:
Other Minerals:
Calories:
Fluid Restriction: Total mLs/24 hours (IV & PO): 2,000
Research:
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Copyright © 2014 University of Wisconsin Hospital and Clinics Authority


Metabolic:
Other Modifiers:
Infant Nutrition (Select product and calories per ounce):
Infant Formula (Calories per Ounce):
Dysphagia Protocol:
Dysphagia Protocol-Modified Consistency (Also select
Dysphagia Protocol Liquid Consistency and Dysphagia
Protocol-Supervision):
Dysphagia Protocol-Liquid Consistency:
Dysphagia Protocol-Supervision:
Tube Feeding (Use Tube Feeding Order Set to indicate order
detail):
Tube Feeding Management:
Room Service Class:
Fluid Restriction Total: 2000 mL (1000 mL from Dietary),
Post-Op/Phase II
Measure Caloric Intake - Starting Postoperative Day 1
[NURDIE0011]
1X DAILY, Starting tomorrow For 7 Days, Routine, Post-
Op/Phase II
Respiratory [89876]
Respiratory Therapy per Protocol [RT0035] CONTINUOUS, Starting today, Routine
Protocol Type:
Post-Op/Phase II
Pulse Oximetry [NURMON0009] CONTINUOUS, Starting today, Routine, Post-Op/Phase II
Suction Airway [NURTAD0017] PRN, Starting today, Routine
Location: Tracheal
Suction endotracheal tube as needed for removal of
secretions., Post-Op/Phase II
Mechanical Ventilation - Adult [117146]
Provide Manual Resuscitator at Bedside [RT0039] CONTINUOUS, Routine, Post-Op/Phase II
Mechanical Ventilation [RT0028] CONTINUOUS, Routine, For ADULT patients order
chlorihexidene gluconate (PERIDEX) 0.12% soln 15 mL to
swab oral cavity 2x daily while on ventilation.
Ventilator Management:
Mode:
Set Rate/Min:
Tidal Volume (Multiplier x Ideal Body Weight): 6
PEEP (cmH2O):
FiO2 (%):
Pressure Support:
Pressure Control:
Wean: Per Cardiothoracic Weaning Algorithm
P High (cmH20):
P Low (cmH20):
T High (sec):
T Low (sec):
Refer to Cardiac Surgery, Transplant, and VAD Early
Extubation Algorithm, Post-Op/Phase II
chlorhexidine (PERIDEX) 0.12 % soln MULTIDOSE
[792004]
15 mL, Mouth/Throat, 2 X DAILY Starting today
Use to swab oral cavity. Discontinue when patient no
longer on ventilation.
Post-Op/Phase II
Respiratory - Post Extubation [89877]
Oxygen Therapy [RT0032] CONTINUOUS, Starting today, Routine
FiO2 (%):
Liter Flow:
Titrate oxygen to maintain O2 sat at (%): 90
O2 Delivery Device: Nasal Cannula
Attempt to Wean Off Oxygen? Yes
Post-extubation, Post-Op/Phase II
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Copyright © 2014 University of Wisconsin Hospital and Clinics Authority


Cough And Deep Breathe [NURTRT0019] EVERY 1 HOUR, Starting today, Routine, Every 1 hour while
awake and every 4 hours while asleep, post-extubation, Post-
Op/Phase II
Incentive Spirometry [NURTRT0018] EVERY 1 HOUR, Starting today, Routine, Every 1 hour while
awake and every 4 hours while asleep, post-extubation, Post-
Op/Phase II
Wound/Procedure Site Care [89878]
Incision Care (Chest) [NURWND0015] CONTINUOUS, Starting today, Routine
Wound Type: Open
Wound Site: Chest
Wound Location:
Assess Frequency: EVERY 8 HOURS
Care Frequency:
Wash With:
Irrigate/Rinse With:
Apply (Must also enter separate medication order to obtain
drug):
Primary Dressing: Other (Comment)
Secondary Dressing:
Provider to perform dressing change if patient's chest is still
open., Post-Op/Phase II
Sternal Site Care [NURWND0015] CONTINUOUS, Starting today, Routine
Wound Type: Closed - Incision
Wound Site: Chest
Wound Location: Anterior
Assess Frequency: EVERY 24 HOURS
Care Frequency:
Wash With:
Irrigate/Rinse With:
Apply (Must also enter separate medication order to obtain
drug):
Primary Dressing: Gauze
Secondary Dressing:
Wash with chlorhexidine gluconate 4% (HIBICLENS). Assess
site daily for infection, erythema, edema or drainage and
separate edges. Palpate for increased tenderness at the
wound margins. Dressing change 24 hours postoperatively,
then every 24 hours and as needed. Use Sterile 4x4 dry
gauze secured with tape., Post-Op/Phase II
Maintain Drain - Begin POD 2 [NURTAD0003] CONTINUOUS, Starting tomorrow, Routine
Type: Closed Suction (Jackson-Pratt)
Site: Chest
Location:
Drainage Options: Bulb
Irrigate Frequency:
Irrigate With:
Irrigant Volume (mL):
Strip:
Strip For:
Dressing Change Frequency: DAILY
Dressing Type: Gauze
Wash with chlorhexidine gluconate 4% (HIBICLENS).
Dressing change 24 hours postoperatively, then every 24
hours and as needed. Use Split Sterile 4x4 Dry Gauze. If
drainage present, apply dry, clean dressing using no
ointments.
Chest Tube Care [89880]
Maintain Chest Tube -20 cm Wall Suction
[NURTAD0001]
CONTINUOUS, Starting today For Until specified, Routine
Location:
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Copyright © 2014 University of Wisconsin Hospital and Clinics Authority


Position: N/A - Single Location
Drainage Options: -20 cm wall suction
Site Assessment Frequency:
Care Frequency: 1 X DAILY
Wash With:
Primary Dressing: Gauze
Secondary Dressing:
Chest tube to portable suction during ambulation.
Assess site for erythema, edema, or drainage. No vaseline
gauze while chest tube in place., Post-Op/Phase II
Wound Care - Post Chest Tube Removal
[NURWND0015]
CONTINUOUS, Starting today For Until specified, Routine
Wound Type: Other (Comment)
Wound Site: Chest
Wound Location: Anterior
Assess Frequency: SEE COMMENTS
Care Frequency: 1X DAILY
Wash With:
Irrigate/Rinse With:
Apply (Must also enter separate medication order to obtain
drug):
Primary Dressing: Gauze
Secondary Dressing: Other (Comment)
Post-Op/Phase II
Ventricular Assist Device Care [89879]
Ventricular Assist Device Care [NURVENT0010] CONTINUOUS, Starting today, Routine, Post-Op/Phase II
Ventricular Assist Device Emergency Care
[NURVENT0011]
CONTINUOUS, Starting today, Routine, Post-Op/Phase II
CentriMag - Device Checks [97513]
RIGHT Ventricular Assist Device Checks - CentriMag
[NURVENT0015]
CONTINUOUS, Starting today, Routine
Set Speed (RPM):
Document Speed: Q1 Hours x 24 Hours, then Q2 Hours
Document Flow (L/min): Q1 Hours x 24 Hours, then Q2 Hours
Assess and Document Presence of Chatter or Clots: Q1
Hours x 24 Hours, then Q2 Hours
Set Low Flow Limit (L/min):
Document Low Flow Limit: Every 8 Hours
Set High Flow Limit (L/min):
Document High Flow Limit: Every 8 Hours
Move Flow Probe 1 Centimeter: Every 8 Hours
Document Presence of Emergency Equipment at Bedside:
Every 8 Hours
Check Tubing Connections are Secure: Every 8 Hours
Check Tubing for Kinks or Sharp Turns: Every 8 Hours
Tubing Secured to Patient in Large Loops: Every 8 Hours
Turn on Back-up Console and Verify Battery is Charged:
Every 8 Hours
Check Pump Locking Screw Engaged Correctly: Every 8
Hours
Notify Provider If:
Chatter of the VAD system; RVAD flows greater than LVAD
flows; Clot in chamber; VAD failure; RVAD flows less than ***
L/min., Post-Op/Phase II
LEFT Ventricular Assist Device Checks - CentriMag
[NURVENT0016]
CONTINUOUS, Starting today, Routine
Set Speed (RPM):
Document Speed: Q1 Hours x 24 Hours, then Q2 Hours
Document Flow (L/min): Q1 Hours x 24 Hours, then Q2 Hours
Assess and Document Presence of Chatter or Clots: Q1
Hours x 24 Hours, then Q2 Hours
Set Low Flow Limit (L/min):
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Copyright © 2014 University of Wisconsin Hospital and Clinics Authority


Document Low Flow Limit: Every 8 Hours
Set High Flow Limit (L/min):
Document High Flow Limit: Every 8 Hours
Move Flow Probe 1 Centimeter: Every 8 Hours
Document Presence of Emergency Equipment at Bedside:
Every 8 Hours
Check Tubing Connections are Secure: Every 8 Hours
Check Tubing for Kinks or Sharp Turns: Every 8 Hours
Tubing Secured to Patient in Large Loops: Every 8 Hours
Turn on Back-up Console and Verify Battery is Charged:
Every 8 Hours
Check Pump Locking Screw Engaged Correctly: Every 8
Hours
Notify Provider If:
Chatter of the VAD system; RVAD flows greater than LVAD
flows; Clot in chamber; VAD failure; LVAD flows less than ***
L/min., Post-Op/Phase II
Heartware - Device Checks [154550]
Mean Arterial Pressure [NURVENT0017] ONCE, Starting today For 1 Occurrences, Keep MAP 65-85,
Post-Op/Phase II
Hematocrit Setting [NURVENT0017] ONCE, Starting today For 1 Occurrences, Change hematocrit
setting in Heartware monitor with every hematocrit value,
Post-Op/Phase II
LEFT Ventricular Assist Device Checks - Heartware
[NURVENT0024]
CONTINUOUS, Starting today, Routine
Speed (rpm) Set speed to keep CI > 2.5:
Document Speed: Q1 Hours x 24 Hours, then Q2 Hours while
in ICU
Document Flow (L\Min): Q1 Hours x 24 Hours, then Q2 Hours
while in ICU
Document Power (w): Q2 Hours while in ICU
Document High Power Alarm Setting: Q4 Hours
Low Flow Alarm Setting: Q4 Hours
Assess VAD Waveforms: Q1 Hours x 24 Hours, then Q2
Hours while in ICU
Post-Op/Phase II
RIGHT Ventricular Assist Device Checks - Heartware
[NURVENT0025]
CONTINUOUS, Starting today, Routine
Speed (rpm) Set speed to keep CI > 2.5:
Document Speed: Q1 Hours x 24 Hours, then Q2 Hours while
in ICU
Document Flow (L\Min): Q1 Hours x 24 Hours, then Q2 Hours
while in ICU
Document Power (w): Q2 Hours while in ICU
Document High Power Alarm Setting: Q4 Hours
Low Flow Alarm Setting: Q4 Hours
Assess VAD Waveforms: Q1 Hours x 24 Hours, then Q2
Hours while in ICU
Post-Op/Phase II
HeartMate II - Device Checks [97511]
Ventricular Assist Device Checks - HeartMate II
[NURVENT0001]
CONTINUOUS, Starting today, Routine
Mode: Fixed
Record Mode: Q1 Hours x 24 Hours, then Q2 Hours
Fixed Speed (RPM):
Record Speed (RPM): Q1 Hours x 24 Hours, then Q2 Hours
Record Flow (Liters/Minutes): Q1 Hours x 24 Hours, then Q2
Hours
Record Power (Watts): Q1 Hours x 24 Hours, then Q2 Hours
Record Pulsatility Index (PI): Q1 Hours x 24 Hours, then Q2
Hours
Notify Provider If:
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Copyright © 2014 University of Wisconsin Hospital and Clinics Authority


VAD Failure; VAD flow less than *** L/min or greater than ***
L/min; Power greater than 8 watts; Red heart alarm sounds;
Pulsatility Index less than 3 and greater than 6., Post-
Op/Phase II
Thoratec - Device Checks [97515]
RIGHT Ventricular Assist Device Checks - Thoratec
[NURVENT0003]
CONTINUOUS, Starting today, Routine
Select Mode:
Document Mode: Q1 Hours x 24 Hours, then Q2 Hours
Document Flow (L/min): Q1 Hours x 24 Hours, then Q2 Hours
Fixed Rate/Back-up Rate in Volume Mode (BPM):
Document Fixed Rate/Back-up Rate in Volume Mode: Q1
Hours x 24 Hours, then Q2 Hours
Eject Time (msec):
Record Eject Time: Q1 Hours x 24 Hours, then Q2 Hours
Drive/Eject Pressure (mmHg):
Record Drive/Eject Pressure: Q1 Hours x 24 Hours, then Q2
Hours
Vacuum (mmHg):
Record Stroke Volume: Q1 Hours x 24 Hours, then Q2 Hours
Percent Systole (%):
Record Percent Systole: Q1 Hours x 24 Hours, then Q2
Hours
Record Flash Test or Flashing Empty Light on Signal
Processor: Q1 Hours x 24 Hours, then Q2 Hours
Record Fill Light Status: Q1 Hours x 24 Hours, then Q2 Hours
Notify Provider If:
VAD failure; RVAD flow less than *** L/min; LVAD flow 0.5
liters less than or equal to RVAD flow or LVAD flow greater
than RVAD flow; VAD unable to fill; VAD unable to eject.,
Post-Op/Phase II
LEFT Ventricular Assist Device Checks - Thoratec
[NURVENT0013]
CONTINUOUS, Starting today, Routine
Select Mode:
Document Mode: Q1 Hours x 24 Hours, then Q2 Hours
Document Flow (L/min): Q1 Hours x 24 Hours, then Q2 Hours
Fixed Rate/Back-up Rate in Volume Mode (BPM):
Document Fixed Rate/Back-up Rate in Volume Mode: Q1
Hours x 24 Hours, then Q2 Hours
Eject Time (msec):
Record Eject Time: Q1 Hours x 24 Hours, then Q2 Hours
Drive/Eject Pressure (mmHg):
Record Drive/Eject Pressure: Q1 Hours x 24 Hours, then Q2
Hours
Vacuum (mmHg):
Record Stroke Volume: Q1 Hours x 24 Hours, then Q2 Hours
Percent Systole (%):
Record Percent Systole: Q1 Hours x 24 Hours, then Q2
Hours
Record Flash Test or Flashing Empty Light on Signal
Processor: Q1 Hours x 24 Hours, then Q2 Hours
Record Fill Light Status: Q1 Hours x 24 Hours, then Q2 Hours
Notify Provider If:
VAD failure; LVAD flow less than *** or greater than *** L/min;
LVAD flow 0.5 liters less than or equal to RVAD flow or LVAD
flow greater than RVAD flow; VAD unable to fill; VAD unable
to eject., Post-Op/Phase II
Intake and Output [87689]
Measure Intake And Output [NURMON0005] SEE COMMENTS, Starting today, Routine, Every 15 minutes
times 4, then every 30 minutes times 4, then every hour.,
Post-Op/Phase II
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Copyright © 2014 University of Wisconsin Hospital and Clinics Authority


Non-Categorized Patient Care Orders [89885]
Refer to "Insulin Infusion - Adult - Supplemental" Order Set for Patients on Insulin Infusion
Refer to "Diabetes Management - Adult - Supplemental" Order Sets for all Glucose Monitoring and Insulin Therapy
Measure Weight [NURMON0015] 1X DAILY, Starting today, Routine
Weigh With?
Weigh when?
Post-Op/Phase II
OG Tube Placement - Adult [120995]
Insert and Maintain Orogastric Tube [NURTAD0015] CONTINUOUS, Routine
Options: Low, Continuous Suction
Flush with:
Flush Frequency:
Check Residual:
Does this need to be inserted/placed?
Device Status: Ready For Use
No anti-reflux valve. Confirm placement prior to use.
Refer to Policy 2.20 Enteral Tubes Used for Instillation of
Fluids, Medications, or Feeding., Post-Op/Phase II
X-RAY ABDOMEN AP VIEW (KUB) [R74000] CONDITIONAL For 3 Days, Routine
Radiology Specialty Area: GENERAL IMAGING
Current signs and symptoms? Orogastric tube placement
What specific question(s) would you like answered by this
exam? Evaluate orogastric tube placement
Relevant recent/past history? Cardiac Surgery
Is patient pregnant?
If being performed remotely, where?
Last patient weight?
Transport Method: Floor Determined/Entered
If Conditional, What Condition? Evaluate orogastric tube
placement. The location of orogastric tube should be
confirmed prior to the instillation of fluids, medications, or
feedings. Refer to Policy 2.20 Enteral Tubes Used for
Instillation of Fluids, Medications, or Feeding
Post-Op/Phase II
NG Tube Placement - Adult [120994]
Insert and Maintain Nasogastric Tube [NURTAD0014] CONTINUOUS, Routine
Options: Low, Continuous Suction
Flush with:
Flush Frequency:
Clamp NG Tube:
Check Residual:
Does this need to be inserted/placed?
Device Status: Ready For Use
No antireflux valve
Refer to Policy 2.20 Enteral Tubes Used for Instillation of
Fluids, Medications, or Feeding, Post-Op/Phase II
lidocaine-oxymetazoline 4%-0.05% (ADULT) nasal
spray [785081]
2 spray, Nasal, ONCE For 1 Doses
For numbing prior to feeding tube insertion.
Slowly spray the chosen nostril once, if required may
repeat x1 in opposite nostril. Angle toward back of throat
spraying the anterior nostril and wait 30-60 seconds
before introducing more local anesthetic into the nostril.
Caution: Entire bottle should not be used for insertion of
tube. Discard excess solution when procedure completed.
Post-Op/Phase II
X-RAY ABDOMEN AP VIEW (KUB) [R74000] CONDITIONAL For 3 Days, Routine
Radiology Specialty Area: GENERAL IMAGING
Current signs and symptoms?
What specific question(s) would you like answered by this
exam? Evaluate nasogastric tube placement
Relevant recent/past history?
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Is patient pregnant?
If being performed remotely, where?
Last patient weight? (will auto pull in value and date in
comment):
Transport Method: Floor Determined/Entered
If Conditional, What Condition? Evaluate nasogastric tube
placement. The location of nasogastric tube should be
confirmed prior to the instillation of fluids, medications, or
feedings. Refer to Policy 2.20 Enteral Tubes Used for
Instillation of Fluids, Medications, or Feeding
Post-Op/Phase II
Insert and Maintain Urinary Catheter [NURELM0013] CONTINUOUS, Starting today, Routine, To discontinue this
order, enter a new order for "Discontinue Urinary Catheter".
To modify this order, enter a new order for "Maintain Urinary
Catheter" and make the necessary changes in the new order.
Type: Indwelling Single Lumen
Indication for Placement:
Initiate Urinary Catheter Removal Protocol? (NP/PA Must
Select "No"): Yes
Details: To Dependent Drainage
Irrigate With:
Irrigation Frequency:
Does this need to be inserted/placed?
Post-Op/Phase II
Apply Ice Pack to Affected Area [NURTRT0008] SEE COMMENTS, Starting today, Routine
Site: Other (Comment)
Cooling blanket or ice bags for temperature greater than 38.8
Celsius., Post-Op/Phase II
Use Warm Air Blanket [NURTRT0027] SEE COMMENTS, Starting today, Routine, As needed for
temperature less than 36.0 degrees Celsius immediately
postoperatively., Post-Op/Phase II
Notify Primary Service to Place Diabetes Management
Service Consult Order if Patient Has A Single Blood
Glucose Result Greater Than 180 milligrams per
deciliter within 24 hours of anesthesia end time.
[NURCOM0022]
CONTINUOUS, Starting today
Initiate B4/5 Insulin Infusion Protocol [NURMON0062] CONTINUOUS, Routine
Glucose, POC [IPGLUCOSE] EVERY 2 HOURS, Starting today For 24 Hours, Routine
If Conditional, What Condition? Draw until patient begins on
clear liquids.
Draw until patient begins on clear liquids.
Glucose, POC [IPGLUCOSE] BEFORE MEALS AND BEDTIME, Starting today For 24
Hours, Routine
If Conditional, What Condition? If patient eating or drinking.
If patient eating or drinking., Post-Op/Phase II
Contingency Parameters [89886]
Notify Provider [NURCOM0001] Provider to Notify: Provider
If systolic blood pressure > (mmHg):
If systolic blood pressure < (mmHg):
If diastolic blood pressure > (mmHg):
If diastolic blood pressure < (mmHg):
If temperature > (C): 38.5
If temperature < (C):
If heart rate > (bpm):
If heart rate < (bpm):
If respiratory rate >:
If respiratory rate <:
If blood glucose > (mg/dL): 400
If blood glucose < (mg/dL):
If pain score >:
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Copyright © 2014 University of Wisconsin Hospital and Clinics Authority


Pulse Oximetry < (%): 90
If urine output < (mL): 30 milliliters/hour time 2 hours
Other: Mean arterial pressure less than 60 or greater than 90
mmHg
Post-Op/Phase II
Intravenous Therapy
Premedications for Needle Insertion [106327]
Use lidocaine topical dressing kit for stable patient, no lidocaine allergies, have at least 30 minutes time prior to needing
to use IV
Sodium chloride (bacteriostatic) 0.9% intradermal: Useful for patients requiring urgent IV access; onset is within 1 minute.
Choice of medication should be based on patient’s previous experience/preference, history of lidocaine allergy and ease
of access.
lidocaine (LMX) 4% topical dressing kit [66882] Topical, EVERY 1 HOUR PRN, peripheral line insertion - see
Admin Instructions
Do NOT apply to area greater than 200 square centimeters
(maximum 2.5 g/site; maximum 4 sites per hour, 6 times per
day). Do NOT leave on longer than 2 hours. Use for stable
patient, no allergies to lidocaine, with at least 30 minutes time
prior to IV use
Post-Op/Phase II
lidocaine (XYLOCAINE) 1% injection [39034] 0.1-0.4 mL, Intradermal, PRN, peripheral line insertion - see
Admin Instructions
Use an insulin or TB syringe with a 25-30 gauge needle to
inject solution and create a wheal. Wait 30 seconds to 1
minute then insert IV catheter into center of wheal. Use if IV
is needed within 30 minutes. Choice of medication should be
based on patient’s previous experience/preference, history of
lidocaine allergy and ease of access
Post-Op/Phase II
sodium chloride (bacteriostatic) 0.9 % injection [50585] 0.05-0.1 mL, Intradermal, PRN, peripheral line insertion - see
Admin Instructions
Use an insulin or TB syringe with a 25-30 gauge needle to
inject solution and create a wheal. Wait 30 seconds to 1
minute then insert IV catheter into center of wheal. Use if IV
is needed within 30 minutes. Choice of medication should be
based on patient’s previous experience/preference, history of
lidocaine allergy and ease of access
Post-Op/Phase II
IV Fluids [89888]
dextrose 5%-NaCl 0.2% infusion [51615] at 5 mL/hr, Intravenous, CONTINUOUS
Per CVP port
Post-Op/Phase II
Insert and Maintain Peripheral IV - Replace all Operating
Room intravenous catheters with peripheral intravenous
catheter within 24 hours postoperatively [NURVAD0013]
CONTINUOUS, Starting today, Routine
Peripheral IV Size:
Peripheral IV Location:
Peripheral IV Device:
Peripheral IV Status:
Flush Solution:
Does this need to be inserted/placed?
Post-Op/Phase II
Cap unused peripheral intravenous catheters/triple
lumen catheters/PICCs and pulmonary artery catheters
(Swan-Ganz) [NURVAD0053]
CONTINUOUS, Starting today, Post-Op/Phase II
Medications
Anti-infectives (Single Response) [144476]
Patients who are 40-159 kg [141444]
cefuroxime (ZINACEF) intraVENOUS [800030] 1.5 g, Intravenous, EVERY 12 HOURS For 3 Doses, Post-
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Copyright © 2014 University of Wisconsin Hospital and Clinics Authority


Op/Phase II
vancomycin (VANCOCIN) intraVENOUS [800084] 10 mg/kg, Intravenous, EVERY 8 HOURS For 5 Doses,
Post-Op/Phase II
Patients who are 160 kg or greater [141445]
cefuroxime (ZINACEF) intraVENOUS [800030] 3 g, Intravenous, EVERY 12 HOURS For 3 Doses, Post-
Op/Phase II
vancomycin (VANCOCIN) intraVENOUS [800084] 10 mg/kg, Intravenous, EVERY 8 HOURS For 5 Doses,
Post-Op/Phase II
Analgesics (Single Response) [89891]
MORPHine PF injection RANGE [750057] 1-2 mg, Intravenous, EVERY 1 HOUR PRN For 24 Hours,
pain
For patients unable to take oral therapy
for 4 Minutes, Post-Op/Phase II
acetaMINOPHEN (TYLENOL) tab [34149] 650 mg, Oral, EVERY 4 HOURS PRN, pain, temperature
greater than 38.5 degrees Celsius
For mild pain. No more than 4 grams acetaminophen per 24
hours for adults or 15mg/kg per dose for peds <40kg.
Post-Op/Phase II
acetaMINOPHEN (TYLENOL) suppository [43994] 650 mg, Rectal, EVERY 4 HOURS PRN, pain/fever,
temperature greater than 38.5 degrees Celsius
For mild pain. No more than 4 grams acetaminophen per 24
hours for adults or 15mg/kg per dose for peds <40kg.
Post-Op/Phase II
hydrocodone-acetaMINOPHEN (NORCO) 5-325 mg per
tab RANGE [750021]
1-2 tab, Oral, EVERY 4 HOURS PRN, pain
For moderate/severe pain. No more than 4 grams
acetaminophen per 24 hours for adults or 15mg/kg per dose
for peds <40kg.
Post-Op/Phase II
oxycodone-acetaminophen (PERCOCET) 5-325 mg per
tab RANGE [750033]
1-2 tab, Oral, EVERY 4 HOURS PRN, pain
For moderate/severe pain. No more than 4 grams
acetaminophen per 24 hours for adults or 15mg/kg per dose
for peds <40kg.
Post-Op/Phase II
Anti-anxiety [89898]
midazolam (VERSED) injection RANGE [750056] 1-2 mg, Intravenous, EVERY 6 HOURS PRN For 24 Hours,
agitation or anxiety while on ventilator
Discontinue when extubated
Post-Op/Phase II
Anti-emetics [89893]
ondansetron (ZOFRAN) injection [800202] 4 mg, Intravenous, EVERY 24 HOURS PRN,
nausea/vomiting, Post-Op/Phase II
Anti-arrhythmics [89894]
amiodarone (CORDARONE) BOLUS - NOTE: Do NOT
order if patient received in OR [800123]
150 mg, Intravenous, ONCE For 1 Doses, Post-Op/Phase II
amiodarone (CORDARONE) non- PVC infusion
[700135]
1 mg/min, Intravenous, Post-Op/Phase II
amiodarone (CORDARONE) non- PVC infusion
[700135]
0.5 mg/min, Intravenous, Post-Op/Phase II
amiodarone (CORDARONE) tab [44131] 400 mg, Oral, 2 X DAILY Starting tomorrow For 7 Days, Post-
Op/Phase II
amiodarone (CORDARONE) tab [44131] 400 mg, Oral, 1 X DAILY Starting 12/2/14 For 7 Days, Post-
Op/Phase II
amiodarone (CORDARONE) tab [44131] 200 mg, Oral, 1 X DAILY Starting 12/9/14 For 90 Days, Post-
Op/Phase II
Bowel Management [144116]
senna-docusate (SENOKOT-S) 8.6-50 mg per tab
[60530]
2 tab, Oral, 2 X DAILY Starting tomorrow
Hold for loose stool or suspected obstruction. Use rescue
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Copyright © 2014 University of Wisconsin Hospital and Clinics Authority


therapy after first 48hrs if inadequate response to scheduled
bowel management.
Post-Op/Phase II
polyethylene glycol (MIRALAX) oral powder [61353] 17 g, Oral, 1 X DAILY PRN Starting tomorrow, constipation
Hold for loose stool or suspected obstruction. Use as first line
rescue therapy if inadequate response to scheduled bowel
management.
Post-Op/Phase II
bisacodyl (DULCOLAX) rectal suppository [35231] 10 mg, Rectal, 1 X DAILY PRN Starting tomorrow,
constipation
Hold for loose stool. Use as second line rescue therapy if no
response to first line rescue therapy within 24 hours and
notify Primary Team.
Post-Op/Phase II
Gastric (Single Response) [89896]
pantoprazole (PROTONIX) susp [780113] 40 mg, Nasogastric Tube, 1 X DAILY, Post-Op/Phase II
ranitidine (ZANTAC) injection [800075] 50 mg, Intravenous, EVERY 8 HOURS, Post-Op/Phase II
Hemostatic Agents [89897]
aminocaproic acid (AMICAR) 15 g/310mL infusion
[700428]
Intravenous
Continue OR bag until empty then discontinue
Post-Op/Phase II
Potassium Supplementation (Single Response) [89899]
potassium chloride 20 mEq/ 100 mL bag [46255] 20 mEq, Intravenous, PRN, potassium supplementation - See
Admin Instructions
For potassium level between 3.8 - 4.0 mmol/L give 20 mEq x1
For potassium level between 3.5 - 3.7 mmol/L give 20 mEq x2
For potassium level between 3.2 - 3.4 mmol/L give 20 mEq x3
for 60 Minutes, Post-Op/Phase II
potassium chloride 10 mEq/100 mL bag - NOTE: Renal
dosing [46253]
10 mEq, Intravenous, PRN, potassium supplementation - See
Administration Instructions
For potassium level between 3.5 - 3.7 mmol/L give 10 mEq x1
For potassium level between 3.2 - 3.4 mmol/L give 10 mEq x2
for 60 Minutes
NOTE: Renal dosing
Post-Op/Phase II
Magnesium Supplementation (Single Response) [89900]
Magnesium Supplemental Scale [950039] PRN - NOTIFY PHARMACY WHEN NEEDED, magnesium
supplementation - See Administation Instructions
For serum magnesium 1.6-1.8 mg/dL give 0.05 g/kg IV x1
over 12 hours
For serum magnesium 1.0-1.5 mg/dL give 0.1 g/kg IV x1 over
24 hours
For serum magnesium less than 1 mg/dL give 0.15 g/kg IV x1
over 24 hours
Post-Op/Phase II
Magnesium Supplemental Scale - NOTE: Order for
RENAL Dosing [950039]
PRN - NOTIFY PHARMACY WHEN NEEDED, magnesium
supplementation - See Administation Instructions
For serum magnesium 1.6-1.8 mg/dL give 0.025 g/kg IV x1
over 12 hours
For serum magnesium 1.0-1.5 mg/dL give 0.05 g/kg IV x1
over 24 hours
For serum magnesium less than 1 mg/dL give 0.075 g/kg IV
x1 over 24 hours
NOTE: Order for RENAL Dosing
Post-Op/Phase II
Phosphate SODIUM [112672]
phosphate-potassium & sodium (PHOS-NAK) oral
packet [112317]
1-2 packet, Oral, PRN, phosphate supplementation - See
Admin Instructions
Page 14 of 21
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Copyright © 2014 University of Wisconsin Hospital and Clinics Authority


For serum phosphate 2.4 - 3 mg/dL, give 1 packet every 4
hours while awake x 3 doses;
For serum phosphate 1.6 - 2.3 mg/dL, give 2 packets every 4
hours while awake x 3 doses;
For serum phosphate less than 1.6 mg/dL, give 1 mmol/kg IV
over 4-6 hrs.
Hold if CrCl < 30 mL/min and notify provider for phosphate
orders
phosphate-potassium & sodium (PHOS-NAK) oral
packet - NOTE: Order in patients with RENAL
impairment (CrCl < 30 mL/min) [112317]
1 packet, Oral, PRN, phosphate supplementation - See
Admin Instructions
For serum phosphate 2.4 - 3 mg/dL, give 1 packet every 4
hours while awake x 2 doses;
For serum phosphate 1.6 - 2.3 mg/dL, give 1 packet every 4
hours while awake x 3 doses;
For serum phosphate less than 1.6 mg/dL, give 0.5 mmol/kg
IV over 4-6 hrs.
Flushes [145104]
sodium chloride 0.9% flush 10 mL injection [785055] 10 mL, Intravenous, EVERY 8 HOURS
Flush every saline lock port with 10mL/port for each line.
Post-Op/Phase II
Vasoactive Agents [125822]
Note: Concentrate All Drips [950029] ONCE For 1 Doses, Post-Op/Phase II
DOPamine (INTROPIN) 800 mg in dextrose 5% 250 mL
infusion [50506]
2 mcg/kg/min, Intravenous, Post-Op/Phase II
DOBUTamine (DOBUTREX) 1000mg in dextrose 5%
250 mL infusion [51747]
Intravenous, Post-Op/Phase II
milrinone (PRIMACOR) 20 mg in dextrose 5% 100 mL
infusion [158103]
Intravenous, Post-Op/Phase II
epINEPHrine infusion [700197] Intravenous, Post-Op/Phase II
norepinephrine (LEVOPHED) infusion [700247] Intravenous, Post-Op/Phase II
vasopressin (PITRESSIN) 100 units in dextrose 5% 250
mL infusion (SEPTIC SHOCK) [700291]
0.04-0.06 Units/min, Intravenous, Post-Op/Phase II
nicardipine (CARDENE) 50 mg in sodium chloride 0.9 %
100 mL infusion [700426]
Intravenous
MAP > *** or SBP > ***
Post-Op/Phase II
nitroprusside 50 mg/sodium thiosulfate 0.5 g infusion
[700503]
0.1-10 mcg/kg/min, Intravenous, Post-Op/Phase II
nitroglycerin 50 mg in dextrose 5% 250 mL infusion
[51611]
0.2-3 mcg/kg/min, Intravenous, Post-Op/Phase II
Non-categorized [89902]
sodium chloride 0.9% flush 10 mL injection [785055] Flush, PRN, flush/line care
Flush per VAD guidelines
Post-Op/Phase II
sodium chloride 0.9% infusion [64367] at 4 mL/hr, Intravenous, CONTINUOUS
Per intraflow for arterial line, Swan-Ganz distal port, and
Central Venous Pressure port
Post-Op/Phase II
lidocaine (XYLOCAINE-CARDIAC) 20 mg/mL injection
[39041]
75 mg, Intravenous, PRN, symptomatic ventricular
arrhythmias, symptomatic hypotension, decreased level of
consciousness, chest pain, shortness of breath or ventricular
tachycardia lasting greater than 30 seconds , Post-Op/Phase
II
Laboratory
Upon Arrival to ICU [89905]
PTT [PTT] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
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Upon arrival to ICU, Post-Op/Phase II
ELECTROLYTES [LYTE] STAT - RN COLLECT, Starting today For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Upon arrival to ICU, Post-Op/Phase II
BUN [BUN] STAT - RN COLLECT, Starting today For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Upon arrival to ICU, Post-Op/Phase II
CREATININE [CRET] STAT - RN COLLECT, Starting today For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Upon arrival to ICU, Post-Op/Phase II
GLUCOSE [GLU] STAT - RN COLLECT, Starting today For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Upon arrival to ICU, Post-Op/Phase II
CALCIUM [CA] STAT - RN COLLECT, Starting today For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Upon arrival to ICU, Post-Op/Phase II
CBC WITHOUT DIFFERENTIAL [HEMO] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Upon arrival to ICU, Post-Op/Phase II
MAGNESIUM [MAG] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Upon arrival to ICU, Post-Op/Phase II
PHOSPHATE [PHOS] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Upon arrival to ICU, Post-Op/Phase II
PROTHROMBIN TIME/INR [PT] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Upon arrival to ICU, Post-Op/Phase II
BLOOD GASES AND O2 SATURATION [HCBGASOS] STAT - RN COLLECT For 1 Occurrences, Routine
If source is OTHER, indicate here:
Indicate FIO2: Per RN
Upon arrival to ICU, Post-Op/Phase II
Postoperative Day 1 [89907]
ELECTROLYTES [LYTE] SPECIFIC TIME - RN COLLECT, Starting tomorrow at 5:00
AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
Page 16 of 21
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previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
BUN [BUN] SPECIFIC TIME - RN COLLECT, Starting tomorrow at 5:00
AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
CREATININE [CRET] SPECIFIC TIME - RN COLLECT, Starting tomorrow at 5:00
AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
GLUCOSE [GLU] SPECIFIC TIME - RN COLLECT, Starting tomorrow at 5:00
AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
CALCIUM [CA] SPECIFIC TIME - RN COLLECT, Starting tomorrow at 5:00
AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
MAGNESIUM [MAG] SPECIFIC TIME - RN COLLECT, Starting tomorrow at 5:00
AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
PHOSPHATE [PHOS] SPECIFIC TIME - RN COLLECT, Starting tomorrow at 5:00
AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
ALKALINE PHOSPHATASE [ALKP] SPECIFIC TIME - RN COLLECT, Starting tomorrow at 5:00
AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
BILIRUBIN, TOTAL [TBIL] SPECIFIC TIME - RN COLLECT, Starting tomorrow at 5:00
AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
AST/SGOT [AST] SPECIFIC TIME - RN COLLECT, Starting tomorrow at 5:00
AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
ALT/SGPT [ALT] SPECIFIC TIME - RN COLLECT, Starting tomorrow at 5:00
AM For 1 Occurrences, Routine
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If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
LD, TOTAL [LDH] SPECIFIC TIME - RN COLLECT, Starting tomorrow at 5:00
AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
CBC WITHOUT DIFFERENTIAL [HEMO] SPECIFIC TIME - RN COLLECT, Starting tomorrow at 5:00
AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
PROTHROMBIN TIME/INR [PT] SPECIFIC TIME - RN COLLECT, Starting tomorrow at 5:00
AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
PTT [PTT] SPECIFIC TIME - RN COLLECT, Starting tomorrow at 5:00
AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
PREALBUMIN [XPRALB] SPECIFIC TIME - RN COLLECT, Starting tomorrow at 5:00
AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
C REACTIVE PROTEIN [CRPN] NEXT AM, Starting tomorrow For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Conditional Labs [97519]
MAGNESIUM [MAG] CONDITIONAL - RN COLLECT, Starting today For 4 Days,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition? 1 hour after IV
supplementation
Post-Op/Phase II
POTASSIUM [K] CONDITIONAL - RN COLLECT, Starting today For 4 Days,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition? Draw postoperative hour 6,
12 and 18
Post-Op/Phase II
PROTHROMBIN TIME/INR [PT] CONDITIONAL - RN COLLECT For 4 Days, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition? 1 hour after plasma infusion
Post-Op/Phase II
HEMATOCRIT [HCT] CONDITIONAL - RN COLLECT For 4 Days, Routine
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If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition? Draw postoperative hour 6,
12 and 18
Post-Op/Phase II
PTT [PTT] CONDITIONAL - RN COLLECT For 4 Days, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition? If chest tube output is greater
than 150 mL/hour
Post-Op/Phase II
PLATELET COUNT [PLT] CONDITIONAL - RN COLLECT For 4 Days, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition? If chest tube output is greater
than 150 mL/hour
Post-Op/Phase II
PHOSPHATE [PHOS] CONDITIONAL - RN COLLECT, Starting today For 4 Days,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition? If patient experiences
arrhythmias
Post-Op/Phase II
BLOOD GASES AND O2 SATURATION [HCBGASOS] CONDITIONAL - RN COLLECT, Starting today For 4 Days,
STAT
If source is OTHER, indicate here:
Indicate FIO2: Per RN
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition? Draw postoperative hour 6,
12 and 18
Post-Op/Phase II
GLUCOSE [GLU] CONDITIONAL - RN COLLECT, Starting today For 4 Days,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition? Draw if blood glucose <40 or
>400 mg/dL
Draw if blood glucose <40 or >400 mg/dL, Post-Op/Phase II
CALCIUM [CA] CONDITIONAL - RN COLLECT, Starting today For 4 Days,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition? If patient experiences
arrhythmias
Post-Op/Phase II
Diagnostic Tests and Imaging
Diagnostic Tests and Imaging [89921]
X-RAY CHEST AP VIEW - Upon Arrival to ICU [R71010] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, Routine
Current signs and symptoms? Status post ventricular assist
device
What specific question(s) would you like answered by this
exam? Evaluate ET tube and line placement
Relevant recent/past history? Postoperative Ventricular Assist
Device placement
Page 19 of 21
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Is patient pregnant?
If being performed remotely, where?
Transport Method: Floor Determined/Entered
Upon arrival to ICU, Post-Op/Phase II
X-RAY CHEST AP VIEW - Postoperative Day 1
[R71010]
ONCE-ON SPECIFIC DATE, Starting tomorrow For 1
Occurrences, Routine
Current signs and symptoms? Status post ventricular assist
device
What specific question(s) would you like answered by this
exam? Evaluate for pulmonary infiltrate
Relevant recent/past history? Postoperative Ventricular Assist
Device placement
Is patient pregnant?
If being performed remotely, where?
Transport Method: Floor Determined/Entered
Post-Op/Phase II
X-RAY CHEST AP VIEW - Postoperative Day 2
[R71010]
ONCE-ON SPECIFIC DATE, Starting 11/26/14 For 1
Occurrences, Routine
Current signs and symptoms? Status post ventricular assist
device
What specific question(s) would you like answered by this
exam? Evaluate for pulmonary infiltrate
Relevant recent/past history? Postoperative Ventricular Assist
Device placement
Is patient pregnant?
If being performed remotely, where?
Transport Method: Floor Determined/Entered
Post-Op/Phase II
X-RAY CHEST AP VIEW - Postoperative Day 3
[R71010]
ONCE-ON SPECIFIC DATE, Starting 11/27/14 For 1
Occurrences, Routine
Current signs and symptoms? Status post ventricular assist
device
What specific question(s) would you like answered by this
exam? Evaluate for pulmonary infiltrate
Relevant recent/past history? Postoperative Ventricular Assist
Device placement
Is patient pregnant?
If being performed remotely, where?
Transport Method: Floor Determined/Entered
Post-Op/Phase II
Ventricular Assist Device Coordinator to Perform 6-
Minute Walk Test on Postoperative Day 6
[NURVENT0017]
ONCE, Starting 11/30/14 For 1 Occurrences, Evaluate
functional status, Post-Op/Phase II
ECG - 12 Lead [EKG0008] ONCE, Routine
Reason for exam: OTHER (COMMENT)
Hold if patient is paced
Transthoracic Resting Echocardiogram [ECH0003] ONCE, Starting today For 1 Occurrences, Routine
Reason for exam:
Do you want Agitated Bubble Study? No
Is patient mechanically ventilated?
Is patient ICU status?
Does patient need continuous monitoring?
Consults
Consults [89923]
Consult Cardiac Rehab/Preventive Cardiology
(Inpatient) [CON0010]
ONCE, Starting today For 1 Occurrences, Routine
Reason for consult: Other (Comment)
Post-Op/Phase II
Consult Nutrition (Inpatient) [CON0043] ONCE, Starting today For 1 Occurrences, Routine
Reason for Consult:
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Copyright © 2014 University of Wisconsin Hospital and Clinics Authority


Delegate to Initiate and Manage Tube Feeding:
Delegate to Manage Diet Order/Supplement Order:
Delegate to Dysphagia Diet Order Progression:
Post-Op/Phase II
Consult Cardiothoracic ICU (Inpatient) [CON0210] ONCE
Intent: Consult and Recommend (Write Orders)
Concern or Specific Question or Task to be Addressed
(Symptom, Sign, or Diagnosis): Postoperative ICU
management
Post-Op/Phase II
Consult Diabetes Management Service (Inpatient)
[CON0022]
ONCE
Intent: Consult and Recommend (Write Orders)
Concern or Specific Question or Task to be Addressed
(Symptom, Sign, or Diagnosis): History of Diabetes
Post-Op/Phase II
Consult Congestive Heart Failure Service (Inpatient)
[CON0017]
ONCE
Intent: Consult and Recommend (Write Orders)
Concern or Specific Question or Task to be Addressed
(Symptom, Sign, or Diagnosis): Status post ventricular assist
device
Post-Op/Phase II
Consult Occupational Therapy (Inpatient) Eval and Treat
[CON0046]
ONCE, Starting today For 1 Occurrences, Routine
Reason for Consult: Mobility/ADL Training
Post-Op/Phase II
Consult Physical Therapy (Inpatient) Eval and Treat
[CON0061]
ONCE, Starting today For 1 Occurrences, Routine
Reason for Consult: Mobility/ADL Training
Post-Op/Phase II
BestPractice
No Hospital Problems have yet been identified [107363]
Specify Hospital Problem(s) [COR0018] You will be prompted to specify a hospital problem on
signing., Post-Op/Phase II
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Pr i nt ed by LIND, JANNA S [JSL237] at 11/24/2014 9:21:54 AM
Copyright © 2014 University of Wisconsin Hospital and Clinics Authority