/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/delegationpractice-protocols/,/clinical/cckm-tools/content/delegationpractice-protocols/inpatient-delegation-protocols/,/clinical/cckm-tools/content/delegationpractice-protocols/inpatient-delegation-protocols/related/,

/clinical/cckm-tools/content/delegationpractice-protocols/inpatient-delegation-protocols/related/name-97324-en.cckm

201605126

page

100

UWHC,UWMF,

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

Immediate Orders - Adult

Immediate Orders - Adult - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Inpatient Delegation Protocols, Related


SmartSet: ED - IMMEDIATE ORDERS DELEGATION PROTOCOL - RN/ED TECH - ADULT
(ID:4222)
General Information
Display name: ED - Immediate Orders Delegation Protocol - RN/ED Tech - Adult
Type: General
Merge priority: 0
Version comment:
Content source:
Synonyms: 1. ER
2. EMERGENCY
3. .ED
SmartSet notes:
Description:
Web information: Title URL
1.
Questionnaire:
Configuration
Venous Access
Orders
lidocaine (LMX) 4% topical dressing kit 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
lidocaine (XYLOCAINE) 1% injection 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
sodium chloride (bacteriostatic) 0.9 % injection 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
Page 1 of 17
Pr i nted by STRAKA, KEVIN F [KFS1] at 8/27/2015 9:53:27 AM
Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison


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
Insert and Maintain Peripheral IV CONTINUOUS, Routine
Peripheral IV Size: RN Discretion
Peripheral IV Location: RN Discretion
Peripheral IV Device: RN Discretion
Peripheral IV Status: Capped
Does this need to be inserted/placed? Yes
Prothrombin Time/INR
Orders
Orders
Draw a blue top tube for an INR when a patient meets one of the following criterion: warfarin as listed
medicatoin, liver transplant patient, cirrhosis (any variety), potentional sepsis, GI bleed, any potential
cardiac patient, or history of hepatitis B,C
PROTHROMBIN TIME/INR STAT - RN COLLECT, Starting S For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Pregnancy Testing
Orders
Orders
Urine, Pregnancy Test STAT - RN COLLECT, Starting S For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Abdominal/Flank Pain
Orders
Orders
Notify Provider of Severe Abdominal Pain ONCE
NPO CONTINUOUS, Starting S For Until specified, Routine
Diet: NPO
ELECTROLYTES STAT - RN COLLECT, Starting S For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
CREATININE STAT - RN COLLECT, Starting S For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
URINALYSIS WITH MICROSCOPY STAT - RN COLLECT For 1 Occurrences, Routine
Page 2 of 17
Pr i nted by STRAKA, KEVIN F [KFS1] at 8/27/2015 9:53:27 AM
Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison


If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
CBC WITH DIFFERENTIAL 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?
Urine, Pregnancy Test 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?
Altered Mental Status
Orders
Orders
ECG - 12 Lead ONCE, Starting S For 1 Occurrences, STAT
Reason for exam: OTHER (COMMENT)
Glucose, POC STAT - RN COLLECT, Starting S For 1 Occurrences,
Routine, Glucose, POC should always be ordered in
conjunction with orders for hypoglycemia management
and monitoring as indicated in the Hypoglycemia
Management (Adult) panel.
If Conditional, What Condition?
ELECTROLYTES STAT - RN COLLECT, Starting S For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
CREATININE STAT - RN COLLECT, Starting S For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
BUN STAT - RN COLLECT, Starting S For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
CBC WITHOUT DIFFERENTIAL STAT - RN COLLECT, Starting S For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
TROPONIN 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?
URINALYSIS WITH MICROSCOPY 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?
Chest Pain, Non-Traumatic
Orders
Page 3 of 17
Pr i nted by STRAKA, KEVIN F [KFS1] at 8/27/2015 9:53:27 AM
Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison


Orders
NPO CONTINUOUS, Starting S For Until specified, Routine
Diet:
aspirin chew tab 324 mg, Oral, ONCE For 1 Doses
ELECTROLYTES STAT - RN COLLECT, Starting S For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
CREATININE STAT - RN COLLECT, Starting S For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
TROPONIN STAT - RN COLLECT, Starting S For 1 Occurrences,
STAT
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
ECG - 12 Lead ONCE, Starting S For 1 Occurrences, STAT
Reason for exam: CHEST PAIN
CBC WITHOUT DIFFERENTIAL STAT - RN COLLECT, Starting S For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
X-RAY CHEST PA & LAT VIEWS ONCE-RAD NEXT AVAILABLE For 1 Occurrences, STAT
Radiology Specialty Area: GENERAL IMAGING
Current signs and symptoms?
What specific question(s) would you like answered by this
exam?
Relevant recent/past history?
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
X-RAY CHEST AP VIEW ONCE-RAD NEXT AVAILABLE, Starting S For 1
Occurrences, STAT
Current signs and symptoms? Chest Pain
What specific question(s) would you like answered by this
exam?
Relevant recent/past history?
Is patient pregnant?
If being performed remotely, where? Bedside
Last patient weight? (will auto pull in value and date in
comment):
Transport Method: Floor Determined/Entered
Drug Overdose
Orders
Orders
ECG - 12 Lead ONCE, Starting S For 1 Occurrences, STAT
Reason for exam: OTHER (COMMENT)
Glucose, POC ONCE For 1 Occurrences, Routine, Glucose, POC should
always be ordered in conjunction with orders for
hypoglycemia management and monitoring as indicated
in the Hypoglycemia Management (Adult) panel.
If Conditional, What Condition?
Page 4 of 17
Pr i nted by STRAKA, KEVIN F [KFS1] at 8/27/2015 9:53:27 AM
Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison


ELECTROLYTES STAT - RN COLLECT, Starting S For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
CREATININE STAT - RN COLLECT, Starting S For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
BUN STAT - RN COLLECT, Starting S For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
ACETAMINOPHEN STAT - RN COLLECT, Starting S For 1 Occurrences,
STAT
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
ALCOHOL STAT - RN COLLECT, Starting S For 1 Occurrences,
STAT
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
SALICYLATE STAT - RN COLLECT, Starting S For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Epistaxis
Orders
Orders
oxymetazoline (AFRIN) 0.05% nasal spray 2 spray, Other, ONCE For 1 Doses
Spray affected nostril(s). Clear nostril before
administering.
Extremity Injury
Orders
Orders
X-RAY FINGER >= 2 VIEWS LEFT ONCE-RAD NEXT AVAILABLE, Starting S For 1
Occurrences, STAT
Which digit should be imaged?
Current signs and symptoms?
What specific question(s) would you like answered by this
exam?
Relevant recent/past history?
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
Page 5 of 17
Pr i nted by STRAKA, KEVIN F [KFS1] at 8/27/2015 9:53:27 AM
Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison


X-RAY FINGER >= 2 VIEWS RIGHT ONCE-RAD NEXT AVAILABLE, Starting S For 1
Occurrences, STAT
Which digit should be imaged?
Current signs and symptoms?
What specific question(s) would you like answered by this
exam?
Relevant recent/past history?
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
X-RAY HAND >= 3 VIEWS LEFT ONCE-RAD NEXT AVAILABLE, Starting S For 1
Occurrences, STAT
Current signs and symptoms?
What specific question(s) would you like answered by this
exam?
Relevant recent/past history?
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
X-RAY HAND >= 3 VIEWS RIGHT ONCE-RAD NEXT AVAILABLE, Starting S For 1
Occurrences, STAT
Current signs and symptoms?
What specific question(s) would you like answered by this
exam?
Relevant recent/past history?
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
X-RAY WRIST >= 3 VIEWS LEFT ONCE-RAD NEXT AVAILABLE, Starting S For 1
Occurrences, STAT
Current signs and symptoms?
What specific question(s) would you like answered by this
exam?
Relevant recent/past history?
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
X-RAY WRIST >= 3 VIEWS RIGHT ONCE-RAD NEXT AVAILABLE, Starting S For 1
Occurrences, STAT
Current signs and symptoms?
What specific question(s) would you like answered by this
exam?
Relevant recent/past history?
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
X-RAY ELBOW >= 3 VIEWS LEFT ONCE-RAD NEXT AVAILABLE, Starting S For 1
Occurrences, STAT
Current signs and symptoms?
What specific question(s) would you like answered by this
exam?
Relevant recent/past history?
Is patient pregnant?
Page 6 of 17
Pr i nted by STRAKA, KEVIN F [KFS1] at 8/27/2015 9:53:27 AM
Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison


If being performed remotely, where?
Last patient weight? (will auto pull in value and date in
comment):
Transport Method: Floor Determined/Entered
X-RAY ELBOW >= 3 VIEWS RIGHT ONCE-RAD NEXT AVAILABLE, Starting S For 1
Occurrences, STAT
Current signs and symptoms?
What specific question(s) would you like answered by this
exam?
Relevant recent/past history?
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
X-RAY SHOULDER >= 2 VIEWS LEFT ONCE-RAD NEXT AVAILABLE, Starting S For 1
Occurrences, STAT
Current signs and symptoms?
What specific question(s) would you like answered by this
exam?
Relevant recent/past history?
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
X-RAY SHOULDER >= 2 VIEWS RIGHT ONCE-RAD NEXT AVAILABLE, Starting S For 1
Occurrences, STAT
Current signs and symptoms?
What specific question(s) would you like answered by this
exam?
Relevant recent/past history?
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
X-RAY TOE >= 2 VIEWS LEFT ONCE-RAD NEXT AVAILABLE, Starting S For 1
Occurrences, STAT
Which digit should be imaged?
Current signs and symptoms?
What specific question(s) would you like answered by this
exam?
Relevant recent/past history?
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
X-RAY TOE >= 2 VIEWS RIGHT ONCE-RAD NEXT AVAILABLE, Starting S For 1
Occurrences, STAT
Which digit should be imaged?
Current signs and symptoms?
What specific question(s) would you like answered by this
exam?
Relevant recent/past history?
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
X-RAY ANKLE >= 3 VIEWS LEFT ONCE-RAD NEXT AVAILABLE, Starting S For 1
Page 7 of 17
Pr i nted by STRAKA, KEVIN F [KFS1] at 8/27/2015 9:53:27 AM
Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison


Occurrences, STAT
Current signs and symptoms?
What specific question(s) would you like answered by this
exam?
Relevant recent/past history?
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
X-RAY ANKLE >= 3 VIEWS RIGHT ONCE-RAD NEXT AVAILABLE, Starting S For 1
Occurrences, STAT
Current signs and symptoms?
What specific question(s) would you like answered by this
exam?
Relevant recent/past history?
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
X-RAY KNEE 1-2 VIEWS LEFT ONCE-RAD NEXT AVAILABLE, Starting S For 1
Occurrences, STAT
Current signs and symptoms?
What specific question(s) would you like answered by this
exam?
Relevant recent/past history?
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
X-RAY KNEE 1-2 VIEWS RIGHT ONCE-RAD NEXT AVAILABLE, Starting S For 1
Occurrences, STAT
Current signs and symptoms?
What specific question(s) would you like answered by this
exam?
Relevant recent/past history?
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
X-RAY FOOT >= 3 VIEWS LEFT ONCE-RAD NEXT AVAILABLE, Starting S For 1
Occurrences, STAT
Current signs and symptoms?
What specific question(s) would you like answered by this
exam?
Relevant recent/past history?
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
X-RAY FOOT >= 3 VIEWS RIGHT ONCE-RAD NEXT AVAILABLE, Starting S For 1
Occurrences, STAT
Current signs and symptoms?
What specific question(s) would you like answered by this
exam?
Relevant recent/past history?
Is patient pregnant?
If being performed remotely, where?
Last patient weight? (will auto pull in value and date in
comment):
Page 8 of 17
Pr i nted by STRAKA, KEVIN F [KFS1] at 8/27/2015 9:53:27 AM
Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison


Transport Method: Floor Determined/Entered
X-RAY PELVIS AP VIEW & HIP 1 VIEW LEFT ONCE-RAD NEXT AVAILABLE, Starting S For 1
Occurrences, STAT
Current signs and symptoms?
What specific question(s) would you like answered by this
exam?
Relevant recent/past history?
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
X-RAY PELVIS AP VIEW & HIP 1 VIEW RIGHT ONCE-RAD NEXT AVAILABLE, Starting S For 1
Occurrences, STAT
Current signs and symptoms?
What specific question(s) would you like answered by this
exam?
Relevant recent/past history?
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
Eye - Suspected Foreign Body
Orders
Orders
Obtain and Document Visual Acuity in Right, Left and
Both Eyes
ONCE, Starting S For 1 Occurrences
Slit Lamp and Woods Lamp in Room ONCE, Starting S For 1 Occurrences
proparacaine (ALCAINE) 0.5 % ophthalmic soln 2 drop, Other, ONCE PRN For 1 Doses, cycloplegia
Have available in room
fluorescein sodium (FLUOR-I-STRIP) ophthalmic strip 1 Strip, Other, ONCE PRN For 1 Doses, eye exam
Have available in room
Fever - Temperature Greater Than 38 C or 100.4 F Actual or Reported
Orders
acetaMINOPHEN (TYLENOL) tab 650 mg, Oral, ONCE For 1 Doses
ibuprofen (MOTRIN) tab 600 mg, Oral, ONCE For 1 Doses
Fever, Neutropenic - Temperature Greater Than 38 C or 100.4 F Actual or Reported
Orders
Orders
Notify Physician of Suspected Neutropenic Fever ONCE, Starting S For 1 Occurrences
acetaMINOPHEN (TYLENOL) tab 650 mg, Oral, ONCE For 1 Doses
ELECTROLYTES 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?
Page 9 of 17
Pr i nted by STRAKA, KEVIN F [KFS1] at 8/27/2015 9:53:27 AM
Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison


CREATININE 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?
BUN 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?
GLUCOSE 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?
CBC WITH DIFFERENTIAL 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?
CULTURE, BLOOD, BACTERIA AND YEAST STAT - RN COLLECT For 1 Occurrences, Routine, For
optimum diagnosis of sepsis, sample 3-4 sites only on the
first day of a septic episode. Cultures on subsequent
days are of minimal diagnostic value. Culture detects
bacteria, Candida and Cryptococcus. If filamentous fungi
are suspected see Culture, Blood, Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition?
Place additional orders as needed for multiple
lines/lumens
CULTURE, URINE STAT - RN COLLECT For 1 Occurrences, Routine
Indication:
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
URINALYSIS WITH MICROSCOPY 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?
X-RAY CHEST PA & LAT VIEWS ONCE-RAD NEXT AVAILABLE For 1 Occurrences, STAT
Radiology Specialty Area: GENERAL IMAGING
Current signs and symptoms? Neutropenic Fever
What specific question(s) would you like answered by this
exam? Rule Out Infection
Relevant recent/past history?
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
LACTATE STAT - RN COLLECT For 1 Occurrences, STAT
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
HyPERglycemia, Signs and Symptoms of
Orders
Hyperglycemia
GLUCOSE, POC, WHOLE BLOOD STAT - RN COLLECT For 1 Occurrences, Routine
If Conditional, What Condition?
GLUCOSE, WHOLE BLOOD STAT - RN COLLECT For 1 Occurrences, STAT
Page 10 of 17
Pr i nted by STRAKA, KEVIN F [KFS1] at 8/27/2015 9:53:27 AM
Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison


If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
ELECTROLYTES STAT - RN COLLECT, Starting S For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
CREATININE STAT - RN COLLECT, Starting S For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
BUN STAT - RN COLLECT, Starting S For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
CBC WITHOUT DIFFERENTIAL STAT - RN COLLECT, Starting S For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
BLOOD GASES STAT - RN COLLECT For 1 Occurrences, STAT
Indicate FIO2:
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
URINALYSIS WITH MICROSCOPY 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?
HypOglycemia, Signs and Symptoms of
Orders
Orders
Hypoglycemia Treatment for blood glucose less than 40
mg/dL and patient able to eat/swallow safely
CONDITIONAL, Starting today, Give 30 grams of
carbohydrate (8 oz. of fruit juice). Recheck in 15 minutes
and repeat treatment until glucose is greater than or equal
to 70 mg/dL
Hypoglycemia Treatment for blood glucose between 40
and 69 mg/dL and patient able to eat/swallow safely
CONDITIONAL, Starting today, Give 15 grams of
carbohydrate (4 oz of fruit juice). Recheck in 15 minutes
and repeat treatment until glucose is greater than or equal
to 70 mg/dL
dextrose injection 12.5-25 g, Intravenous, PRN, per hypoglycemia treatment
algorithm
Glucose, POC STAT - RN COLLECT, Starting S For 1 Occurrences,
Routine, Glucose, POC should always be ordered in
conjunction with orders for hypoglycemia management
and monitoring as indicated in the Hypoglycemia
Management (Adult) panel.
If Conditional, What Condition?
GLUCOSE STAT - RN COLLECT, Starting S For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
ELECTROLYTES STAT - RN COLLECT, Starting S For 1 Occurrences,
Routine
Page 11 of 17
Pr i nted by STRAKA, KEVIN F [KFS1] at 8/27/2015 9:53:27 AM
Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison


If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
CREATININE STAT - RN COLLECT, Starting S For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
BUN STAT - RN COLLECT, Starting S For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
CBC WITHOUT DIFFERENTIAL STAT - RN COLLECT, Starting S For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Nausea/Vomiting
Antiemetics
ondansetron (ZOFRAN) injection 4 mg, Intravenous, ONCE For 1 Doses
ondansetron (ZOFRAN ODT) disintegrating tab 4 mg, Oral, ONCE For 1 Doses
Orders
Orders
Glucose, POC ONCE, Starting S For 1 Occurrences, Routine, Glucose,
POC should always be ordered in conjunction with orders
for hypoglycemia management and monitoring as
indicated in the Hypoglycemia Management (Adult) panel.
If Conditional, What Condition?
ELECTROLYTES STAT - RN COLLECT, Starting S For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
CREATININE STAT - RN COLLECT, Starting S For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
CBC WITHOUT DIFFERENTIAL STAT - RN COLLECT, Starting S For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
URINALYSIS WITH MICROSCOPY 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?
Urine Pregnancy if female STAT - RN COLLECT For 1 Occurrences, Routine
If Conditional, What Condition?
Pain, MILD
Orders
Page 12 of 17
Pr i nted by STRAKA, KEVIN F [KFS1] at 8/27/2015 9:53:27 AM
Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison


acetaMINOPHEN (TYLENOL) tab 650 mg, Oral, ONCE For 1 Doses
ibuprofen (MOTRIN) tab 600 mg, Oral, ONCE For 1 Doses
Pain, MODERATE to SEVERE
Analgesics
HYDROmorphone PF (DILAUDID) injection 0.5 mg, Intravenous, ONCE For 1 Doses
Notify ED attending MD/resident of each administration
hydrocodone-acetaMINOPHEN (NORCO) 5-325 MG
per tab
1 tab, Oral, ONCE For 1 Doses
Seizure
Orders
Orders
Notify Provider if Patient is Seizing ONCE
Seizure Precautions - Adult CONTINUOUS, Routine
Glucose, POC STAT - RN COLLECT, Starting S For 1 Occurrences,
Routine, Glucose, POC should always be ordered in
conjunction with orders for hypoglycemia management
and monitoring as indicated in the Hypoglycemia
Management (Adult) panel.
If Conditional, What Condition?
GLUCOSE STAT - RN COLLECT, Starting S For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
ELECTROLYTES STAT - RN COLLECT, Starting S For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
CREATININE STAT - RN COLLECT, Starting S For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
CBC WITH DIFFERENTIAL STAT - RN COLLECT, Starting S For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Drug Levels
VALPROATE ONCE, Starting S For 1 Occurrences, STAT
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
PHENYTOIN ONCE, Starting S For 1 Occurrences, STAT
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
PHENOBARBITAL ONCE, Starting S For 1 Occurrences, STAT
If add on test, what should lab do if unable to add test to
Page 13 of 17
Pr i nted by STRAKA, KEVIN F [KFS1] at 8/27/2015 9:53:27 AM
Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison


previous specimen?
If Conditional, What Condition?
CARBAMAZEPINE ONCE, Starting S For 1 Occurrences, STAT
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Shortness of Breath
Orders
Orders
Pulse Oximetry on Room Air If Patient Able to Safely
Tolerate
ONCE For 1 Occurrences, Routine
X-RAY CHEST PA & LAT VIEWS ONCE-RAD NEXT AVAILABLE For 1 Occurrences, STAT
Radiology Specialty Area: GENERAL IMAGING
Current signs and symptoms?
What specific question(s) would you like answered by this
exam?
Relevant recent/past history?
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
X-RAY CHEST AP VIEW ONCE-RAD NEXT AVAILABLE, Starting S For 1
Occurrences, STAT
Current signs and symptoms? Shortness of Breath
What specific question(s) would you like answered by this
exam? Infective vs. Other
Relevant recent/past history?
Is patient pregnant?
If being performed remotely, where? Bedside
Last patient weight? (will auto pull in value and date in
comment):
Transport Method: Floor Determined/Entered
ECG - 12 Lead ONCE For 1 Occurrences, Routine
Reason for exam: SHORTNESS OF BREATH
Sickle Cell Crisis
Orders
Orders
Oxygen Therapy CONTINUOUS, Starting S For Until specified, Routine
FiO2 (%):
Liter Flow:
Titrate oxygen to maintain O2 sat at (%):
O2 Delivery Device:
Attempt to Wean Off Oxygen? No
Pulse Oximetry on Room Air If Patient Able to Safely
Tolerate
ONCE For 1 Occurrences, Routine
HYDROmorphone PF (DILAUDID) injection 0.5 mg, Intravenous, ONCE PRN For 1 Doses, pain
ELECTROLYTES STAT - RN COLLECT, Starting S For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Page 14 of 17
Pr i nted by STRAKA, KEVIN F [KFS1] at 8/27/2015 9:53:27 AM
Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison


CREATININE STAT - RN COLLECT, Starting S For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
RETICULOCYTE COUNT STAT - RN COLLECT, Starting S For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
CBC WITHOUT DIFFERENTIAL STAT - RN COLLECT, Starting S For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
URINALYSIS WITH MICROSCOPY 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?
Suicide Precautions
Orders
Orders
Constant Supervision by Staff - FOR ED USE ONLY CONTINUOUS, Routine
Patient placed in a hospital gown ONCE
Belongings removed ONCE
If gown and removal of belongings are refused, patient
will be screened by Security
ONCE
Syncope
Orders
Orders
Pulse Oximetry on Room Air if Patient Able to Safely
Tolerate
ONCE For 1 Occurrences, Routine
Glucose, POC STAT - RN COLLECT, Starting S For 1 Occurrences,
Routine, Glucose, POC should always be ordered in
conjunction with orders for hypoglycemia management
and monitoring as indicated in the Hypoglycemia
Management (Adult) panel.
If Conditional, What Condition?
ELECTROLYTES STAT - RN COLLECT, Starting S For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
GLUCOSE STAT - RN COLLECT, Starting S For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
CREATININE STAT - RN COLLECT, Starting S For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
Page 15 of 17
Pr i nted by STRAKA, KEVIN F [KFS1] at 8/27/2015 9:53:27 AM
Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison


If Conditional, What Condition?
CBC WITHOUT DIFFERENTIAL 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?
ECG - 12 Lead ONCE, Starting S For 1 Occurrences, STAT
Reason for exam: SYNCOPE
Vaginal Bleeding
Orders
Orders
Set Up for Pelvic Exam ONCE
CBC WITHOUT DIFFERENTIAL STAT - RN COLLECT, Starting S For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
URINALYSIS WITH MICROSCOPY 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?
Urine Pregnancy for females only STAT - RN COLLECT For 1 Occurrences, Routine
If Conditional, What Condition?
Wheezing
Orders
Orders
Notify Provider of Wheezing and Initiation of Albuterol
Nebulization
Provider to Notify: Provider
Notify based on:
Oxygen Therapy CONTINUOUS, Starting S For Until specified, Routine
FiO2 (%):
Liter Flow:
Titrate oxygen to maintain O2 sat at (%):
O2 Delivery Device:
Attempt to Wean Off Oxygen? No
Pulse Oximetry CONTINUOUS, Starting S, Routine
albuterol neb soln (3 mL) 5 mg, Nebulization, ONCE For 1 Doses
Criteria
Suggestions:
Filter: RESTRICTION LOCATOR - UWHC ED[486]
Restrict SmartSet:
Settings
Discontinue action:
Deselect sections for
Page 16 of 17
Pr i nted by STRAKA, KEVIN F [KFS1] at 8/27/2015 9:53:27 AM
Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison


Pended/Held orders:
Pended/Held orders display:
Release date: Use System Definitions Setting
Disallow user override:
Page 17 of 17
Pr i nted by STRAKA, KEVIN F [KFS1] at 8/27/2015 9:53:27 AM
Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison