/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/,

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201605126

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UWHC,UWMF,

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

IP - Brain Dead Donor - Pediatric - Supplemental

IP - Brain Dead Donor - Pediatric - Supplemental - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Inpatient Delegation Protocols, Related


IP - Brain Dead Donor - Pediatric - Supplemental [4287]
Consent for organ procurement must have been obtained prior to use of this order set.
Do NOT use on patients with paralytics actively present at the time this protocol is enacted. This is to avoid confusion between withdrawing life-
sustaining measures and euthanasia.
A note must be written that documents the rationale for comfort care, discussions with attending and discussion with family in order to proceed with this order set.
Educate family regarding tachypnea not being equal to dyspnea, secretion build-
up in airways and snoring, changes in skin color, bowel/bladder control, unpredictability in the timing of death, etc. Post-
mortem examination must be requested per hospital Policy.
Patient Care Orders


Order to Initiate Donation After Cardiac Death (DCD) Order Set [113116]

Initiate Comprehensive Donation After Cardiac Death (DCD) Order Set
[NURCOM0067]
Details
Vital Signs [113118]

Measure Blood Pressure [NURMON0019] EVERY 1 HOUR, Starting today, Routine
BP Source:
BP Location:
BP Position:
BP Restrictions:

Measure Heart Rate [NURMON0056] EVERY 1 HOUR, Starting today, Routine

Measure Temperature [NURMON0029] EVERY 1 HOUR, Starting today, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:

Pulse Oximetry [NURMON0009] EVERY 1 HOUR, Starting today, Routine

Measure Central Venous Pressure [NURMON0002] EVERY 2 HOURS, Starting today, Routine

Measure Arterial Pressure [NURMON0060] EVERY 1 HOUR, Starting today

Measure Respiratory Rate [NURMON0028] SEE COMMENTS, Starting today, Routine, Every 1 Hour
Patient Monitoring [113119]

Measure Urine Output [NURMON0012] EVERY 1 HOUR, Starting today, Routine
GI/GU [113120]

Insert and Maintain Nasogastric Tube [NURTAD0014] CONTINUOUS, Starting today, Routine
Options: Low, Intermittent Suction
Flush with:
Flush Frequency:
Clamp NG Tube:
Check Residual:
Does this need to be inserted/placed?:
Device Status: Not Ready For Use

Insert and Maintain Urinary Catheter [NURELM0013] CONTINUOUS, Starting today, Routine
Type: Indwelling Single Lumen
Indication for Placement: End of Life Care
Details: To Dependent Drainage
Irrigate With:
Irrigation Frequency:
Does this need to be inserted/placed?:
.
Respiratory [113121]

chlorhexidine (PERIDEX) soln MULTIDOSE - NOTE: Order For
Patients on Mechanical Ventilation [792004]
15 mL, Mouth/Throat, 2 X DAILY
Use to swab oral cavity. D/C when patient no longer on ventilation

Elevate Head Of Bed [NURACT0002] Equal to (degrees):
Greater than (degrees): 30
Less than (degrees): 43
Other options:
Routine, CONTINUOUS, Starting today

Consult Pulmonary Medicine (Inpatient) [CON0065] ONCE, Starting today
Intent: Consult and Recommend (Write Orders)
Concern or Specific Question or Task to be Addressed (Symptom, Sign,:
Bronchoscopy - To evaluate for lung procurement. Assess all lobes and
upper airway.

X-RAY CHEST AP VIEW [R71010] ONCE-RAD NEXT AVAILABLE, Starting today For 1 Occurrences, Routine
Current signs and symptoms?: Evaluate for Lung Procurement
What specific question(s) would you like answered by this exam?: Evaluate
for Lung Procurement
Relevant recent/past history?: Evaluate for Lung Procurement
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

X-RAY CHEST AP VIEW [R71010] ONCE-RAD NEXT AVAILABLE, Starting tomorrow For 1 Occurrences,
Routine
Current signs and symptoms?: Evaluate for Lung Procurement
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Copyright © 2011 University of Wisconsin Hospitals and Clinics Authority


What specific question(s) would you like answered by this exam?: Evaluate
for Lung Procurement
Relevant recent/past history?: Evaluate for Lung Procurement
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

X-RAY CHEST AP VIEW [R71010] ONCE-RAD NEXT AVAILABLE, Starting 2/11/12 For 1 Occurrences, Routine
Current signs and symptoms?: Evaluate for Lung Procurement
What specific question(s) would you like answered by this exam?: Evaluate
for Lung Procurement
Relevant recent/past history?: Evaluate for Lung Procurement
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

BLOOD GASES [HCBGAS] CONDITIONAL - RN COLLECT, Starting today For 4 Occurrences, STAT
Indicate FIO2: Per DCD Protocol
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?: 30 minutes after increase FiO2 to 100% if
change in ventilation (seems clinicals indicated) t+3
Cardiac [114590]

ECG - 12 Lead With Rhythm Strip (PEDS) [EKG0018] ONCE, Starting today, Routine
Reason for exam: HEART OR LUNG TRANSPLANT

Transthoracic Resting Echocardiogram (PEDS) [ECH0012] ONCE, Starting today, Routine
Current signs and symptoms?: Brain death
What specific question(s) would you like answered by this exam?: Evaluate
for potential cardiac donation
Relevant recent/past history?: Brain death
To whom can we send the results of the study? (include clinician and
location): Peds ICU Attending
Do you want Agitated Bubble Study?:
Last patient height? (will auto pull in value and date in comment):
Last patient weight? (will auto pull in value and date in comment):

Consult Cardiology (Inpatient) [CON0012] ONCE, Starting today
Intent: Consult and Recommend (No Orders)
Concern or Specific Question or Task to be Addressed (Symptom, Sign,: To
evaluate for cardiac procurement
Non-Categorized Patient Care Orders [113122]

Measure Height [NURMON0052] ONCE, Starting today For 1 Occurrences, Routine

Measure Weight [NURMON0015] ONCE, Starting today For 1 Occurrences, Routine
Weigh With?:
Weigh when?:

Maintain Arterial Line [NURVAD0001] CONTINUOUS, Starting today, Routine
Flush Solution:

Maintain Central Venous Access [NURVAD0023] CONTINUOUS, Starting today, Routine
Device Status:

Leave All Lines and Catheters Provided They Are Not Causing
Discomfort for the Patient [NURCOM0022]
CONTINUOUS, Starting today

RN to Verify Consent for Organ Donation Has Been Obtained
[NURCOM0022]
CONTINUOUS, Starting today

Order Blood Product as Needed Based on Calculate Amount Needed
in Donor Navigator [NURCOM0022]
CONTINUOUS, Starting today
Contingency Parameters [113128]

Notify Primary Team [NURCOM0001] Provider to Notify: Other (Comment)
If systolic blood pressure > (mmHg): 125
If systolic blood pressure < (mmHg): 90
If diastolic blood pressure > (mmHg):
If diastolic blood pressure < (mmHg):
If temperature > (C): 38
If temperature < (C): 36.5
If heart rate > (bpm): 120
If heart rate < (bpm): 70
If respiratory rate >: 24
If respiratory rate <: 14
If blood glucose > (mg/dL): 200 milligrams/deciliter if patient not on an insulin
drip
If blood glucose < (mg/dL): 80
If pain score >:
Pulse Oximetry < (%): 95
If urine output < (mL): 1 mL/kg/hr or greater than 4 mL/kg/hr for 2 consecutive
hours
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Copyright © 2011 University of Wisconsin Hospitals and Clinics Authority


Other: Central venous pressure less than 4 mmHg or grater than 14 mmHg
Intravenous Therapy
IV Fluids [113061]

dextrose 5%-NaCl 0.9% with KCl 20 mEq/L infusion [44904] at 125 mL/hr, Intravenous, CONTINUOUS

dextrose 5% IV BOLUS [730000] 1-2,500 mL, Intravenous, EVERY 6 HOURS PRN, free water deficit - see
Admin Instructions
Administer calculated dose displayed in Free Water Deficit section of the
Donor Navigator

sodium chloride 0.9% IV BOLUS [730003] 1-2,000 mL, Intravenous, EVERY 2 HOURS PRN, decreased CVP - see
Admin Instructions
Administer calculated dose displayed in Serum Volume Adjustment section of
the Donor Navigator
IV Fluids [114424]

sodium chloride 0.9% with KCl 20 mEq/L infusion [46261] at 125 mL/hr, Intravenous, CONTINUOUS

dextrose 5% IV BOLUS [730000] 1-2,500 mL, Intravenous, EVERY 6 HOURS PRN, free water deficit - see
Admin Instructions
Administer calculated dose displayed in Free Water Deficit section of the
Donor Navigator

sodium chloride 0.9% IV BOLUS [730003] 1-2,000 mL, Intravenous, EVERY 2 HOURS PRN, decreased CVP - see
Admin Instructions
Administer calculated dose displayed in Serum Volume Adjustment section of
the Donor Navigator
Medications


Albumin [113072]

albumin human 25% infusion [44037] 0.5 g/kg, Intravenous, EVERY 12 HOURS PRN, serum albumin less than 3.3
g/dL
Non-categorized [115985]

acetaMINOPHEN alcohol free (TYLENOL INFANTS) susp CUSTOM
[780003]
10 mg/kg, Nasogastric Tube, EVERY 4 HOURS PRN, pain, temperature
greater than 38.5 degrees Celcius

albuterol HFA (VENTOLIN HFA) 90 mcg/act inhaler [53730] 4 puff, Inhalation, EVERY 2 HOURS PRN, dyspnea
May give through ventilator circuit

diphenhydramine (BENADRYL) injection CUSTOM [760079] 0.5 mg/kg, Intravenous, EVERY 6 HOURS PRN, infusion reaction during
blood administration, for 1 Minutes
Antihypertensives - PRN [113063]

labetalol (NORMODYNE;TRANDATE) injection RANGE [750053] 0.2-0.5 mg/kg, Intravenous, EVERY 1 HOUR PRN, hypertension
For MAP greater than *** mmHg with HR greater than *** bpm while no
vasopressors are running for 2 minutes
for 2 Minutes

hydrALAZINE (APRESOLINE) injection RANGE [750049] 0.1-0.2 mg/kg, Intravenous, EVERY 1 HOUR PRN, hypertension
For MAP greater than *** mmHg while no vasopressors are running for 3
minutes. Maximum IV push rate 10 mg/min
for 3 Minutes
Diabetes Insipidus [114122]

vasopressin (PITRESSIN) infusion PEDS - NOTE: For DI [700125] 0.5 milli-units/kg/hr, Intravenous
Diuretics [113065]

furosemide (LASIX) intraVENOUS [800046] 0.5 mg/kg, Intravenous, EVERY 6 HOURS PRN, edema, CVP greater than
12 mmHg
Electrolyte Supplements [113066]

potassium chloride injection PEDS from Bag [755021] 0.5 mEq/kg, Intravenous, PRN, for potassium less than 3.5 mmol/liter, for 60
Minutes

calcium GLUConate injection CUSTOM [760034] 50 mg/kg, Intravenous, PRN, for ionized calcium less than 4.6 mg/dL

magnesium sulfate injection CUSTOM [760151] 50 mg/kg, Intravenous, PRN, for magnesium less than 1.8 mg/dL

phosphate SODIUM injection PEDS [760227] 0.35 mmol/kg, Intravenous, PRN, For phosphate less than 3 mg/dL
Levothyroxine [13538]

levothyroxine injection - NOTE: Suggested dose 1-5 mcg/kg [760146] Intravenous, ONCE For 1 Doses, for 1 Minutes

levothyroxine 200 mcg in sodium chloride 0.9 % 500 mL infusion
[700224]
Intravenous
Initiate at 0.8 mcg/kg/hr. Increase by ***mcg/kg/hr every 30 minutes to
maintain systolic blood pressure greater than *** mmHg and mean arterial
pressure greater than *** mmHg (maximum of *** mcg/hr)
Vasopressors [113064]

dopamine infusion PEDS [700110] 5-20 mcg/kg/min, Intravenous

norepinephrine (LEVOPHED) infusion PEDS - NOTE: For shock
[700122]
0.01-0.1 mcg/kg/min, Intravenous
Non-categorized [113062]

acetaMINOPHEN alcohol free (TYLENOL INFANTS) susp CUSTOM
[780003]
10 mg/kg, Nasogastric Tube, EVERY 4 HOURS PRN, pain, temperature
greater than 38.5 degrees Celcius

acetylcysteine 20% soln(ORAL) CUSTOM [780005] 140 mg/kg, Nasogastric Tube, ONCE For 1 Doses
albuterol HFA (VENTOLIN HFA) 90 mcg/act inhaler [53730] 4 puff, Inhalation, EVERY 2 HOURS PRN, dyspnea
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Copyright © 2011 University of Wisconsin Hospitals and Clinics Authority



May give through ventilator circuit

diphenhydramine (BENADRYL) injection CUSTOM [760079] 0.5 mg/kg, Intravenous, EVERY 6 HOURS PRN, infusion reaction during
blood administration, for 1 Minutes

methylprednisolone sod succ. in sodium chloride 0.9% (SOLU-
MEDROL) injection CUSTOM [755013]
10 mg/kg, Intravenous, EVERY 12 HOURS
Dilute with 50-100 mL dextrose 5%
for 30 Minutes

tocopherol (VITAMIN E) soln CUSTOM [780183] 15 Units/kg, Nasogastric Tube, ONCE For 1 Doses

ursodiol (ACTIGALL) susp CUSTOM [780143] 5 mg/kg, Nasogastric Tube, ONCE For 1 Doses
For Lung Donors [114603]

naloxone (NARCAN)1 mg/mL injection CUSTOM [760177] 0.1 mg/kg, Intravenous, ONCE For 1 Doses, for 2 Minutes
Insulin Infusion


Non-Categorized Patient Care Orders [113141]

GLUCOSE, POC [HCMGLUC] SEE COMMENTS, Starting today For 7 Days, Routine
If Conditional, What Condition?:
Every hour until within target range (90-180 mg/dL. NOTE: Pilot target range
is 110-150 mg/dL) for 3 hours (3 readings in a row), then decrease frequency
to every 2 hours. Hourly monitoring must be resumed if blood glucose
deviates from target range.

GLUCOSE [GLU] NEXT AM, Starting today For 7 Days, Routine
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?:
Every hour until within target range (80-200mg/dL). NOTE: Pilot target range
is 110-150 mg/dL) for 3 hours (3 readings in a row), then decrease frequency
to every 2 hours. Hourly monitoring must be resumed if blood glucose
deviates from target range.

After Priming IV Tubing with Insulin, Waste 20 mL Insulin Drip to
Saturate all IV Tubing Binding Sites [NURCOM0022]
CONTINUOUS, Starting today
Contingency Parameters [113142]

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):
If temperature < (C):
If heart rate > (bpm):
If heart rate < (bpm):
If respiratory rate >:
If respiratory rate <:
If blood glucose > (mg/dL): 180
If blood glucose < (mg/dL): 90
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL):
Other: Infusion rate is less than 1 unit/hour with glucose value less than
Target Range (90-180 milligrams/deciliter)
Insulin [113073]

insulin regular (human) infusion PEDS [700116] 0.1 Units/kg/hr, Intravenous
Initiate at blood glucose great that 180 mg/dL. Administer insulin drip at ***
Hypoglycemia [113074]

dextrose 50% injection CUSTOM [760072] 0.5 g/kg, Intravenous, PRN, hypoglycemia. See Admin Instructions
Give *** g for blood glucose greater than 40 mg/dL and less than 70 mg/dL if
patient unable to eat or swallow safely or NPO.
Give *** g for blood glucose less than or equal to 40 mg/dL
Laboratory


Draw Now [116877]

TYPE AND SCREEN [HCTS] STAT - RN COLLECT, Starting today For 1 Occurrences, STAT
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?:

BLOOD GASES [HCBGAS] EVERY 6 HOURS, Starting today, STAT
If source is OTHER, indicate here:
Indicate FIO2: Per DCD Protocol
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?:

CBC WITH DIFFERENTIAL [CBC] EVERY 6 HOURS, Starting today, STAT
If add on test, what should lab do if unable to add test to previous specimen?:
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Copyright © 2011 University of Wisconsin Hospitals and Clinics Authority



If Conditional, What Condition?:

PROTHROMBIN TIME/INR [PT] EVERY 6 HOURS, Starting today, STAT
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?:

PTT [PTT] EVERY 6 HOURS, Starting today, STAT
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?:

ALKALINE PHOSPHATASE [ALKP] EVERY 6 HOURS, Starting today, STAT
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?:

ALT/SGPT [ALT] EVERY 6 HOURS, Starting today, STAT
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?:

AMYLASE [AMYL] EVERY 6 HOURS, Starting today, STAT
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?:

AST/SGOT [AST] EVERY 6 HOURS, Starting today, STAT
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?:

BILIRUBIN, DIRECT [DBIL] EVERY 6 HOURS, Starting today, STAT
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?:

BILIRUBIN, TOTAL [TBIL] EVERY 6 HOURS, Starting today, STAT
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?:

BUN [BUN] EVERY 6 HOURS, Starting today, STAT
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?:

CALCIUM, IONIZED [XICAL] EVERY 6 HOURS, Starting today, STAT
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?:

CK, TOTAL [CPK] EVERY 6 HOURS, Starting today, STAT
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?:

CKMB AND INDEX [MBI] EVERY 6 HOURS, Starting today, STAT
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?:

CREATININE [CRET] EVERY 6 HOURS, Starting today, STAT
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?:

ELECTROLYTES [LYTE] EVERY 6 HOURS, Starting today, STAT
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?:

GLUCOSE [GLU] EVERY 6 HOURS, Starting today, STAT
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?:

GGT [GGT] EVERY 6 HOURS, Starting today, STAT
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?:

LD, TOTAL [LDH] EVERY 6 HOURS, Starting today, STAT
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?:

LIPASE [LIPS] EVERY 6 HOURS, Starting today, STAT
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?:
MAGNESIUM [MAG] EVERY 6 HOURS, Starting today, STAT
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Copyright © 2011 University of Wisconsin Hospitals and Clinics Authority



If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?:

PROTEIN, TOTAL [TP] EVERY 6 HOURS, Starting today, STAT
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?:

TROPONIN [GM2447] EVERY 6 HOURS, Starting today, STAT
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?:

HEMOGLOBIN A1C [HA1C] EVERY 6 HOURS, Starting today, STAT
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?:

CULTURE, BLOOD, BACTERIA/YEAST (2 SITES) [HCBLOC2] Panel

CULTURE, BLOOD, BACTERIA AND YEAST [GM4045] NEXT DRAW, Starting today, Routine

CULTURE, BLOOD, BACTERIA AND YEAST [GM4045] NEXT DRAW, Starting today, Routine

CULTURE, SPUTUM WITH GRAM STAIN [HCSPUCS] ONCE, 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?:

CULTURE, URINE [URC] 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?:

URINALYSIS, NO MICROSCOPY [UACHEM] 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?:
Scheduled [109206]

ALBUMIN [ALB] EVERY 12 HOURS, Starting today For 3 Days, Routine
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?:

HEMATOCRIT [HCT] EVERY 6 HOURS, Starting today For 3 Days, Routine
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?:

SODIUM [NA] EVERY 6 HOURS, Starting today For 3 Days, Routine
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?:
Conditional Orders [105866]

BLOOD GASES [HCBGAS] CONDITIONAL - RN COLLECT, Starting today For 3 Days, STAT
If source is OTHER, indicate here:
Indicate FIO2: Per DCD Protocol
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?: Draw per OPO request. For potential Organ
Donation.

CBC WITH DIFFERENTIAL [CBC] CONDITIONAL - RN COLLECT, Starting today For 3 Days, STAT
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?: Draw per OPO request. For potential Organ
Donation.

PROTHROMBIN TIME/INR [PT] CONDITIONAL - RN COLLECT, Starting today For 3 Days, STAT
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?: Draw per OPO request. For potential Organ
Donation.

PTT [PTT] CONDITIONAL - RN COLLECT, Starting today For 3 Days, STAT
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?: Draw per OPO request. For potential Organ
Donation.

ALKALINE PHOSPHATASE [ALKP] CONDITIONAL - RN COLLECT, Starting today For 3 Days, STAT
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?: Draw per OPO request. For potential Organ
Donation.

ALT/SGPT [ALT] CONDITIONAL - RN COLLECT, Starting today For 3 Days, STAT
If add on test, what should lab do if unable to add test to previous specimen?:
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If Conditional, What Condition?: Draw per OPO request. For potential Organ
Donation.

AMYLASE [AMYL] CONDITIONAL - RN COLLECT, Starting today For 3 Days, STAT
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?: Draw per OPO request. For potential Organ
Donation.

AST/SGOT [AST] CONDITIONAL - RN COLLECT, Starting today For 3 Days, STAT
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?: Draw per OPO request. For potential Organ
Donation.

BILIRUBIN, DIRECT [DBIL] CONDITIONAL - RN COLLECT, Starting today For 3 Days, STAT
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?: Draw per OPO request. For potential Organ
Donation.

BILIRUBIN, TOTAL [TBIL] CONDITIONAL - RN COLLECT, Starting today For 3 Days, STAT
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?: Draw per OPO request. For potential Organ
Donation.

BUN [BUN] CONDITIONAL - RN COLLECT, Starting today For 3 Days, STAT
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?: Draw per OPO request. For potential Organ
Donation.

CALCIUM, IONIZED [XICAL] CONDITIONAL - RN COLLECT, Starting today For 3 Days, STAT
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?: Draw per OPO request. For potential Organ
Donation.

CK, TOTAL [CPK] CONDITIONAL - RN COLLECT, Starting today For 3 Days, STAT
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?: Draw per OPO request. For potential Organ
Donation.

CKMB AND INDEX [MBI] CONDITIONAL - RN COLLECT, Starting today For 3 Days, Routine
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?: Draw per OPO request. For potential Organ
Donation.

CREATININE [CRET] CONDITIONAL - RN COLLECT, Starting today For 3 Days, STAT
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?: Draw per OPO request. For potential Organ
Donation.

ELECTROLYTES [LYTE] CONDITIONAL - RN COLLECT, Starting today For 3 Days, STAT
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?: Draw per OPO request. For potential Organ
Donation.

GLUCOSE [GLU] CONDITIONAL - RN COLLECT, Starting today For 3 Days, STAT
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?: Draw per OPO request. For potential Organ
Donation.

GGT [GGT] CONDITIONAL - RN COLLECT, Starting today For 3 Days, STAT
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?: Draw per OPO request. For potential Organ
Donation.

LD, TOTAL [LDH] CONDITIONAL - RN COLLECT, Starting today For 3 Days, STAT
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?: Draw per OPO request. For potential Organ
Donation.

LIPASE [LIPS] CONDITIONAL - RN COLLECT, Starting today For 3 Days, STAT
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?: Draw per OPO request. For potential Organ
Donation.

MAGNESIUM [MAG] CONDITIONAL - RN COLLECT, Starting today For 3 Days, STAT
If add on test, what should lab do if unable to add test to previous specimen?:
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If Conditional, What Condition?: Draw per OPO request. For potential Organ
Donation.

PROTEIN, TOTAL [TP] CONDITIONAL - RN COLLECT, Starting today For 3 Days, STAT
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?: Draw per OPO request. For potential Organ
Donation.

TROPONIN [GM2447] CONDITIONAL - RN COLLECT, Starting today For 3 Days, STAT
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?: Draw per OPO request. For potential Organ
Donation.

HEMOGLOBIN A1C [HA1C] CONDITIONAL - RN COLLECT, Starting today For 3 Days, STAT
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?: Draw per OPO request. For potential Organ
Donation.

CULTURE, URINE [URC] CONDITIONAL - RN COLLECT, Starting tomorrow For 3 Days, Routine
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?: Draw every 24 hours or per OPO request.
For potential Organ Donation
Labs [103228]

POTASSIUM [K] CONDITIONAL - RN COLLECT, Starting today For 7 Days, Routine
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?: Draw 1 hour after IV replacement and 4
hours after oral replacement

MAGNESIUM [MAG] CONDITIONAL - RN COLLECT, Starting today For 7 Days, Routine
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?: Draw AM following completion of infusion

PHOSPHATE [PHOS] CONDITIONAL - RN COLLECT, Starting today For 7 Days, Routine
If add on test, what should lab do if unable to add test to previous specimen?:

If Conditional, What Condition?: Draw 1 hour after IV replacement
Consults


Consults [113143]

Consult Spiritual Care (Inpatient) [CON0056] ONCE, Starting today, Routine
Reason for Consult: End of Life and organ donation

Consult Palliative Care - Pediatric (Inpatient) [CON0172] ONCE, Starting today, Routine
Reason for Consult: End of Life and organ donation
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Printed by STRAKA, KEVIN F [KFS1] at 2/9/2012 9:44:46 AM
Copyright © 2011 University of Wisconsin Hospitals and Clinics Authority