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201612340

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100

UWHC,UWMF,

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Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Ambulatory,BMT/Oncology/Hematology

FDS - Bone Marrow Harvest Adult - Preoperative [2940]

FDS - Bone Marrow Harvest Adult - Preoperative [2940] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Ambulatory, BMT/Oncology/Hematology


SmartSet: FDS - BONE MARROW HARVEST - ADULT - PREOPERATIVE
(ID:2940)
General Information
Display name: FDS - Bone Marrow Harvest - Adult - Preprocedure
Type: General
Merge priority: 0
Version comment:
Content source:
Synonyms: 1. BMT
2. .BMT
SmartSet notes:
Description: Intended for Adult Patients Only
Web information: Title URL
1.
Questionnaire:
Configuration
Pre-Day of Procedure
Laboratory
CBC WITH DIFFERENTIAL Status: Standing, Expires:S+45 MANUAL,Count:1,
Normal, Routine
PROTHROMBIN TIME/INR Status: Standing, Expires:S+45 MANUAL,Count:1,
Normal, Routine
ELECTROLYTES Status: Standing, Expires:S+45 MANUAL,Count:1,
Normal, Routine
GLUCOSE Status: Standing, Expires:S+45 MANUAL,Count:1,
Normal, Routine
MAGNESIUM Status: Standing, Expires:S+45 MANUAL,Count:1,
Normal, Routine
CALCIUM Status: Standing, Expires:S+45 MANUAL,Count:1,
Normal, Routine
BUN Status: Standing, Expires:S+45 MANUAL,Count:1,
Normal, Routine
CREATININE Status: Standing, Expires:S+45 MANUAL,Count:1,
Normal, Routine
Page 1 of 7
Printed by STRAKA, KEVIN F [KFS1] at 12/5/2016 11:31:53 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2016CCKM@uwhealth.org

CALCIUM Status: Standing, Expires:S+45 MANUAL,Count:1,
Normal, Routine
URIC ACID Status: Standing, Expires:S+45 MANUAL,Count:1,
Normal, Routine
PHOSPHATE Status: Standing, Expires:S+45 MANUAL,Count:1,
Normal, Routine
ALBUMIN Status: Standing, Expires:S+45 MANUAL,Count:1,
Normal, Routine
PROTEIN, TOTAL Status: Standing, Expires:S+45 MANUAL,Count:1,
Normal, Routine
BILIRUBIN, TOTAL Status: Standing, Expires:S+45 MANUAL,Count:1,
Normal, Routine
AST/SGOT Status: Standing, Expires:S+45 MANUAL,Count:1,
Normal, Routine
ALT/SGPT Status: Standing, Expires:S+45 MANUAL,Count:1,
Normal, Routine
ALKALINE PHOSPHATASE Status: Standing, Expires:S+45 MANUAL,Count:1,
Normal, Routine
GGT Status: Standing, Expires:S+45 MANUAL,Count:1,
Normal, Routine
LD, TOTAL Status: Standing, Expires:S+45 MANUAL,Count:1,
Normal, Routine
SICKLE CELL SCREEN Status: Standing, Expires:S+45 MANUAL,Count:1,
Normal, Routine
BMT DONOR IDM SCREEN Status: Standing, Expires:S+45 MANUAL,Count:1,
Normal, Routine
URINALYSIS WITH MICROSCOPY AND
CULTURE IF >5 WBC/HPF
Status: Standing, Expires:S+45 MANUAL,Count:1,
Normal, Routine
STR ENGRAFTMENT UNSEPARATED
LINEAGES, BONE MARROW
Status: Standing, Expires:S+45 MANUAL,Count:1,
Normal, Routine
Laboratory - STR Engraftment/Separated Lineages
STR ENGRAFTMENT POPULATION 1 Status: Standing, Expires:S+45 MANUAL,Count:1,
Normal, Routine
STR ENGRAFTMENT POPULATION 2 Status: Standing, Expires:S+45 MANUAL,Count:1,
Normal, Routine
Laboratory - Pregnancy Test
Urine, Pregnancy Test Status: Standing, Expires:S+45 MANUAL,Count:1,
Normal, Routine
Serum, Pregnancy Test Status: Standing, Expires:S+45 MANUAL,Count:1,
Normal, Routine
Diagnostic Tests and Imaging
ECG - 12 Lead Status: Future, Expires: M+13, Normal, Routine
X-RAY CHEST PA & LAT VIEWS Status: Future, Expires: M+14, Normal, Routine
X-Ray Chest PA & LAT Views Dual Energy Status: Future, Expires: M+14, Normal, Routine
Pre-Op Day of Procedure
Isolation Status
Isolation - Enhanced Contact - Clostridium
Difficile
CONTINUOUS, Separate order must be placed for
isolation cart., Pre-Op Day Of Procedure
Page 2 of 7
Printed by STRAKA, KEVIN F [KFS1] at 12/5/2016 11:31:53 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2016CCKM@uwhealth.org

Isolation - Contact - MRSA CONTINUOUS, Separate order must be placed for
isolation cart., Pre-Op Day Of Procedure
Isolation - Contact - VRE CONTINUOUS, Separate order must be placed for
isolation cart., Pre-Op Day Of Procedure
Isolation - Protective Precautions - Panel
Protective Precautions CONTINUOUS
Reason for Protective Precautions:
Pre-Op Day Of Procedure
Protective - Positive Pressure Room CONTINUOUS, Pre-Op Day Of Procedure
Isolation - Contact - Multidrug Resistant
Organism - Panel
Isolation - Contact - Multidrug Resistant
Organism (MDR)
CONTINUOUS, Pre-Op Day Of Procedure
Isolation Cart CONTINUOUS, Routine, Pre-Op Day Of
Procedure
Isolation - Contact - Extensively Resistant
Organism (XDR) - Panel
Isolation - Contact - Extensively Drug Resistant
Organism (XDR)
CONTINUOUS, Pre-Op Day Of Procedure
Isolation Cart CONTINUOUS, Routine, Pre-Op Day Of
Procedure
Contingency Parameters
Notify Surgeon Provider to Notify: Other (Comment)
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): 300
If blood glucose < (mg/dL): 70
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL):
Other:
Premedications for Needle Insertion
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
Pre-Op Day Of Procedure
Page 3 of 7
Printed by STRAKA, KEVIN F [KFS1] at 12/5/2016 11:31:53 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2016CCKM@uwhealth.org

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
Pre-Op Day Of Procedure
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 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
Pre-Op Day Of Procedure
Laboratory
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?
Pre-Op Day Of Procedure
ELECTROLYTES, WHOLE BLOOD 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?
Pre-Op Day Of Procedure
GLUCOSE, WHOLE BLOOD 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?
Pre-Op Day Of Procedure
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?
Pre-Op Day Of Procedure
CREATININE, WHOLE BLOOD 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?
Pre-Op Day Of Procedure
CALCIUM 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?
Pre-Op Day Of Procedure
Page 4 of 7
Printed by STRAKA, KEVIN F [KFS1] at 12/5/2016 11:31:53 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2016CCKM@uwhealth.org

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?
Pre-Op Day Of Procedure
PLATELET 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?
Pre-Op Day Of Procedure
Laboratory - Pregnancy Test
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?
Pre-Op Day Of Procedure
Laboratory - Blood Bank
ANTIBODY SCREEN 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?
Pre-Op Day Of Procedure
ABO AND RH TYPING 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?
Pre-Op Day Of Procedure
Tests
TYPE AND SCREEN STAT - RN COLLECT, Starting S For 1 Occurrences,
Routine, As good clinical practice and for patient
safety, the Transfusion Service will automatically
crossmatch 2 packed RBCs on all patients with
antibodies to ensure blood would be available in the
event it is needed. If you would like to opt out of this
automatic order for this patient please contact the
UWHC Blood Bank at (608) 263-8367 or The
American Center Lab at (608) 234-6600 as
appropriate., Pre-Op Day Of Procedure
IntraOp
Laboratory
ABO AND RH TYPING 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?
IntraOp
Page 5 of 7
Printed by STRAKA, KEVIN F [KFS1] at 12/5/2016 11:31:53 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2016CCKM@uwhealth.org

NUCLEATED CELL COUNT STAT - RN COLLECT, Starting S For 1 Occurrences,
Routine, Available on bone marrow transplant
harvests only.
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
IntraOp
Diagnosis
Diagnosis - Pre Op
Pre-operative general physical examination Other specified pre-operative examination
Level of Service
Office Visit - Established Patients
99211 - Level I LOS Code
99212 - Level II LOS Code
99213 - Level III LOS Code
99214 - Level IV LOS Code
99215 - Level V LOS Code
99211 - w/ Resident (GC) - Level I LOS Code
99212 - w/ Resident (GC) - Level II LOS Code
99213 - w/ Resident (GC) - Level III LOS Code
99214 - w/ Resident (GC) - Level IV LOS Code
99215 - w/ Resident (GC) - Level V LOS Code
Office visit - New Patients
99201- Level I LOS Code
99202- Level II LOS Code
99203- Level III LOS Code
99204- Level IV LOS Code
99205 - Level V LOS Code
99201- w/ Resident (GC) - Level I LOS Code
99202- w/ Resident (GC) - Level II LOS Code
99203- w/ Resident (GC) - Level III LOS Code
99204- w/ Resident (GC) - Level IV LOS Code
99205- w/ Resident (GC) - Level V LOS Code
Consults
99241 - Level I LOS Code
99242 - Level II LOS Code
99243 - Level III LOS Code
99244 - Level IV LOS Code
99245 - Level V LOS Code
Page 6 of 7
Printed by STRAKA, KEVIN F [KFS1] at 12/5/2016 11:31:53 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2016CCKM@uwhealth.org

99241- w/ Resident (GC) - Level I LOS Code
99242 - w/ Resident (GC)- Level II LOS Code
99243 - w/ Resident (GC) - Level III LOS Code
99244 - w/ Resident (GC) - Level IV LOS Code
99245 - w/ Resident (GC) - Level V LOS Code
Preoperative Exam (Global)
Preoperative H&P, No Charge, Surgical
Package
LOS Code
Criteria
Suggestions:
Filter: UWHC W/ INPATIENT ENCOUNTER FOR POC[1344]
Restrict SmartSet:
Settings
Discontinue action:
Deselect sections for
Pended/Held orders:
Pended/Held orders
display:
Release date: Use System Definitions Setting
Disallow user override:
Page 7 of 7
Printed by STRAKA, KEVIN F [KFS1] at 12/5/2016 11:31:53 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2016CCKM@uwhealth.org