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Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Ambulatory,Breast Center

OP - Breast/Melanoma Surgery - Adult - Postoperative [2739]

OP - Breast/Melanoma Surgery - Adult - Postoperative [2739] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Ambulatory, Breast Center


OP - Breast/Melanoma Surgery - Adult - Postoperative [2739]
Post-Op/Phase II
Post-Op Care Orders [200920]
Vital Signs [NURMON0013] ONCE For 1 Occurrences, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Post-Op/Phase II
Discontinue IV when tolerating oral intake
[NURCOM0022]
ONCE, Post-Op/Phase II
Prior to Discharge [200921]
Patient Must Be Seen by Attending Prior to
Discharge [NURMON0083]
ONCE, Routine, Post-Op/Phase II
Patient Must Be Seen by Resident Prior to
Discharge [NURMON0082]
ONCE, Routine, Post-Op/Phase II
Medications - Analgesics - Acetaminophen [201089]
acetaMINOPHEN (TYLENOL) tab [34150] 500 mg, Oral, EVERY 4 HOURS PRN, pain
See Pain Management Algorithm for the Selection of
As-Needed Analgesic
No more than 4 grams acetaminophen per 24 hours
for adults or 15mg/kg per dose for peds <40kg
Post-Op/Phase II
Medications - Analgesics - Oral - Opioids (Single Response) [241960]
oxycodone tab [45976] 5 mg, Oral, EVERY 4 HOURS PRN, pain
See Pain Management Algorithm for the Selection of
As-Needed Analgesics
Post-Op/Phase II
oxycodone tab [45976] 10 mg, Oral, EVERY 4 HOURS PRN, pain
See Pain Management Algorithm for the Selection of
As-Needed Analgesics
Post-Op/Phase II
oxycodone-acetaMINOPHEN (PERCOCET)
5-325 MG per tab [40668]
1-2 tab, Oral, EVERY 4 HOURS PRN, pain
See Pain Management Algorithm for the Selection of
As-Needed Analgesics
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 [71425]
1-2 tab, Oral, EVERY 4 HOURS PRN, pain
See Pain Management Algorithm for the Selection of
As-Needed Analgesics
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) 10-325
MG per tab [64942]
1-2 tab, Oral, EVERY 4 HOURS PRN, pain
See Pain Management Algorithm for the Selection of
As-Needed Analgesics
No more than 4 grams acetaminophen per 24 hours
for adults or 15mg/kg per dose for peds <40kg
Post-Op/Phase II
Medications - Anti-emetics [201090]
Adult - Standard - Anti-emetics [241962]
Page 1 of 5
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 12:28:01 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

ondansetron (ZOFRAN ODT) disintegrating tab
[64224]
4 mg, Sublingual, ONCE PRN For 1 Doses,
nausea/vomiting
Use first line
Post-Op/Phase II
ondansetron (ZOFRAN) injection [800202] 4 mg, Intravenous, ONCE PRN For 1 Doses,
nausea/vomiting
Use first line if unable to take medications by mouth
or enteral tube OR if immediate effect is needed.
Post-Op/Phase II
prochlorperazine (COMPAZINE) tab [41372] 10 mg, Oral, ONCE PRN For 1 Doses,
nausea/vomiting
Use second line if there is inadequate response to
first line anti-emetic within 30 minutes. If there is no
response to second line therapy within 30 minutes,
notify provider
Post-Op/Phase II
prochlorperazine (COMPAZINE) injection [41369] 10 mg, Intravenous, ONCE PRN For 1 Doses,
nausea/vomiting
Use second line. Use if there is inadequate
response to first line anti-emetic within 30 minutes
and if unable to take medications by mouth or
enteral tube OR if immediate effect is needed. If
there is no response to second line therapy within 30
minutes, notify provider
Post-Op/Phase II
Outpatient Discharge Orders
Medications - Prescriptions - Pain Management - Discharge (Single Response) [196103]
oxycodone 5 MG tab [45976] starting 12/7/17, Normal
oxycodone 10 MG tab [128434] 10 mg, starting 12/7/17, Normal
oxycodone-acetaMINOPHEN (PERCOCET)
5-325 MG per tab [40668]
starting 12/7/17, Normal
hydrocodone-acetaMINOPHEN (NORCO) 5-325
MG per tab [71425]
starting 12/7/17, Normal
hydrocodone-acetaMINOPHEN (NORCO) 10-325
MG per tab [64942]
starting 12/7/17, Normal
traMADOL (ULTRAM) 50 MG tab [50258] 50-100 mg, starting 12/7/17, Normal
Medications - Prescriptions - Pain Management - Other [197481]
ibuprofen (MOTRIN) 400 MG tab [38355] 400 mg, starting 12/7/17, Normal
acetaMINOPHEN (TYLENOL) 500 MG tab
[34150]
500 mg, starting 12/7/17, Normal
Medications - Prescriptions - Bowel Management - Discharge [195660]
senna-docusate (SENOKOT S) 8.6-50 MG per
tab [60530]
1 tab, Oral, 1 X DAILY
Hold for loose stools
docusate sodium (COLACE) cap [36859] 100 mg, Oral, 2 X DAILY
Hold for loose stools
polyethylene glycol (MIRALAX) oral packet
[61829]
Oral, 1 X DAILY PRN, constipation
Dissolve in 8 oz water. Use as first line rescue therapy
if no response to scheduled bowel management after
48 hours. Hold for loose stools.
Activity [98691]
Activity [NURACT0011] Routine, No heavy lifting over 10 pounds until follow
up.
Page 2 of 5
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 12:28:01 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

Bathing Instructions [NURACT0011] Routine, May shower after 24 hours. OK for incision to
get wet. Gently pat surgical area dry after showering.
No bath tubs for 14 days. Do no soak incision in water
(no swimming, no hot tubs, no baths).
Driving Restrictions [NURACT0011] Routine, No driving while taking narcotic medications.
Nutrition [195661]
Diet - General (No Modifications) [NUT8888] Routine
General: General (No Modifications)
Diet Modifications:
Other Diet Modifications:
Wound Care [98693]
Wound Care [NURWND0018] Routine, Remove dressing after 24-48 hours or as
necessary if dressing becomes wet or saturated.
Cover incision with dressing only as necessary for
comfort.
Apply Ice as Needed [NURWND0018] Routine, Ice wound as needed for 20 minute intervals.
Wear Supportive Bra, Jobst Bra, or Breast Binder
[NURWND0018]
Routine, Wear supportive bra, Jobst bra or breast
binder as instructed
Other Patient Care Instructions [195662]
Other Discharge Patient Care Instructions
[NURCOM0071]
Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care
Plan., Routine, Please refer to your educational
materials in the Breast Binder for further information
When to Call Your Doctor [195663]
When to Call Your Doctor [NURCOM0079] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care
Plan.
You should include specific instructions on when and
who to call.
You should include actual provider names (i.e. not
'PCP').
You should NOT include the discharging unit as a
contact., Routine, Call your doctor if you have any of
these symptoms:
-increased pain not relieved by medication
-fever over 100.5 degrees F for two readings taken
four hours apart
-signs of infection (excess swelling or bleeding from
surgical wound, increased redness and/or warmth at
the incision site, or pus-like drainage)
-nausea or vomiting lasting more than 24 hours
-problems urinating or emptying your bladder
-cramping or swelling to leg
-if you have not had a bowel movement in 3 days
For severe chest pain or shortness of breath call 911.
Contact {Pick Breast or General Surgery Clinic:31552}
Monday-Friday 8am-4:30pm for any of the symptoms
listed above or any other questions/problems. If after
hours, contact the paging operator at 608-263-6400
and ask for the general surgery resident on call.
Follow-Up Appointments [196104]
Page 3 of 5
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 12:28:01 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

Schedule Appointment [NURCOM0026] Routine
Reason for Hospital Follow Up Appointment: Follow
up
Which Provider: Patient's Specific PCP/Care Team
When do you want appointment: 1-2 weeks
Which Clinic or Specialty:
Schedule follow-up appointment in 1-2 weeks after
surgery, if not already scheduled for you.
Schedule Appointment [NURCOM0026] Routine
Reason for Hospital Follow Up Appointment:
Which Provider:
Diagnosis
Diagnosis - Pre Op [711]
Pre-operative general physical examination
[255759]
Other specified pre-operative examination
Level of Service
Office Visit - Established Patients [30779]
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 [30778]
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 - New or Established Patients [30780]
If Medicare patient, do not use Consult LOS. Choose an Established or New Patient LOS. Add the
appropriate additional E/M Code of 99354-99359 for prolonged office consultations in the LOS
section of the Visit Navigator.
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
99241- w/ Resident (GC) - Level I LOS Code
Page 4 of 5
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 12:28:01 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

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
Page 5 of 5
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 12:28:01 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org