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201712341

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UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Ambulatory,ENT

OP - Otolaryngologic Surgery - Adult - Postoperative [2867]

OP - Otolaryngologic Surgery - Adult - Postoperative [2867] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Ambulatory, ENT


OP - Otolaryngologic Surgery - Adult - Postoperative [2867]
for Adult Patients OnlyIntended
PostOp/Phase II
Analgesics - Non-opioid (Single Response) [204892]
acetaMINOPHEN (TYLENOL) tab [34149] 650 mg, Oral, EVERY 4 HOURS PRN For 24 Hours,
pain
See Pain management Algorithm for the Selection of
As-needed Analgesics
No more than 4 grams acetaminophen per 24 hours
for adults or 15 mg/kg per dose for peds <40 kg
Post-Op/Phase II
acetaMINOPHEN alcohol free (TYLENOL) oral
suspension [800005]
650 mg, Oral, EVERY 4 HOURS PRN For 24 Hours,
pain/fever
See Pain management Algorithm for the Selection of
As-needed Analgesics
No more than 4 grams acetaminophen per 24 hours
for adults or 15 mg/kg per dose for peds <40 kg
Post-Op/Phase II
Analgesics - Opioids (Single Response) [92414]
hydrocodone-acetaMINOPHEN (NORCO) 5-325
mg per tab RANGE [750021]
1-2 tab, Oral, EVERY 4 HOURS PRN For 24 Hours,
pain
See Pain management Algorithm for the Selection of
As-needed Analgesics
Post-Op/Phase II
oxycodone-acetaminophen (PERCOCET) 5-325
mg per tab RANGE [750033]
1-2 tab, Oral, EVERY 4 HOURS PRN For 24 Hours,
pain
See Pain management Algorithm for the Selection of
As-needed Analgesics
Post-Op/Phase II
oxycodone soln RANGE [750031] 5-10 mg, Oral, EVERY 4 HOURS PRN, pain
See Pain management Algorithm for the Selection of
As-needed Analgesics
Post-Op/Phase II
oxycodone tab RANGE [750032] 5-10 mg, Oral, EVERY 4 HOURS PRN, pain
See Pain management Algorithm for the Selection of
As-needed Analgesics
Post-Op/Phase II
Prior to Discharge [92767]
Patient Must Be Seen by Attending Prior to
Discharge [NURMON0083]
ONCE, Starting today For 1 Occurrences, Routine,
Post-Op/Phase II
Patient Must Be Seen by Resident Prior to
Discharge [NURMON0082]
ONCE, Starting today For 1 Occurrences, Routine,
Post-Op/Phase II
Follow-Up Appointments
Follow-Up Appointments [109056]
Schedule Appointment with Otolaryngology
[NURCOM0026]
Routine
Reason for Hospital Follow Up Appointment: Post-op
Evaluation
Which Provider: Other Provider or Specialist
When do you want appointment:
Which Clinic or Specialty: Otolaryngology
Follow Up Apointment Already Scheduled
[NURCOM0022]
Routine, Follow up appointment already scheduled
Page 1 of 6
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 12:20:42 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

Schedule Appointment with Otolaryngology
[NURCOM0026]
Routine
Reason for Hospital Follow Up Appointment: Post-op
Evaluation
Which Provider: Other Provider or Specialist
When do you want appointment:
Which Clinic or Specialty: Otolaryngology
Otolaryngology Clinic to Phone Patient for Follow-
Up [NURCOM0026]
Routine
Reason for Hospital Follow Up Appointment:
Which Provider: Other Provider or Specialist
When do you want appointment:
Which Clinic or Specialty: Otolaryngology Clinic
If Otolaryngology and Audiology Follow Up Needed, Order Both [109058]
Schedule Appointment with Otolaryngology
[NURCOM0026]
Routine
Reason for Hospital Follow Up Appointment: Post-op
Evaluation
When do you want appointment:
Which Clinic or Specialty: Otolaryngology
Which Provider (Optional):
To be scheduled with Audiology Follow-Up.
Schedule Appointment with Audiology
[NURCOM0026]
Routine
Reason for Hospital Follow Up Appointment: For
audiogram
When do you want appointment:
Which Clinic or Specialty: Audiology
Which Provider (Optional):
To be scheduled with Otolaryngology Follow-Up
If Otolaryngology and Voice/Speech Follow-Up Needed, Order Both [110393]
Schedule Appointment with Otolaryngology
[NURCOM0026]
Routine
Reason for Hospital Follow Up Appointment: Post-op
Evaluation
When do you want appointment:
Which Clinic or Specialty: Otolaryngology
Which Provider (Optional):
To be scheduled with Voice/Speech Follow-Up.
Schedule Appointment with Voice/Speech
[NURCOM0026]
Routine
Reason for Hospital Follow Up Appointment: Post-op
evaluation
When do you want appointment:
Which Clinic or Specialty: Voice/Speech
Which Provider (Optional):
To be scheduled with Otolaryngology Follow-Up.
Outpatient Discharge Orders
Medications - Prescriptions - Anti-infectives [89294]
amoxicillin (AMOXIL) 500 mg cap - 3x/d 7d
[34524]
500 mg, 21 cap, 0, starting 12/7/17 until 12/14/17,
Normal, Phase II Discharge
amoxicillin (AMOXIL) 250 mg/5 mL susp - 10 mL
3x/d 7d [34527]
250 mg, 0, starting 12/7/17 until 12/14/17, Normal,
Phase II Discharge
amoxicillin-clavulanate (AUGMENTIN) 875-125
mg per tab - 2x/d 7d [70053]
1 tab, 14 tab, 0, starting 12/7/17 until 12/14/17,
Normal, Phase II Discharge
amoxicillin-clavulanate (AUGMENTIN) 400-57
MG/5ML susp [70055]
10 mL, 200 mL, , starting 12/7/17, Normal, Phase II
Discharge
azithromycin (ZITHROMAX) 250 mg tab [57023] 6 tab, 0, starting 12/7/17 until 12/12/17, Normal,
Phase II Discharge
azithromycin (ZITHROMAX) 200 MG/5ML SUSR
[51547]
38 mL, 0, starting 12/7/17 until 12/12/17, Normal,
Phase II Discharge
Page 2 of 6
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 12:20:42 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

cephalexin (KEFLEX) 500 mg cap - 4x/d 7d
[44594]
500 mg, 28 cap, 0, starting 12/7/17 until 12/14/17,
Normal, Phase II Discharge
Medications - Prescriptions - Anti-infectives - NOTE : Order for patients with PRESUMED ACTIVE
Infection [96557]
amoxicillin-clavulanate (AUGMENTIN) 875-125
mg per tab - 2x/d-14d [70053]
1 tab, 28 tab, 0, starting 12/7/17 until 12/21/17,
Normal, Phase II Discharge
amoxicillin-clavulanate (AUGMENTIN) 400-57
MG/5ML susp [70055]
10 mL, 300 mL, , starting 12/7/17, Normal, Phase II
Discharge
cefpodoxime (VANTIN) 200 mg tab - 2x/d-14d
[44563]
200 mg, 28 tab, 0, starting 12/7/17 until 12/21/17,
Normal, Phase II Discharge
cefuroxime (CEFTIN) 500 mg tab - 2x/d-14d
[44590]
500 mg, 28 tab, 0, starting 12/7/17 until 12/21/17,
Normal, Phase II Discharge
clarithromycin (BIAXIN) 500 mg tab - 2x/d-14d
[44719]
500 mg, 28 tab, 0, starting 12/7/17 until 12/21/17,
Normal, Phase II Discharge
moxifloxacin (AVELOX) 400 mg tab - 1x/d-14d
[63314]
400 mg, 14 tab, 0, starting 12/7/17, Normal, Phase II
Discharge
clindamycin (CLEOCIN) 300 MG cap - 3x/d-14d
[44723]
300 mg, 42 cap, 0, starting 12/7/17 until 12/21/17,
Normal, Phase II Discharge
Medications - Prescriptions - Analgesics [89293]
hydrocodone-acetaMINOPHEN (NORCO) 5-325
mg per tab - 1-2t q4h prn [71425]
1-2 tab, 25 tab, 0, starting 12/7/17, Normal, Phase II
Discharge
Hydrocodone-Acetaminophen 7.5-325 MG/15ML
SOLN [74885]
15-30 mL, 500 mL, 0, starting 12/7/17 until 1/6/18,
Normal, Phase II Discharge
oxycodone-acetaminophen (PERCOCET) 5-325
mg per tab - 1-2t q4h prn [40668]
1-2 tab, 25 tab, 0, starting 12/7/17, Normal, Phase II
Discharge
oxycodone 5 MG tab [750032] 5-10 mg, 0, starting 12/7/17, Normal, Phase II
Discharge
oxycodone 5 MG/5ML soln [750031] 5-10 mg, 0, starting 12/7/17, Normal, Phase II
Discharge
ibuprofen (MOTRIN) 600 MG tab [38356] 600 mg, starting 12/7/17, No Print, Phase II Discharge
acetaMINOPHEN alcohol free (TYLENOL) 160
MG/5ML susp [43991]
650 mg, starting 12/7/17, No Print, Phase II Discharge
acetaMINOPHEN (TYLENOL) 325 MG tab
[34149]
650 mg, starting 12/7/17, No Print, Phase II Discharge
Medications - Prescriptions - Otic [92436]
ciprofloxacin-dexamethasone (CIPRODEX)
0.3-0.1% otic susp [73602]
starting 12/7/17 until 1/6/18, Normal, Phase II
Discharge
ofloxacin (OCUFLOX) 0.3 % ophthalmic soln
[55774]
starting 12/7/17 until 1/6/18, Normal, Phase II
Discharge
ciprofloxacin (CETRAXAL) 0.2 % otic soln
[136381]
starting 12/7/17, Normal, Phase II Discharge
Medications - Prescriptions - Non-categorized [92437]
senna-docusate (SENOKOT-S) 8.6-50 mg per tab
- 2t 2x/d [60530]
2 tab, 28 tab, 0, starting 12/7/17, Normal, Phase II
Discharge
ondansetron (ZOFRAN ODT) 4 MG disintegrating
tab - Note: Not for patients under 40kg [64224]
4 mg, 10 tab, , starting 12/7/17, Normal, Phase II
Discharge
bacitracin 500 UNIT/GM ointment [49271] 1 Tube, , starting 12/7/17 until 12/14/17, Normal,
Phase II Discharge
Medication Instructions [92438]
No NSAIDs (ibuprofen, aspirin, etc) for 7 days
after surgery [NURCOM0022]
Routine
Maximum acetaminophen dose per 24 hours
[NURCOM0022]
Routine, No more than 4 grams acetaminophen per 24
hours for adults or 15 mg/kg per dose for peds <40 kg
Resume steroid taper [NURCOM0022] Routine
Activity/Return to Work [89048]
Page 3 of 6
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 12:20:42 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

Activity [NURACT0008] Routine
Discharge Activity: Other (Comment)
May return to work/school as previously discussed.
Light activity and no heavy lifting for one week. No
driving while taking pain medication., Phase II
Discharge
Strict Voice Rest [NURACT0011] Routine, For *** hours.
Moderate Voice Use (No Yelling or Screaming)
for 1 Week Beginning after Voice Rest
[NURACT0011]
Routine
Nutrition [89050]
Soft Diet [NUT8888] Routine
General:
Diet Modifications: Palate Soft
Other Diet Modifications:
Soft diet for 7 days.
Genereal Diet (No Diet Restrictions) [NUT8888] Routine
General: General (No Modifications)
Diet Modifications:
Other Diet Modifications:
Clear Liquid Diet [NUT8888] Routine
General:
Diet Modifications:
Other Diet Modifications: -
Solid Consistency:
Liquid Consistency:
Liquid: Clear Liquid
Esophagectomy:
Fat Controlled:
Fiber:
Fluid Restriction:
Heart Healthy:
Metabolic:
Renal:
Sodium Controlled:
NPO:
Clear liquid diet for 7 days.
Wound Care [89051]
Leave Original Surgical Dressing On
[NURWND0018]
Routine, For *** days.
Leave Original Surgical Dressing on Until MD
Follow-Up [NURWND0018]
Routine
Keep Incision Completely Dry [NURWND0018] Routine, For *** days.
Keep Incision Completely Dry Until MD Follow-Up
[NURWND0018]
Routine
No Nose Blowing [NURWND0018] Routine, For *** days.
No Nose Blowing Until MD Follow-Up
[NURWND0018]
Routine
Cough and Sneeze with Mouth Open
[NURWND0018]
Routine, For *** days.
Cough and Sneeze with Mouth Open Until MD
Follow-Up [NURWND0018]
Routine
Keep Soapy Water out of Ears [NURWND0018] Routine
Keep Ear Dry [NURWND0018] Routine, Keep *** ear(s) completely dry for *** days.
Page 4 of 6
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 12:20:42 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

Keep Ear Dry Until MD Follow-Up
[NURWND0018]
Routine, Keep *** ear(s) completely dry until MD
follow-up.
No Bearing Down [NURWND0018] Routine, For *** days.
Do Not Scrub Incision [NURWND0018] Routine
Remove Mastoid Dressing (Hours)
[NURWND0018]
Routine, In *** hours.
Change Cottonball as Needed [NURWND0018] Routine
Apply ice to wound [NURWND0018] Routine, Every two hours for 10 minutes for 48 hours
while awake.
Wound Care [NURWND0018] Routine
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 [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 5 of 6
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 12:20:42 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 6 of 6
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 12:20:42 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org