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/clinical/cckm-tools/content/order-sets/ambulatory/general-surgery/name-98580-en.cckm

201706156

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UWHC,UWMF,

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Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Ambulatory,General Surgery

OP - Endocrine Surgery - Adult - Preoperative [4280]

OP - Endocrine Surgery - Adult - Preoperative [4280] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Ambulatory, General Surgery


OP - Endocrine Surgery - Adult - Preoperative [4280]
Intended for Adult Patients Only
Pre-Day of Procedure
Laboratory - Adrenal [113918]
ANTIBODY SCREEN [ABSCR] Status: Standing, Expires:7/15/17 MANUAL,Count:1,
Normal, Routine
CBC WITHOUT DIFFERENTIAL [HEMO] Status: Standing, Expires:7/15/17 MANUAL,Count:1,
Normal, Routine
ELECTROLYTES [LYTE] Status: Standing, Expires:7/15/17 MANUAL,Count:1,
Normal, Routine
BUN [BUN] Status: Standing, Expires:7/15/17 MANUAL,Count:1,
Normal, Routine
CREATININE [CRET] Status: Standing, Expires:7/15/17 MANUAL,Count:1,
Normal, Routine
GLUCOSE [GLU] Status: Standing, Expires:7/15/17 MANUAL,Count:1,
Normal, Routine
Medications - Parathyroid [152414]
calcium carbonate (TUMS) 500 MG chew tab
[44477]
500 mg, 14 tab, 0, starting 5/31/17 until 6/30/17,
Normal, Pre-Day of Procedure
calcitriol (ROCALTROL) 0.25 MCG cap [44439] 0.25 mcg, 14 cap, 0, starting 5/31/17 until 6/30/17,
Normal, Pre-Day of Procedure
Laboratory - Parathyroid [113920]
ELECTROLYTES [LYTE] Status: Standing, Expires:7/15/17 MANUAL,Count:1,
Normal, Routine
CREATININE [CRET] Status: Standing, Expires:7/15/17 MANUAL,Count:1,
Normal, Routine
CALCIUM [CA] Status: Standing, Expires:7/15/17 MANUAL,Count:1,
Normal, Routine
PTH [HCPTHIN] Status: Standing, Expires:7/15/17 MANUAL,Count:1,
Normal, Routine
PHOSPHATE [PHOS] Status: Standing, Expires:7/15/17 MANUAL,Count:1,
Normal, Routine
ALKALINE PHOSPHATASE [ALKP] Status: Standing, Expires:7/15/17 MANUAL,Count:1,
Normal, Routine
VITAMIN D 25 HYDROXY [SACRVD25Q] Status: Standing, Expires:7/15/17 MANUAL,Count:1,
Back Office, Routine
GLUCOSE [GLU] Status: Standing, Expires:7/15/17 MANUAL,Count:1,
Normal, Routine
Medications - Thyroid [152415]
Potassium Iodide (SSKI) 1 GM/ML soln [41228] 0.2 mL, 30 mL, 0, starting 5/31/17 until 6/30/17,
Normal, Pre-Day of Procedure
Laboratory - Thyroid [113921]
CALCIUM [CA] Status: Standing, Expires:7/15/17 MANUAL,Count:1,
Normal, Routine
MICROSOMAL (TPO) AB [XTPO] Status: Standing, Expires:7/15/17 MANUAL,Count:1,
Normal, Routine
PTH [HCPTHIN] Status: Standing, Expires:7/15/17 MANUAL,Count:1,
Normal, Routine
TSH [TSH] Status: Standing, Expires:7/15/17 MANUAL,Count:1,
Normal, Routine
T4, FREE [FT4] Status: Standing, Expires:7/15/17 MANUAL,Count:1,
Normal, Routine
Page 1 of 6
Printed by STRAKA, KEVIN F [KFS1] at 5/31/2017 4:18:55 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 05/2017CCKM@uwhealth.org

T3, FREE [FT3] Status: Standing, Expires:7/15/17 MANUAL,Count:1,
Normal, Routine, For Graves' patients only
THYROGLOBULIN WITH REFLEX TO LC-
MS/MS OR CIA (INCLUDES THYROGLOBULIN
AB) [THYROG]
Status: Standing, Expires:7/15/17 MANUAL,Count:1,
Normal, Routine
THYROID STIMULATING HORMONE
RECEPTOR AB (TRAB) [HCTRAB]
Status: Standing, Expires:7/15/17 MANUAL,Count:1,
Normal, Routine
GLUCOSE [GLU] Status: Standing, Expires:7/15/17 MANUAL,Count:1,
Normal, Routine
Diagnostic Tests and Images [113922]
ECG - 12 Lead Without Rhythm [EKG0008] Status: Future, Expires: 6/30/18, Normal, STAT
PreOp Day of Procedure
Premedications for Needle Insertion [106313]
Use lidocaine topical dressing kit for stable patient, no lidocaine allergies, have at least 30
minutes time prior to needing to use IV
Sodium chloride (bacteriostatic) 0.9% intradermal: Useful for patients requiring urgent IV
access; onset is within 1 minute. 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 [NURVAD0013] CONTINUOUS, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
lidocaine (LMX) 4% topical dressing kit [66882] 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
lidocaine (XYLOCAINE) 1% injection [39034] 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
[50585]
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
Medications [113969]
Page 2 of 6
Printed by STRAKA, KEVIN F [KFS1] at 5/31/2017 4:18:55 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
05/2017CCKM@uwhealth.org

hydrocortisone sod suc in sodium chloride 0.9%
injection [800189]
100 mg, Intravenous, ON CALL For 1 Doses
Administer one hour prior to surgery
Pre-Op Day Of Procedure
dexamethasone (DECADRON) intraVENOUS
[800037]
8 mg, Intravenous, ON CALL For 1 Doses
Administer 90 minutes prior to surgery
Pre-Op Day Of Procedure
Isolation Status [97372]
Isolation - Enhanced Contact - Clostridium
Difficile [ISO0010]
CONTINUOUS, Separate order must be placed for
isolation cart., Pre-Op Day Of Procedure
Isolation - Contact - MRSA [ISO0039] CONTINUOUS, Separate order must be placed for
isolation cart., Pre-Op Day Of Procedure
Isolation - Contact - VRE [ISO0051] CONTINUOUS, Separate order must be placed for
isolation cart., Pre-Op Day Of Procedure
Isolation - Protective Precautions - Panel
[116356]
Protective Precautions [ISO0001] CONTINUOUS
Reason for Protective Precautions:
Pre-Op Day Of Procedure
Protective - Positive Pressure Room
[NURCOM0109]
CONTINUOUS, Pre-Op Day Of Procedure
Isolation - Contact - Multidrug Resistant
Organism - Panel [116335]
Isolation - Contact - Multidrug Resistant
Organism (MDR) [ISO0006]
CONTINUOUS, Pre-Op Day Of Procedure
Isolation Cart [EQP0016] CONTINUOUS, Routine, Pre-Op Day Of Procedure
Isolation - Contact - Extensively Resistant
Organism (XDR) - Panel [193206]
Isolation - Contact - Extensively Drug Resistant
Organism (XDR) [ISO0320]
CONTINUOUS, Pre-Op Day Of Procedure
Isolation Cart [EQP0016] CONTINUOUS, Routine, Pre-Op Day Of Procedure
Laboratory [113924]
Glucose, POC [IPGLUCOSE] ONCE, Starting today 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?
Pre-Day of Procedure
PROTHROMBIN TIME/INR [PT] 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?
Pre-Op Day Of Procedure
POTASSIUM [K] 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?
Pre-Op Day Of Procedure
Tests [91574]
Page 3 of 6
Printed by STRAKA, KEVIN F [KFS1] at 5/31/2017 4:18:55 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
05/2017CCKM@uwhealth.org

TYPE AND SCREEN [HCTS] STAT - RN COLLECT, Starting today 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
Laboratory - Pregnancy Test [81397]
surgery is pelvic, renal, pregnancy test if female between menarche & menopause and any of: (1) Obtain
intercourse, (3) patient missed menses, (4) patient says abdominal, (2) patient had unprotected -or intra
pregnant. she "could" be
Urine, Pregnancy Test [UPREG] 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?
Pre-Op Day Of Procedure
Diagnostic Tests and Imaging [224714]
X-RAY CERVICAL SPINE 2-3 VIEWS [R72040] ONCE-RAD NEXT AVAILABLE, Routine
Current signs and symptoms? Inflammatory arthritis
What specific question(s) would you like answered by
this exam? Evaluate for instability prior to intubation
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
VTE Prophylaxis
VTE Prophylaxis [105649]
• If low risk for development of VTE - select VTE Prophylaxis - Reason Not Ordered
• If requires VTE prophylaxis AND
◦ LOW bleed risk - select pharmacologic agent only
◦ ABSOLUTE bleed risk - select mechanical agents only
◦ HIGH bleed risk - weigh risk of bleed vs risk of VTE development and select drug OR
mechanical agent
NOTE: Mechanical and pharmacologic agents should only be used together in patients
with a very high risk of VTE development
VTE Risk Factor Assessment Tool URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/hematology-and-
coagulation/related/name-97521-en.cckm
Sequential Compression Device (SCD) Panel
(TREATMENT AND SUPPLY) [206111]
Sequential Compression Device (SCD)
(TREATMENT) [NURTRT0028]
CONTINUOUS, Routine
Left/Right/Bilateral? Bilateral
IntraOp
Sequential Compression Device (SCD) / Foot
Pump (SUPPLY) [EQP0023]
CONTINUOUS, Routine
Left/Right/Bilateral?
Type: Knee High
IntraOp
Page 4 of 6
Printed by STRAKA, KEVIN F [KFS1] at 5/31/2017 4:18:55 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
05/2017CCKM@uwhealth.org

Apply and Maintain Anti-Embolism Stocking
[NURTRT0039]
CONTINUOUS, Routine
Does this need to be inserted/placed?
Left/Right/Bilateral? Bilateral
Type: Knee high
Pre-Op Day Of Procedure
heparin PF 5000 UNIT/0.5ML injection [156571] 5,000 units, Subcutaneous, ON CALL For 1 Doses
If patient scheduled for block, give after block placed
IntraOp
enoxaparin (LOVENOX) subcutanoeus injection
[800040]
40 mg, Subcutaneous, ON CALL For 1 Doses,
IntraOp
VTE Prophylaxis - Reason Not Ordered
[COR0008]
ONCE For 1 Occurrences, Routine
Reason Not Ordered:
Pre-Op Day Of Procedure
Surgical Prophylaxis
First Line (Single Response) [145071]
cefazolin (ANCEF) intraVENOUS - NOTE: Order
for patients greater than 41-120 kg [800000]
2 g, Intravenous, ON CALL For 1 Doses
Send on call to OR.
IntraOp
cefazolin (ANCEF) intraVENOUS - NOTE: Order
for patients greater than 121 kg and greater
[800000]
3 g, Intravenous, ON CALL For 1 Doses
Send on call to OR
IntraOp
cefoxitin (MEFOXIN) intraVENOUS - NOTE:
Order for patients 40-120 kg [800022]
2 g, Intravenous, ON CALL For 1 Doses
Send on call to OR
cefoxitin (MEFOXIN) intraVENOUS - NOTE:
Order for patients 121 kg and greater [800022]
3 g, Intravenous, ON CALL For 1 Doses
Send on call to OR
IntraOp
MRSA/Documented MRSA History (Single Response) [145072]
Order for patients 41-120 kg - Cefazolin and
Vancomycin [224462]
cefazolin (ANCEF) intraVENOUS [800000] 2 g, Intravenous, ON CALL For 1 Doses
Send on call to OR
IntraOp
vancomycin (VANCOCIN) intraVENOUS -
Maximum Dose = 2000 mg [800084]
20 mg/kg, Intravenous, ON CALL For 1 Doses
Send on call to OR
Pre-Op Day Of Procedure
Order for patients 121 kg and greater - Cefazolin
and Vancomycin [224465]
cefazolin (ANCEF) intraVENOUS [800000] 3 g, Intravenous, ON CALL For 1 Doses
Send on call to OR
IntraOp
vancomycin (VANCOCIN) intraVENOUS -
Maximum Dose = 2000 mg [800084]
20 mg/kg, Intravenous, ON CALL For 1 Doses
Send on call to OR
Pre-Op Day Of Procedure
Order for patients 40-120 kg - Cefoxitin and
Vancomycin [224468]
cefoxitin (MEFOXIN) intraVENOUS [800022] 2 g, Intravenous, ON CALL For 1 Doses
Send on call to OR
IntraOp
vancomycin (VANCOCIN) intraVENOUS
[800084]
20 mg/kg, Intravenous, ON CALL For 1 Doses
Send on call to OR
Pre-Op Day Of Procedure
Order for patients 121 kg or greater - Cefoxitin
and Vancomycin [224471]
cefoxitin (MEFOXIN) intraVENOUS [800022] 3 g, Intravenous, ON CALL For 1 Doses
Send on call to OR
IntraOp
Page 5 of 6
Printed by STRAKA, KEVIN F [KFS1] at 5/31/2017 4:18:55 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
05/2017CCKM@uwhealth.org

vancomycin (VANCOCIN) intraVENOUS -
Maximum Dose = 2000 mg [800084]
20 mg/kg, Intravenous, ON CALL For 1 Doses
Send on call to OR
Pre-Op Day Of Procedure
MRSA Negative and Immediate/Severe Reactions to Penicillin or Known Cephalosporin Allergies
[152412]
vancomycin (VANCOCIN) intraVENOUS -
Maximum Dose = 2000 mg [800084]
20 mg/kg, Intravenous, ONCE For 1 Doses
Send on call to OR
Pre-Op Day Of Procedure
MRSA and Immediate/Severe Reactions to Penicillin or Known Cephalosporin Allergies [152413]
vancomycin (VANCOCIN) intraVENOUS -
Maximum Dose = 2000 mg [800084]
20 mg/kg, Intravenous, ON CALL For 1 Doses
Send on call to OR
Pre-Op Day Of Procedure
Page 6 of 6
Printed by STRAKA, KEVIN F [KFS1] at 5/31/2017 4:18:55 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
05/2017CCKM@uwhealth.org