/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/order-sets/,/clinical/cckm-tools/content/order-sets/ambulatory/,/clinical/cckm-tools/content/order-sets/ambulatory/general-surgery/,

/clinical/cckm-tools/content/order-sets/ambulatory/general-surgery/name-98583-en.cckm

201606170

page

100

UWHC,UWMF,

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

OP/FDS General Surgery - Pediatric - Pre-operative [4996]

OP/FDS General Surgery - Pediatric - Pre-operative [4996] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Ambulatory, General Surgery


OP/FDS General Surgery - Pediatric - Pre-operative [4996]
PreOp Day of Procedure
Nursing Communication [105629]
No Pre-op Day of Surgery Orders Needed
[NURCOM0059]
CONTINUOUS, Starting today, 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 Resistant Organism
(XDR) [ISO0320]
CONTINUOUS, Pre-Op Day Of Procedure
Isolation Cart [EQP0016] CONTINUOUS, Routine, Pre-Op Day Of Procedure
Medications - Steroids (Single Response) [86919]
hydrocortisone sod suc in sodium chloride 0.9% injection
- NOTE: Recommended dose = 1 mg/kg (Max dose 50
mg) [800189]
1 mg/kg, Intravenous, ONCE For 1 Doses
Give 30 minutes prior to incision
Pre-Op Day Of Procedure
Laboratory [94896]
CBC WITH DIFFERENTIAL [CBC] 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
ELECTROLYTES, WHOLE BLOOD [HCWBLYTS] 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
Laboratory - Pregnancy Test [81397]
Obtain pregnancy test if female between menarche & menopause and any of: (1) surgery is pelvic, renal, or intra-
abdominal, (2) patient had unprotected intercourse, (3) patient missed menses, (4) patient says she "could" be pregnant.
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
Tests [91574]
TYPE AND SCREEN [HCTS] STAT - RN COLLECT, Starting today For 1 Occurrences,
Page 1 of 5
Printed by GUETZLAFF, SCOTT F [SFG091] at 11/12/2015 12:27:51 PM
Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison

 

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
Surgical Prophylaxis - Abdominal
Gastrocutaneous Fistula Closure, Ladd's Procedure, Laparoscopic Nissen Fundoplication, Redo Nissen, Urachal
Remnant Excision
First Line [185884]
cefoxitin (MEFOXIN) intraVENOUS [800022] 40 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op Day Of
Procedure
MRSA/Documented MRSA History [185885]
cefoxitin AND vancomycin [195682]
cefoxitin (MEFOXIN) intraVENOUS [800022] 40 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op Day Of
Procedure
vancomycin (VANCOCIN) intraVENOUS - NOTE: max
dose of 2 g [800084]
15 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op Day Of
Procedure
Patients with Immediate/Severe Reactions to Penicillin or Known Cephalosporin Allergies Who Are MRSA negative
(Single Response) [185889]
ciprofloxacin AND metRONIDazole [195674]
ciprofloxacin (CIPRO) intraVENOUS [800031] 10 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op Day Of
Procedure
metRONIDazole (FLAGYL) intraVENOUS [800062] 15 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op Day Of
Procedure
vancomycin (VANCOCIN) intraVENOUS - (max dose of
2 grams) - NOTE: Order for gastrocutaneous fistula
closure [800084]
15 mg/kg, Intravenous, ONCE For 1 Doses
MRSA and Immediate/Severe Reactions to Penicillin or Known Cephalosporin Allergies (Single Response) [195583]
ciprofloxacin AND medRONIDazole AND vancomycin
[195676]
ciprofloxacin (CIPRO) intraVENOUS [800031] 10 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op Day Of
Procedure
metRONIDazole (FLAGYL) intraVENOUS [800062] 15 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op Day Of
Procedure
vancomycin (VANCOCIN) intraVENOUS [800084] 15 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op Day Of
Procedure
vancomycin (VANCOCIN) intraVENOUS - - (max dose
of 2 grams) - NOTE: Order for gastrocutaneous fistula
closure [800084]
15 mg/kg, Intravenous, ONCE For 1 Doses
Surgical Prophylaxis - Appendectomy
First Line [186339]
ceftiaxone AND metronidazole [195675]
ceftriaxone (ROCEPHIN) intraVENOUS [800027] 50 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op Day Of
Procedure
metRONIDazole (FLAGYL) intraVENOUS [800062] 15 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op Day Of
Procedure
MRSA/Documented MRSA History [185885]
cefoxitin AND vancomycin [195682]
cefoxitin (MEFOXIN) intraVENOUS [800022] 40 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op Day Of
Procedure
vancomycin (VANCOCIN) intraVENOUS - NOTE: max
dose of 2 g [800084]
15 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op Day Of
Procedure
Page 2 of 5
Printed by GUETZLAFF, SCOTT F [SFG091] at 11/12/2015 12:27:51 PM
Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison

 

Patients with Immediate/Severe Reactions to Penicillin or Known Cephalosporin Allergies Who Are MRSA negative
(Single Response) [185889]
ciprofloxacin AND metRONIDazole [195674]
ciprofloxacin (CIPRO) intraVENOUS [800031] 10 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op Day Of
Procedure
metRONIDazole (FLAGYL) intraVENOUS [800062] 15 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op Day Of
Procedure
vancomycin (VANCOCIN) intraVENOUS - (max dose of
2 grams) - NOTE: Order for gastrocutaneous fistula
closure [800084]
15 mg/kg, Intravenous, ONCE For 1 Doses
MRSA and Immediate/Severe Reactions to Penicillin or Known Cephalosporin Allergies (Single Response) [195583]
ciprofloxacin AND medRONIDazole AND vancomycin
[195676]
ciprofloxacin (CIPRO) intraVENOUS [800031] 10 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op Day Of
Procedure
metRONIDazole (FLAGYL) intraVENOUS [800062] 15 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op Day Of
Procedure
vancomycin (VANCOCIN) intraVENOUS [800084] 15 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op Day Of
Procedure
vancomycin (VANCOCIN) intraVENOUS - - (max dose
of 2 grams) - NOTE: Order for gastrocutaneous fistula
closure [800084]
15 mg/kg, Intravenous, ONCE For 1 Doses
Surgical Prophylaxis - CCAM Resection/VATS
First Line [185917]
cefuroxime (ZINACEF) intraVENOUS [800030] 50 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op Day Of
Procedure
MRSA/Documented MRSA History [185919]
Choose both cefazolin and vancomycin
Cefuroxime - Vancomycin (Maximum Dose 2 grams)
[195681]
cefuroxime (ZINACEF) intraVENOUS [800030] 50 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op Day Of
Procedure
vancomycin (VANCOCIN) intraVENOUS [800084] 15 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op Day Of
Procedure
Patients with Immediate/Severe Reactions to Penicillin or Known Cephalosporin Allergies [195587]
vancomycin (VANCOCIN) intraVENOUS - NOTE: max
dose of 2 grams [800084]
15 mg/kg, Intravenous, ONCE For 1 Doses
Surgical Prophylaxis - Clean Procedure, Skin Coverage Only
Central Line/Port Placement, Central Line/Port Remval, Cholecystectomy (possible intraop cholangiogram), Cyst/mass
Excission, Foreign Body Removal, Laparoscopic Splenectomy, Nuss Bar Removal, Nuss Procedure, Orchopexy, PEG
Tube Placement, Pilonidal Cyst Removal, Pyloroplasty, Ravitch Bar Removal, Ravitch Procedure
First Line [195590]
cefazolin (ANCEF) intraVENOUS [800000] 30 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op Day Of
Procedure
MRSA/Documented MRSA History [186340]
cefazolin AND vancomycin [195677]
cefazolin (ANCEF) intraVENOUS [800000] 30 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op Day Of
Procedure
vancomycin (VANCOCIN) intraVENOUS [800084] 15 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op Day Of
Procedure
Patients with Immediate/Severe Reactions to Penicillin or Known Cephalosporin Allergies Who Are MRSA negative
(Single Response) [195584]
vancomycin (VANCOCIN) intraVENOUS - NOTE: max
dose of 2 grams [800084]
15 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op Day Of
Procedure
ciprofloxacin AND metRONIDazole - NOTE: order for
cholecystectomy (possible intraop cholangiogram)
Page 3 of 5
Printed by GUETZLAFF, SCOTT F [SFG091] at 11/12/2015 12:27:51 PM
Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison

 

[195678]
ciprofloxacin (CIPRO) intraVENOUS [800031] 10 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op Day Of
Procedure
metRONIDazole (FLAGYL) intraVENOUS [800062] 15 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op Day Of
Procedure
MRSA and Immediate/Severe Reactions to Penicillin or Known Cephalosporin Allergies (Single Response) [195585]
vancomycin (VANCOCIN) intraVENOUS - NOTE: max
dose of 2 grams [800084]
15 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op Day Of
Procedure
ciprofloxacin AND medRONIDazole AND vancomycin
[195679]
ciprofloxacin (CIPRO) intraVENOUS [800031] 10 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op Day Of
Procedure
metRONIDazole (FLAGYL) intraVENOUS [800062] 15 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op Day Of
Procedure
vancomycin (VANCOCIN) intraVENOUS [800084] 15 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op Day Of
Procedure
Surgical Prophylaxis - Colorectal
Bowel Resection, Colostomy Closure, EUA and Dilations, Fistulotomy/Fistulectomy, Laparoscopic Colectomy,
PSARP/Anoplasty, Soave Endorectal
First Line [185884]
cefoxitin (MEFOXIN) intraVENOUS [800022] 40 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op Day Of
Procedure
MRSA/Documented MRSA History [185885]
cefoxitin AND vancomycin [195682]
cefoxitin (MEFOXIN) intraVENOUS [800022] 40 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op Day Of
Procedure
vancomycin (VANCOCIN) intraVENOUS - NOTE: max
dose of 2 g [800084]
15 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op Day Of
Procedure
Patients with Immediate/Severe Reactions to Penicillin or Known Cephalosporin Allergies Who Are MRSA negative
(Single Response) [185889]
ciprofloxacin AND metRONIDazole [195674]
ciprofloxacin (CIPRO) intraVENOUS [800031] 10 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op Day Of
Procedure
metRONIDazole (FLAGYL) intraVENOUS [800062] 15 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op Day Of
Procedure
vancomycin (VANCOCIN) intraVENOUS - (max dose of
2 grams) - NOTE: Order for gastrocutaneous fistula
closure [800084]
15 mg/kg, Intravenous, ONCE For 1 Doses
MRSA and Immediate/Severe Reactions to Penicillin or Known Cephalosporin Allergies (Single Response) [195583]
ciprofloxacin AND medRONIDazole AND vancomycin
[195676]
ciprofloxacin (CIPRO) intraVENOUS [800031] 10 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op Day Of
Procedure
metRONIDazole (FLAGYL) intraVENOUS [800062] 15 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op Day Of
Procedure
vancomycin (VANCOCIN) intraVENOUS [800084] 15 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op Day Of
Procedure
vancomycin (VANCOCIN) intraVENOUS - - (max dose
of 2 grams) - NOTE: Order for gastrocutaneous fistula
closure [800084]
15 mg/kg, Intravenous, ONCE For 1 Doses
PACU
Diagnostic Tests and Imaging - For Patients Having Central Venous Catheter Placement [86416]
X-RAY CHEST AP VIEW [R71010] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, Routine
Current signs and symptoms? Central venous catheter
Page 4 of 5
Printed by GUETZLAFF, SCOTT F [SFG091] at 11/12/2015 12:27:51 PM
Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison

 

placement
What specific question(s) would you like answered by this
exam? Rule out pneumothorax
Relevant recent/past history? Central venous catheter
placement
Is patient pregnant?
If being performed remotely, where? Bedside
Transport Method: Floor Determined/Entered
To be done in PACU, PACU
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
Preoperative Exam (Global) [1265]
Preoperative H&P, No Charge, Surgical Package LOS Code
Page 5 of 5
Printed by GUETZLAFF, SCOTT F [SFG091] at 11/12/2015 12:27:51 PM
Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison