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/clinical/cckm-tools/content/order-sets/ambulatory/gynecology/name-98573-en.cckm

20180112

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

OP - Gynecology - Oncology - Postoperative [2985]

OP - Gynecology - Oncology - Postoperative [2985] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Ambulatory, Gynecology


OP - Gynecology - Oncology - Postoperative [2985]
for Adult Patients OnlyIntended
PostOp/Phase II
Analgesics - Opioid (Oral) (Single Response) [92130]
hydrocodone-acetaMINOPHEN (NORCO) 5-325
mg per tab [71425]
1 tab, Oral, ONCE PRN For 1 Doses, 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 tab, Oral, ONCE PRN For 1 Doses, 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
oxycodone-acetaminophen (PERCOCET) 5-325
mg per tab [40668]
1 tab, Oral, ONCE PRN For 1 Doses, 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
oxycodone tab [45976] 5 mg, Oral, ONCE PRN For 1 Doses, pain
See Pain Management Algorithm for the Selection of
As-Needed Analgesics
oxycodone tab [45976] 10 mg, Oral, ONCE PRN For 1 Doses, pain
See Pain Management Algorithm for the Selection of
As-Needed Analgesics
Analgesics - NSAID (Oral) (Single Response) [198423]
ibuprofen (MOTRIN) tab RANGE [750024] 400-600 mg, Oral, ONCE PRN For 1 Doses, pain
See Pain Management Algorithm for the Selection of
As-Needed Analgesics
Post-Op/Phase II
Respiratory Therapy [244006]
Respiratory Therapy per Protocol [RT0035] Routine
Protocol Type:
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
Outpatient Discharge Orders
Analgesics - Opioid (Oral) - Prescriptions (Single Response) [92129]
hydrocodone-acetaMINOPHEN (NORCO) 5-325
mg per tab - q4h prn [71425]
1-2 tab, 0, starting 1/10/18, Normal, Phase II
Discharge
hydrocodone-acetaMINOPHEN (NORCO) 10-325
mg per tab - q4h prn [64942]
1 tab, 0, starting 1/10/18, Normal, Phase II Discharge
oxycodone-acetaminophen (PERCOCET) 5-325
mg per tab - q4h prn [40668]
1-2 tab, 0, starting 1/10/18, Normal, Phase II
Discharge
oxycodone-acetaminophen (PERCOCET) 7.5-325
mg per tab - q4h prn [68619]
1 tab, 0, starting 1/10/18, Normal, Phase II Discharge
Page 1 of 3
Printed by WILLIAMS, HEATHER R [HRS0] at 1/10/2018 3:16:49 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

oxycodone 5 mg tab - 1-2t q 4h prn [45976] 5-10 mg, 0, starting 1/10/18, Normal, Phase II
Discharge
Analgesics - NSAID (Oral) - Prescriptions (Single Response) [197966]
ibuprofen (MOTRIN) 200 MG tab [38353] 400-600 mg, 100 tab, 0, starting 1/10/18, Normal
Medications - General - Prescriptions [198425]
senna-docusate (SENNA-DOCUSATE SODIUM)
8.6-50 MG per tab [60530]
2 tab, starting 1/10/18, Normal
polyethylene glycol (MIRALAX) oral powder
[61353]
17 g, starting 1/10/18, Normal, Phase II Discharge
Activity/Return to Work [91328]
Activity [NURACT0008] Routine
Discharge Activity:
May return to work/school in ***.
No lifting greater than *** for ***.
No driving for 2 days or while taking pain pills.
No sex and nothing in the vagina for***., Phase II
Discharge
Suture Line Care - Wound Care [92114]
Discharge - Suture Line Care [DC0021] Routine, Patient has (select all that apply): {Select
type(s):4001480}
Leave original surgical dressing on for 24-48 hours.
Keep incision clean and dry. You may shower after
surgical dressing is removed. Let clean water run
over incision and gently pat dry after shower. No
soaking, swimming, hot tubs until cleared by MD after
postoperative follow up.
Other: ***
Wound Care [NURWND0015] Routine
Vulvar Care [198424]
Sitz Bath 2 X Daily [NURCOM0022] CONTINUOUS, Clean perineal area with warm water
peri bottle.
Follow-Up Appointments (Single Response) [92115]
Patient to Schedule Appointment [NURCOM0056] Routine
Purpose:
With whom:
For when:
No Follow-Up Appointment is Necessary
[NURCOM0022]
Routine
Symptom Management [105169]
Symptom Management [NURMON0060] Routine, Call your doctor if you have any of these
symptoms: increased pain not relieved by medication,
fever over 100.4 degrees for two readings taken 4
hours apart, increased shortness of breath,
redness/drainage at incision site, inability to tolerate
food/liquid by mouth, vaginal bleeding greater than
one pad per hour.
Call 911 for emergencies.
Call your doctor at Gynecology Oncology clinic
Monday-Friday 8:00am to 5:00pm at 608-263-1548.
To reach a doctor after hours or on weekends, call
608-263-1548 and ask for the gynecology oncology
physician on call.
For clinic appointments call 608-265-1700. Toll free
phone number is 800-323-8942. Clinic fax number is
608-263-2201.
Diagnosis
Page 2 of 3
Printed by WILLIAMS, HEATHER R [HRS0] at 1/10/2018 3:16:49 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

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 [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
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 3 of 3
Printed by WILLIAMS, HEATHER R [HRS0] at 1/10/2018 3:16:49 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org