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201606170

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Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Ambulatory,Madison Surgery Center

MSC - Eye and Strabismus Surgery - Pediatric - Postoperative [5160]

MSC - Eye and Strabismus Surgery - Pediatric - Postoperative [5160] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Ambulatory, Madison Surgery Center


MSC - Eye and Strabismus Surgery - Pediatric - Postoperative [5160]
PostOp/Phase II
Patient to be discharged to home when deemed stable per MSC Discharge from Phase II Recovery to Home Policy
[135357]
Patient to be discharged to home when deemed stable
per MSC Discharge from Phase II Recovery to Home
Policy [NURCOM0022]
ONCE, Phase II Discharge
Outpatient Discharge Orders (Medications)
Medications - RIGHT Eye [138035]
tobramycin-dexamethasone (TOBRADEX) 0.3-0.1 %
ophthalmic susp [46771]
5 mL, 2, starting 1/14/16, Normal
sulfacetamide-prednisolone (BLEPHAMIDE) 10-0.2 %
ophthalmic susp [66422]
5 mL, 2, starting 1/14/16, Normal
sulfacetamide-prednisolone (BLEPHAMIDE) 10-0.2 %
ophthalmic ointment [46645]
3.5 g, 2, starting 1/14/16, Normal
prednisolone (PRED FORTE) 1 % ophthalmic susp
[41271]
5 mL, 2, starting 1/14/16, Normal
tobramycin-dexamethasone (TOBRADEX) 0.3-0.1 %
ophthalmic ointment - Bedtime dosing [46770]
1 Tube, 2, starting 1/14/16, Normal
tobramycin-dexamethasone (TOBRADEX) 0.3-0.1 %
ophthalmic ointment - Three times daily dosing [46770]
1 Tube, 2, starting 1/14/16, Normal
bacitracin-polymyxin b (POLYSPORIN) ophthalmic
ointment [55599]
1 Tube, 2, starting 1/14/16, Normal
artificial tears PF ophthalmic ointment [157764] 1 Tube, 2, starting 1/14/16, Normal
BACITRACIN 500 UNIT/GM OPHTH OINT [34988] 1 Tube, 2, starting 1/14/16, Normal
neomycin-polymyxin-dexamethasone 3.5-10000-0.1
ophthalmic ointment [142697]
1 Tube, , starting 1/14/16, Normal
neomycin-polymyxin-dexamethasone 3.5-10000-0.1
ophthalmic susp [142696]
1 Bottle, , starting 1/14/16, Normal
Medications - LEFT Eye [138036]
tobramycin-dexamethasone (TOBRADEX) 0.3-0.1 %
ophthalmic susp [46771]
5 mL, 2, starting 1/14/16, Normal
sulfacetamide-prednisolone (BLEPHAMIDE) 10-0.2 %
ophthalmic susp [66422]
5 mL, 2, starting 1/14/16, Normal
sulfacetamide-prednisolone (BLEPHAMIDE) 10-0.2 %
ophthalmic ointment [46645]
3.5 g, 2, starting 1/14/16, Normal
prednisolone (PRED FORTE) 1 % ophthalmic susp
[41271]
5 mL, 2, starting 1/14/16, Normal
tobramycin-dexamethasone (TOBRADEX) 0.3-0.1 %
ophthalmic ointment - Bedtime dosing [46770]
1 Tube, 2, starting 1/14/16, Normal
tobramycin-dexamethasone (TOBRADEX) 0.3-0.1 %
ophthalmic ointment - Three times daily dosing [46770]
1 Tube, 2, starting 1/14/16, Normal
bacitracin-polymyxin b (POLYSPORIN) ophthalmic
ointment [55599]
1 Tube, 2, starting 1/14/16, Normal
artificial tears PF ophthalmic ointment [157764] 1 Tube, 2, starting 1/14/16, Normal
BACITRACIN 500 UNIT/GM OPHTH OINT [34988] 1 Tube, 2, starting 1/14/16, Normal
neomycin-polymyxin-dexamethasone 3.5-10000-0.1
ophthalmic ointment [142697]
1 Tube, , starting 1/14/16, Normal
neomycin-polymyxin-dexamethasone 3.5-10000-0.1
ophthalmic susp [142696]
1 Bottle, , starting 1/14/16, Normal
Medications - BOTH Eyes [138037]
tobramycin-dexamethasone (TOBRADEX) 0.3-0.1 %
ophthalmic susp [46771]
5 mL, 2, starting 1/14/16, Normal
sulfacetamide-prednisolone (BLEPHAMIDE) 10-0.2 %
ophthalmic susp [66422]
5 mL, 2, starting 1/14/16, Normal
sulfacetamide-prednisolone (BLEPHAMIDE) 10-0.2 % 3.5 g, 2, starting 1/14/16, Normal
Page 1 of 4
Printed by GUETZLAFF, SCOTT F [SFG091] at 1/14/2016 2:17:22 PM

Copyright © 2015 University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:



















 
01/2016Lee Vermeulen, CCKM@uwhealth.org

ophthalmic ointment [46645]
prednisolone (PRED FORTE) 1 % ophthalmic susp
[41271]
5 mL, 2, starting 1/14/16, Normal
tobramycin-dexamethasone (TOBRADEX) 0.3-0.1 %
ophthalmic ointment - Bedtime dosing [46770]
1 Tube, 2, starting 1/14/16, Normal
tobramycin-dexamethasone (TOBRADEX) 0.3-0.1 %
ophthalmic ointment - Three times daily dosing [46770]
1 Tube, 2, starting 1/14/16, Normal
bacitracin-polymyxin b (POLYSPORIN) ophthalmic
ointment [55599]
1 Tube, 2, starting 1/14/16, Normal
artificial tears PF ophthalmic ointment [157764] 1 Tube, 2, starting 1/14/16, Normal
BACITRACIN 500 UNIT/GM OPHTH OINT [34988] 1 Tube, 2, starting 1/14/16, Normal
neomycin-polymyxin-dexamethasone 3.5-10000-0.1
ophthalmic ointment [142697]
1 Tube, , starting 1/14/16, Normal
neomycin-polymyxin-dexamethasone 3.5-10000-0.1
ophthalmic susp [142696]
1 Bottle, , starting 1/14/16, Normal
Medications - Analgesics [138033]
acetaMINOPHEN alcohol free (TYLENOL) 160 MG/5ML
susp [43991]
1 Bottle, 0, starting 1/14/16, No Print
ibuprofen (MOTRIN) 100 MG/5ML susp [45376] 60 mL, 0, starting 1/14/16, No Print
ACETAMINOPHEN 325 MG PO TABS [34149] starting 1/14/16, Normal
IBUPROFEN 200 MG PO TABS [38353] starting 1/14/16, Normal
Outpatient Discharge Orders (Discharge Instructions)
Activity [138893]
Activity [NURACT0011] Routine, Progressive ambulation as tolerated
No underwater activity for 14 days
Resume school/work next week as discussed with physician
No physical education classes for 7 days
Nutrition [139237]
Diet Comments [NURDIE0013] Routine, Resume preoperative diet as tolerated.
Wound Care [137589]
Wound Care [NURWND0015] Routine, Wear patch and shield until seen tomorrow at clinic.
Wear shield over operative eyes while sleeping for two
weeks. Wear glasses during the day.
Medication Instructions [138034]
Resume medications for operative eye after patch
removed [NURCOM0071]
Please complete in PATIENT FRIENDLY terms. This order
will appear on the patient's After Hospital Care Plan., Routine
No more than 4 grams of acetaminophen per day
[NURCOM0071]
Please complete in PATIENT FRIENDLY terms. This order
will appear on the patient's After Hospital Care Plan., Routine
Other Discharge Instructions [197556]
What to Expect [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This order
will appear on the patient's After Hospital Care Plan., Routine,
• Mild to moderate pain, most controlled with over the counter
Tylenol, usually gets better after 2-3 days although eye
discomfort , light sensitivity, foreign body sensation typically
persists for a few weeks.
• Temporary double vision (this is a good sign, shows eyes
are trying to work together-takes time for brain and body to
adjust - will resolve in days to week for most children).
• Don't worry if the eyes appear overcorrected initially; we will
evaluate eye alignment the week after surgery. This will
fluctuate for 2-3 months after surgery.
• Eye surface may be bright red (improves over weeks).
• Don't worry if one side of the eye is more swollen than the
other - depends on what muscle surgery was done.
• Use a cool clean compress if you want, but do not apply
pressure to the eyes.
• You may or may not be prescribed an eye drop or ointment
after surgery.
Page 2 of 4
Printed by GUETZLAFF, SCOTT F [SFG091] at 1/14/2016 2:17:22 PM

Copyright © 2015 University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:



















 
01/2016Lee Vermeulen, CCKM@uwhealth.org

When to Call Your Surgeon [138896]
When to Call Your Surgeon [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 surgeon if increased pain uncontrolled by
pain medications, prolonged vomiting or unable to eat within
24 hours.
Contact Information [135666]
Contact Information [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This order
will appear on the patient's After Hospital Care Plan., Routine,
Your Surgeon's name is @ATTPROV@ and can be reached
at @ATTENDPH@, Monday - Friday between 8:00am and
4:30pm. After 4:30pm or on weekends please call the after
hours clinic at 262-2122.
Diagnosis
Diagnosis - Pre Op [138902]
Pre-operative general physical examination [255759] Other specified pre-operative examination
Level of Service
Office Visit - Established Patients [138903]
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 [138904]
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 [138905]
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
Page 3 of 4
Printed by GUETZLAFF, SCOTT F [SFG091] at 1/14/2016 2:17:22 PM

Copyright © 2015 University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:



















 
01/2016Lee Vermeulen, CCKM@uwhealth.org

99244 - w/ Resident (GC) - Level IV LOS Code
99245 - w/ Resident (GC) - Level V LOS Code
Page 4 of 4
Printed by GUETZLAFF, SCOTT F [SFG091] at 1/14/2016 2:17:22 PM

Copyright © 2015 University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:



















 
01/2016Lee Vermeulen, CCKM@uwhealth.org