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OP – Oculoplastic Surgery – Adult – Preoperative [2930]

OP – Oculoplastic Surgery – Adult – Preoperative [2930] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Ambulatory, Ophthalmology


OP - Oculoplastic Surgery - Adult - Preoperative [2930]
for Adult Patients OnlyIntended
Pre-Op Day of Procedure
Isolation Status [114327]
Enhanced Contact Isolation - CDIFF [ISO0348] What is the reason for isolation? CDIFF
Separate order must be placed for isolation cart., Pre-
Op Day Of Procedure
Contact Isolation - MDRO (MRSA) [ISO0334] CONTINUOUS
What is the Reason for Isolation? MRSA
Separate order must be placed for isolation cart., Pre-
Op Day Of Procedure
Contact Isolation - MDRO (VRE) [ISO0334] CONTINUOUS
What is the Reason for Isolation? VRE
Separate order must be placed for isolation cart., Pre-
Op Day Of Procedure
Isolation - Protective Precautions [3000922]
Protective Precautions [ISO0349] What is the Reason for Isolation?
Isolation Cart [EQP0016] CONTINUOUS, Routine
Protective - Positive Pressure Room
[NURCOM0109]
CONTINUOUS
Airborne Isolation - Confirmed/Sustpected
Pulmonary TB [ISO0325]
Separate order must be placed for isolation cart., Pre-
Op Day Of Procedure
DVT Prophylatic Measures [114328]
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
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 immediate.
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
Pre-Op Day Of Procedure
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
Page 1 of 5
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 11:27:05 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

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.
Pre-Op Day Of Procedure
Medications [90645]
methylprednisolone sodium succ. (SOLU-
MEDROL) intraVENOUS [800058]
500 mg, Intravenous, ON CALL For 1 Doses
Give on call to OR
Pre-Op Day Of Procedure
methylprednisolone sodium succ. (SOLU-
MEDROL) intraVENOUS [800058]
1,000 mg, Intravenous, ON CALL For 1 Doses
Give on call to OR
Pre-Op Day Of Procedure
oxymetazoline (AFRIN) 0.05% nasal spray
[40671]
2 spray, Nostril (Each), EVERY 5 MINUTES For 3
Doses
Give on call to OR
Pre-Op Day Of Procedure
tetracaine 0.5% ophthalmic soln [42707] 1 drop, Eyes (Each), ON CALL For 1 Doses
Give on call to OR. For monitored anesthesia cases
only. If patched, do not remove patch to apply drops.
Apply only to unpatched eye(s).
Pre-Op Day Of Procedure
Medications - RIGHT Eye [114119]
phenylEPHRINE 2.5% ophthalmic soln - RIGHT
eye [41006]
1 drop, Eye (Right), EVERY 5 MINUTES For 2 Doses
Give on call to OR
Pre-Op Day Of Procedure
tropicamide (MYDRIACYL) 1% ophthalmic soln -
RIGHT eye [43208]
1 drop, Eye (Right), EVERY 5 MINUTES For 2 Doses
Give on call to OR
Pre-Op Day Of Procedure
Medications - LEFT Eye [114120]
phenylEPHRINE 2.5% ophthalmic soln - LEFT
eye [41006]
1 drop, Eye (Left), EVERY 5 MINUTES For 2 Doses
Give on call to OR
Pre-Op Day Of Procedure
tropicamide (MYDRIACYL) 1% ophthalmic soln -
LEFT eye [43208]
1 drop, Eye (Left), EVERY 5 MINUTES For 2 Doses
Give on call to OR
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, 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
IntraOp
First Line (Single Response) [223854]
cefazolin (ANCEF) intraVENOUS - NOTE:
Patients who are 40-120 kg [800000]
2 g, Intravenous, ON CALL For 1 Doses, IntraOp
cefazolin (ANCEF) intraVENOUS - NOTE:
Patients who are greater than 120 kg [800000]
3 g, Intravenous, ON CALL For 1 Doses, IntraOp
IgE-mediated or severe reaction to beta-lactam with or without MRSA [223859]
vancomycin (VANCOCIN) intraVENOUS [800084] 20 mg/kg, Intravenous, ON CALL For 1 Doses, Pre-
Op Day Of Procedure
Page 2 of 5
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 11:27:05 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

MRSA/Documented History of MRSA (Single Response) [147679]
Patients who are 40 - 120 kg [228793]
cefazolin (ANCEF) intraVENOUS [800000] 2 g, Intravenous, ON CALL For 1 Doses, IntraOp
vancomycin (VANCOCIN) intraVENOUS -
Maximum Dose = 2000 mg/dose [800084]
20 mg/kg, Intravenous, ON CALL For 1 Doses, Pre-
Op Day Of Procedure
Patients who are greater than 120 kg [228795]
cefazolin (ANCEF) intraVENOUS [800000] 3 g, Intravenous, ON CALL For 1 Doses, IntraOp
vancomycin (VANCOCIN) intraVENOUS -
Maximum Dose = 2000 mg/dose [800084]
20 mg/kg, Intravenous, ON CALL For 1 Doses, Pre-
Op Day Of Procedure
Medications - Other [186665]
alcohol dehydrated 98 % ampule [34323] 5 mL, Other, ONCE For 1 Doses
To use intraoperatively for evisceration
IntraOp
PACU
Non-Categorized Patient Care Orders [91705]
Elevate Head Of Bed [NURACT0002] Equal to (degrees):
Greater than (degrees):
Less than (degrees):
Other options:
Routine, CONTINUOUS, PACU
Contingency Parameters [91281]
Notify Anesthesiology [NURCOM0001] Provider to Notify: Other (Comment)
If systolic blood pressure > (mmHg):
If systolic blood pressure < (mmHg):
If diastolic blood pressure > (mmHg):
If diastolic blood pressure < (mmHg):
If temperature > (C):
If temperature < (C):
If heart rate > (bpm):
If heart rate < (bpm):
If respiratory rate >:
If respiratory rate <:
If blood glucose > (mg/dL):
If blood glucose < (mg/dL):
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL):
Other:
PACU
Post-Op/Phase II
Medications - Analgesics - Acetaminophen [223865]
acetaMINOPHEN (TYLENOL) tab [34149] 650 mg, Oral, ONCE 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 15mg/kg per dose for peds <40kg
Post-Op/Phase II
Medications - Analgesics - Opioids (Single Response) [101584]
Page 3 of 5
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 11:27:05 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

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
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
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 [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
Page 4 of 5
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 11:27:05 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

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
Preoperative Exam (Global) [1265]
Preoperative H&P, No Charge, Surgical Package LOS Code
Page 5 of 5
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 11:27:05 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org