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201712341

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Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Ambulatory,Orthopedics/Rehab

OP - Orthopedics - Minor Procedure - Adult - Postoperative [2864]

OP - Orthopedics - Minor Procedure - Adult - Postoperative [2864] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Ambulatory, Orthopedics/Rehab


OP - Orthopedics - Minor Procedure - Adult - Postoperative [2864]
for Adult Patients OnlyIntended
PACU
Laboratory [89111]
PROTHROMBIN TIME/INR [PT] 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?
PACU
HEMATOCRIT [HCT] 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?
PACU
Diagnostic Tests and Imaging [89112]
X-RAY ANKLE >= 3 VIEWS LEFT [R73610L] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, Routine
Current signs and symptoms?
What specific question(s) would you like answered by
this exam?
Relevant recent/past history?
Is patient pregnant?
If being performed remotely, where? Bedside
Last patient weight? (will auto pull in value and date in
comment):
Transport Method: Floor Determined/Entered
To be done in PACU, PACU
X-RAY ANKLE >= 3 VIEWS RIGHT [R73610R] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, Routine
Current signs and symptoms?
What specific question(s) would you like answered by
this exam?
Relevant recent/past history?
Is patient pregnant?
If being performed remotely, where? Bedside
Last patient weight? (will auto pull in value and date in
comment):
Transport Method: Floor Determined/Entered
To be done in PACU, PACU
X-RAY ELBOW 2 VIEWS LEFT [R73070L] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, Routine
Current signs and symptoms?
What specific question(s) would you like answered by
this exam?
Relevant recent/past history?
Is patient pregnant?
If being performed remotely, where? Bedside
Last patient weight? (will auto pull in value and date in
comment):
Transport Method: Floor Determined/Entered
To be done in PACU, PACU
Page 1 of 6
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 12:17:48 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

X-RAY ELBOW 2 VIEWS RIGHT [R73070R] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, Routine
Current signs and symptoms?
What specific question(s) would you like answered by
this exam?
Relevant recent/past history?
Is patient pregnant?
If being performed remotely, where? Bedside
Last patient weight? (will auto pull in value and date in
comment):
Transport Method: Floor Determined/Entered
To be done in PACU, PACU
X-RAY KNEE 1-2 VIEWS LEFT [R73560L] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, Routine
Current signs and symptoms?
What specific question(s) would you like answered by
this exam?
Relevant recent/past history?
Is patient pregnant?
If being performed remotely, where? Bedside
Last patient weight? (will auto pull in value and date in
comment):
Transport Method: Floor Determined/Entered
To be done in PACU, PACU
X-RAY KNEE 1-2 VIEWS RIGHT [R73560R] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, Routine
Current signs and symptoms?
What specific question(s) would you like answered by
this exam?
Relevant recent/past history?
Is patient pregnant?
If being performed remotely, where? Bedside
Last patient weight? (will auto pull in value and date in
comment):
Transport Method: Floor Determined/Entered
To be done in PACU, PACU
X-RAY SHOULDER >= 2 VIEWS LEFT
[R73030L]
ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, Routine
Current signs and symptoms?
What specific question(s) would you like answered by
this exam?
Relevant recent/past history?
Is patient pregnant?
If being performed remotely, where? Bedside
Last patient weight? (will auto pull in value and date in
comment):
Transport Method: Floor Determined/Entered
To be done in PACU, PACU
Page 2 of 6
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 12:17:48 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

X-RAY SHOULDER >= 2 VIEWS RIGHT
[R73030R]
ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, Routine
Current signs and symptoms?
What specific question(s) would you like answered by
this exam?
Relevant recent/past history?
Is patient pregnant?
If being performed remotely, where? Bedside
Last patient weight? (will auto pull in value and date in
comment):
Transport Method: Floor Determined/Entered
To be done in PACU, PACU
PostOp/Phase II
Analgesics - Acetaminophen - PRN [218468]
acetaMINOPHEN (TYLENOL) tab [34149] 650 mg, Oral, ONCE PRN For 1 Doses, pain
See Pain Management Algorithm for the Selection of
As-Needed Analgesics
Post-Op/Phase II
Analgesics - NSAIDS - PRN [218470]
ibuprofen (MOTRIN) tab [38355] 800 mg, Oral, ONCE PRN For 1 Doses, pain
See Pain Management Algorithm for the Selection of
As-Needed Analgesics
Post-Op/Phase II
Analgesics - Opioids - Oral - PRN (Single Response) [92392]
hydrocodone-acetaMINOPHEN (NORCO) 5-325
mg per tab RANGE [750021]
1-2 tab, Oral, ONCE PRN For 1 Doses, pain
No more than 4 grams acetaminophen per 24 hours
for adults or 15mg/kg per dose for peds <40kg.
See Pain Management Algorithm for the Selection of
As-Needed Analgesics
Post-Op/Phase II
oxycodone tab RANGE [750032] 5-10 mg, Oral, ONCE PRN For 1 Doses, pain
See Pain Management Algorithm for the Selection of
As-Needed Analgesics
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
Activity/Return to Work [89208]
May Resume Normal Activities 1-2 Week(s) After
Surgery [NURACT0011]
Routine, No lifting greater than 20 pounds for 5 days
after surgery. Check with your doctor before going
back to work.
Return to Work [NURACT0011] Routine, Patient may return to work in *** days.
Driving Instructions [NURACT0011] Routine, No driving while on pain medication or {while
in sling/while in brace/while on crutches:21974}.
Keep leg brace in full locked position until follow-
up appointment [NURACT0011]
Routine
Keep arm in sling until follow-up appointment
[NURACT0011]
Routine
Walking Boot [NURACT0011] Routine
Use crutches while walking [NURACT0011] Routine
Page 3 of 6
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 12:17:48 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

Short Leg Splint [NURACT0011] Routine, Patient to wear splint *** hours per day.
Keep arm in sling until until nerve block wears off
[NURACT0011]
Routine
Post-op Shoe [NURACT0011] Routine
Cast [NURACT0011] Routine
Weight Bearing Instructions [NURACT0011] Routine
Elevation [NURACT0011] Routine
Elevate the extremity over the level of the heart
[NURACT0011]
Routine
Okay to ice the fingers/wrist as needed (keep
dressing dry) [NURACT0011]
Routine
Medication Instructions [92409]
No non-steroidal anti-inflammatories (NSAIDs) in
any form, except baby aspirin (These impair bone
healing) [NURCOM0022]
Routine
Nutrition [89210]
Normal Diet as Tolerated (Low Fat Initially is
Best) [NUT8888]
Routine
General:
Diet Modifications:
Other Diet Modifications:
Normal diet as tolerated, low fat initially is best.
Wound Care [89211]
Wound Care [NURWND0018] Routine, Leave bandage on for *** days. If bandage
becomes soaked in first 24 hours call the Ortho Clinic
at 608-263-7540 from 8am - 4:30pm. On weekends
call 608-262-0486. No swimming or soaking in water
for 7 days after surgery. OK to shower as long as
bandage stays dry. Cover with plastic bag or
equivalent as needed. Do NOT use ointments,
powders, or creams on the wound.
Contingency Parameters [89212]
Notify Doctor [NURCOM0001] Routine, Call doctor for nausea or vomiting lasting
more than 24 hours; if you have not had a bowel
movement in 3 days; temperature above 100.4 F by
mouth, for 2 readings taken 4 hours apart; excess
swelling or bleeding; increased redness and/or warmth
at the incision site; pus-like drainage; pain not relieved
by pain pills; rapid or excess bruising (some bruising is
normal); sudden shortness of breath or cough;
cramping/swelling to leg; and/or dark urine.
Medications - Prescriptions [89049]
acetaMINOPHEN (TYLENOL) 325 mg tab - 2t
q4h prn [34149]
650 mg, 100 tab, 0, starting 12/7/17, Normal, Phase II
Discharge
aspirin EC (ASPIRIN) 325 MG delayed release
tab [49098]
starting 12/7/17, Normal, Phase II Discharge
aspirin 81 mg chew tab - 1x/d [34786] 81 mg, 100 tab, 0, starting 12/7/17, Normal, Phase II
Discharge
hydrocodone-acetaMINOPHEN (NORCO) 5-325
mg per tab - q4h prn [71425]
1-2 tab, 20 tab, 0, starting 12/7/17 until 1/6/18,
Normal, Phase II Discharge
ibuprofen (MOTRIN) 800 mg tab - q8h prn
[38355]
400 mg, starting 12/7/17, Normal, Phase II Discharge
oxycodone 5 mg tab - 1-2t q4h prn [45976] 5-10 mg, 20 tab, 0, starting 12/7/17 until 1/6/18,
Normal, Phase II Discharge
senna-docusate (SENOKOT-S) 8.6-50 mg per tab
[60530]
2 tab, 30 tab, 0, starting 12/7/17, Normal, Phase II
Discharge
Page 4 of 6
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 12:17:48 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

Follow-Up Appointments [89214]
Patient to Schedule Orthopedic Follow-Up
[NURCOM0056]
Routine
Purpose: Postoperative follow-up clinic visit
With whom:
For when: 1 day after surgery
Patient to Schedule Orthopedic Follow-Up
[NURCOM0056]
Routine
Purpose: Postoperative follow-up visit
With whom:
For when: 2 weeks after surgery
Patient Needs X-Rays at Follow-Up Clinic Visit
[NURCOM0022]
Routine, Order surgery-specific X-Ray to be
performed at follow-up clinic visit
Patient Needs MRI at Follow-Up Clinic Visit
[NURCOM0022]
Routine, Order surgery-specific MRI to be performed
at follow-up clinic visit
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 - New or Established [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
Page 5 of 6
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 12:17:48 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

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 6 of 6
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 12:17:48 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org