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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 - Podiatry - General - Adult - Pre/Postoperative [4888]

OP - Podiatry - General - Adult - Pre/Postoperative [4888] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Ambulatory, Orthopedics/Rehab


OP - Podiatry - General - Adult - Pre/Postoperative [4888]
for Adult Patients OnlyIntended
Pre-Op Day of Procedure
Isolation Status [97372]
Enhanced Contact Isolation - CDIFF [ISO0348] What is the reason for isolation?
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 [240760]
Protective Precautions [ISO0349] What is the Reason for Isolation?
Pre-Op Day Of Procedure
Isolation Cart [EQP0016] CONTINUOUS, Routine, Pre-Op Day Of Procedure
Protective - Positive Pressure Room
[NURCOM0109]
CONTINUOUS
Isolation - Contact - Multidrug Resistant
Organism (MDRO) [233557]
Contact Isolation - MDRO [ISO0334] CONTINUOUS
What is the Reason for Isolation? MDR
Pre-Op Day Of Procedure
Isolation Cart [EQP0016] CONTINUOUS, Routine, Pre-Op Day Of Procedure
Isolation - Contact - Multidrug Resistant
Organism (XDR) [233558]
Contact Isolation - MDRO (XDR) [ISO0334] CONTINUOUS
What is the Reason for Isolation? XDR
Pre-Op Day Of Procedure
Isolation Cart [EQP0016] CONTINUOUS, Routine, 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
Premedications for Needle Insertion [241915]
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.
Page 1 of 6
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 11:46:21 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

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
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
Surgical Prophylaxis
First Line (Single Response) [151944]
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 121 kg and greater [800000]
3 g, Intravenous, ON CALL For 1 Doses, IntraOp
MRSA/Documented MRSA History (Single Response) [152274]
Cefazolin - Vancomycin - NOTE: Patients who
are 40-120 kg [228864]
cefazolin (ANCEF) intraVENOUS [800000] 2 g, Intravenous, ON CALL For 1 Doses, IntraOp
vancomycin (VANCOCIN) intraVENOUS
[800084]
20 mg/kg, Intravenous, ON CALL For 1 Doses,
IntraOp
Cefazolin - Vancomycin - NOTE: Patients who
are 121 kg and greater [228865]
cefazolin (ANCEF) intraVENOUS [800000] 3 g, 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
Immediate/Severe Reactions to Penicillin or Known Cephalosporin Allergies [151964]
vancomycin (VANCOCIN) intraVENOUS [800084] 20 mg/kg, Intravenous, ON CALL For 1 Doses
Maximum Dose of 2000 mg
Pre-Op Day Of Procedure
PostOp Phase II
Activity [152003]
Elevate Foot Above Heart with Ice
[NURACT0010]
Extremity:
Routine, CONTINUOUS, Starting today, Post-
Op/Phase II
Elevate Foot Above Heart without Ice
[NURACT0010]
Extremity:
Routine, CONTINUOUS, Starting today, Post-
Op/Phase II
Page 2 of 6
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 11:46:21 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

Ad Lib [NURACT0008] CONTINUOUS, Starting today, Routine
AD LIB: ad lib
AMBULATE:
CHAIR:
DANGLE:
BEDREST:
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Post-Op/Phase II
Ambulate with Crutches [NURACT0008] CONTINUOUS, Starting today, Routine
AD LIB:
AMBULATE: other (comment)
CHAIR:
DANGLE:
BEDREST:
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
With crutches., Post-Op/Phase II
Diagnostic Tests and Imaging [152282]
X-RAY FOOT >= 3 VIEWS LEFT [R73630L] 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?
Last patient weight? (will auto pull in value and date in
comment):
Transport Method: Floor Determined/Entered
Post-Op/Phase II
X-RAY FOOT >= 3 VIEWS RIGHT [R73630R] 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?
Last patient weight? (will auto pull in value and date in
comment):
Transport Method: Floor Determined/Entered
Post-Op/Phase II
Page 3 of 6
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 11:46:21 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

X-RAY ANKLE >= 3 VIEWS LEFT [R73610L] ONCE-RAD NEXT AVAILABLE 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?
Last patient weight? (will auto pull in value and date in
comment):
Transport Method: Floor Determined/Entered
Post-Op/Phase II
X-RAY ANKLE >= 3 VIEWS RIGHT [R73610R] ONCE-RAD NEXT AVAILABLE 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?
Last patient weight? (will auto pull in value and date in
comment):
Transport Method: Floor Determined/Entered
Post-Op/Phase II
Wound Care [152283]
Wound Care - Foot [NURWND0031] CONTINUOUS, Starting today, Routine
Wound Type:
Wound Site:
Wound Location:
Assess Frequency:
Care Frequency:
Irrigate With: Normal Saline
Soak With:
Apply (Must also enter separate medication order to
obtain drug):
Primary Dressing: Sterile Gauze
Secondary Dressing: Gauze Wrap (KERLIX)
Leave the dressing dry and intact. Reinforce dressing
with gauze if drainage is present. Page surgeon if
there is persistent bleeding not easily contained by the
dressing., Post-Op/Phase II
Contingency Parameters [152015]
Page 4 of 6
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 11:46:21 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

Notify Provider [NURCOM0001] Provider to Notify: Provider
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: Bleeding not contained by dressing.
Post-Op/Phase II
Analgesics - Acetaminophen - Oral - PRN [218564]
acetaMINOPHEN (TYLENOL) tab [34149] 650 mg, 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
Analgesics - NSAIDS - PRN (Single Response) [152279]
ibuprofen (MOTRIN) tab [38353] 800 mg, Oral, ONCE PRN For 1 Doses, pain
See Pain Management Algorithm for the Selection of
As-needed Analgesics
Post-Op/Phase II
naproxen (NAPROSYN) tab [720103] 500 mg, Oral, ONCE PRN For 1 Doses, pain
See Pain Management Algorithm for the Selection of
As-needed Analgesics
Post-Op/Phase II
ketOROLAC (TORADOL) injection [800050] 15 mg, Intravenous, ONCE PRN For 1 Doses, pain
See Pain Management Algorithm for the Selection of
As-needed Analgesics
If ordered IV: push over 15-30 seconds
Post-Op/Phase II
Analgesics - Opioids - Oral - PRN (Single Response) [218563]
oxycodone tab [45976] 5 mg, 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) 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
Page 5 of 6
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 11:46:21 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

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
Outpatient Discharge Orders
Activity/Return to Work [152023]
Ice and Elevate [NURACT0011] Routine, Elevate foot with ice 20 minutes per hour
while awake until follow up appointment.
Wear walking boot at all times and when walking.
Continue to wear until next follow-up
appointment. [NURACT0011]
Routine
Use crutches while walking [NURACT0011] Routine
Short Leg Splint [NURACT0011] Routine, Patient to wear splint 24 hours per day.
Non-Weight Bearing [NURCOM0022] Routine
You Should Use Crutches/Walker:
You May Move Your Ankle:
You May Move Your Toes:
Weight Bear as Tolerated [NURCOM0022] Routine
You Should Use Crutches/Walker:
You May Move Your Ankle:
You May Move Your Toes:
Partial Weight Bearing, Heel Only
[NURCOM0022]
Routine
You Should Use Crutches/Walker:
You May Move Your Ankle:
You May Move Your Toes:
Wound Care [152284]
Wound Care [NURWND0015] Routine, Leave bandage on until follow up
appointment. If bandage becomes soaked call the
Podiatry Clinic at 608-831-8086. Keep bandage
clean, dry, and intact.
Medications - Prescriptions [152280]
oxycodone-acetaMINOPHEN (PERCOCET)
5-325 MG per tab [40668]
1-2 tab, 20 tab, 0, starting 12/7/17, Local Printer,
Phase II Discharge
hydrocodone-acetaMINOPHEN (NORCO) 5-325
MG per tab [71425]
1-2 tab, 20 tab, 0, starting 12/7/17, Local Printer,
Phase II Discharge
oxycodone 5 MG tab [45976] 5-10 mg, 20 tab, 0, starting 12/7/17, Local Printer,
Phase II Discharge
naproxen (NAPROSYN) 500 MG tab [40052] 500 mg, 60 tab, 0, starting 12/7/17, Normal, Phase II
Discharge
ibuprofen (MOTRIN) 600 MG tab [38356] 600 mg, starting 12/7/17, Normal, Phase II Discharge
traMADOL (ULTRAM) 50 MG tab [50258] 50-100 mg, 20 tab, 0, starting 12/7/17, Local Printer,
Phase II Discharge
Page 6 of 6
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 11:46:21 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org