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/clinical/cckm-tools/content/order-sets/ambulatory/plastics/name-98538-en.cckm

20180129

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UWHC,UWMF,

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

OP/FDS - Plastic Surgery - Pediatric - Preoperative [2774]

OP/FDS - Plastic Surgery - Pediatric - Preoperative [2774] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Ambulatory, Plastics


OP/FDS - Plastic Surgery - Pediatric - Preoperative [2774]
Pre-Day of Procedure
Laboratory [89928]
CBC WITHOUT DIFFERENTIAL [HEMO] Status: Standing, Expires:3/15/18 MANUAL,Count:1,
Normal, Routine
HEMOGLOBIN [HGB] Status: Standing, Expires:3/15/18 MANUAL,Count:1,
Normal, Routine
ELECTROLYTES [LYTE] Status: Standing, Expires:3/15/18 MANUAL,Count:1,
Normal, Routine
GLUCOSE [GLU] Status: Standing, Expires:3/15/18 MANUAL,Count:1,
Normal, Routine
BUN [BUN] Status: Standing, Expires:3/15/18 MANUAL,Count:1,
Normal, Routine
CREATININE [CRET] Status: Standing, Expires:3/15/18 MANUAL,Count:1,
Normal, Routine
PreOp Day of Procedure
Isolation Status [136644]
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 [240751]
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
Airborne Isolation - Confirmed/Suspected
Pulmonary TB [ISO0325]
Separate order must be placed for isolation cart., Pre-
Op Day Of Procedure
DVT Prophylactic Measures - Bleeding Risk [88993]
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
Patient Care Orders [86468]
Page 1 of 5
Printed by WILLIAMS, HEATHER R [HRS0] at 1/29/2018 3:00:41 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Glucose, POC [IPGLUCOSE] ONCE, Starting today For 1 Occurrences, Routine,
Glucose, POC should always be ordered in
conjunction with orders for hypoglycemia management
and monitoring as indicated in the Hypoglycemia
Management (Adult) panel.
If Conditional, What Condition?
Pre-Op Day Of Procedure
GLUCOSE, WHOLE BLOOD [HCWBGLU] CONDITIONAL, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? if Glucose, POC
results <40 mg/dL or >400 mg/dL
Pre-Op Day Of Procedure
Notify [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): 400
If blood glucose < (mg/dL): 40
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL):
Other:
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
Tests [198784]
TYPE AND SCREEN [HCTS] STAT, Starting today For 1 Occurrences, Routine, As
good clinical practice and for patient safety, the
Transfusion Service will automatically crossmatch 2
packed RBCs on all patients with antibodies to ensure
blood would be available in the event it is needed. If
you would like to opt out of this automatic order for this
patient please contact the UWHC Blood Bank at (608)
263-8367 or The American Center Lab at (608) 234-
6600 as appropriate., Pre-Op Day Of Procedure
Surgical Prophylaxis
First Line [135648]
cefazolin (ANCEF) intraVENOUS [800000] 30 mg/kg, Intravenous, ON CALL For 1 Doses,
IntraOp
First Line - Maxillofacial Coverage [245591]
Page 2 of 5
Printed by WILLIAMS, HEATHER R [HRS0] at 1/29/2018 3:00:41 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

ampicillin/sulbactam (UNASYN) intraVENOUS
[800010]
75 mg/kg, Intravenous, ON CALL For 1 Doses,
IntraOp
MRSA/Documented MRSA History [145826]
both cefazolin and vancomycinChoose
Cefazolin - Vancomycin [236057]
cefazolin (ANCEF) intraVENOUS - Maximum
Dose = 2000 mg [800000]
30 mg/kg, Intravenous, ON CALL For 1 Doses,
IntraOp
vancomycin (VANCOCIN) intraVENOUS -
Maximum Dose = 2000 mg [800084]
15 mg/kg, Intravenous, ON CALL For 1 Doses, Pre-
Op Day Of Procedure
MRSA/Documented MRSA History - Maxillofacial Coverage [245592]
ampicillin/sulbactam - vancomycin [245602]
ampicillin/sulbactam (UNASYN) intraVENOUS -
Maximum Dose = 3 grams [800010]
75 mg/kg, Intravenous, ON CALL For 1 Doses
vancomycin (VANCOCIN) intraVENOUS -
Maximum Dose = 2000 mg [800084]
15 mg/kg, Intravenous, ON CALL For 1 Doses, Pre-
Op Day Of Procedure
MRSA Negative and Immediate/Severe Reactions to Penicillin or Known Cephalosporin Allergies
[135649]
clindamycin (CLEOCIN) intraVENOUS - NOTE:
Patients who are less than 40 kg [800033]
10 mg/kg, Intravenous, ON CALL For 1 Doses
Do Not Administer IV Push NOTE: Suggested dose 10
mg/kg (Maximum 600 mg/dose)
IntraOp
MRSA and Immediate/Severe Reactions to Penicillin or Known Cephalosporin Allergies [195815]
vancomycin (VANCOCIN) intraVENOUS - NOTE:
Patients who are less than 40 kg [800084]
15 mg/kg, Intravenous, ON CALL For 1 Doses,
IntraOp
IntraOp
Diagnostic Tests and Imaging [97050]
Imaging in OR [R10000] 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?
IntraOp
Diagnosis
Diagnosis - Pre Op [711]
Pre-operative general physical examination
[255759]
Other specified pre-operative examination
Diagnosis - Pre-op Risk Factors [86499]
Hypertension [196343] Unspecified essential hypertension
Hyperlipidemia [152137] Other and unspecified hyperlipidemia
Coronary artery disease [120486] Coronary atherosclerosis of unspecified type of
vessel, native or graft
Diabetes mellitus, type 2 [192137] Type II or unspecified type diabetes mellitus without
mention ofcomplication, not stated as uncontrolled
Asthma [914206] Diagnosis
Diagnosis - Structural Face [86504]
Skin aging [159172] Other specified hypertrophic and atrophic condition of
skin
Congenital anomaly of face and neck [193762] Unspecified congenital anomaly of face and neck
Congenital anomaly of ear [123784] Unspecified congenital anomaly of ear
Deviated nasal septum [470.ICD-9-CM] Deviated nasal septum
Page 3 of 5
Printed by WILLIAMS, HEATHER R [HRS0] at 1/29/2018 3:00:41 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Cleft lip [913607] Diagnosis
Cleft palate [913608] Diagnosis
Cleft palate and lip [200379] Cleft lip and cleft palate, unspecified
Spider telangiectasia [219836] Nevus, non-neoplastic
Diagnosis - Head/Neck Trauma [86507]
Closed fracture of facial bone [301586] Other facial bones, closed fracture
Closed fracture of nasal bone [382086] Nasal bones, closed fracture
Open wound of cheek with complication [134934] Open wound of cheek, complicated
Open wound of lip with complication [134937] Open wound of lip, complicated
Open wound of external ear with complication
[134897]
Open wound of external ear, unspecified site,
complicated
Open wound of scalp with complication [134916] Open wound of scalp, complicated
Open wound of face [194254] Open wound of face, unspecified site, without mention
of complication
Injury of head, face and neck [334799] Injury of face and neck
Nose deformities, acquired [155892] Acquired deformity of nose
Ear deformity [253827] Unspecified congenital anomaly of ear
Diagnosis - Breast [86509]
Hypoplasia of breast [611.82.ICD-9-CM] Hypoplasia of breast
Hypertrophy of breast [611.1.ICD-9-CM] Hypertrophy of breast
Ptosis of breast [611.81.ICD-9-CM] Ptosis of breast
Congenital anomaly of breast [122894] Specified congenital anomalies of breast
Congenital absence of breast [122895] Specified congenital anomalies of breast
Ectopic breast tissue [122905] Specified congenital anomalies of breast
Gynecomastia, male [247599] Hypertrophy of breast
Breast cancer [172793] Malignant neoplasm of breast (female), unspecified
site
Diagnosis - Abdomen [86511]
Abdominal obesity [257646] Localized adiposity
Obesity [196432] Obesity, unspecified
Hypertrophic condition of skin [118612] Unspecified hypertrophic and atrophic condition of
skin
Striae [140213] Striae atrophicae
Diagnosis - Extremities [86513]
Localized adiposity [278.1.ICD-9-CM] Localized adiposity
Hypertrophic and atrophic condition of skin
[193469]
Unspecified hypertrophic and atrophic condition of
skin
Varicose veins of leg with pain [245223] Varicose veins of lower extremities with other
complications
Forearm injury [149855] Injury, other and unspecified, elbow, forearm, and
wrist
Wrist injury [161453] Injury, other and unspecified, elbow, forearm, and
wrist
Carpal tunnel syndrome [354.0.ICD-9-CM] Carpal tunnel syndrome
Superficial foreign body (splinter) [253259] Other, multiple, and unspecified sites, superficial
foreign body(splinter), without major open wound and
without mention of infection
Multiple sites, superficial foreign body (splinter),
infected [194410]
Other, multiple, and unspecified sites, superficial
foreign body(splinter), without major open wound,
infected
Injury of lower limb [302435] Injury, other and unspecified, knee, leg, ankle, and
foot
Page 4 of 5
Printed by WILLIAMS, HEATHER R [HRS0] at 1/29/2018 3:00:41 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Level of service
Cosmetic Pre-op Exam - No Charge [86517]
Pre-op visit, no charge LOS Code
Nurse Visit - No Charge [86520]
Nurse visit, no charge LOS Code
Office Visit - Established Patient (Single Response) [826]
99211, Level 1 (5 min) LOS Code
99212, Level 2 (10 min) LOS Code
99213, Level 3 (15 min) LOS Code
99214, Level 4 (25 min) LOS Code
99215, Level 5 (40 min) LOS Code
Preoperative Exam (Global) [1265]
Preoperative H&P, No Charge, Surgical Package LOS Code
Page 5 of 5
Printed by WILLIAMS, HEATHER R [HRS0] at 1/29/2018 3:00:41 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org