/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/order-sets/,/clinical/cckm-tools/content/order-sets/ambulatory/,/clinical/cckm-tools/content/order-sets/ambulatory/transformations-surgery-center/,

/clinical/cckm-tools/content/order-sets/ambulatory/transformations-surgery-center/name-98459-en.cckm

201711317

page

100

UWHC,UWMF,

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

TSC - General Surgery - Adult - Preoperative [4766]

TSC - General Surgery - Adult - Preoperative [4766] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Ambulatory, Transformations Surgery Center


TSC - General Surgery - Adult - Preoperative [4766]
Pre-op Day of Procedure
VTE Prophylaxis [129450]
• If low risk for development of VTE - select VTE Prophylaxis - Reason Not Ordered
• If requires VTE prophylaxis AND
◦ LOW bleed risk - select pharmacologic agent only
◦ ABSOLUTE bleed risk - select mechanical agents only
◦ HIGH bleed risk - weigh risk of bleed vs risk of VTE development and select drug
OR mechanical agent
NOTE: Mechanical and pharmacologic agents should only be used together in
patients with a very high risk of VTE development
VTE Risk Factor Assessment Tool URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/hematology-and-
coagulation/related/name-97521-en.cckm
Sequential Compression Device (SCD) Panel
(TREATMENT AND SUPPLY) [206111]
Sequential Compression Device (SCD)
(TREATMENT) [NURTRT0028]
CONTINUOUS, Routine
Left/Right/Bilateral? Bilateral
Pre-Op Day Of Procedure
Sequential Compression Device (SCD) / Foot
Pump (SUPPLY) [EQP0023]
CONTINUOUS, Routine
Left/Right/Bilateral?
Type: Knee High
Pre-Op Day Of Procedure
VTE Prophylaxis - Reason Not Ordered
[COR0008]
ONCE, Starting today For 1 Occurrences, Routine
Reason Not Ordered: Other (Comment Required)
Pre-Op Day Of Procedure
Non-categorized Patient Care Orders [141229]
Consent [NURCOM0022] ONCE, Starting today For 1 Occurrences, Consent to
read: ***, Pre-Op Day Of Procedure
Premedications for Needle Insertion [129449]
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 within 1 minute. Choice of medication should be based on patient’s previous
experience/preference, history of lidocaine allergy and ease of access.
lidocaine 1 % vial [39034] 0.1-0.4 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.
Choice of medication should be based on patient’s
previous experience/preference, history of lidocaine
allergy and ease of access
Pre-Op Day Of Procedure
Page 1 of 5
Printed by WILLIAMS, HEATHER R [HRS0] at 11/10/2017 11:29:45 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@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.
Choice of medication should be based on patient’s
previous experience/preference, history of lidocaine
allergy and ease of access
Pre-Op Day Of Procedure
IV Fluids [128995]
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
lactated ringers infusion [38890] at 75 mL/hr, Intravenous, CONTINUOUS, Pre-Op Day
Of Procedure
Medications (Single Response) [130346]
cloNIDINE (CATAPRES) tab [35979] 0.1 mg, Oral, ONCE For 1 Doses, Pre-Op Day Of
Procedure
cloNIDINE (CATAPRES) tab [35979] 0.2 mg, Oral, ONCE For 1 Doses, Pre-Op Day Of
Procedure
Laboratory [128901]
GLUCOSE, POC [HCMGLUC] ONCE, Routine
If Conditional, What Condition?
Pre-Op Day Of Procedure
HEMOGLOBIN, POC [HCHGBPOC] ONCE, Routine
If Conditional, What Condition?
Pre-Op Day Of Procedure
HCG, QUAL, URINE, POC [HCPREGPOC] ONCE, Routine
If Conditional, What Condition?
Pre-Op Day Of Procedure
Surgical Prophylaxis
First line (Single Response) [132701]
Cefazolin (Single Response) [230998]
cefazolin (ANCEF) - Patients who are 40-119 kg
[35637]
2 g, Intravenous, ON CALL For 1 Doses
See infusion guidelines
Pre-Op Day Of Procedure
cefazolin (ANCEF) - Patients who are 120 kg or
greater [35637]
3 g, Intravenous, ON CALL For 1 Doses
See infusion guidelines
Pre-Op Day Of Procedure
Cefuroxime (Single Response) [231000]
cefuroxime (ZINACEF) - Patients who are 40-119
kg [67822]
1.5 g, Intravenous, ON CALL For 1 Doses
See infusion guidelines
Pre-Op Day Of Procedure
cefuroxime (ZINACEF) - Patients who are 120 kg
or greater [67822]
3 g, Intravenous, ON CALL For 1 Doses
See infusion guidelines
Pre-Op Day Of Procedure
MRSA/Document MRSA History (Single Response) [135177]
Patients who are 40-43 kg [231001]
cefazolin (ANCEF) [35637] 2 g, Intravenous, ON CALL For 1 Doses
See infusion guidelines
Pre-Op Day Of Procedure
vancomycin (VANCOCIN) [46836] 750 mg, Intravenous, ON CALL For 1 Doses
See infusion guidelines
Pre-Op Day Of Procedure
Page 2 of 5
Printed by WILLIAMS, HEATHER R [HRS0] at 11/10/2017 11:29:45 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

Patients who are 44-56 kg [231003]
cefazolin (ANCEF) [35637] 2 g, Intravenous, ON CALL For 1 Doses
See infusion guidelines
Pre-Op Day Of Procedure
vancomycin (VANCOCIN) [46836] 1,000 mg, Intravenous, ON CALL For 1 Doses
See infusion guidelines
Pre-Op Day Of Procedure
Patients who are 57-68 kg [231004]
cefazolin (ANCEF) [35637] 2 g, Intravenous, ON CALL For 1 Doses
See infusion guidelines
Pre-Op Day Of Procedure
vancomycin (VANCOCIN) [46836] 1,250 mg, Intravenous, ON CALL For 1 Doses
See infusion guidelines
Pre-Op Day Of Procedure
Patients who are 69-81 kg [231006]
cefazolin (ANCEF) [35637] 2 g, Intravenous, ON CALL For 1 Doses
See infusion guidelines
Pre-Op Day Of Procedure
vancomycin (VANCOCIN) [46836] 1,500 mg, Intravenous, ON CALL For 1 Doses
See infusion guidelines
Pre-Op Day Of Procedure
Patients who are 82-93 kg [231008]
cefazolin (ANCEF) [35637] 2 g, Intravenous, ON CALL For 1 Doses
See infusion guidelines
Pre-Op Day Of Procedure
vancomycin (VANCOCIN) [46836] 1,750 mg, Intravenous, ON CALL For 1 Doses
See infusion guidelines
Pre-Op Day Of Procedure
Patients who are 94-120 kg [231010]
cefazolin (ANCEF) [35637] 2 g, Intravenous, ON CALL For 1 Doses
See infusion guidelines
Pre-Op Day Of Procedure
vancomycin (VANCOCIN) [46836] 2,000 mg, Intravenous, ON CALL For 1 Doses
See infusion guidelines
Pre-Op Day Of Procedure
Patients who are greater than 120 kg [231011]
cefazolin (ANCEF) [35637] 3 g, Intravenous, ONCE For 1 Doses
See infusion guidelines
Pre-Op Day Of Procedure
vancomycin (VANCOCIN) [46836] 2,000 mg, Intravenous, ONCE For 1 Doses
See infusion guidelines
Pre-Op Day Of Procedure
MRSA Negative and Immediate/Severe Reactions to Penicillin or Known Cephalosporin Allergies (Single
Response) [135233]
Clindamycin should only be used for ENT and other oropharyngeal procedures.
vancomycin (VANCOCIN) - Patients who are 40-
43 kg [46836]
750 mg, Intravenous, ON CALL For 1 Doses
See infusion guidelines
Pre-Op Day Of Procedure
vancomycin (VANCOCIN) - Patients who are 44-
56 kg [46836]
1,000 mg, Intravenous, ON CALL For 1 Doses
See infusion guidelines
Pre-Op Day Of Procedure
vancomycin (VANCOCIN) - Patients who are 57-
68 kg [46836]
1,250 mg, Intravenous, ON CALL For 1 Doses
See infusion guidelines
Pre-Op Day Of Procedure
Page 3 of 5
Printed by WILLIAMS, HEATHER R [HRS0] at 11/10/2017 11:29:45 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

vancomycin (VANCOCIN) - Patients who are 69-
81 kg [46836]
1,500 mg, Intravenous, ON CALL For 1 Doses
See infusion guidelines
Pre-Op Day Of Procedure
vancomycin (VANCOCIN) - Patients who are 82-
93 kg [46836]
1,750 mg, Intravenous, ON CALL For 1 Doses
See infusion guidelines
Pre-Op Day Of Procedure
vancomycin (VANCOCIN) - Patients who are
greater than 93 kg [46836]
2,000 mg, Intravenous, ON CALL For 1 Doses
See infusion guidelines
Pre-Op Day Of Procedure
clindamycin (CLEOCIN) - Patients who are 40-79
kg [144945]
600 mg, Intravenous, ON CALL For 1 Doses
See infusion guidelines
Pre-Op Day Of Procedure
clindamycin (CLEOCIN) - Patients who are 80-
159 kg [144945]
900 mg, Intravenous, ON CALL For 1 Doses
See infusion guidelines
Pre-Op Day Of Procedure
clindamycin (CLEOCIN) - Patients who are 160
kg or greater [144945]
1,200 mg, Intravenous, ON CALL For 1 Doses
See infusion guidelines
Pre-Op Day Of Procedure
MRSA and Immediate/Severe Reactions to Pencillin or Known Cephalosporin Allergies (Single
Response) [135232]
vancomycin (VANCOCIN) - Patients who are 40-
43 kg [46836]
750 mg, Intravenous, ON CALL For 1 Doses
See infusion guidelines
Pre-Op Day Of Procedure
vancomycin (VANCOCIN) - Patients who are 44-
56 kg [46836]
1,000 mg, Intravenous, ON CALL For 1 Doses
See infusion guidelines
Pre-Op Day Of Procedure
vancomycin (VANCOCIN) - Patients who are 57-
68 kg [46836]
1,250 mg, Intravenous, ON CALL For 1 Doses
See infusion guidelines
Pre-Op Day Of Procedure
vancomycin (VANCOCIN) - Patients who are 69-
81 kg [46836]
1,500 mg, Intravenous, ON CALL For 1 Doses
See infusion guidelines
Pre-Op Day Of Procedure
vancomycin (VANCOCIN) - Patients who are 82-
93 kg [46836]
1,750 mg, Intravenous, ON CALL For 1 Doses
See infusion guidelines
Pre-Op Day Of Procedure
vancomycin (VANCOCIN) - Patients who are
greater than 93 kg [46836]
2,000 mg, Intravenous, ON CALL For 1 Doses
See infusion guidelines
Pre-Op Day Of Procedure
IntraOp
Medications [130750]
dexamethasone (DECADRON) 4 MG/ML injection
[36596]
10 mg, Intravenous, ONCE For 1 Doses, IntraOp
Postoperative Prescriptions for Home (Plastics)
Medications-Prescriptions-Non-Opioids (Oral) Scheduled [200906]
acetaMINOPHEN (TYLENOL) 325 MG tab - 2t
q6h x7d [34149]
650 mg, starting 11/10/17 until 11/17/17, Normal,
Phase II Discharge
naproxen (NAPROSYN) 500 MG tab - 1t 2x/d x7d
[40052]
500 mg, 0, starting 11/10/17 until 11/17/17, Normal,
Phase II Discharge
Medications - Prescriptions - Opioid (Oral) PRN (Single Response) [143581]
oxycodone 5 MG tab - 1t q4hprn #5 [45976] 5 mg, 5 tab, 0, starting 11/10/17, Normal, Phase II
Discharge
oxycodone 5 mg tab - 1-2t q4hprn #15 [45976] 5-10 mg, 15 tab, 0, starting 11/10/17, Normal, Phase II
Discharge
oxycodone 5 mg tab - 1-2t q4hprn #25 [45976] 5-10 mg, 25 tab, 0, starting 11/10/17, Normal, Phase II
Discharge
Medications - Prescriptions - Bowel Management [143582]
Page 4 of 5
Printed by WILLIAMS, HEATHER R [HRS0] at 11/10/2017 11:29:45 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

senna-docusate (SENOKOT-S) 8.6-50 mg per tab
[60530]
2 tab, 30 tab, 0, starting 11/10/17, Normal, Phase II
Discharge
docusate sodium (COLACE) cap [36857] 100 mg, 30 cap, 0, starting 11/10/17, Normal, Phase II
Discharge
polyethylene glycol (MIRALAX) oral powder
[61353]
17 g, starting 11/10/17, Normal, Phase II Discharge
Medications - Prescriptions - Anti-infectives [143583]
cephalexin (KEFLEX) 250 mg cap - 4x/d-7d
[44594]
500 mg, 28 cap, 0, starting 11/10/17 until 11/17/17,
Normal, Phase II Discharge
amoxicillin-clavulanate (AUGMENTIN) 875-125
MG per tab - 2x/d x7d [70053]
1 tab, 0, starting 11/10/17 until 11/17/17, Normal,
Phase II Discharge
clindamycin (CLEOCIN) 300 MG cap - 3x/d x7d
[44723]
300 mg, starting 11/10/17 until 11/17/17, Normal,
Phase II Discharge
Medications - Prescriptions - Non-categorized [141907]
methylprednisolone 4 MG tab pack [170928] 1 each, 0, starting 11/10/17, Normal, Phase II
Discharge
diazepam (VALIUM) 5 mg tab - q6-8hp #12
[36679]
5 mg, 12 tab, 0, starting 11/10/17, Normal, Phase II
Discharge
ondansetron (ZOFRAN) tab [45939] 4 mg, 10 tab, 0, starting 11/10/17, Normal, Phase II
Discharge
Page 5 of 5
Printed by WILLIAMS, HEATHER R [HRS0] at 11/10/2017 11:29:45 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org