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Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,HOD,Cardiac Cath and Electrophysiology Labs

Cardiac Cath/EP – Heart Transplant Cardiac Annual Cath and Biopsy – Adult – Preproc [4784]

Cardiac Cath/EP – Heart Transplant Cardiac Annual Cath and Biopsy – Adult – Preproc [4784] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, HOD, Cardiac Cath and Electrophysiology Labs


Cardiac Cath/EP - Heart Transplant Cardiac Annual Catheterization and Biopsy -
Adult - Preprocedure [4784]
Have diabetic patients hold all oral hypoglycemic and insulin medications. Check record and
Accucheck.
Invasive Cardiology Procedure
Invasive Cardiology Procedure and Biopsy [215227]
Heart And Vascular Care Procedure - Cath Lab
[CARD0006]
Status: Future, Expires: 5/10/17, Normal, Routine,
Qty-1
Heart replaced by transplant [V42.1.ICD-9-CM] Heart replaced by transplant
SURGICAL PATHOLOGY [HCPATHS] NEXT AM For 1 Occurrences, Routine, This order is
to be used for fresh or formalin-fixed (for gross and
micro evaluation) tissues.
Slides and/or paraffin-embedded blocks coming from
outside institutions needing second opinion pathology
review should be ordered as Surgical Pathology
Consult [HCPATHSP].
Specimen Source Description: Heart Biopsy
Number of containers: Per MD
Clinical Diagnosis: Status post heart transplant Z94.1
Reason for procedure: Routine Rejection Screening
Other pertinent information:
Frozen section call back number:
Type of procedure:
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Cardiac Cath/EP
Patient Care Orders
Vital Signs [140713]
Vital Signs [NURMON0013] ONCE, Starting today For 1 Occurrences, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location: Bilateral Arms
BP Position:
BP Restrictions:
Once upon admission, Cardiac Cath/EP
Diet [139947]
NPO Except Medications [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: NPO
NPO: NPO except Medications
Bedside Meal Instructions:
Room Service Class:
Cardiac Cath/EP
Patient Monitoring [139949]
Measure Weight [NURMON0015] ONCE For 1 Occurrences, Routine
Weigh With?
Weigh when?
Upon admission, Cardiac Cath/EP
Measure Height [NURMON0052] ONCE For 1 Occurrences, Routine, Upon admission,
Cardiac Cath/EP
Non-Categorized Patient Care Orders [139955]
Page 1 of 9
Printed by LIND, JANNA S [JSL237] at 2/9/2017 12:55:55 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2017CCKM@uwhealth.org

Void On Call [NURELM0022] CONTINUOUS, Routine, Cardiac Cath/EP
Page Transplant Coordinator when patient
returns from procedure [NURCOM0022]
ONCE For 1 Occurrences, {Transplant
Coordinators:22549}, Cardiac Cath/EP
Please instruct patient to wear PCM 2000
(duckbill) mask when transferring outside of the
Cardiac Catheterization Lab. [NURCOM0022]
ONCE For 1 Occurrences, Please instruct patient to
wear PCM 2000 (duckbill) mask when transferring
outside of the Cardiac Catheterization Lab., Cardiac
Cath/EP
Contingency Parameters [140725]
Notify Provider [NURCOM0001] Provider to Notify: Provider
If systolic blood pressure > (mmHg): 150
If systolic blood pressure < (mmHg):
If diastolic blood pressure > (mmHg):
If diastolic blood pressure < (mmHg): 80
If temperature > (C): 38.0
If temperature < (C):
If heart rate > (bpm): 130
If heart rate < (bpm): 50 and symptomatic; otherwise
40
If respiratory rate >: 30
If respiratory rate <: 12
If blood glucose > (mg/dL):
If blood glucose < (mg/dL):
If pain score >:
Pulse Oximetry < (%): 89
If urine output < (mL):
Other:
Cardiac Cath/EP
Intravenous Therapy
Premedications for Needle Insertion [139592]
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 (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
Cardiac Cath/EP
lidocaine (XYLOCAINE) 1% injection [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
Cardiac Cath/EP
Page 2 of 9
Printed by LIND, JANNA S [JSL237] at 2/9/2017 12:55:55 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2017CCKM@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
Cardiac Cath/EP
Intravenous Fluids [139965]
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
Cardiac Cath/EP
sodium chloride 0.9% infusion [64367] at 100 mL/hr, Intravenous, CONTINUOUS, Cardiac
Cath/EP
Medications
Medications - Allergy to Contrast [139966]
prednisone (DELTASONE) tab [41277] 50 mg, Oral, ONCE PRN For 1 Doses, Allergy to
contrast
Administer prior to procedure
Cardiac Cath/EP
ranitidine (ZANTAC) tab [720131] 150 mg, Oral, ONCE PRN For 1 Doses, dyspepsia,
Allergy to contrast
Administer prior to procedure
Cardiac Cath/EP
diphenhydramine (BENADRYL) cap RANGE
[750014]
25-50 mg, Oral, ONCE PRN For 1 Doses, Allergy to
contrast
Administer prior to procedure
Cardiac Cath/EP
Non-Categorized Medications [139967]
Patients may self-administer medications after
lab draw [NURCOM0022]
ONCE, Cardiac Cath/EP
Laboratory
Laboratory [139972]
LIPID PANEL [LIPID] STAT - RN COLLECT For 1 Occurrences, Routine,
Test includes Cholesterol, Total; HDL Cholesterol;
Triglyceride; LDL cholesterol, calculated; and non-
HDL cholesterol.
Patient must fast for 12-14 hours and be heparin free
for 48 hours prior to specimen collection. The patient
can only have water or black coffee during the fasting
period.
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Patient must have completed 10 hour fast prior to
draw., Cardiac Cath/EP
ELECTROLYTES [LYTE] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Cardiac Cath/EP
Page 3 of 9
Printed by LIND, JANNA S [JSL237] at 2/9/2017 12:55:55 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2017CCKM@uwhealth.org

GLUCOSE [GLU] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Cardiac Cath/EP
BUN [BUN] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Cardiac Cath/EP
CREATININE [CRET] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Cardiac Cath/EP
CALCIUM [CA] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Cardiac Cath/EP
ALBUMIN [ALB] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Cardiac Cath/EP
PROTEIN, TOTAL [TP] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Cardiac Cath/EP
BILIRUBIN, TOTAL [TBIL] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Cardiac Cath/EP
ALT/SGPT [ALT] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Cardiac Cath/EP
AST/SGOT [AST] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Cardiac Cath/EP
ALKALINE PHOSPHATASE [ALKP] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Cardiac Cath/EP
CBC WITH DIFFERENTIAL [CBC] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Cardiac Cath/EP
Page 4 of 9
Printed by LIND, JANNA S [JSL237] at 2/9/2017 12:55:55 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2017CCKM@uwhealth.org

MAGNESIUM [MAG] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Cardiac Cath/EP
LD, TOTAL [LDH] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Cardiac Cath/EP
PHOSPHATE [PHOS] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Cardiac Cath/EP
Page 5 of 9
Printed by LIND, JANNA S [JSL237] at 2/9/2017 12:55:55 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2017CCKM@uwhealth.org

VITAMIN D, 25-HYDROXY BY HPLC [HCLCD25] STAT - RN COLLECT For 1 Occurrences, Routine,
Screening for Vitamin D deficiency is not covered by
Medicare. If this is the reason for the test, please
advise the patient of non-coverage via the ABN
process. Coverage is allowed in some other
circumstances. If one of these diagnoses is
appropriate for your patient, please associate the
corresponding code with this order.
252.00 (ICD-9); E21.3 (ICD-10)
Hyperparathyroidism, unspecified
252.01 (ICD-9); E21.0 (ICD-10) Primary
Hyperparathyroidism
252.02 (ICD-9); E21.1 (ICD-10) Secondary
Hyperparathyroidism, Non-Renal
252.08 (ICD-9); E21.2 (ICD-10) Other
Hyperparathyroidism
252.1 (ICD-9); E20.9 (ICD-10) Hypoparathyroidism
268.0 (ICD-9); E55.0 (ICD-10) Rickets Active
268.2 (ICD-9); M83.9 (ICD-10) Osteomalacia
Unspecified
268.9 (ICD-9); E55.9 (ICD-10) Established Vitamin D
Deficiency (monitoring efficacy of replacement
therapy)
275.3 (ICD-9); E83.30 (ICD-10) Disorders of
Phosphorus Metabolism
275.41 (ICD-9); E83.51 (ICD-10) Hypocalcemia
275.42 (ICD-9); E83.52 (ICD-10) Hypercalcemia
585.3 (ICD-9); N18.3 (ICD-10) Chronic Kidney
Disease, Stage III (Moderate)
585.4 (ICD-9); N18.4 (ICD-10) Chronic Kidney
Disease, Stage IV (Severe)
585.5 (ICD-9); N18.5 (ICD-10) Chronic Kidney
Disease, Stage V
585.6 (ICD-9); N18.6 (ICD-10) End Stage Renal
Disease
588.81 (ICD-9); N25.81 (ICD-10) Secondary
Hyperparathyroidism (of Renal Origin)
733.00 (ICD-9); M81.0 (ICD-10) Osteoporosis
Unspecified
Page 6 of 9
Printed by LIND, JANNA S [JSL237] at 2/9/2017 12:55:55 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2017CCKM@uwhealth.org

733.01 (ICD-9); M81.0 (ICD-10) Senile Osteoporosis
733.02 (ICD-9); M81.8 (ICD-10) Idiopathic
Osteoporosis
733.03 (ICD-9); M81.8 (ICD-10) Disuse Osteoporosis
733.09 (ICD-9); M81.8 (ICD-10) Other Osteoporosis
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Cardiac Cath/EP
CK, TOTAL [CPK] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Cardiac Cath/EP
TACROLIMUS LEVEL [HCTAC] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Cardiac Cath/EP
SIROLIMUS [HCSIRO] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Cardiac Cath/EP
CYCLOSPORINE [XCYCA] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Cardiac Cath/EP
HLA CLASS I DONOR SPECIFIC AB BY
LUMINEX [HCDSA1B]
STAT - RN COLLECT For 1 Occurrences, Routine
Indicate organ for transplant:
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Cardiac Cath/EP
HLA CLASS II DONOR SPECIFIC AB BY
LUMINEX [HCDSA2B]
STAT - RN COLLECT For 1 Occurrences, Routine
Indicate organ for transplant:
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Cardiac Cath/EP
First Annual Evaluation [139973]
Page 7 of 9
Printed by LIND, JANNA S [JSL237] at 2/9/2017 12:55:55 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2017CCKM@uwhealth.org

HIV AB/AG COMBO [HIVABAG] STAT - RN COLLECT For 1 Occurrences, Routine, I,
the ordering provider, have verified that the
patient/patient's authorized representative was:
1. Notified that the patient will be subjected to an HIV
test unless the patient/rep declines the test;
2. Given educational materials on HIV and HIV
testing;
3. Notified that they may decline the test and health
care providers may not use the fact that the
patient/rep declined an HIV test as a basis for
denying other services; and
4. Provided an opportunity to ask questions and to
decline the HIV test.
The ordering provider verifies:
5. The patient/patient's authorized representative
understands that an HIV test will be performed; and
6. The decision of the patient/rep regarding whether
to have an HIV test performed was not coerced or
involuntary.
Pt/Pt's Rep did not opt out. Steps listed in
instructions taken. If test is declined, type
".HIVTESTDECLINE" in progress note.
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Cardiac Cath/EP
HEPATITIS B CORE AB, TOTAL [HBCAB] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Cardiac Cath/EP
HEPATITIS B SURFACE AB (IMMUNE
STATUS) [HBSABI]
STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Cardiac Cath/EP
HEPATITIS B SURFACE AG [HBSAG] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Cardiac Cath/EP
HEPATITIS C AB [HCV] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Cardiac Cath/EP
Diagnostic Tests and Imaging
Diagnostic Tests and Imaging [139977]
Page 8 of 9
Printed by LIND, JANNA S [JSL237] at 2/9/2017 12:55:55 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2017CCKM@uwhealth.org

Transthoracic Resting Heart Failure Protocol
Echocardiogram [ECH0023]
ONCE For 1 Occurrences, Routine
Reason for exam:
Do you want Agitated Bubble Study?
Is patient mechanically ventilated?
Is patient ICU status?
Does patient need continuous monitoring?
Cardiac Cath/EP
ECG - 12 Lead [EKG0008] ONCE For 1 Occurrences, Routine
Reason for exam:
Upon admission, Cardiac Cath/EP
X-RAY CHEST PA & LAT VIEWS [R71020] ONCE-RAD NEXT AVAILABLE For 1 Occurrences,
Routine
Radiology Specialty Area: GENERAL IMAGING
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
Cardiac Cath/EP
Page 9 of 9
Printed by LIND, JANNA S [JSL237] at 2/9/2017 12:55:55 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2017CCKM@uwhealth.org