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Anesthesiology - Adult - Recovery/PACU [1396]

Anesthesiology - Adult - Recovery/PACU [1396] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Anesthesiology


Anesthesiology - Adult - Recovery/PACU [1396]
for Adult Patients OnlyIntended
Patient Care Orders
Patient Monitoring - Glucose [96087]
Glucose, POC - Immediately Postoperatively
[IPGLUCOSE]
CONDITIONAL, 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?
Immediately Postoperatively, PACU
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 point of care
results with <40 mg/dL or >400 mg/dL
PACU
Glucose, POC - Prior to discharge from PACU
[IPGLUCOSE]
CONDITIONAL, 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?
PACU
Hypoglycemia Management (Adult) [191576]
Glucose, POC [IPGLUCOSE] AS NEEDED FOR SIGNS AND SYMPTOMS OF
HYPOGLYCEMIA, Starting today For Until specified,
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?
Glucose, POC [IPGLUCOSE] AFTER PROVIDING HYPOGLYCEMIA
TREATMENT, Starting today For Until specified,
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?
Per hypoglycemia treatment algorithm Recheck
glucose 15 minutes after providing treatment until
glucose is greater than or equal to 70 mg/dL. If
patient has been critically low (i.e., glucose less than
40 mg/dL), recheck glucose after 1 hour to ensure
glucose remains greater than or equal to 70mg/dL.
After resolution of mild hypoglycemia (i.e., glucose
40-69 mg/dL), consider rechecking after 1 hour if
patient has signs/symptoms of hypoglycemia or is at
risk for a subsequent hypoglycemic event (e.g.,
previously administered insulin still active, altered
renal status, altered mental status, NPO or
interrupted nutrition, or any other condition that
increases hypoglycemia risk)
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Notify Provider [NURCOM0001] Provider to Notify: Provider
Notify based on: Blood Glucose,Other
If blood glucose > (mg/dL): 400
If blood glucose < (mg/dL): 40
Other: Nutritional status changes
Hypoglycemia Treatment for blood glucose less
than 40 mg/dL and patient able to eat/swallow
safely [NURCOM0022]
CONDITIONAL, Starting today For Until specified
If Conditional, What Condition? If blood glucose less
than 40mg/dL and patient able to eat/swallow safely.
Give 30 grams of carbohydrate (8 oz. of fruit juice).
Repeat treatment until glucose is 70 mg/dL or
greater.
Hypoglycemia Treatment for blood glucose
between 40 to 69 mg/dL and patient able to
eat/swallow safely [NURCOM0022]
CONDITIONAL, Starting today For Until specified
If Conditional, What Condition? If glucose is 40-69
mg/dL and patient able to eat/swallow safely
Give 15 grams of carbohydrate (4 oz of fruit juice).
Repeat treatment until glucose is 70 mg/dL or
greater.
glucose-vitamin C chew tab [50690] 16 g, Oral, EVERY 15 MINUTES PRN,
hypoglycemia, Hypoglycemia, For blood glucose 40-
69 mg/dL
Use in patients able to safely eat/swallow but unable
to tolerate volume of fruit juice or per patient
preference. Repeat every 15 minutes until blood
glucose is 70 mg/dL or greater.
glucose-vitamin C chew tab [50690] 32 g, Oral, EVERY 15 MINUTES PRN,
hypoglycemia, Hypoglycemia, For blood glucose
less than 40 mg/dL
Use in patients able to safely eat/swallow but unable
to tolerate volume of fruit juice or per patient
preference. Repeat every 15 minutes until blood
glucose is 70 mg/dL or greater.
glucagon injection kit [107799] 1 mg, Subcutaneous, PRN, For blood glucose less
than 69 mg/dL and patient unable to eat/swallow
safely AND has NO IV access
Repeat every 15 minutes until blood glucose is 70
mg/dL or greater. See Adult Hypoglycemia Algorithm
dextrose injection [800233] 12.5 g, Intravenous, PRN, For blood glucose 40-69
mg/dL and patient unable to eat/swallow safely AND
has IV access
Repeat every 15 minutes until blood glucose is 70
mg/dL or greater. See Adult Hypoglycemia Algorithm
dextrose injection [800233] 25 g, Intravenous, PRN, For blood glucose less than
40 mg/dL and patient unable to eat/swallow safely
AND has IV access.
Repeat every 15 minutes until blood glucose is 70
mg/dL or greater. See Adult Hypoglycemia Algorithm
GLUCOSE, WHOLE BLOOD [HCWBGLU] CONDITIONAL, Starting today For 7 Days, STAT
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition? Draw if blood
glucose is less than 40 mg/dL or greater than 400
mg/dL.
Page 2 of 16
Printed by BENNETT, SARA J [SJB008] at 12/15/2017 6:58:04 AM
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GLUCOSE, WHOLE BLOOD [HCWBGLU] CONDITIONAL, Starting 12/23/17 For 7 Days, STAT
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition? Draw if blood
glucose is less than 40 mg/dL or greater than 400
mg/dL.
Respiratory [81398]
Initiate Adult PACU Oxygen Titration Protocol
[NURTRT0082]
CONTINUOUS, Starting today, Routine
O2 Delivery Device: Nasal Cannula
FiO2 (%) Titrate to Keep Sats >/= to ___%:
Liter Flow:
Titrate oxygen to maintain O2 sat at (%):
Attempt to Wean Off Oxygen?
PACU
CPAP Continuous [RT0009] Routine
PEEP (cmH2O):
FiO2 (%) Titrate to Keep Sats >/= to ___%:
Titrate oxygen to maintain O2 sat at (%):
Self Administered (Only RT may document in this box
after patient assessment): RT Approval Required
If patient brings own device, RT to evaluate., PACU
Biphasic Positive Airway Pressure (BIPAP)
[RT0004]
Routine
Mode:
IPAP (cm H2O):
EPAP (cm H2O):
FiO2 (%) Titrate to Keep Sats >/= to ___%:
Set Rate/Min:
Titrate oxygen to maintain O2 sat at (%):
Self Administered (Only RT may document in this box
after patient assessment): RT Approval Required
PACU
Mechanical Ventilation - Adult [117146]
Provide Manual Resuscitator at Bedside
[RT0039]
CONTINUOUS, Routine
Mechanical Ventilation [RT0028] Routine, For ADULT patients order chlorihexidene
gluconate (PERIDEX) 0.12% soln 15 mL to swab
oral cavity 2x daily while on ventilation.
Is this a modification to a current vent order?
Ventilator Management:
Wean:
Set Rate/Min:
PEEP (cmH2O):
Mode:
Tidal Volume Multiplier: 6
FiO2 (%) Titrate to Keep Sats >/= to ___%:
Pressure Support:
Pressure Control:
P High (cmH20):
P Low (PEEP) (cmH20):
T High (sec):
T Low (T PEEP) (sec):
PS above P High (cmH2O):
PS above PEEP (cmH2O):
NAVA Level (µV):
Page 3 of 16
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12/2017CCKM@uwhealth.org

chlorhexidine (PERIDEX) 0.12 % soln
MULTIDOSE [792004]
15 mL, Mouth/Throat, 2 X DAILY Starting today
Use to swab oral cavity. Discontinue when patient no
longer on ventilation.
Non-Categorized Patient Care Orders [19137]
Please Call Anesthesia Before Giving Any IV
Opioids in Phase II [NURCOM0022]
ONCE, Post-Op/Phase II
Urinary Catheterization-Intermittent
[NURELM0018]
PRN, Starting today For Until specified, Routine,
Perform a urinary bladder drainage straight cath, if
bladder volume via bladder scan meets PACU criteria,
and Notify Anesthesiologist, PACU
May Use Postoperative Regional Analgesia
Orders [NURCOM0022]
ONCE, Starting today For 1 Occurrences, May Use
Postoperative Regional Analgesia Orders, PACU
May Use Surgeon's Postoperative Patient
Controlled Analgesia (PCA) Orders
[NURCOM0022]
ONCE, Starting today For 1 Occurrences, May Use
Surgeon's Postoperative Patient Controlled Analgesia
(PCA) Orders, PACU
DISCHARGE Patient to Home, Skilled Medical
Facility, or Supervised Living Facility IF patient is
designated as Outpatient Surgery class, AND
anesthesiology faculty have filed a postop Faculty
note, AND patient has achieved minimum or
greater Phase II Discharge Score
[NURCOM0022]
ONCE For 1 Occurrences, PACU
May Use Surgeon's Supplemental Insulin Orders
[NURCOM0022]
CONTINUOUS, PACU
Do NOT Discharge from Inpatient PACU Per
Discharge Scoring System [NURCOM0022]
SEE COMMENTS, Starting today For Until specified,
Do NOT discharge from Inpatient PACU per discharge
scoring system., PACU
Do NOT Discharge Patient From Hospital After
Outpatient Surgery Unless Anesthesiologist Gives
a Specific, Separate Discharge Order
[NURCOM0022]
ONCE For 1 Occurrences, PACU
Contingency Parameters [180159]
Physiologic Parameters to Notify Anesthesiologist
[NURCOM0022]
CONTINUOUS, SBP < 85 or >175 mmHg by either
arterial line or cuff for 15 minutes or longer.
HR < 42 or >105 bpm for 15 minutes or longer.
RR < 8 or >18 breaths per minute for 10 minutes or
longer.
O2 sat < 91 % for 5 minutes or longer.
ETCO2 > 60 mmHg for 10 minutes or longer. (if CO2
measured)
Any critical laboratory value, PACU
Intravenous Therapy
IV Fluids [92554]
sodium chloride 0.9% infusion [64367] at 125 mL/hr, Intravenous, CONTINUOUS, PACU
lactated ringers infusion [38890] Intravenous, CONTINUOUS, PACU
dextrose 5%-NaCl 0.45% infusion [51613] Intravenous, CONTINUOUS, PACU
PLASMA-LYTE A infusion [41099] Intravenous, CONTINUOUS, PACU
Medications
Respiratory/Airway [150575]
albuterol neb soln (3 mL) [800248] 2.5 mg, Nebulization, ONCE For 1 Doses, PACU
ipratropium (ATROVENT) neb soln [47883] 500 mcg, Nebulization, ONCE For 1 Doses, PACU
racepinephrine 2.25 % neb soln [150812] 0.5 mL, Nebulization, ONCE For 1 Doses, PACU
Page 4 of 16
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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

ipratropium-albuterol (DUO-NEB) 0.5-2.5 mg/3
mL neb soln [67220]
3 mL, Nebulization, ONCE For 1 Doses, PACU
Bradycardia [24892]
atropine injection [800178] 0.5 mg, Intravenous, ONCE PRN For 1 Doses,
bradycardia
Administer for symptomatic bradycardia and notify
anesthesiologist. Symptoms include decreased level
of consciousness, nausea, and a heart rate of less
than 40 beats per minute.
PACU
Parenteral Opioid Analgesic - First Line Rescue Therapy (Single Response) [124159]
MORPHine PF injection RANGE- Maximum Dose
= 4 mg [750057]
1-4 mg, Intravenous, EVERY 6 MINUTES PRN, pain
First Line Parenteral Analgesic Agent- Administer first
line if unable to tolerate oral opioids. Administer up to
a maximum of *** mg. If insufficient pain relief after
administration of maximum dose, give second line
parenteral therapy or notify provider if no second line
therapy is ordered. When bridging to oral opioid
analgesic, may administer single IV dose following
administration of initial oral opioid analgesic dose.
for 4 Minutes, PACU
HYDROmorphone PF (DILAUDID) injection
RANGE - Maximum Dose = 1 mg [750050]
0.2-0.6 mg, Intravenous, EVERY 6 MINUTES PRN,
pain
First Line Parenteral Analgesic Agent- Administer first
line if unable to tolerate oral opioids. Administer up to
a maximum of *** mg. If insufficient pain relief after
administration of maximum dose, give second line
parenteral therapy or notify provider if no second line
therapy is ordered. When bridging to oral opioid
analgesic, may administer single IV dose following
administration of initial oral opioid analgesic dose.
for 3 Minutes, PACU
FENTanyl PF injection RANGE - Maximum Dose
= 100 mcg [750047]
25-50 mcg, Intravenous, EVERY 6 MINUTES PRN,
pain
Administer first line if unable to tolerate oral opioids.
Administer up to a maximum of *** mcg. If insufficient
pain relief after administration of maximum dose, give
second line parenteral therapy or notify provider if no
second line therapy is ordered. When bridging to oral
opioid analgesic, may administer single IV dose
following administration of initial oral opioid analgesic
dose.
for 1 Minutes, PACU
Parenteral Opioid Analgesic - Second Line Rescue Therapy (Single Response) [124160]
MORPHine PF injection RANGE- Maximum Dose
= 4 mg [750057]
1-4 mg, Intravenous, EVERY 6 MINUTES PRN, pain
Second Line Parenteral Analgesic Agent - Administer
second line if unable to tolerate oral opioids.
Administer up to a maximum of *** mg. If insufficient
pain relief after administration of maximum dose,
notify the provider. If bridging to oral opioid analgesic,
may administer single IV dose following administration
of initial oral opioid analgesic dose.
for 4 Minutes, PACU
Page 5 of 16
Printed by BENNETT, SARA J [SJB008] at 12/15/2017 6:58:04 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

HYDROmorphone PF (DILAUDID) injection
RANGE - Maximum Dose = 1 mg [750050]
0.2-0.6 mg, Intravenous, EVERY 6 MINUTES PRN,
pain
Second Line Parenteral Analgesic Agent - Administer
second line if unable to tolerate oral opioids.
Administer up to a maximum of *** mg. If insufficient
pain relief after administration of maximum dose,
notify the provider. If bridging to oral opioid analgesic,
may administer single IV dose following administration
of initial oral opioid analgesic dose.
for 3 Minutes, PACU
FENTanyl PF injection RANGE - Maximum Dose
= 100 mcg [750047]
25-50 mcg, Intravenous, EVERY 6 MINUTES PRN,
pain
Second Line Parenteral Analgesic Agent - Administer
second line if unable to tolerate oral opioids.
Administer up to a maximum of *** mcg. If insufficient
pain relief after administration of maximum dose,
notify the provider. If bridging to oral opioid analgesic,
may administer single IV dose following administration
of initial oral opioid analgesic dose.
for 1 Minutes, PACU
Parenteral Opioid Antishivering - Meperidine [124161]
meperidine (DEMEROL) injection [800195] 12.5 mg, Intravenous, EVERY 5 MINUTES PRN For 2
Doses, rigors, shivering
If shivering/rigors persist after second dose notify
provider
PACU
Parenteral Analgesic - Ketamine (Single Response) [149434]
ketAMINE injection [800191] Intravenous, ONCE For 1 Doses, PACU
Oral Opioid Analgesic [242142]
Hyperlink to Pain Fast Fact - Multimodal
Analgesia
URL: https://uconnect.wisc.edu/clinical/references/pain-
management/references-
guidelines/resources/name-29968-en.file
oxycodone tab RANGE [750032] 5-10 mg, Oral, EVERY 1 HOUR PRN For 2 Doses,
pain
Administer when able to tolerate oral administration.
Administer up to a maximum of 20 mg. If insufficient
pain relief after administration of maximum dose,
notify provider. When bridging to oral opioid
analgesic, may administer single IV dose of parenteral
opioid following administration of initial oral opioid
analgesic dose. If insufficient pain relief with bridging,
notify provider.
PACU
NSAID Analgesics Note: May only select one NSAID Analgesic (Single Response) [124163]
URL:
ketOROLAC (TORADOL) injection [800050] 15 mg, Intravenous, ONCE For 1 Doses
IV push over 15-30 seconds.
PACU
ketOROLAC (TORADOL) injection [800050] 30 mg, Intravenous, ONCE For 1 Doses
IV push over 30 seconds.
PACU
ibuprofen (MOTRIN) tab [38353] 400 mg, Oral, ONCE For 1 Doses, PACU
ibuprofen (MOTRIN) tab [38353] 600 mg, Oral, ONCE For 1 Doses, PACU
ibuprofen (MOTRIN) tab [38353] 800 mg, Oral, ONCE For 1 Doses, PACU
Other Analgesics Note: Do not order if within 6 hours of parenteral acetaminophen administration
(Single Response) [124164]
Page 6 of 16
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URL:
acetaMINOPHEN (TYLENOL) tab [34149] 650 mg, Oral, ONCE For 1 Doses, PACU
acetaMINOPHEN (TYLENOL) disintegrating tab
[64412]
320 mg, Oral, ONCE For 1 Doses, PACU
Hypotensive Therapies [242145]
sodium chloride 0.9% BOLUS [730003] 500 mL, Intravenous, ONCE PRN For 1 Doses,
hypotension - see Admin Instructions
Administer for systolic blood pressure less than *** Hg.
If two - three hypotension therapies are ordered,
these should be considered to be concurrent
administration orders. If blood pressure increase is
insufficient within *** minutes of administration, notify
provider.
PACU
lactated ringers BOLUS [730001] 500 mL, Intravenous, ONCE PRN For 1 Doses,
hypotension - see Admin Instructions
.Administer for systolic blood pressure less than ***
Hg. If two - three hypotension therapies are ordered,
these should be considered to be concurrent
administration orders. If blood pressure increase is
insufficient within *** minutes of administration, notify
provider.
PACU
albumin human 5% infusion [44038] 12.5 g, Intravenous, ONCE PRN For 1 Doses,
hypotension - see Admin Instructions
Administer for systolic blood pressure less than *** Hg.
If two - three hypotension therapies are ordered,
these should be considered to be concurrent
administration orders. If blood pressure increase is
insufficient within *** minutes of administration, notify
provider. Hang to gravity. Albumin tubing needed.
PACU
epHEDRINE in sodium chloride 0.9% 5MG/ML
injection [755112]
5-10 mg, Intravenous, EVERY 10 MINUTES PRN For
3 Doses, hypotension - see Admin Instructions
Administer for systolic blood pressure less than *** Hg.
If two - three hypotension therapies are ordered,
these should be considered to be concurrent
administration orders. If blood pressure increase is
insufficient within *** minutes of administration, notify
provider.
PACU
phenylEPHRINE in sodium chloride 0.9% 0.1
MG/ML injection [755110]
Intravenous, EVERY 10 MINUTES PRN For 3 Doses,
hypotension - see Admin Instructions
Administer for systolic blood pressure less than *** Hg.
If two - three hypotension therapies are ordered,
these should be considered to be concurrent
administration orders. If blood pressure increase is
insufficient within *** minutes of administration, notify
provider.
PACU
Antiemetics - First Line Rescue Therapy [119123]
If the patient received a single prophylactic antiemetic agent during the procedure, select an
agent with a different mechanism of action for rescue therapy in the anesthesia recovery period
(e.g., if ondansetron was given prophylactically, rescue with prochlorperazine). If two - three
agents are ordered within a 1
st
, 2
nd
, or 3
rd
Line Panel, these should be considered as concurrent
administration orders.
Page 7 of 16
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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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12/2017CCKM@uwhealth.org

prochlorperazine (COMPAZINE) injection [41369] Intravenous, ONCE PRN For 1 Doses,
nausea/vomiting
First Line Agent. If two - three first line agents are
ordered, these should be considered as concurrent
administration orders
If ordered IV: push slowly, max rate 5 mg/minute.
PACU
haloperidol lactate (HALDOL) injection - NOTE:
0.5-1.0 mg/dose (max 1 mg) [800108]
Intravenous, ONCE PRN For 1 Doses, other,
Nausea/Vomiting
First Line Agent. If two - three first line agents are
ordered, these should be considered as concurrent
administration orders.
PACU
promethazine (PHENERGAN) injection [800112] Intravenous, ONCE PRN For 1 Doses,
nausea/vomiting
First Line Agent. If two - three first line agents are
ordered, these should be considered as concurrent
administration orders.
Extravasation Risk: CENTRAL or LARGE VEIN
required. No hand, foot, wrist, or antecubital veins or
areas of flexion
Requires further dilution in 10 to 20 mL NS or
preparation in a minibag. Administer over 10 to 15
minutes through a running IV line at a port furthest
from the patient's vein.
Discontinue immediately if burning or pain occurs with
administration.
PACU
metoclopramide (REGLAN) injection [800059] 10 mg, Intravenous, ONCE PRN For 1 Doses,
nausea/vomiting
First Line Agent. If two - three first line agents are
ordered, these should be considered as concurrent
administration orders
If ordered IV: Administer over 2 minutes
PACU
ondansetron (ZOFRAN) injection [800202] 4 mg, Intravenous, ONCE PRN For 1 Doses,
nausea/vomiting
First Line Agent. If two - three first line agents are
ordered, these should be considered as concurrent
administration orders
PACU
diphenhydramine (BENADRYL) injection [800106] 12.5 mg, Intravenous, ONCE PRN For 1 Doses,
nausea/vomiting
First Line Agent. If two - three first line agents are
ordered, these should be considered as concurrent
administration orders.
PACU
olanzapine (ZYPREXA ZYDIS) disintegrating tab
[64700]
Oral, ONCE PRN For 1 Doses, nausea
First Line Agent. If two - three first line agents are
ordered, these should be considered as concurrent
administration orders
PACU
Antiemetics - Second Line Rescue Therapy [119183]
Page 8 of 16
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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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12/2017CCKM@uwhealth.org

If the patient received a single prophylactic antiemetic agent during the procedure, select an
agent with a different mechanism of action for rescue therapy in the anesthesia recovery period
(e.g., if ondansetron was given prophylactically, rescue with prochlorperazine). If two - three
agents are ordered within a 1
st
, 2
nd
, or 3
rd
Line Panel, these should be considered as concurrent
administration orders.
prochlorperazine (COMPAZINE) injection [41369] Intravenous, ONCE PRN For 1 Doses,
nausea/vomiting
Second Line Agent - Give if patient fails to respond to
first line agent after 30 minutes. If two - three second
line agents are ordered, these should be considered
as concurrent administration order. If response is
insufficient within 30 minutes, notify provider.
PACU
haloperidol lactate (HALDOL) injection - NOTE:
0.5-1.0 mg/dose (max 1 mg) [800108]
Intravenous, ONCE PRN For 1 Doses, other,
Nausea/Vomiting
Second Line Agent - Give if patient fails to respond to
first line agent after 30 minutes. If two - three second
line agents are ordered, these should be considered
as concurrent administration order. If response is
insufficient within 30 minutes, notify provider.
PACU
promethazine (PHENERGAN) injection [800112] Intravenous, ONCE PRN For 1 Doses,
nausea/vomiting
Second Line Agent - Give if patient fails to respond to
first line agent after 30 minutes. If two - three second
line agents are ordered, these should be considered
as concurrent administration order. If response is
insufficient within 30 minutes, notify provider.
Extravasation Risk: CENTRAL or LARGE VEIN
required. No hand, foot, wrist, or antecubital veins or
areas of flexion Requires further dilution in 10 to 20
mL NS or preparation in a minibag. Administer over 10
to 15 minutes through a running IV line at a port
furthest from the patient's vein. Discontinue
immediately if burning or pain occurs with
administration.Extravasation Risk: CENTRAL or
LARGE VEIN required. No hand, foot, wrist, or
antecubital veins or areas of flexion Requires further
dilution in 10 to 20 mL NS or preparation in a minibag.
Administer over 10 to 15 minutes through a running IV
line at a port furthest from the patient's vein.
Discontinue immediately if burning or pain occurs with
administration.
PACU
metoclopramide (REGLAN) injection [800059] 10 mg, Intravenous, ONCE PRN For 1 Doses,
nausea/vomiting
Second Line Agent - Give if patient fails to respond to
first line agent after 30 minutes. If two - three second
line agents are ordered, these should be considered
as concurrent administration order. If response is
insufficient within 30 minutes, notify provider.
PACU
Page 9 of 16
Printed by BENNETT, SARA J [SJB008] at 12/15/2017 6:58:04 AM
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ondansetron (ZOFRAN) injection [800202] 4 mg, Intravenous, ONCE PRN For 1 Doses,
nausea/vomiting
Second Line Agent - Give if patient fails to respond to
first line agent after 30 minutes. If two - three second
line agents are ordered, these should be considered
as concurrent administration orders.
PACU
diphenhydramine (BENADRYL) injection [800106] 12.5 mg, Intravenous, ONCE PRN For 1 Doses,
nausea/vomiting
Second Line Agent - Give if patient fails to respond to
first line agent after 30 minutes. If two - three second
line agents are ordered, these should be considered
as concurrent administration order. If response is
insufficient within 30 minutes, notify provider.
PACU
olanzapine (ZYPREXA ZYDIS) disintegrating tab
[64700]
Oral, ONCE PRN For 1 Doses, nausea
Second Line Agent - Give if patient fails to respond to
first line agent after 30 minutes. If two - three second
line agents are ordered, these should be considered
as concurrent administration order. If response is
insufficient within 30 minutes, notify provider.
PACU
Anti-emetics for nausea due to postural hypotension - Scheduled (Single Response) [242147]
epHEDRINE injection [37166] 5 mg, Intravenous, ONCE For 1 Doses, PACU
epHEDRINE injection [37166] 10 mg, Intravenous, ONCE For 1 Doses, PACU
Anti-hypertensives (Single Response) [242146]
enalaprilat (VASOTEC) injection [45046] 0.625 mg, Intravenous, ONCE PRN For 1 Doses, see
Admin Instructions
Administer for systolic blood pressure greater than ***
mmHg or diastolic blood pressure greater than ***
mmHg. If blood pressure decrease is insufficient
within *** minutes, notify provider
for 5 Minutes, PACU
enalaprilat (VASOTEC) injection [45046] 1.25 mg, Intravenous, ONCE PRN For 1 Doses, see
Admin Instructions
Administer for systolic blood pressure greater than ***
mmHg or diastolic blood pressure greater than ***
mmHg. If blood pressure decrease is insufficient
within *** minutes, notify provider
for 5 Minutes, PACU
hydrALAZINE (APRESOLINE) injection 5 mg
[800109]
5 mg, Intravenous, ONCE PRN For 1 Doses, see
Admin Instructions
Administer for systolic blood pressure greater than ***
mmHg or diastolic blood pressure greater than ***
mmHg. If blood pressure decrease is insufficient
within *** minutes, notify provider
PACU
hydrALAZINE (APRESOLINE) injection 10 mg
[800109]
10 mg, Intravenous, ONCE PRN For 1 Doses, see
Admin Instructions
Administer for systolic blood pressure greater than ***
mmHg or diastolic blood pressure greater than ***
mmHg. If blood pressure decrease is insufficient
within *** minutes, notify provider
PACU
Page 10 of 16
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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

labetalol (NORMODYNE;TRANDATE) injection
RANGE [750053]
5-10 mg, Intravenous, EVERY 10 MINUTES PRN,
hypertension - see Admin Instructions
Administer for systolic blood pressure greater than ***
mmHg or diastolic blood pressure greater than ***
mmHg. If blood pressure decrease is insufficient
within *** minutes, notify provider
for 2 Minutes, PACU
metoprolol (LOPRESSOR) injection [800274] Intravenous, ONCE PRN For 1 Doses, see Admin
Instructions
Administer for systolic blood pressure greater than ***
mmHg or diastolic blood pressure greater than ***
mmHg. If blood pressure decrease is insufficient
within *** minutes, notify provider
PACU
nitroglycerin (NITROSTAT) sublingual tab 0.4 mg
[40283]
0.4 mg, Sublingual, EVERY 10 MINUTES PRN, chest
pain, hypertension - see Admin Instructions
Administer for systolic blood pressure greater than ***
mmHg or diastolic blood pressure greater than ***
mmHg. If blood pressure decrease is insufficient
within *** minutes, notify provider
PACU
Insulins [82520]
insulin regular (human) 100 units/mL vial [45422] Subcutaneous, ONCE For 1 Doses, PACU
insulin lispro (human) (HUMALOG) 100 UNIT/ML
injection [53264]
Subcutaneous, ONCE For 1 Doses, PACU
insulin regular (human) infusion [700217] 0.2-30 Units/hr, Intravenous, CONTINUOUS, PACU
Infusions [19679]
amiodarone (CORDARONE) non- PVC infusion
[700135]
0.5 mg/min, Intravenous, CONTINUOUS, PACU
diltiazem (CARDIZEM) infusion [700192] Intravenous, CONTINUOUS, PACU
epINEPHrine infusion [700197] Intravenous, CONTINUOUS, PACU
isoproterenol (ISUPEL) infusion [700221] Intravenous, CONTINUOUS, PACU
naloxone (NARCAN) infusion [700242] Intravenous, CONTINUOUS, PACU
nicardipine (CARDENE) 50 mg in sodium chloride
0.9 % 250 mL infusion [700960]
Intravenous, CONTINUOUS, PACU
norepinephrine (LEVOPHED) infusion [700247] Intravenous, CONTINUOUS, PACU
phenylEPHRINE(NEO-SYNEPHRINE) infusion
[700258]
Intravenous, CONTINUOUS, PACU
sodium bicarbonate 250 mEq/250 mL
UNDILUTED infusion [785158]
Intravenous, CONTINUOUS, PACU
propofol (DIPRIVAN) 10 mg/mL infusion [800260] Intravenous, CONTINUOUS, PACU
vasopressin (PITRESSIN) 20 units in dextrose 5
% 100 mL infusion [700977]
Intravenous, CONTINUOUS, PACU
Infusions - Stock Bags [19678]
DOBUTamine (DOBUTREX) 1000mg in dextrose
5% 250 mL infusion [51747]
Intravenous, CONTINUOUS, PACU
DOPamine (INTROPIN) 800 mg in dextrose 5%
250 mL infusion [50506]
Intravenous, CONTINUOUS, PACU
esmolol (BREVIBLOC) 2.5 g in sodium chloride
0.9% 250 mL infusion [66486]
Intravenous, CONTINUOUS, PACU
lidocaine 2000 mg in dextrose 5% 500 mL
infusion [50530]
Intravenous, CONTINUOUS, PACU
milrinone (PRIMACOR) 20 mg in dextrose 5%
100 mL infusion [175995]
Intravenous, CONTINUOUS, PACU
Page 11 of 16
Printed by BENNETT, SARA J [SJB008] at 12/15/2017 6:58:04 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

nitroglycerin 50 mg in dextrose 5% 250 mL
infusion [51611]
Intravenous, CONTINUOUS, PACU
Nalbuphine [81188]
nalbuphine (NUBAIN) injection [39994] 2.5 mg, Intravenous, ONCE PRN For 1 Doses, opioid-
induced pruritus, for 3 Minutes, PACU
Self-administered Medications [151458]
Note: Self Administered Medication Program
Documentation [950000]
ONCE For 1 Doses
Patient may self-administer and use own supply of the
following medications: ***
PACU
Laboratory
Immediately Postoperatively (CSC lab) [19141]
CALCIUM, IONIZED, WHOLE BLOOD
[HCWBICA]
STAT, Starting today For 1 Occurrences, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Draw immediately postoperatively., PACU
CALCIUM [CA] 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?
Draw immediately postoperatively., PACU
MAGNESIUM [MAG] 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?
Draw immediately postoperatively., PACU
POTASSIUM, WHOLE BLOOD [HCWBK] STAT, Starting today For 1 Occurrences, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Draw immediately postoperatively., PACU
SODIUM, WHOLE BLOOD [HCWBNA] STAT, Starting today For 1 Occurrences, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Draw immediately postoperatively., PACU
Troponin Panel [126087]
Troponin to be drawn every 6 hours for 3 occurrances or until peak. Panel created to allow for
initial draw in PACU and remaining draws on the inpatient unit.
Troponin [GM2447] ONCE, 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?
To be drawn every 6 hours for 3 occurrences or until
peak. First draw to be immediately postop in PACU,
PACU
Troponin [GM2447] CONDITIONAL, Starting today For 3 Days, Routine
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition? To be drawn every 6
hours for 3 occurrences or until peak. First draw to
be immediately postop in PACU
Post-Op/Phase II
Page 12 of 16
Printed by BENNETT, SARA J [SJB008] at 12/15/2017 6:58:04 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

BUN [BUN] 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?
Draw immediately postoperatively., PACU
CREATININE, WHOLE BLOOD [HCWBCRET] STAT, Starting today For 1 Occurrences, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Draw immediately postoperatively., PACU
HEMOGLOBIN, WHOLE BLOOD [HCWBHGB] STAT, Starting today For 1 Occurrences, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Draw immediately postoperatively., PACU
PLATELET COUNT [PLT] 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?
Draw immediately postoperatively., PACU
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?
Draw immediately postoperatively., PACU
PTT [PTT] 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?
Draw immediately postoperatively., PACU
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., Draw immediately
postoperatively., PACU
BLOOD GASES AND O2 SATURATION
[HCBGASOS]
STAT, Starting today For 1 Occurrences, STAT
Indicate FIO2:
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Draw immediately postoperatively., PACU
Immediately Postoperatively (TAC lab) [194254]
CALCIUM, IONIZED, WHOLE BLOOD
[HCWBICA]
STAT, Starting today For 1 Occurrences, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Draw immediately postoperatively., PACU
CALCIUM [CA] 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?
Draw immediately postoperatively., PACU
Page 13 of 16
Printed by BENNETT, SARA J [SJB008] at 12/15/2017 6:58:04 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

MAGNESIUM [MAG] 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?
Draw immediately postoperatively., PACU
POTASSIUM, WHOLE BLOOD [HCWBK] STAT, Starting today For 1 Occurrences, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Draw immediately postoperatively., PACU
SODIUM, WHOLE BLOOD [HCWBNA] STAT, Starting today For 1 Occurrences, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Draw immediately postoperatively., PACU
Troponin Panel [126087]
Troponin to be drawn every 6 hours for 3 occurrances or until peak. Panel created to allow for
initial draw in PACU and remaining draws on the inpatient unit.
Troponin [GM2447] ONCE, 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?
To be drawn every 6 hours for 3 occurrences or until
peak. First draw to be immediately postop in PACU,
PACU
Troponin [GM2447] CONDITIONAL, Starting today For 3 Days, Routine
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition? To be drawn every 6
hours for 3 occurrences or until peak. First draw to
be immediately postop in PACU
Post-Op/Phase II
BUN [BUN] 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?
Draw immediately postoperatively., PACU
CREATININE [CRET] 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?
Draw immediately postoperatively., PACU
HEMOGLOBIN, WHOLE BLOOD [HCWBHGB] STAT, Starting today For 1 Occurrences, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Draw immediately postoperatively., PACU
PLATELET COUNT [PLT] 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?
Draw immediately postoperatively., PACU
Page 14 of 16
Printed by BENNETT, SARA J [SJB008] at 12/15/2017 6:58:04 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

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?
Draw immediately postoperatively., PACU
PTT [PTT] 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?
Draw immediately postoperatively., PACU
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., Draw immediately
postoperatively., PACU
BLOOD GASES AND O2 SATURATION
[HCBGASOS]
STAT, Starting today For 1 Occurrences, STAT
Indicate FIO2:
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Draw immediately postoperatively., PACU
Diagnostic Tests and Imaging
Studies [19143]
X-RAY CHEST AP VIEW [R71010] 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? IP PACU
Last patient weight? (will auto pull in value and date in
comment):
Transport Method: Floor Determined/Entered
PACU
X-RAY CHEST PA & LAT VIEWS [R71020] ONCE-RAD NEXT AVAILABLE, Starting today 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
PACU
Page 15 of 16
Printed by BENNETT, SARA J [SJB008] at 12/15/2017 6:58:04 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

ECG - 12 Lead [EKG0008] ONCE, Starting today For 1 Occurrences, Routine
Reason for exam:
Disclaimer for University Hospital Only: A Stat status
for an ECG is in reference to the timing of the ECG.
The goal is to perform a STAT ECG within 10 minutes
of the order being placed. It is the responsibility of the
ordering provider to review the STAT ECGs. All ECGs
(stat or routine) will be formally reviewed within one
business day.
PACU
Page 16 of 16
Printed by BENNETT, SARA J [SJB008] at 12/15/2017 6:58:04 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org