/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/order-sets/,/clinical/cckm-tools/content/order-sets/inpatient/,/clinical/cckm-tools/content/order-sets/inpatient/bmtoncologyhematology/,

/clinical/cckm-tools/content/order-sets/inpatient/bmtoncologyhematology/name-97834-en.cckm

20180105

page

100

UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,BMT/Oncology/Hematology

IP - BMT - Non-Myeloablative Double Unit Umbilical Cord Blood Transplant - Adult - Admission [2329]

IP - BMT - Non-Myeloablative Double Unit Umbilical Cord Blood Transplant - Adult - Admission [2329] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, BMT/Oncology/Hematology


IP - BMT - Non-Myeloablative Double Unit Umbilical Cord Blood Transplant -
Adult - Admission [2329]
for Adult Patients OnlyIntended
Admission Status
Level of Care (Single Response) [187515]
*An admit patient order has already been written, but the level of care at which the patient
should be placed still needs to be identified.
Place Patient on General Care [ADT0018] General Care, has already been signed. This order
will ensure that the patient is placed at the appropriate
level of care.
Place Patient on Intermediate Care (IMC)
[ADT0018]
Intermediate Care, has already been signed. This
order will ensure that the patient is placed at the
appropriate level of care.
Place Patient on Intensive Care (ICU) [ADT0018] Intensive Care, has already been signed. This order
will ensure that the patient is placed at the appropriate
level of care.
Admit to Inpatient (Single Response) [188296]
Admit To Inpatient [ADT0001] Attending:
Admitting Resident:
Requested Floor:
Service:
I certify that an inpatient stay is medically necessary
because of either an anticipated LOS >2 midnights,
complexity and/or severity of illness, an inpatient-
only surgery, or a previously-authorized inpatient
stay. Rationale listed below. Yes
C - CLEAR DIAGNOSIS:
E - EVALUATIONS PLANNED:
R - RESULTS EXPECTED:
T - TREATMENTS ORDERED:
Admit to Observation (Single Response)
[188297]
Admit To Observation [ADT0002] Attending:
Admitting Resident:
Requested Floor:
Service:
Admit to Outpatient Short Stay (Single
Response) [188298]
Admit To Outpatient Short Stay [ADT0003] Attending:
Admitting Resident:
Requested Floor:
Service:
Admission Status [106407]
Admit To Inpatient [ADT0001] Attending:
Admitting Resident:
Requested Floor:
Service: BONE MARROW TRANSPLANT
Rationale for LOS greater than 2 midnights:
Admit To Observation [ADT0002] Attending:
Admitting Resident:
Requested Floor:
Service:
Page 1 of 18
Printed by STRAKA, KEVIN F [KFS1] at 1/4/2018 2:16:46 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Admit To Outpatient Short Stay [ADT0003] Attending:
Admitting Resident:
Requested Floor:
Service:
Admission Status [122711]
Admit To Inpatient [ADT0001] Attending:
Admitting Resident:
Requested Floor:
Service: BONE MARROW TRANSPLANT
Rationale for LOS greater than 2 midnights:
Admit To Observation [ADT0002] Attending:
Admitting Resident:
Requested Floor:
Service:
Admit To Outpatient Short Stay [ADT0003] Attending:
Admitting Resident:
Requested Floor:
Service:
Venous Thromboembolism (VTE) Prophylaxis
VTE Prophylaxis (Single Response) [130119]
Padua VTE Risk Assessment URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/hematology-and-
coagulation/related/name-97520-en.cckm
Low VTE Risk [130084]
VTE Prophylaxis - Reason Not Ordered
[COR0008]
ONCE, Routine
Reason Not Ordered: Low Risk
High VTE Risk with Low Bleed Risk (Single
Response) [129777]
enoxaparin (LOVENOX) subcutaneous injection
[800040]
40 mg, Subcutaneous, EVERY 24 HOURS
heparin subcutaneous injection [800290] 5,000 units, Subcutaneous, EVERY 12 HOURS
High Bleed Risk with High VTE Risk [129757]
Sequential Compression Device (SCD)
(TREATMENT) [NURTRT0028]
CONTINUOUS, Routine
Left/Right/Bilateral? Bilateral
Sequential Compression Device (SCD) / Foot
Pump (SUPPLY) [EQP0023]
CONTINUOUS, Routine
Left/Right/Bilateral?
Type: Knee High
Apply and Maintain Anti-Embolism Stocking
[NURTRT0039]
CONTINUOUS, Routine
Does this need to be inserted/placed?
Left/Right/Bilateral? Bilateral
Type: Knee high
No VTE Prophylaxis [130084]
VTE Prophylaxis - Reason Not Ordered
[COR0008]
ONCE, Routine
Reason Not Ordered:
VTE Prophylaxis (Single Response) [150156]
Padua VTE Risk Assessment URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/hematology-and-
coagulation/related/name-97520-en.cckm
Low VTE Risk [130084]
VTE Prophylaxis - Reason Not Ordered
[COR0008]
ONCE, Routine
Reason Not Ordered: Low Risk
High VTE Risk with Low Bleed Risk (Single
Response) [129777]
enoxaparin (LOVENOX) subcutaneous injection
[800040]
40 mg, Subcutaneous, EVERY 24 HOURS
Page 2 of 18
Printed by STRAKA, KEVIN F [KFS1] at 1/4/2018 2:16:46 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

heparin subcutaneous injection [800290] 5,000 units, Subcutaneous, EVERY 12 HOURS
High Bleed Risk with High VTE Risk [129757]
Sequential Compression Device (SCD)
(TREATMENT) [NURTRT0028]
CONTINUOUS, Routine
Left/Right/Bilateral? Bilateral
Sequential Compression Device (SCD) / Foot
Pump (SUPPLY) [EQP0023]
CONTINUOUS, Routine
Left/Right/Bilateral?
Type: Knee High
Apply and Maintain Anti-Embolism Stocking
[NURTRT0039]
CONTINUOUS, Routine
Does this need to be inserted/placed?
Left/Right/Bilateral? Bilateral
Type: Knee high
No VTE Prophylaxis [130084]
VTE Prophylaxis - Reason Not Ordered
[COR0008]
ONCE, Routine
Reason Not Ordered:
Patient Care Orders
Vital Signs [33444]
Vital Signs [NURMON0013] EVERY 4 HOURS, Starting today, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Activity [33445]
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:
Nutrition [33446]
Patient Approved for Additional Menu Items
[NURDIE0013]
CONTINUOUS
Patient may order food items from UWHC café or
Mendota Market? Yes
Patient may order regular soda or other sugar-
sweetened beverages? Yes
General Diet [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: General (no Modifications)
Bedside Meal Instructions:
Room Service Class:
Neutropenic Diet [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: Diet Modifications
Diet Modifications: Neutropenic
Bedside Meal Instructions:
Room Service Class:
Intake and Output [33452]
Measure Intake And Output [NURMON0005] EVERY 8 HOURS, Starting today, Routine
Page 3 of 18
Printed by STRAKA, KEVIN F [KFS1] at 1/4/2018 2:16:46 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Measure Intake And Output [NURMON0005] EVERY 4 HOURS, Starting today, Routine
BMT Transfusion Protocol [113191]
Initiate BMT Service Transfusion Protocol
[TRAN0001]
CONTINUOUS, Starting today, Routine
Analgesics to be Ordered:
Antihistamines to be Ordered:
Steroids to be Ordered:
Labs to be Ordered:
Total Volume (units) RBC (Pediatric):
Total Volume (mL) RBC (Pediatric):
Total Units Platelets (Pediatric) (1 random donor unit =
45-65 mL; Suggested dose = 1 RDU/12kg; 4 RDU=1
SDU):
Does patient require single donor platelets (If yes,
Blood Bank MD approval required): No
Platelet Threshold: 10,000/microliter
Hemoglobin Threshold: 8 grams/deciliter
Order blood products, premeds and/or post labs as
indicated using order set #4179 IP - BMT - Blood
Transfusion - Supplemental
Non-Categorized Patient Care Orders [33455]
Procedurecare per Bone Marrow Transplant Standard Operating Mouth
Measure Weight Upon Admission
[NURMON0015]
ONCE For 1 Occurrences, Routine
Weigh With?
Weigh when?
Measure once upon admission
Measure Height Upon Admission [NURMON0052] ONCE For 1 Occurrences, Routine, Measure once
upon admission
Measure Weight [NURMON0015] 1X DAILY, Starting today, Routine
Weigh With?
Weigh when?
Nursing Communication [NURCOM0022] CONTINUOUS, Starting today, Neutropenic
Precautions should start on Day -3.
Contingency Parameters [33456]
Notify Provider [NURCOM0001] Provider to Notify: Provider
If systolic blood pressure > (mmHg): 160
If systolic blood pressure < (mmHg): 90
If diastolic blood pressure > (mmHg): 100
If diastolic blood pressure < (mmHg): 50
If temperature > (C): 38.2 or temperature greater than
38.0 degrees Celsius sustained for greater than 1 hour
If temperature < (C):
If heart rate > (bpm): 120
If heart rate < (bpm): 50
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: Pain not controlled with ordered analgesics or
ordered interventions,Patient is not engrafted by Day
+28 for alternative pneumocystis pneumonia (PCP)
prophylaxis. Do not start
trimethoprim/sulfamethoxazole,Inconsistent blood
pressure
Page 4 of 18
Printed by STRAKA, KEVIN F [KFS1] at 1/4/2018 2:16:46 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Intravenous Therapy
Premedications for Needle Insertion [106310]
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.
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
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.
Flushes [29948]
Initiate Venous Access Device Flushing Protocol
[NURVAD0053]
ONCE, Starting today For 1 Occurrences
Medications - General
Analgesics - Acetaminophen PRN [217512]
acetaMINOPHEN (TYLENOL) tab [34149] 650 mg, Oral, EVERY 4 HOURS PRN, pain/fever
Mild pain, multimodal therapy or temperature greater
than 38.2 C
acetaMINOPHEN alcohol free (TYLENOL) oral
suspension [800005]
650 mg, Oral, EVERY 4 HOURS PRN, pain
Mild pain, multimodal therapy or temperature greater
than 38.2 C
Analgesics - Opioids - PRN [33214]
oxycodone tab RANGE [750032] 5-10 mg, Oral, EVERY 4 HOURS PRN, pain
Severe pain
Anti-emetics [33225]
ondansetron (ZOFRAN ODT) disintegrating tab
[64224]
8 mg, Oral, EVERY 4 HOURS PRN, nausea/vomiting
First line therapy. Administer if patient not already on
scheduled ondansetron (ZOFRAN) as part of
chemotherapy plan. Maximum 24 mg every 24 hours.
ondansetron (ZOFRAN) injection [800202] 8 mg, Intravenous, EVERY 8 HOURS PRN,
nausea/vomiting
Maximum 24 mg every 24 hours. For first line therapy.
Administer if patient not already on scheduled
ondanestron (ZOFRAN) as part of chemotherapy plan.
Administer if patient is unable to tolerate orally.
prochlorperazine (COMPAZINE) tab [41372] 10 mg, Oral, EVERY 6 HOURS PRN, nausea/vomiting
Second line therapy. Administer when there is no
response to first line therapy with 30 minutes.
prochlorperazine (COMPAZINE) injection [41369] 10 mg, Intravenous, EVERY 6 HOURS PRN,
nausea/vomiting
Second line therapy. Administer if there is no
response to first line therapy within 30 minutes.
Antacids [22313]
Page 5 of 18
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Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

mag-al-simeth (MYLANTA ES) susp MULTIDOSE
[44073]
15 mL, Oral, EVERY 4 HOURS PRN, dyspepsia
Bowel Management [33208]
polyethylene glycol (MIRALAX) oral packet
[61829]
17 g, Oral, 1 X DAILY PRN, constipation, constipation
when there is no response to first line therapy.
Dissolve in 240 mL of liquid. For first line therapy.
senna-docusate (SENOKOT S) 8.6-50 MG per
tab [60530]
2 tab, Oral, 2 X DAILY PRN, constipation
For second line therapy.
magnesium hydroxide (MILK OF MAGNESIA)
susp [65443]
30 mL, Oral, 1 X DAILY PRN, constipation
Third line therapy. Administer when there is no
response to first and second line therapies and
immediate laxation is needed.
Hypnotics [217513]
traZODONE (DESYREL) tab [720150] 25-50 mg, Oral, 1 X DAILY (HS) PRN, sleep
Offer only after failure of non-pharmacologic
interventions.
Stress Ulcer Prophylaxis (Single Response) [22316]
famotidine (PEPCID) tab [45134] 20 mg, Oral, 1 X DAILY (HS)
Magnesium Supplements [22325]
magnesium sulfate intraVENOUS [800111] 2 g, Intravenous, 1 X DAILY PRN, serum magnesium
less than or equal to 1.4 mg/dL
Potassium Supplements [22324]
potassium chloride 20 mEq/ 50 mL bag
CENTRAL LINE ONLY [46256]
20 mEq, Intravenous, 1 X DAILY PRN, serum
potassium less than or equal to 3.2 mmol/L, for 60
Minutes
Non-categorized [33211]
cepastat lozenge [114373] 1-2 lozenge, Oral, EVERY 2 HOURS PRN, sore throat
diphenhydramine (BENADRYL) cap [36791] 25 mg, Oral, EVERY 6 HOURS PRN, itching
diphenhydramine (BENADRYL) injection RANGE
[750044]
25-50 mg, Intravenous, EVERY 6 HOURS PRN,
itching, for 1 Minutes
diphenhydramine-lidocaine-al&mag-simethicone
(MAGIC MOUTHWASH) susp [104892]
15-30 mL, Swish & Swallow, EVERY 4 HOURS PRN,
mucositis
folic acid (FOLVITE) tab - NOTE : Start on Day +
14 [37644]
1 mg, Oral, 1 X DAILY
Start on Day +14
multivitamin with mineral tab [800240] 1 tab, Oral, 1 X DAILY
Start on Day 0
labetalol injection [800192] 20 mg, Intravenous, PRN, For Systolic Blood Pressure
greater than or equal to 160 mmHg or Diastolic Blood
Pressure greater than or equal to 100 mmHg.
for SBP > or equal to 160 mmHg or DBP > or equal to
100 mmHg Hold and notify physician if heart rate less
than 60 mmHg.
naloxone (NARCAN) injection [800199] 0.1 mg, Intravenous, PRN, opioid overdose
Administer every 3 minutes times 4 doses for
respiratory rate less than 8 breaths/minute or sedation
score of 5 or greater. Notify MD if naloxone
administered.
sodium chloride (SALINE) 0.65 % nasal spray
[41865]
2 spray, Nostril (Each), EVERY 4 HOURS PRN, nasal
dryness
May leave at bedside.
biotene calcium mouthwash RANGE [750070] 10-15 mL, Swish & Spit, EVERY 4 HOURS PRN, dry
mouth
Leave at bedside
guaifenesin (ROBITUSSIN) 100 MG/5ML soln
[113643]
Oral, EVERY 4 HOURS PRN, cough
Medications - Anti-infective Prophylaxis
Page 6 of 18
Printed by STRAKA, KEVIN F [KFS1] at 1/4/2018 2:16:46 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Antivirals for CMV Seronegative patients - Start on Day of Admission [33201]
For Varicella Zoster Virus Seronegative Patients
[233669]
acyclovir (ZOVIRAX) cap [44025] 400 mg, Oral, 2 X DAILY
Start on Day of Admission
Note: Initiate acyclovir 200 mg IV every 12 hours
if patient unable to tolerate oral medication
[950018]
PRN - NOTIFY PHARMACY WHEN NEEDED
Initiate 200 mg IV every 12 hours if patient unable to
tolerate oral medications. Start on Day of
Admission. Maximum dose 200 mg.
For Varicella Zoster Virus Seropositive Patients
[233696]
acyclovir (ZOVIRAX) cap [44025] 800 mg, Oral, 2 X DAILY
Note: Note: Initiate acyclovir 200 mg IV every 12
hours if patient unable to tolerate oral medication
[950018]
ONCE
Start on Day of Admission. Maximum Dose 200 mg
Antivirals for CMV Seropositive Patients - Start on Day of Admission through Day +13 [33203]
For Varicella Zoster Virus Seronegative Patients
[233697]
acyclovir (ZOVIRAX) cap [44025] 400 mg, Oral, 2 X DAILY
Start on Day of Admission through Day +13
Note: Initiate acyclovir 200 mg IV every 12 hours
if patient unable to tolerate oral medication
[950018]
ONCE
Note: Initiate acyclovir 200 mg IV every 12 hours if
patient unable to tolerate oral medication. Start on
Day of Admission. Maximum Dose 200 mg.
For Varicella Zoster Virus Seropositive Patients
[233695]
acyclovir (ZOVIRAX) cap [44025] 800 mg, Oral, 2 X DAILY
Start on Day of Admission through Day +13
Note: Initiate acyclovir 200 mg IV every 12 hours
if patient unable to tolerate oral medication
[950018]
PRN - NOTIFY PHARMACY WHEN NEEDED
Note: Initiate acyclovir 200 mg IV every 12 hours if
patient unable to tolerate oral medication. Start on
Day of Admission. Maximum Dose 200 mg.
Antivirals for CMV Seropositive Patients - Start on Day +14 [33204]
For Varicella Zoster Virus Seropositive Patients
[233691]
valACYclovir (VALTREX) tab [48495] 1,000 mg, Oral, 3 X DAILY Starting 1/18/18
Note: Initiate acyclovir 10 mg/kg IV every 8 hours
if unable to tolerate oral acyclovir [950018]
PRN - NOTIFY PHARMACY WHEN NEEDED
Note: Initiate acyclovir 200 mg IV every 12 hours if
patient unable to tolerate oral medication. Maximum
200 mg
Antifungals - Start on Day 0 [33205]
posaconazole (NOXAFIL) delayed release tab
[159987]
300 mg, Oral, 1 X DAILY For 96 Hours
First line therapy
voriconazole (VFEND) tab [69966] 200 mg, Oral, 2 X DAILY (BEFORE MEALS) For 96
Hours
Second line therapy if patient unable to receive
posaconazole
Anti-infectives - Start on Day 0 [33207]
levofloxacin (LEVAQUIN) tab [54885] 500 mg, Oral, 1 X DAILY (HS) Starting today For 365
Days
Start on Day 0. Discontinue when ANC has been
greater than 500/microliter for 3 consecutive days.
Discontinue if patient develops neutropenic fever and
is started on additional antibiotic therapy. Administer
at least 4 hours before or 8 hours after antacids
containing magnesium or aluminum, sucralfate, iron,
multivitamin preparations with zinc, or didanosine.
Page 7 of 18
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Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

cefpodoxime (VANTIN) tab - For patient unable to
tolerate fluoroquinolones [44562]
200 mg, Oral, 2 X DAILY (AT MEALTIME)
Anti-infectives - Start When ANC is greater than 1000/microliter [33206]
Note: Start sulfamethoxazole-trimethoprim
(BACTRIM) 400-80 mg 2 tab by mouth every
Monday, Wednesday and Friday on the First
Monday after Day +28 when absolute neutrophil
count is greater than 2,000/microliter for 3
Consecutive Days, AND Platelets Greater than
80,000/microliter [950018]
PRN, See Admin Instructions
Note: Start sulfamethoxazole-trimethoprim (BACTRIM)
400-80 mg 2 tab by mouth every Monday, Wednesday
and Friday on the First Monday after Day +28 when
absolute neutrophil count is greater than
2,000/microliter for 3 Consecutive Days, AND
Platelets Greater than 80,000/microliter
Medications - Anti-infectives For Fever
negative agent -positive and one Gram-one GramOrder
Neutropenic Fever Standard Operating Procedure URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/oncology/name-97716-en.cckm
Broad Spectrum Coverage (Single Response) [106256]
Pharmacokinetic/Pharmacodynamic Dose
Optimization of Antibiotics for the Treatment of
Gram Negative Infection
URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/?path=/content/cpg/infection-and-
isolation/name-97543-en.cckm
Treatment of Patients with Reported Allergies to
Beta-Lactam Antibiotics – Adult – Inpatient clinical
practice guideline
URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/?path=/content/cpg/infection-and-
isolation/name-97535-en.cckm
cefepime (MAXIPIME) intraVENOUS [240031]
cefepime (MAXIPIME) 1 g vial + minibag [52161] 1 g, Intravenous, PRN - NOTIFY PHARMACY
WHEN NEEDED
Give for first temperature spike greater than 38.2
Celsius or temperature greater than 38.0 Celsius
sustained for one hour or longer
for 30 Minutes
cefepime (MAXIPIME) 1 g vial + minibag [52161] 1 g, Intravenous, PRN - NOTIFY PHARMACY
WHEN NEEDED
Start 6 hours after initial one-time order. Give every
6 hours for first temperature spike greater than 38.2
Celsius or temperature greater than 38.0 Celsius
sustained for one hour or longer
for 4 Hours
NOTE: Run cefepime over 4 hours every 6 hours.
For additional information please refer to
“Pharmacokinetic/ Pharmacodynamic Dose
Optimization of Antibiotics for the Treatment of
Gram Negative Infection” as above [950056]
PRN - NOTIFY PHARMACY WHEN NEEDED
meropenem (MERREM) intraVENOUS - Choose
meropenem when patient has received both
cefepime and piperacillin/ tazobactam in the past
90 days. [800055]
500 mg, Intravenous, PRN - NOTIFY PHARMACY
WHEN NEEDED For 365 Days, See Admin
Instructions
Administer every 6 hours per UWHC Guidelines for
the Pharmacokinetic/Pharmacodynamic Dose
Optimization of Antibiotics for the Treatment of Gram
Negative Infection for first fever spike.
aztreonam (AZACTAM) intraVENOUS - Choose
when patient has severe or immediate IgE
mediated allergy to beta-lactam antibiotics. Must
order concurrent IV vancomycin. [800013]
2 g, Intravenous, PRN - NOTIFY PHARMACY WHEN
NEEDED For 365 Days
Do Not Administer IV Push Give every 8 hours for first
temperature spike greater than 38.2 Celsius or
temperature greater than 38.0 Celsius sustained for
one hour or longer. See Treatment of Patients with
Reported Allergies to Beta-Lactam Antibiotics - Adult -
Inpatient clinical practice guideline.
Page 8 of 18
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Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

ciprofloxacin (CIPRO) intraVENOUS - Choose
when patient has severe or immediate IgE
mediated allergy to beta-lactam antibiotics. Must
order concurrent IV vancomycin [800031]
400 mg, Intravenous, PRN - NOTIFY PHARMACY
WHEN NEEDED
Give every 8 hours for first temperature spike greater
than 38.2 Celsius or temperature greater than 38.0
Celsius sustained for one hour or longer
See Treatment of Patients with Reported Allergies to
Beta-Lactam Antibiotics - Adult - Inpatient clinical
practice guideline.
Gram-Positive Coverage [105048]
vancomycin (VANCOCIN) intraVENOUS -
Choose when there is concern for cellulitis or line
infection [800084]
1 g, Intravenous, PRN - NOTIFY PHARMACY WHEN
NEEDED, See Admin Instructions
Give every 12 hours for first temperature spike greater
than 38.2 Celsius or temperature greater than 38.0
Celsius sustained for one hour or longer
Anaerobic Coverage (Single Response) [217539]
metRONIDazole (FLAGYL) intraVENOUS -
Choose when there is concern for intra-abdominal
infection [800062]
500 mg, Intravenous, PRN - NOTIFY PHARMACY
WHEN NEEDED
Give every 6 hours for first temperature spike greater
than 38.2 Celsius or temperature greater than 38.0
Celsius sustained for one hour or longer
metRONIDazole (FLAGYL) tab - Choose when
there is concern for intra-abdominal infection
[39639]
500 mg, Oral, PRN - NOTIFY PHARMACY WHEN
NEEDED
Give every four times a day for first temperature spike
greater than 38.2 Celsius or temperature greater than
38.0 Celsius sustained for one hour or longer
Laboratory
Draw on Admission [33459]
CBC WITH DIFFERENTIAL [CBC] NEXT DRAW, 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?
PROTHROMBIN TIME/INR [PT] NEXT DRAW, 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?
ELECTROLYTES [LYTE] NEXT DRAW, 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?
BUN [BUN] NEXT DRAW, 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?
CREATININE [CRET] NEXT DRAW, 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?
Page 9 of 18
Printed by STRAKA, KEVIN F [KFS1] at 1/4/2018 2:16:46 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

GLUCOSE [GLU] NEXT DRAW, 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?
MAGNESIUM [MAG] NEXT DRAW, 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?
CALCIUM [CA] NEXT DRAW, 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?
PHOSPHATE [PHOS] NEXT DRAW, 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?
URIC ACID [URIC] NEXT DRAW, 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?
PROTEIN, TOTAL [TP] NEXT DRAW, 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?
BILIRUBIN, TOTAL [TBIL] NEXT DRAW, 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?
ALBUMIN [ALB] NEXT DRAW, 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?
AST/SGOT [AST] NEXT DRAW, 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?
ALT/SGPT [ALT] NEXT DRAW, 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?
ALKALINE PHOSPHATASE [ALKP] NEXT DRAW, 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?
Page 10 of 18
Printed by STRAKA, KEVIN F [KFS1] at 1/4/2018 2:16:46 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

LD, TOTAL [LDH] NEXT DRAW, 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?
CREATININE, URINE, 24 HOUR [UCR] 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?
C. DIFF TOXIN B PCR, B6/6 SCREENING ONLY
[CDIFFS]
ONCE 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 on Admission, if Patient has Existing Central Venous Catheter [33461]
CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
CONDITIONAL For 2 Days, Routine, For optimum
diagnosis of sepsis, sample 3-4 sites only on the first
day of a septic episode. Cultures on subsequent days
are of minimal diagnostic value. Culture detects
bacteria, Candida and Cryptococcus. If filamentous
fungi are suspected see Culture, Blood, Filamentous
Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition? Draw on admission if
patient has existing central venous catheter, one from
each port
CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
CONDITIONAL For 2 Days, Routine, For optimum
diagnosis of sepsis, sample 3-4 sites only on the first
day of a septic episode. Cultures on subsequent days
are of minimal diagnostic value. Culture detects
bacteria, Candida and Cryptococcus. If filamentous
fungi are suspected see Culture, Blood, Filamentous
Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition? Draw on admission if
patient has existing central venous catheter, one from
each port
Draw on Admission if Patient is CMV Positive [33462]
CMV QUANTITATIVE BY PCR [HCCMVDNA] CONDITIONAL For 2 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw on admission if
patient is CMV positive
Draw Once for First Temperature Greater than or Equal to 38.2 Degrees Celsius or Sustained Fever of
38.0 Degrees Celsius for Greater than 1 Hour - Days 1-7 [33483]
For First Fever Spike: [NURCOM0055] ONCE, Starting today For 1 Occurrences, Routine,
For first fever spike, draw from all ports of line and
peripheral. To be placed with Culture, Blood, Bacteria
and Yeast order.
Page 11 of 18
Printed by STRAKA, KEVIN F [KFS1] at 1/4/2018 2:16:46 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
CONDITIONAL For 7 Days, Routine, For optimum
diagnosis of sepsis, sample 3-4 sites only on the first
day of a septic episode. Cultures on subsequent days
are of minimal diagnostic value. Culture detects
bacteria, Candida and Cryptococcus. If filamentous
fungi are suspected see Culture, Blood, Filamentous
Fungi.
Patient's Active Lines:
No Active Lines Found.
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Once, for first
temperature greater than or equal to 38.2 Celsius or
sustained fever of 38.0 Celsius for greater than 1 hour.
Days 1-7.
CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
CONDITIONAL For 7 Days, Routine, For optimum
diagnosis of sepsis, sample 3-4 sites only on the first
day of a septic episode. Cultures on subsequent days
are of minimal diagnostic value. Culture detects
bacteria, Candida and Cryptococcus. If filamentous
fungi are suspected see Culture, Blood, Filamentous
Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition? Once, for first
temperature greater than or equal to 38.2 Celsius or
sustained fever of 38.0 Celsius for greater than 1 hour.
Days 1-7.
URINALYSIS WITH MICROSCOPY [UA] CONDITIONAL For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Once, for first
temperature greater than or equal to 38.2 Celsius or
sustained fever of 38.0 Celsius for greater than 1 hour.
Days 1 - 7
CULTURE, URINE [URC] CONDITIONAL For 7 Days, Routine
Does patient have an indwelling urinary catheter?
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Once, for first
temperature greater than or equal to 38.2 Celsius or
sustained fever of 38.0 Celsius for greater than 1 hour.
Days 1-7.
Draw Once for First Temperature Greater than or Equal to 38.2 Degrees Celsius or Sustained Fever of
38.0 Degrees Celsius for Greater than 1 Hour - Days 8-14 [98573]
Page 12 of 18
Printed by STRAKA, KEVIN F [KFS1] at 1/4/2018 2:16:46 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
CONDITIONAL, Starting 1/12/18 For 7 Days, Routine,
For optimum diagnosis of sepsis, sample 3-4 sites
only on the first day of a septic episode. Cultures on
subsequent days are of minimal diagnostic value.
Culture detects bacteria, Candida and Cryptococcus.
If filamentous fungi are suspected see Culture, Blood,
Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Once, for first
temperature greater than or equal to 38.2 Celsius or
sustained fever of 38.0 Celsius for greater than 1 hour.
Days 8-14.
CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
CONDITIONAL, Starting 1/12/18 For 7 Days, Routine,
For optimum diagnosis of sepsis, sample 3-4 sites
only on the first day of a septic episode. Cultures on
subsequent days are of minimal diagnostic value.
Culture detects bacteria, Candida and Cryptococcus.
If filamentous fungi are suspected see Culture, Blood,
Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition? Once, for first
temperature greater than or equal to 38.2 Celsius or
sustained fever of 38.0 Celsius for greater than 1 hour.
Days 8-14.
URINALYSIS WITH MICROSCOPY [UA] CONDITIONAL, Starting 1/12/18 For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Once, for first
temperature greater than or equal to 38.2 Celsius or
sustained fever of 38.0 Celsius for greater than 1 hour.
Days 8-14
CULTURE, URINE [URC] CONDITIONAL, Starting 1/12/18 For 7 Days, Routine
Does patient have an indwelling urinary catheter?
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Once, for first
temperature greater than or equal to 38.2 Celsius or
sustained fever of 38.0 Celsius for greater than 1 hour.
Days 8-14.
Draw Once for First Temperature Greater than or Equal to 38.2 Degrees Celsius or Sustained Fever of
38.0 Degrees Celsius for Greater than 1 Hour - Days 15-21 [98574]
Page 13 of 18
Printed by STRAKA, KEVIN F [KFS1] at 1/4/2018 2:16:46 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
CONDITIONAL, Starting 1/19/18 For 7 Days, Routine,
For optimum diagnosis of sepsis, sample 3-4 sites
only on the first day of a septic episode. Cultures on
subsequent days are of minimal diagnostic value.
Culture detects bacteria, Candida and Cryptococcus.
If filamentous fungi are suspected see Culture, Blood,
Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Once, for first
temperature greater than or equal to 38.2 Celsius or
sustained fever of 38.0 Celsius for greater than 1 hour.
Days 15-21.
CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
CONDITIONAL, Starting 1/19/18 For 7 Days, Routine,
For optimum diagnosis of sepsis, sample 3-4 sites
only on the first day of a septic episode. Cultures on
subsequent days are of minimal diagnostic value.
Culture detects bacteria, Candida and Cryptococcus.
If filamentous fungi are suspected see Culture, Blood,
Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition? Once, for first
temperature greater than or equal to 38.2 Celsius or
sustained fever of 38.0 Celsius for greater than 1 hour.
Days 15-21.
URINALYSIS WITH MICROSCOPY [UA] CONDITIONAL, Starting 1/19/18 For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Once, for first
temperature greater than or equal to 38.2 Celsius or
sustained fever of 38.0 Celsius for greater than 1 hour.
Days 15-21
CULTURE, URINE [URC] CONDITIONAL, Starting 1/19/18 For 7 Days, Routine
Does patient have an indwelling urinary catheter?
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Once, for first
temperature greater than or equal to 38.2 Celsius or
sustained fever of 38.0 Celsius for greater than 1 hour.
Days 15-21.
Draw Once for First Temperature Greater than or Equal to 38.2 Degrees Celsius or Sustained Fever of
38.0 Degrees Celsius for Greater than 1 Hour - Days 22-28 [98575]
Page 14 of 18
Printed by STRAKA, KEVIN F [KFS1] at 1/4/2018 2:16:46 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
CONDITIONAL, Starting 1/26/18 For 7 Days, Routine,
For optimum diagnosis of sepsis, sample 3-4 sites
only on the first day of a septic episode. Cultures on
subsequent days are of minimal diagnostic value.
Culture detects bacteria, Candida and Cryptococcus.
If filamentous fungi are suspected see Culture, Blood,
Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Once, for first
temperature greater than or equal to 38.2 Celsius or
sustained fever of 38.0 Celsius for greater than 1 hour.
Days 22-28.
CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
CONDITIONAL, Starting 1/26/18 For 7 Days, Routine,
For optimum diagnosis of sepsis, sample 3-4 sites
only on the first day of a septic episode. Cultures on
subsequent days are of minimal diagnostic value.
Culture detects bacteria, Candida and Cryptococcus.
If filamentous fungi are suspected see Culture, Blood,
Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition? Once, for first
temperature greater than or equal to 38.2 Celsius or
sustained fever of 38.0 Celsius for greater than 1 hour.
Days 22-28.
URINALYSIS WITH MICROSCOPY [UA] CONDITIONAL, Starting 1/26/18 For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Once, for first
temperature greater than or equal to 38.2 Celsius or
sustained fever of 38.0 Celsius for greater than 1 hour.
Days 22-28
CULTURE, URINE [URC] CONDITIONAL, Starting 1/26/18 For 7 Days, Routine
Does patient have an indwelling urinary catheter?
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Once, for first
temperature greater than or equal to 38.2 Celsius or
sustained fever of 38.0 Celsius for greater than 1 hour.
Days 22-28.
Draw Once for First Temperature Greater than or Equal to 38.2 Degrees Celsius or Sustained Fever of
38.0 Degrees Celsius for Greater than 1 Hour - Days 29-35 [98576]
Page 15 of 18
Printed by STRAKA, KEVIN F [KFS1] at 1/4/2018 2:16:46 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
CONDITIONAL, Starting 2/2/18 For 7 Days, Routine,
For optimum diagnosis of sepsis, sample 3-4 sites
only on the first day of a septic episode. Cultures on
subsequent days are of minimal diagnostic value.
Culture detects bacteria, Candida and Cryptococcus.
If filamentous fungi are suspected see Culture, Blood,
Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Once, for first
temperature greater than or equal to 38.2 Celsius or
sustained fever of 38.0 Celsius for greater than 1 hour.
Days 29-35.
CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
CONDITIONAL, Starting 2/2/18 For 7 Days, Routine,
For optimum diagnosis of sepsis, sample 3-4 sites
only on the first day of a septic episode. Cultures on
subsequent days are of minimal diagnostic value.
Culture detects bacteria, Candida and Cryptococcus.
If filamentous fungi are suspected see Culture, Blood,
Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition? Once, for first
temperature greater than or equal to 38.2 Celsius or
sustained fever of 38.0 Celsius for greater than 1 hour.
Days 29-35.
URINALYSIS WITH MICROSCOPY [UA] CONDITIONAL, Starting 2/2/18 For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Once, for first
temperature greater than or equal to 38.2 Celsius or
sustained fever of 38.0 Celsius for greater than 1 hour.
Days 29-35
CULTURE, URINE [URC] CONDITIONAL, Starting 2/2/18 For 7 Days, Routine
Does patient have an indwelling urinary catheter?
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Once, for first
temperature greater than or equal to 38.2 Celsius or
sustained fever of 38.0 Celsius for greater than 1 hour.
Days 29-35.
Draw Once for First Temperature Greater than or Equal to 38.2 Degrees Celsius or Sustained Fever of
38.0 Degrees Celsius for Greater than 1 Hour - Days 36-42 [98577]
Page 16 of 18
Printed by STRAKA, KEVIN F [KFS1] at 1/4/2018 2:16:46 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
CONDITIONAL, Starting 2/9/18 For 7 Days, Routine,
For optimum diagnosis of sepsis, sample 3-4 sites
only on the first day of a septic episode. Cultures on
subsequent days are of minimal diagnostic value.
Culture detects bacteria, Candida and Cryptococcus.
If filamentous fungi are suspected see Culture, Blood,
Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Once, for first
temperature greater than or equal to 38.2 Celsius or
sustained fever of 38.0 Celsius for greater than 1 hour.
Days 36-42.
CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
CONDITIONAL, Starting 2/9/18 For 7 Days, Routine,
For optimum diagnosis of sepsis, sample 3-4 sites
only on the first day of a septic episode. Cultures on
subsequent days are of minimal diagnostic value.
Culture detects bacteria, Candida and Cryptococcus.
If filamentous fungi are suspected see Culture, Blood,
Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition? Once, for first
temperature greater than or equal to 38.2 Celsius or
sustained fever of 38.0 Celsius for greater than 1 hour.
Days 36-42.
URINALYSIS, NO MICROSCOPY [UACHEM] CONDITIONAL, Starting 2/9/18 For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Once, for first
temperature greater than or equal to 38.2 Celsius or
sustained fever of 38.0 Celsius for greater than 1 hour
Days 36-42.
CULTURE, URINE [URC] CONDITIONAL, Starting 2/9/18 For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Once, for first
temperature greater than or equal to 38.2 Celsius or
sustained fever of 38.0 Celsius for greater than 1 hour.
Days 36-42.
Diagnostic Tests and Imaging
Diagnostic Tests and Imaging [33484]
Page 17 of 18
Printed by STRAKA, KEVIN F [KFS1] at 1/4/2018 2:16:46 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

X-RAY CHEST 2 VIEWS [R71046] CONDITIONAL, Routine
Radiology Specialty Area: GENERAL IMAGING
Current signs and symptoms? New onset of fever
What specific question(s) would you like answered by
this exam? Neutropenic fever
Relevant recent/past history? Patient is post
autologous stem cell transplant
Is patient pregnant?
If being performed remotely, where?
Transport Method: Floor Determined/Entered
If Conditional, What Condition? Obtain once if
temperature is greater than 38.2 degrees Celsius or
sustained fever of 38.0 degrees Celsius for greater
than 1 hour
Consults
Consults [33485]
Consult Physical Therapy (Inpatient) Eval and
Treat [CON0061]
ONCE, Starting today For 1 Occurrences, Routine
Reason for Physical Therapy Consult: Mobility
Training
Bone Marrow Transplant Patient
Consult Social Work (Inpatient) [CON0076] ONCE, Starting today For 1 Occurrences, Routine
Reason for Consult: OTHER
Evaluate and follow during Bone Marrow Transplant.
Consult Radiation Oncology (Inpatient)
[CON0066]
ONCE
Intent:
Concern or Specific Question or Task to be Addressed
(Symptom, Sign, or Diagnosis): Evaluate and plan for
total body radiation
BestPractice
No Hospital Problems have yet been identified. [107035]
Specify Hospital Problem(s) [COR0018] You will be prompted to specify a hospital problem on
signing.
Page 18 of 18
Printed by STRAKA, KEVIN F [KFS1] at 1/4/2018 2:16:46 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org