/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/cardiologyct-surgery/,

/clinical/cckm-tools/content/order-sets/inpatient/cardiologyct-surgery/name-98391-en.cckm

201606170

page

100

UWHC,UWMF,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,Cardiology/CT Surgery

IP – Cardiac Surgery - Adult – Discharge [3490]

IP – Cardiac Surgery - Adult – Discharge [3490] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Cardiology/CT Surgery


IP - Cardiac Surgery - Adult - Discharge [3490]
Skilled Nursing Facility Orders
This Patient is going to a skilled nursing facilty, directly below is a group of orders commonly associated with this patient
population. Please review the orders below and select the appropriate ones for this patient. If this patient is not going to a
SNF, contact Case Management to update the discharge plan. Updating the discharge plan will remove this set of SNF
orders from the order set.
Skilled Nursing Facility Certification Statement [114940]
SNF Certification Statement [NURCOM0069] Routine
Skilled Nursing Facility Certification Statement [118260]
SNF Certification Statement [NURCOM0069] Routine
Skilled Nursing Facility Admit Order [114941]
Admit to Skilled Nursing Facility [ADT0015] Routine
Skilled Nursing Facility Admit Order [118261]
Admit to Skilled Nursing Facility [ADT0015] Routine
Skilled Nursing Facility Patient Care Orders [111713]
For dyspnea, Oxygen at 2 L/minute per nasal canula; If
this is an acute change for the patient call PCP with
assessment ASAP after oxygen is started. Suction PRN
to clear airways. [NURCOM0022]
Routine
Facility Therapy Needs [113391]
Physical Therapy to Evaluate and Treat at Next Facility
[NURCOM0022]
Routine
Occupational Therapy to Evaluate and Treat at Next
Facility [NURCOM0022]
Routine
Speech Therapy to Evaluate and Treat at Next Facility
[NURCOM0022]
Routine
Communicable Diseases [111717]
State Law requires at least one of the following statements be checked for your patient. May check both if applicable
DHS 132.52 URL: http://docs.legis.wisconsin.gov/code/admin_code/dhs/110/132/V/52
Patient has been screened for TB within the last 90 days
prior to admission and does not have any other clinically
apparent communicable diseases. [NURCOM0022]
Routine
Patient has been found to have a communicable
disease, procedures to treat and limit the spread of the
disease have been ordered. [NURCOM0022]
Routine
Communicable Diseases [118262]
State Law requires at least one of the following statements be checked for your patient. May check both if applicable
DHS 132.52 URL: http://docs.legis.wisconsin.gov/code/admin_code/dhs/110/132/V/52
Patient has been screened for TB within the last 90 days
prior to admission and does not have any other clinically
apparent communicable diseases. [NURCOM0022]
Routine
Patient has been found to have a communicable
disease, procedures to treat and limit the spread of the
disease have been ordered. [NURCOM0022]
Routine
Analgesics [111708]
acetaMINOPHEN (TYLENOL) tab [34149] 1 tab, 1, starting 9/8/15, No Print
acetaMINOPHEN (TYLENOL) suppository [34153] 1 suppository, 1, starting 9/8/15, No Print
Blood Glucose Management [111710]
glucagon 1 mg injection kit [107799] 1 each, 1, starting 9/8/15, No Print
Glucose 40 % oral gel [118089] 1 Tube, 1, starting 9/8/15, No Print
Nursing Communication [NURCOM0022] Routine, Notify {Notify for Blood Glucose:3004146} if blood
glucose is greater than 400 mg/dL or less than 40 mg/dL
Bowel Management [111709]
magnesium hydroxide (MILK OF MAGNESIA) susp
[65443]
1 Bottle, 1, starting 9/8/15, No Print
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bisacodyl (DULCOLAX) rectal suppository [35231] 1 suppository, 1, starting 9/8/15, No Print
Senna-Docusate Sodium 8.6-50 MG per tab [70181] 1 tab, 1, starting 9/8/15, No Print
polyethylene glycol (MIRALAX) oral powder [61353] 1 Bottle, 1, starting 9/8/15, No Print
phosphate (FLEET) enema [37517] 1 enema, 1, starting 9/8/15, No Print
Non-categorized Medications [111711]
guaifenesin-dextroMETHORPHAN (ROBITUSSIN DM)
syrup [51568]
1 Bottle, 1, starting 9/8/15, No Print
carbamide peroxide (DEBROX) 6.5% otic soln [35545] 1 Bottle, 1, starting 9/8/15 until 9/13/15, No Print
alum-mag-simeth (MYLANTA ES) susp [44073] 1 Bottle, 1, starting 9/8/15, No Print
Core Measures - This Does NOT Generate A Medication Order (Use Med Reconciliation
To Prescribe Medications)
Core Measure Documentation - Beta Blocker (Single Response) [103027]
Beta-Blocker Reason Not Ordered [COR0002] ONCE, Starting today For 1 Occurrences, Routine
Reason Not Ordered:
Beta-Blocker Already Ordered [COR0002] ONCE, Starting today For 1 Occurrences, Routine
Reason Not Ordered: Other (Comment Required)
Core Measure Documentation - ACE Inhibitor/ARB (Single Response) [103028]
ACE Inhibitor/ARB Reason Not Ordered [COR0001] ONCE, Starting today For 1 Occurrences, Routine
Reason Not Ordered:
ACE Inhibitor/ARB Already Ordered [COR0001] ONCE, Starting today For 1 Occurrences, Routine
Reason Not Ordered: Other (Comments required for not
ordering BOTH an ACEI and an ARB)
Core Measure Documentation - Aspirin (Single Response) [103029]
Aspirin Reason Not Ordered - Cardiac Surgery
[COR0014]
ONCE, Starting today For 1 Occurrences, Routine
Reason Not Ordered:
Aspirin Already Ordered [COR0014] ONCE, Starting today For 1 Occurrences, Routine
Reason Not Ordered: Already on Aspirin
Core Measure Documentation - Statin (Single Response) [103030]
Statin Reason Not Ordered - Cardiac Surgery
[COR0015]
ONCE, Starting today For 1 Occurrences, Routine
Reason Not Ordered:
Statin Already Ordered [COR0015] ONCE, Starting today For 1 Occurrences, Routine
Reason Not Ordered: Already on Statin
Guideline-based Practice - Plavix (Single Response) [144393]
Plavix Reason Not Ordered - Cardiac Surgery
[COR0056]
ONCE, Starting today For 1 Occurrences, Routine
Reason Not Ordered:
Plavix Already Ordered [COR0056] ONCE, Starting today For 1 Occurrences, Routine
Reason Not Ordered: Already on Plavix
Discharge Orders
Reason for Hospitalization [129999]
Why You Were Hospitalized [NURCOM0073] Please complete in PATIENT FRIENDLY terms. This order
will appear on the patient's After Hospital Care Plan., Routine,
You were hospitalized for your {CARDIAC
SURGERIES:3022193} surgery.
Activity [102924]
Lifting Restriction - Sternotomy [NURACT0011] Routine, • Do not lift greater than 8 pounds for 6 weeks from
surgery. Then do not lifter greater than 15-20 pounds until 12
weeks from surgery
• Do not push or pull with your arms when moving in bed and
getting out of bed.
• Do not flex or extend your shoulders over 90°, no over the
shoulder activity.
• Avoid twisting, deep bending, or reaching too far across
your body.
• Brace your chest when coughing or sneezing.
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• If you feel any pulling or stretching in your chest, stop what
you are doing. Do not repeat the motion that caused this
feeling.
• Report any clicking or popping noise around your chest
bone to your surgeon right away.
Lifting Restriction - Robotic [NURACT0011] Routine, Do not lift greater than 10 pounds for 2 weeks
Activity Restriction [NURACT0011] Routine, Ambulate 4 times a day, at a minimum.
Driving Instructions [102925]
Driving Restrictions - Sternotomy [NURACT0011] Routine, • No driving or riding in the front seat for 4 weeks (or
as directed by your surgeon). No driving while on narcotic
pain medications.
Driving Restrictions - Robotic [NURACT0011] Routine, No driving for 2 weeks or while on narcotic pain
medications
Nutrition [102926]
Low Fat, Low Sodium, Low Cholesterol Diet with 2 Liter
Fluid Restriction [NUT0006]
Routine
General:
Liquids and Modified Consistency:
Fluid Restriction: 2 liters: See Health Facts for You #475
Sodium: No Added Salt
Dysphagia:
Fat: Low Fat, Low Cholesterol: See Health Facts for You
#225
Renal:
Potassium:
Micronutrients:
Infant Formula Product:
Infant Formula Concentration:
Low Sodium with 2 Liter Fluid Restriction [NUT0006] Routine
General:
Liquids and Modified Consistency:
Fluid Restriction: 2 liters: See Health Facts for You #475
Sodium: No Added Salt
Dysphagia:
Fat:
Renal:
Potassium:
Micronutrients:
Infant Formula Product:
Infant Formula Concentration:
No Added Salt [NUT0006] Routine
General:
Liquids and Modified Consistency:
Fluid Restriction:
Sodium: No Added Salt
Dysphagia:
Fat:
Renal:
Potassium:
Micronutrients:
Infant Formula Product:
Infant Formula Concentration:
Diabetes Diet [NUT0006] Routine
General: Diabetes Meal Plan: See Health Facts for You #262,
#371
Liquids and Modified Consistency:
Fluid Restriction:
Sodium:
Dysphagia:
Fat:
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Renal:
Potassium:
Micronutrients:
Infant Formula Product:
Infant Formula Concentration:
Wound Care [102927]
Wound Care [NURWND0018] Routine, • No tub baths for 30 days or until incision is
completely healed.
• Patient may shower but keep back to shower head.
• Monitor your wound(s) for signs and symptoms of infection,
including redness, swelling, drainage, and odor. If you notice
these symptoms, call your surgeon's office.
• Wash incision daily with soap and water. Do not rub the site.
Do not use lotions and/or ointments on incision.
• You may leave your incisions open to air. No dressing is
needed unless drainage is present.
• If drainage is present, notify your surgeon’s office
immediately. Change dressing daily or more often if
saturated.
Respiratory [100204]
DME - Home Oxygen [142943]
Both of the following orders MUST be completed in order for this DME to be delivered to the patient.
New reimbursement requirements in 2013 require that a physician, PA, NP, or CNS has a face-to-face encounter with a
patient prior to ordering certain durable medical equipment (DME). It also requires that the DME supplier be provided with
the documentation of the face-to-face encounter and a signed order prior to delivery of the DME.
National Coverage Determination for Home Use of
Oxygen (See section D for qualifying diagnoses)
URL: http://www.cms.gov/medicare-coverage-
database/details/ncd-details.aspx?
NCDId=169&ncdver=1&bc=AgAAQAAAAAAAAA%3d%
3d&
DME - Home Oxygen [1009468] Patient's O2 Requirements Assessed and Meets Criteria
for Home O2:
Delivery Device:
Equipment Needed:
Continuous (liters/min):
Continuous (FiO2):
With Activity (liters/min):
With Activity (FiO2):
With Sleep (liters/min):
With Sleep (FiO2):
Length of Need:
Vendor:
DME - Home Oxygen Justification [1009463] Details
Bowel Care [123352]
Bowel Care [NURELM0068] Routine, - Notify {surgeon's office/transplant
coordinator:3022352} if no bowel movement in 3 days
Bladder Care [123364]
Bladder Care [NURELM0067] Routine
Other Patient Care Instructions [123382]
Other Discharge Patient Care Instructions
[NURCOM0071]
Please complete in PATIENT FRIENDLY terms. This order
will appear on the patient's After Hospital Care Plan., Routine,
- Weigh self daily on home scale. Notify MD if weight
increases or decreases by 2 pounds in 1 day or 5 pounds in 1
week.
- Measure and record blood pressure and pulse daily until
next clinic visit.
Other Discharge Patient Care Instructions - Valve
Patients [NURCOM0071]
Please complete in PATIENT FRIENDLY terms. This order
will appear on the patient's After Hospital Care Plan., Routine,
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- Weigh self daily on home scale. Notify MD if weight
increases or decreases by 2 pounds in 1 day or 5 pounds in 1
week.
- Measure and record blood pressure and pulse daily until
next clinic visit.
- Take preventive antibiotics prior to dental work or other
invasive procedures
Other Patient Care Instructions - Heart Transplant
Patients [NURCOM0071]
Please complete in PATIENT FRIENDLY terms. This order
will appear on the patient's After Hospital Care Plan., Routine,
- Weigh self daily on home scale
- Take temperature daily
- Measure and record blood pressure and pulse two times a
day until next clinic visit
- Take preventive antibiotics prior to dental work or other
invasive procedures
- Check blood sugars four times daily. For blood sugars >400
or <60 phone the Diabetes Management Service Monday
through Friday 8:30 to 4:00 by calling 608-263-2416. After
hours or on the weekend, you can reach the on call person
for the Diabetes Management Service by calling the hospital
paging operator at 608-263-6400. Ask them to contact pager
#0218, the on call person for the Inpatient Diabetes
Management Team.
When to Call Your Doctor [130000]
When to Call Your Doctor [NURCOM0079] Please complete in PATIENT FRIENDLY terms. This order
will appear on the patient's After Hospital Care Plan.
You should include specific instructions on when and who to
call.
You should include actual provider names (i.e. not 'PCP').
You should NOT include the discharging unit as a contact.,
Routine, Call your surgeon's office if you have any of these
symptoms:
- Increased pain not relieved by medication
- fever over 100.5 degrees for 24 hours
- increased shortness of breath
- weight gain as directed
For questions or concerns regarding your surgery recovery:
-During regular business hours (Monday through Friday 8 AM
to 4:30 PM): Contact {DISCHARGE CONTACTS:3022194}.
-After business hours and weekends: Contact the cardiac
surgery resident or mid-level provider on-call at hospital
switchboard at 608-263-6400.
Contact your cardiologist, Dr. ***, at *** with heart related
questions or concerns.
Contact your primary care provider, ***, at *** with general
questions or concerns regarding your overall health.
When to Call Your Doctor - Heart Transplant Patients
[NURCOM0079]
Please complete in PATIENT FRIENDLY terms. This order
will appear on the patient's After Hospital Care Plan.
You should include specific instructions on when and who to
call.
You should include actual provider names (i.e. not 'PCP').
You should NOT include the discharging unit as a contact.,
Routine, Call your transplant coordinator at 608-262-8915
with any questions, concerns, worsening or new symptoms or
if you have any of the following symptoms: Increased pain,
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not relieved by medication; Fever over 99 degrees for 24
hours; Weight change of 3 pounds/day or 5 pounds/week;
Blood pressure higher than 145/90; Heart rate higher than
130 or lower than 60 beats per minute.
Heart Failure Recommended Care
These order groups are showing because either your patient has an EF < 40% documented or has Heart Failure on their
problem list.
UW Health HF guideline URL: https://uconnect.wisc.edu/clinical/cckm-
tools/cpg/guidelines/cardiovascular/resources/name-
28523-en.file
Heart Failure Discharge Instructions [190359]
Weigh yourself daily or as directed [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This order
will appear on the patient's After Hospital Care Plan., Routine
When to Call Your Doctor [NURCOM0079] Please complete in PATIENT FRIENDLY terms. This order
will appear on the patient's After Hospital Care Plan.
You should include specific instructions on when and who to
call.
You should include actual provider names (i.e. not 'PCP').
You should NOT include the discharging unit as a contact.,
Routine, Call your doctor if you have any of these symptoms
as they may indicate worsening Heart Failure:
- Increased shortness of breath
- Cough or chest congestion
- Swelling in your abdomen or legs
- Any increase or decrease in weight of more than 3 pounds
in a day or 5 pounds total
If you do not have a scheduled return appointment,
please schedule an appointment with your primary
physician [NURCOM0071]
Please complete in PATIENT FRIENDLY terms. This order
will appear on the patient's After Hospital Care Plan., Routine
Follow Up Care - Cardiac Rehab
Follow Up Appointments - Cardiac Rehab (Single Response) [112507]
Referral Cardiac Rehab (Outpatient) [CON0174] All patients being discharged from UWHC IP CVM with the
following diagnoses should receive a referral to cardiac
rehab: Acute Myocardial Infarction (410.) (i.e. all STEMI or
NSTEMI patients), Stable Angina (413.9), Coronary Artery
Bypass Surgery (V45.81), Valve Surgery (repair or
replacement) (V42.2 or V42.3), Percutaneous Coronary
Angioplasty or Stenting (V45.82), or Heart Transplant (V42.1).
Typically, outpatient cardiac rehab follow-up appointments
occur 3-4 weeks post-hospitalization. Inpatient Preventive
Cardiology staff clinicians will refer and make arrangements
for the patient. If you have further questions, you may call
them at 263-6630.
Routine
Has this patient been seen by inpatient Cardiac
Rehab/Preventive Cardiology during this encounter?
Reason Cardiac Rehab Not Ordered [COR0027] Routine
Reason Not Ordered:
Follow Up Care
Follow Up Appointments [102928]
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Schedule Follow Up Appointment with Cardiac Surgeon
[NURCOM0026]
Reason for Appointment: Postoperative follow up
When do you want appointment: 2 weeks
Which Clinic or Specialty:
Which Provider (Optional): NP/PA
Status post ***
Schedule Follow Up Appointment with Primary Care
Provider [NURCOM0026]
Reason for Appointment:
When do you want appointment: 1-2 weeks
Which Clinic or Specialty:
Which Provider (Optional): PCP
Schedule Follow Up Appointment with Cardiology (4-6
weeks) [NURCOM0026]
Reason for Appointment:
When do you want appointment: 4-6 weeks
Which Clinic or Specialty: Cardiology
Which Provider (Optional):
Schedule Follow Up Appointment with Physical Therapy
[NURCOM0026]
Reason for Appointment:
When do you want appointment:
Which Clinic or Specialty:
Which Provider (Optional):
Schedule Follow Up Appointment with Occupational
Therapy [NURCOM0026]
Reason for Appointment:
When do you want appointment:
Which Clinic or Specialty:
Which Provider (Optional):
Schedule Follow Up Appointment with Speech Therapy
[NURCOM0026]
Reason for Appointment:
When do you want appointment:
Which Clinic or Specialty:
Which Provider (Optional):
Schedule Follow Up Appointment with Nutrition
[NURCOM0026]
Reason for Appointment: Healthy Eating
When do you want appointment: 4 weeks
Which Clinic or Specialty:
Which Provider (Optional): Registered Dietitian
Schedule Appointment [NURCOM0026] Reason for Appointment:
When do you want appointment:
Which Clinic or Specialty:
Which Provider (Optional):
Schedule Appointment [NURCOM0026] Reason for Appointment:
When do you want appointment:
Which Clinic or Specialty:
Which Provider (Optional):
Patient to Schedule Appointment [NURCOM0056] Purpose:
With whom:
For when:
Follow Up Appointments - Diabetes (Single Response) [148552]
*** RESPONSE REQUIRED *** This order facilitates documentation (only) about follow-up appointments for patients with
diabetes. Scheduling an appointment before discharge with a provider who will manage a patient’s diabetes care (e.g.,
primary care physician, endocrinologist, etc.) is a Joint Commission requirement. Exclusions are allowed based upon
patient situation (e.g., discharge to a skilled nursing facility, patient refusal, etc.). Only select “Appointment Scheduled” if
an appointment has already been scheduled, and use the Schedule Appointment order as needed to request assistance
in scheduling
No appointment: Patient does not have diabetes
[COR0064]
ONCE, Starting today For 1 Occurrences, Routine
Documentation (required): No appointment: Patient does not
have diabetes
1. This order facilitates documentation (only) about follow-up
appointments for patients with diabetes.
2. Scheduling an appointment before discharge with a
provider who will manage a patient's diabetes care (e.g.,
primary care physician, endocrinologist, etc.) is a Joint
Commission requirement. Exclusions are allowed based upon
patient situation (e.g., patient discharging to a skilled nursing
facility, patient refusal, etc.)
3. Only select "Appointment Scheduled" if an appointment
has already been scheduled with a provider who can manage
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patient's diabetes.
4. Use the Schedule Appointment order as needed to request
assistance in scheduling an appointment.
Appointment scheduled (with provider who can manage
diabetes) [COR0064]
ONCE, Starting today For 1 Occurrences, Routine
Documentation (required): Appointment scheduled (with
provider who can manage diabetes)
1. This order facilitates documentation (only) about follow-up
appointments for patients with diabetes.
2. Scheduling an appointment before discharge with a
provider who will manage a patient's diabetes care (e.g.,
primary care physician, endocrinologist, etc.) is a Joint
Commission requirement. Exclusions are allowed based upon
patient situation (e.g., patient discharging to a skilled nursing
facility, patient refusal, etc.)
3. Only select "Appointment Scheduled" if an appointment
has already been scheduled with a provider who can manage
patient's diabetes.
4. Use the Schedule Appointment order as needed to request
assistance in scheduling an appointment.
Appointment scheduled per patient report (ENTER
DATE IN COMMENTS) [COR0064]
ONCE, Starting today For 1 Occurrences, Routine
Documentation (required): Appointment scheduled per patient
report (ENTER DATE IN COMMENTS)
1. This order facilitates documentation (only) about follow-up
appointments for patients with diabetes.
2. Scheduling an appointment before discharge with a
provider who will manage a patient's diabetes care (e.g.,
primary care physician, endocrinologist, etc.) is a Joint
Commission requirement. Exclusions are allowed based upon
patient situation (e.g., patient discharging to a skilled nursing
facility, patient refusal, etc.)
3. Only select "Appointment Scheduled" if an appointment
has already been scheduled with a provider who can manage
patient's diabetes.
4. Use the Schedule Appointment order as needed to request
assistance in scheduling an appointment.
Appointment pending: patient discharged on weekend;
follow-up information provided [COR0064]
ONCE, Starting today For 1 Occurrences, Routine
Documentation (required): Appointment pending: patient
discharged on weekend; follow-up information provided
1. This order facilitates documentation (only) about follow-up
appointments for patients with diabetes.
2. Scheduling an appointment before discharge with a
provider who will manage a patient's diabetes care (e.g.,
primary care physician, endocrinologist, etc.) is a Joint
Commission requirement. Exclusions are allowed based upon
patient situation (e.g., patient discharging to a skilled nursing
facility, patient refusal, etc.)
3. Only select "Appointment Scheduled" if an appointment
has already been scheduled with a provider who can manage
patient's diabetes.
4. Use the Schedule Appointment order as needed to request
assistance in scheduling an appointment.
Free clinic information provided [COR0064] ONCE, Starting today For 1 Occurrences, Routine
Documentation (required): Free clinic information provided
1. This order facilitates documentation (only) about follow-up
appointments for patients with diabetes.
2. Scheduling an appointment before discharge with a
provider who will manage a patient's diabetes care (e.g.,
primary care physician, endocrinologist, etc.) is a Joint
Commission requirement. Exclusions are allowed based upon
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patient situation (e.g., patient discharging to a skilled nursing
facility, patient refusal, etc.)
3. Only select "Appointment Scheduled" if an appointment
has already been scheduled with a provider who can manage
patient's diabetes.
4. Use the Schedule Appointment order as needed to request
assistance in scheduling an appointment.
No appointment: Patient discharging to a facility (e.g.,
skilled nursing facility, correctional facility, etc.)
[COR0064]
ONCE, Starting today For 1 Occurrences, Routine
Documentation (required): No appointment: Patient
discharging to a facility (e.g., skilled nursing facility,
correctional facility, etc.)
1. This order facilitates documentation (only) about follow-up
appointments for patients with diabetes.
2. Scheduling an appointment before discharge with a
provider who will manage a patient's diabetes care (e.g.,
primary care physician, endocrinologist, etc.) is a Joint
Commission requirement. Exclusions are allowed based upon
patient situation (e.g., patient discharging to a skilled nursing
facility, patient refusal, etc.)
3. Only select "Appointment Scheduled" if an appointment
has already been scheduled with a provider who can manage
patient's diabetes.
4. Use the Schedule Appointment order as needed to request
assistance in scheduling an appointment.
No appointment: Patient refusal [COR0064] ONCE, Starting today For 1 Occurrences, Routine
Documentation (required): No appointment: Patient refusal
1. This order facilitates documentation (only) about follow-up
appointments for patients with diabetes.
2. Scheduling an appointment before discharge with a
provider who will manage a patient's diabetes care (e.g.,
primary care physician, endocrinologist, etc.) is a Joint
Commission requirement. Exclusions are allowed based upon
patient situation (e.g., patient discharging to a skilled nursing
facility, patient refusal, etc.)
3. Only select "Appointment Scheduled" if an appointment
has already been scheduled with a provider who can manage
patient's diabetes.
4. Use the Schedule Appointment order as needed to request
assistance in scheduling an appointment.
Follow Up Diagnostic Tests and Imaging [102929]
ECG - 12 Lead [EKG0008] Status: Standing, Expires:12/7/15 Manual-release, Normal,
Routine
Transthoracic Resting Echocardiogram [ECH0003] Status: Standing, Expires:12/7/15 Auto-release, Normal,
Routine
X-RAY CHEST PA & LAT VIEWS [R71020] Status: Standing, Expires:12/7/15 AUTO, Normal, Routine
Discharge Labs [134929]
Please use the table below to determine what type of order to use to place discharge lab orders.
Who is Responsible for the Result? Where Will Labs be Completed? What Order Should You Use?
Current Attending Provider UW Health Lab Specific lab orders (A)
Non-UW Health Lab Specific lab orders with order class changed to OUTSIDE (B)
Current Consulting Provider UW Health Lab Specific lab orders with AUTHORIZING PROVIDER CHANGED TO
CONSULTANT (A)
Non-UW Health Lab Specific lab orders with order class changed to OUTSIDE and AUTHORIZING PROVIDER
CHANGED TO CONSULTANT (B)
Another Provider UW Health Lab Recommended Discharge Labs (C)
Non-UW Health Lab Recommended Discharge Labs (C)
(A) SPECIFIC LAB ORDERS:
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison

 

These orders should be used if the CURRENT ATTENDING OR CONSULTING PROVIDER will be responsible for the
result of the lab AND the patient will have the labs completed at a UW HEALTH LAB.
If a CONSULTING PROVIDER currently involved in the patient's care will be responsible for the result, you must change
the AUTHORIZING PROVIDER on the order to the CONSULTING PROVIDER before signing the order. To do this, click
the Providers button near the top of the Review, Sign & Hold tab of the discharge navigator. Update the authorizing
provider to the consulting provider.
(B) SPECIFIC LAB ORDER WITH ORDER CLASS CHANGED TO OUTSIDE:
These orders should be used if the CURRENT ATTENDING OR CONSULTING PROVIDER will be responsible for the
result of the lab AND the patient will have labs completed at a NON-UW HEALTH LAB.
If a CONSULTING PROVIDER currently involved in the patient’s care will be responsible for the result, you must change
the AUTHORIZING PROVIDER on the order to the CONSULTING PROVIDER before signing the order. To do this, click
the Providers button near the top of the Review, Sign & Hold tab of the discharge navigator. Update the authorizing
provider to the consulting provider.
The patient will receive a paper order to take to the lab.
(C) RECOMMENDED DISCHARGE LABS:
This order should be used to recommend to another provider labs that a patient should have completed after discharge.
The provider designated in the 'Send Recommendations To' field is responsible for PLACING the lab orders AND will be
responsible for the RESULTS of any ordered labs.
Recommended Discharge Labs [NURCOM0075] Details
Follow Up Labs [102930]
These lab orders should only be used if the current Attending Provider or Consulting Provider will be responsible for the
result of the lab.
Lab Instructions [NURCOM0055] Routine, Bring lab sheet to follow-up visit. Draw all labs at
***.
CBC WITH DIFFERENTIAL [CBC] Status: Standing, Expires:10/23/15 MANUAL,Count:1,
Normal, Routine
CBC WITHOUT DIFFERENTIAL [HEMO] Status: Standing, Expires:10/23/15 MANUAL,Count:1,
Normal, Routine
PROTHROMBIN TIME/INR [PT] Status: Standing, Expires:10/23/15 MANUAL,Count:1,
Normal, Routine
ELECTROLYTES [LYTE] Status: Standing, Expires:10/23/15 MANUAL,Count:1,
Normal, Routine
BUN [BUN] Status: Standing, Expires:10/23/15 MANUAL,Count:1,
Normal, Routine
CREATININE [CRET] Status: Standing, Expires:10/23/15 MANUAL,Count:1,
Normal, Routine
GLUCOSE [GLU] Status: Standing, Expires:10/23/15 MANUAL,Count:1,
Normal, Routine
CALCIUM [CA] Status: Standing, Expires:10/23/15 MANUAL,Count:1,
Normal, Routine
BILIRUBIN, TOTAL [TBIL] Status: Standing, Expires:10/23/15 MANUAL,Count:1,
Normal, Routine
PROTEIN, TOTAL [TP] Status: Standing, Expires:10/23/15 MANUAL,Count:1,
Normal, Routine
ALBUMIN [ALB] Status: Standing, Expires:10/23/15 MANUAL,Count:1,
Normal, Routine
ALKALINE PHOSPHATASE [ALKP] Status: Standing, Expires:10/23/15 MANUAL,Count:1,
Normal, Routine
AST/SGOT [AST] Status: Standing, Expires:10/23/15 MANUAL,Count:1,
Normal, Routine
ALT/SGPT [ALT] Status: Standing, Expires:10/23/15 MANUAL,Count:1,
Normal, Routine
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Pr i nt ed by LIND, JANNA S [JSL237] at 9/8/2015 4:06:32 PM
Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison