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IP – Cardiac Surgery – Pediatric – Discharge [4607]

IP – Cardiac Surgery – Pediatric – Discharge [4607] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Cardiology/CT Surgery


IP - Cardiac Surgery - Pediatric - Discharge [4607]
Discharge Orders
Reason for Hospitalization [130356]
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 heart surgery
Activity [124392]
Lifting Restriction [NURACT0011] Routine, Lifting restrictions/sternal precaution the first 6
weeks after surgery:
Your child may be up and about as he/she is able. Encourage
normal play with frequent rest.
Young children should be lifted in a scooping motion with
support for their bottoms. Avoid lifting by the arms or under
the armpits. This is mostly for comfort, but also it helps the
breast bone stay fixed in place as it heals.
Your child may return to school or work after your first clinic
visit and to daycare in 4 weeks.
Avoid running, climbing, or overuse of arms and shoulders.
No bike riding, or wearing a backpack.
Your child may not take part in physical education or any
contact sports.
Your child may go out for recess upon return to school, but
your child should not be running, climbing, or playing on any
equipment.
Your child may not lift greater than 8 pounds (a gallon of
milk).
Do not allow your child to drive a car if he/she drives. As a
passenger he/she should be in the back seat to avoid air
bags.
Nutrition [124393]
General Diet [NUT0006] Routine
General: General: No restrictions: See Health Facts for You
#276
Liquids and Modified Consistency:
Fluid Restriction:
Sodium:
Dysphagia:
Fat:
Renal:
Potassium:
Micronutrients:
Infant Formula Product:
Infant Formula Concentration:
For children and young adults, restart the regular diet. Any
other instructions will be given to you before discharge.
Wound Care [124394]
Wound Care [NURWND0015] Routine, Keep the incision and the chest tube sites clean and
dry.
Leave Steri-Strips® in place until they peel or fall off on their
own in 10-14 days.
Apply a clean Band-Aid® to the chest tube site and change
daily until dry. Then, you may leave it open to the air. If your
child has a chest tube stitch, it will be removed at your child's
first office visit.
Starting the 4th day after surgery, your child may shower with
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Printed by LIND, JANNA S [JSL237] at 5/27/2016 1:50:25 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 05/2016CCKM@uwhealth.org

the stream of water to her back. Pat the incision dry before
dressing.
Do not soak the incision in the tub or go swimming for 2
weeks after surgery.
Do not go swimming for 4 weeks after surgery.
Do not use any creams, lotions, or perfumed soaps near
wounds until all scabs and Steri-Strips® have fallen off.
Protect the wounds from any direct sunlight until they have
faded (at least 6 months). Use a sunscreen and t-shirt when
outside.
Bladder Care [130357]
Bladder Care [NURELM0067] Routine
Bowel Care [130358]
Bowel Care [NURELM0068] Routine
Other Discharge Patient Care Instructions [130359]
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
Symptom Management [124395]
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 Pediatric Cardiology at (608) 263-6420 if your
child has:
- Any questions about the wound
- Increased swelling around the wound
- Redness around the wound
-Pain
- Drainage from the wound
- A fever over 101° F
- Takes less feedings
- Is irritable or more tired than usual
- Breathing problems
- Changes in skin color (gray, blue)
- Starts to sweat a lot
- Nausea, vomiting, or chest pain with breathing. This may be
associated with your child's surgery and needs immediate
follow up. This may occur in the first few days up to six
weeks after surgery.
After hours, nights, weekends, and holidays, please call (608)
262-0486. If you live out of the area, call 1-800-323-8942.
This will give you the paging operator. Ask for the pediatric
cardiologist on call. Give your name and phone number with
the area code. The doctor will call you back.
Follow Up Care
Follow Up Appointment [124408]
Schedule Follow Up Appointment with Pediatric Cardiac
Surgeon [NURCOM0026]
Reason for Appointment: Postoperative follow-up
When do you want appointment:
Which Clinic or Specialty:
Which Provider (Optional): Dr. Petros Anagnostopoulos
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Please coordinate with an Echocardiogram appointment
Schedule Follow Up Appointment with Pediatric
Cardiology [NURCOM0026]
Reason for Appointment: Postoperative Follow Up
When do you want appointment: Four weeks Post-Op
Which Clinic or Specialty:
Which Provider (Optional):
Please coordinate with an Echocardiogram appointment.
Schedule Follow Up Appointment with Primary Care
Provider [NURCOM0026]
Reason for Appointment: Postoperative Follow Up
When do you want appointment:
Which Clinic or Specialty:
Which Provider (Optional):
Schedule Follow Up Appointment with Brain Care Clinic
[NURCOM0026]
Reason for Appointment:
When do you want appointment:
Which Clinic or Specialty:
Which Provider (Optional):
Schedule Follow Up Appointment [NURCOM0026] Reason for Appointment:
When do you want appointment:
Which Clinic or Specialty:
Which Provider (Optional):
Schedule Follow Up Appointment [NURCOM0026] Reason for Appointment:
When do you want appointment:
Which Clinic or Specialty:
Which Provider (Optional):
Schedule Follow Up Appointment [NURCOM0026] Reason for Appointment:
When do you want appointment:
Which Clinic or Specialty:
Which Provider (Optional):
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
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.)
Page 3 of 6
Printed by LIND, JANNA S [JSL237] at 5/27/2016 1:50:25 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 05/2016CCKM@uwhealth.org

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
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.,
Page 4 of 6
Printed by LIND, JANNA S [JSL237] at 5/27/2016 1:50:25 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 05/2016CCKM@uwhealth.org

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 [126838]
Transthoracic Resting Echocardiogram (PEDS)
[ECH0012]
Status: Future, Expires: 5/27/22, Normal, Routine
Transthoracic Resting Echocardiogram (PEDS)
[ECH0012]
Status: Future, Expires: 5/27/22, Normal, Routine
X-RAY Chest PA & LAT Views [R71020] Status: Future, Expires: 7/27/17, 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:
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.
Page 5 of 6
Printed by LIND, JANNA S [JSL237] at 5/27/2016 1:50:25 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 05/2016CCKM@uwhealth.org

(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.
Discharge Labs Workflow URL: https://uconnect.wisc.edu/growth/training--
education/health-link/10-minutes/inpatient-discharge-
consult/resources/name-82993-en.file
Recommended Discharge Labs [NURCOM0075] Details
Page 6 of 6
Printed by LIND, JANNA S [JSL237] at 5/27/2016 1:50:25 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 05/2016CCKM@uwhealth.org