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/clinical/cckm-tools/content/order-sets/inpatient/cardiologyct-surgery/name-98403-en.cckm

201606170

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UWHC,UWMF,

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

IP – Electrophysiology Study /Ablation – Adult – Postprocedure [902]

IP – Electrophysiology Study /Ablation – Adult – Postprocedure [902] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Cardiology/CT Surgery


IP-Electrophysiology Study/Ablation - Adult- Postprocedure [902]
Admission Status
Level of Care (Single Response) [186484]
*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] 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] 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] 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 (Single Response) [144929]
Admit To Inpatient Status [ADT0001] Attending:
Admitting Resident:
Requested Floor:
Service: CARDIOVASCULAR ELECTROPHYSIOLOGY
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:
Anticipated Discharge Date:
Admit To Outpatient Short Stay [ADT0003] Attending:
Admitting Resident:
Requested Floor:
Service: CARDIOVASCULAR ELECTROPHYSIOLOGY
Admission Status [144931]
Admit To Inpatient [ADT0001] Attending:
Admitting Resident:
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Copyright © 2015 University of Wisconsin Hospital and Clinics Authority


Requested Floor:
Service: CARDIOVASCULAR ELECTROPHYSIOLOGY
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:
Anticipated Discharge Date:
Admit To Outpatient Short Stay [ADT0003] Attending:
Admitting Resident:
Requested Floor:
Service: CARDIOVASCULAR ELECTROPHYSIOLOGY
Discharge Status [150833]
Confirmed Discharge Date/Time [ADT0013] Confirmed Discharge Date:
Confirmed Discharge Time:
Conditions for Discharge:
Provider to be Present at Discharge?
Venous Thromboembolism (VTE) Prophylaxis
VTE Prophylaxis (Single Response) [130119]
Padua VTE Risk Assessment URL: https://uconnect.wisc.edu/clinical/references/medication-
use-manual/anticoagulation-resources/resources/name-
26463-en.file
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) injection [800040] 40 mg, Subcutaneous, EVERY 24 HOURS
heparin PF 5000 UNIT/0.5ML injection [156571] 5,000 units, Subcutaneous, EVERY 12 HOURS
heparin PF 5000 UNIT/0.5ML injection [156571] 5,000 units, Subcutaneous, EVERY 8 HOURS
High Bleed Risk with High VTE Risk (Single Response)
[129757]
Sequential Compression Device (SCD) / Foot Pump
[EQP0023]
CONTINUOUS, Routine
Left/Right/Bilateral? 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/references/medication-
use-manual/anticoagulation-resources/resources/name-
26463-en.file
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) injection [800040] 40 mg, Subcutaneous, EVERY 24 HOURS
heparin PF 5000 UNIT/0.5ML injection [156571] 5,000 units, Subcutaneous, EVERY 12 HOURS
heparin PF 5000 UNIT/0.5ML injection [156571] 5,000 units, Subcutaneous, EVERY 8 HOURS
High Bleed Risk with High VTE Risk (Single Response)
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Copyright © 2015 University of Wisconsin Hospital and Clinics Authority


[129757]
Sequential Compression Device (SCD) / Foot Pump
[EQP0023]
CONTINUOUS, Routine
Left/Right/Bilateral? 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 [9673]
Vital Signs [NURMON0013] SEE COMMENTS, Starting today with First Occurrence As
Scheduled, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Assess every 15 minutes times 4, then every 30 minutes
times 4, then every 1 hour times 4, then every 8 hours.
Patient Monitoring [9677]
Cardiac Rhythm Monitoring - Adult [NURMON0010] CONTINUOUS, Starting today, Routine
Notify Provider: Symptomatic Change in Rhythm,Serious
Arrhythmia
Functional Cardiac Defibrillator Present:
Activity (Single Response) [9674]
Bedrest For 3 Hours [NURACT0008] CONTINUOUS, Starting today For Until specified, Routine
AD LIB:
AMBULATE:
CHAIR:
DANGLE:
BEDREST: with bathroom privileges
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Bedrest for 3 hours, then up as tolerated prior to discharge.
Bedrest For 4 Hours [NURACT0008] CONTINUOUS, Starting today For Until specified, Routine
AD LIB:
AMBULATE:
CHAIR:
DANGLE:
BEDREST: with bathroom privileges
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Bedrest for 4 hours, then up as tolerated prior to discharge.
Bedrest For 5 Hours [NURACT0008] CONTINUOUS, Starting today For Until specified, Routine
AD LIB:
AMBULATE:
CHAIR:
DANGLE:
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BEDREST: with bathroom privileges
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Bedrest for 5 hours, then up as tolerated prior to discharge.
Nutrition [9675]
General Diet [NUT0001] EFFECTIVE NOW, Starting today, Routine
General Diet: GENERAL;
Diabetic Diet:
NPO (If patient receiving tube feeding see question 25):
Liquids & Modified Consistency (If Dysphagia Protocol see
questions 21-24):
Fiber:
Renal & Dialysis Multi-Nutrient Restriction:
Lactose Restricted:
Protein:
Fat:
Sodium:
Potassium:
Phosphorus:
Other Minerals:
Calories:
Fluid Restriction: Total mLs/24 hours (IV & PO):
Research:
Metabolic:
Other Modifiers:
Infant Nutrition (Select product and calories per ounce):
Infant Formula (Calories per Ounce):
Dysphagia Protocol:
Dysphagia Protocol-Modified Consistency (Also select
Dysphagia Protocol Liquid Consistency and Dysphagia
Protocol-Supervision):
Dysphagia Protocol-Liquid Consistency:
Dysphagia Protocol-Supervision:
Tube Feeding (Use Tube Feeding Order Set to indicate order
detail):
Tube Feeding Management:
Room Service Class:
Low Fat/Low Cholesterol/No Added Salt Diet [NUT0001] EFFECTIVE NOW, Starting today, Routine
General Diet:
Diabetic Diet:
NPO (If patient receiving tube feeding see question 25):
Liquids & Modified Consistency (If Dysphagia Protocol see
questions 21-24):
Fiber:
Renal & Dialysis Multi-Nutrient Restriction:
Lactose Restricted:
Protein:
Fat: LOW FAT/CHOLESTEROL;
Sodium: NO ADDED SALT;
Potassium:
Phosphorus:
Other Minerals:
Calories:
Fluid Restriction: Total mLs/24 hours (IV & PO):
Research:
Metabolic:
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Other Modifiers:
Infant Nutrition (Select product and calories per ounce):
Infant Formula (Calories per Ounce):
Dysphagia Protocol:
Dysphagia Protocol-Modified Consistency (Also select
Dysphagia Protocol Liquid Consistency and Dysphagia
Protocol-Supervision):
Dysphagia Protocol-Liquid Consistency:
Dysphagia Protocol-Supervision:
Tube Feeding (Use Tube Feeding Order Set to indicate order
detail):
Tube Feeding Management:
Room Service Class:
Diabetes Meal Plan [NUT0001] EFFECTIVE NOW, Starting today For Until specified, Routine
General Diet:
Diabetic Diet: DIABETES MEAL PLAN;
NPO (If patient receiving tube feeding see question 25):
Liquids & Modified Consistency (If Dysphagia Protocol see
questions 21-24):
Fiber:
Renal & Dialysis Multi-Nutrient Restriction:
Lactose Restricted:
Protein:
Fat:
Sodium:
Potassium:
Phosphorus:
Other Minerals:
Calories:
Fluid Restriction: Total mLs/24 hours (IV & PO):
Research:
Metabolic:
Other Modifiers:
Infant Nutrition (Select product and calories per ounce):
Infant Formula (Calories per Ounce):
Dysphagia Protocol:
Dysphagia Protocol-Modified Consistency (Also select
Dysphagia Protocol Liquid Consistency and Dysphagia
Protocol-Supervision):
Dysphagia Protocol-Liquid Consistency:
Dysphagia Protocol-Supervision:
Tube Feeding (Use Tube Feeding Order Set to indicate order
detail):
Tube Feeding Management:
Room Service Class:
Wound/Procedure Site Care [9676]
Assess Groin Site [NURMON0036] ONCE, Starting today For 1 Occurrences, Routine, Check
groin site for bleeding prior to discharge.
Monitor Entry Site [NURMON0060] SEE COMMENTS, Starting today, Site: ***
Location: {right, left, bilaterally:4001510}
Monitor entry site for hematoma or new bleeding every 15
minutes times 4, then every 30 minutes times 4, then every
hour times 4, then every 4 hours times 2, then every 8 hours.
Keep entry site clean and dry for 24 hours postprocedure.
Apply direct pressure to procedure site for hematoma or
persistent bleeding. Remove dressing 24 hours
postprocedure.
Contingency Parameters [145028]
Notify Provider [NURCOM0001] Provider to Notify: Provider
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If systolic blood pressure > (mmHg): 160
If systolic blood pressure < (mmHg): 90
If diastolic blood pressure > (mmHg): 90
If diastolic blood pressure < (mmHg): 40
If temperature > (C): 38
If temperature < (C):
If heart rate > (bpm): 120
If heart rate < (bpm): 50
If respiratory rate >: 32
If respiratory rate <: 8
If blood glucose > (mg/dL): 400
If blood glucose < (mg/dL): 40
If pain score >:
Pulse Oximetry < (%): 90
If urine output < (mL):
Other: Return of arrythmia
Medications
For Patients with Atrial Fibrillation [99785]
pantoprazole (PROTONIX) EC tab [62662] 40 mg, Oral, 1 X DAILY (HS)
colchicine tab [36051] 0.6 mg, Oral, 2 X DAILY
ibuprofen 200 mg (MOTRIN) tab RANGE [750024] 400-600 mg, Oral, EVERY 6 HOURS PRN, pain, For
pericardial pain not relieved by colchicine
Laboratory
Labs [137859]
PROTHROMBIN TIME/INR [PT] NEXT AM, Starting tomorrow For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
POTASSIUM [K] NEXT AM, Starting tomorrow 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 AM, Starting tomorrow 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 AM, Starting tomorrow 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 AM, Starting tomorrow For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Diagnostic Test and Imaging
Diagnostic Test and Imaging [137864]
ECG - 12 Lead - Obtain Upon Arrival to PACU
[EKG0008]
ONCE For 1 Occurrences, Routine
Reason for exam: OTHER (COMMENT)
Post-Op/Phase II
Non-Categorized Orders
Non-Categorized Orders [9678]
May discharge when patient meets Phase II on Modified
Aldrete Scoring System [NURCOM0022]
ONCE, Starting today For 1 Occurrences
Provide patient with "Caring For Yourself After
Electrophysiology Study" (HFFY #: 5860)
[NURCOM0025]
ONCE, Starting today For 1 Occurrences, Routine
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Schedule Appointment [NURCOM0026] Reason for Appointment: Follow-up Post Electrophysiology
Study
When do you want appointment: 4-6 weeks
Which Clinic or Specialty:
Which Provider (Optional): Physician who performed
procedure
Discontinue Urinary Catheter and Initiate Bladder
Management Protocol [187185]
Un-check the Initiate Bladder Management Protocol order when it does not apply.
The Bladder Management Protocol (Adult Inpatient) does NOT apply to Urology, Gynecology, spinal cord injured patients,
or patients with catheters placed by Urology.
The Bladder Management Protocol is NOT appropriate for Pediatric patients.
Discontinue Urinary Catheter [NURELM0069] ONCE, Routine
Initiate Bladder Management Protocol [NURELM0014] CONTINUOUS, Routine
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.
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