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/clinical/cckm-tools/content/order-sets/inpatient/cardiologyct-surgery/name-98408-en.cckm

20170109

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UWHC,UWMF,

Tools,

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

IP - Heart and Vascular Care Center - Brachial/Radial Approach - Adult - Postprocedure [1656]

IP - Heart and Vascular Care Center - Brachial/Radial Approach - Adult - Postprocedure [1656] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Cardiology/CT Surgery


IP - Heart & Vascular Care Center - Brachial/Radial Approach - Adult -
Postprocedure [1656]
Admission Status
Level of Care (Single Response) [187485]
*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:
Post-Op/Phase II
Admit to Observation (Single Response)
[188297]
Admit To Observation [ADT0002] Attending:
Admitting Resident:
Requested Floor:
Service:
Post-Op/Phase II
Admit to Outpatient Short Stay (Single
Response) [188298]
Admit To Outpatient Short Stay [ADT0003] Attending:
Admitting Resident:
Requested Floor:
Service:
Post-Op/Phase II
Admission Status [122576]
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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:
Post-Op/Phase II
Admit To Observation [ADT0002] Attending:
Admitting Resident:
Requested Floor:
Service:
Post-Op/Phase II
Admit To Outpatient Short Stay [ADT0003] Attending:
Admitting Resident:
Requested Floor:
Service:
Post-Op/Phase II
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) subcutanoeus injection
[800040]
40 mg, Subcutaneous, EVERY 24 HOURS
heparin PF 5000 UNIT/0.5ML injection [156571] 5,000 units, Subcutaneous, EVERY 12 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/cckm-
tools/content/cpg/hematology-and-
coagulation/related/name-97520-en.cckm
Low VTE Risk [130084]
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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) subcutanoeus injection
[800040]
40 mg, Subcutaneous, EVERY 24 HOURS
heparin PF 5000 UNIT/0.5ML injection [156571] 5,000 units, Subcutaneous, EVERY 12 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:
Patient Care Orders
Vital Signs [23347]
Vital Signs [NURMON0013] SEE COMMENTS, Starting today, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
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.
Patient Monitoring [23358]
Monitor Entry Site [NURMON0060] SEE COMMENTS, Starting today, 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. Apply direct pressure to procedure site for
hematoma or persistent bleeding. Site:
{Catheterization site:33003114}
High Risk Entry Site [NURCOM0022] CONTINUOUS, Pain in the arm may indicate internal
bleeding. Notify Cardiology Fellow.
For bleeding, oozing, swelling, or hematoma at
entry site [NURCOM0022]
CONTINUOUS, For bleeding, oozing, swelling, or
hematoma at entry site
-Apply direct manual pressure
-Notify Cardiology Fellow
-Do not apply sandbag
Neurovascular Checks [NURMON0045] SEE COMMENTS, Starting today For Until specified,
Routine, Monitor neurovascular status.
Location: {right, left, bilateral:4001510} upper
extremity.
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.
Page 3 of 10
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Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
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Cardiac Rhythm Monitoring - Adult
[NURMON0010]
ONCE, Routine
Notify Provider: Symptomatic Change in
Rhythm,Serious Arrhythmia
Functional Cardiac Defibrillator Present:
Activity [23361]
Activity [NURACT0008] CONTINUOUS, Routine
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:
Out of Bed with assistance.
Nutrition [83598]
Cardiac Diet [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: Diet Modifications
Diet Modifications: Heart Healthy
Heart Healthy Options: Custom
Sodium: NAS (2400 mg)
Fat: Low Saturated Fat/Low Cholesterol
Fluid Restriction Total mLs/24H (IV/PO):
Caffeine: Low Caffeine
Bedside Meal Instructions:
Room Service Class:
General Diet [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: General (no Modifications)
Bedside Meal Instructions:
Room Service Class:
Diabetes Meal Plan [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: Diet Modifications
Diet Modifications: Diabetes
Bedside Meal Instructions:
Room Service Class:
Encourage Fluids [NURDIE0006] CONTINUOUS, Starting today, Routine
Restrict Fluids - Must Indicate Restriction
[NUT9999]
EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: Diet Modifications
Diet Modifications: Fluid Restriction
Fluid Restriction Total mLs/24H (IV/PO):
Bedside Meal Instructions:
Room Service Class:
Diet - Mediterranean/DASH [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: Diet Modifications
Diet Modifications: Heart Healthy
Heart Healthy Options: DASH
Bedside Meal Instructions:
Room Service Class:
Wound Care [183961]
Page 4 of 10
Printed by LIND, JANNA S [JSL237] at 7/28/2016 9:07:43 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 07/2016CCKM@uwhealth.org

Wound Care [NURCOM0022] CONTINUOUS, Starting today, Apply sterile
transparent dressing to the puncture site after
compression device is removed.
Contingency Parameters [23364]
Notify Provider [NURCOM0001] Provider to Notify: Provider
If systolic blood pressure > (mmHg): 160
If systolic blood pressure < (mmHg): 90
If diastolic blood pressure > (mmHg):
If diastolic blood pressure < (mmHg):
If temperature > (C):
If temperature < (C):
If heart rate > (bpm): 110
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: Platelet count decreases by more than 100
K/uL of baseline value or falls below 100 K/uL,Chest
pain/rhythm changes,Bleeding, oozing, swelling, or
hematoma at entry site site (Radial = wrist, forearm,
or upper arm. Brachial = elbow or upper arm),Loss of
plethysmography,Change in neurovasular exam of
affected extremity including pain, cool/cold to touch,
numbness, or tingling
Discharge Instructions
Discharge Instructions [206931]
Post Radial/Brachial Cath [132329]
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
Activity restriction - Do not let anyone take your
blood pressure on your affected arm for 3 days.
For 1 week or until the wound has healed:
- Do not lift more than 10 pounds
- No vigorous arm activity
- Do not sit in a bathtub, hot tub, or go into a
swimming pool.
Activity recommendations - Keep your arm elevated
overnight and while you are at rest for 2-3 days
after your procedure to prevent swelling. You may
cook, type, clean, and drive, if able, the day after
you go home.
Page 5 of 10
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Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
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Symptom Management [NURCOM0071] Please complete in PATIENT FRIENDLY terms.
This order will appear on the patient's After
Hospital Care Plan., Routine, What to expect:
Soreness or tenderness at the site that may last 1
week; Bruising at the site that may take 2-3 weeks
to go away; A small lump (dime to quarter size)
which may last up to 6 weeks.
For MINOR pain: You may take acetaminophen
(Tylenol®) 325 mg tablets every 4-6 hours; You
may place an ice pack or warm pack over the site
for 20 minutes every 2 hours. Gently wipe the site
after you remove the pack if it is wet.
For angina: If your heart symptoms return (chest,
arm, neck pain or pressure, sweatiness, or
breathlessness), sit or lie down. If prescribed, take
nitroglycerin as directed. If the symptoms have not
gone away within 15 minutes, call 911.
Wound Care [NURWND0015] Routine, You may shower after 24 hours. Remove
the bandage over the incision before showering.
For the next 3 days, gently clean the site using
soap and water while in the shower. Dry
thoroughly. Do not rub the site. You may apply an
antibacterial ointment. Do not use lotions or
powders in the area. Cover the site with a bandage.
Make sure to cover the entire area. A square
adhesive Band-Aid works well. Keep the site clean
and dry to prevent infection. If the bandage
becomes wet, remove it and replace it with a new
one. Inspect the site daily for redness, swelling, or
drainage.
Page 6 of 10
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Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
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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, - If bleeding or sudden swelling
should occur at the site, apply direct pressure. If
the bleeding does not stop after 10 minutes of
placing constant pressure on the site, call 911 for
emergency help. Keep pressure on the site until
help arrives.
- If your extremity becomes numb, cold, or turns
blue, call 911 for emergency help.
- If you have severe pain or notice any signs of
infection including: Redness, swelling, or drainage
at the site/Prolonged pain/Fever over 100.4°F for
two readings taken a few hours apart or have any
other questions/concerns, call the UW Health Heart
and Vascular Clinic at (608) 263-1530 (Monday -
Friday, 8am - 5pm). After hours, nights, weekends,
and holidays, this same number is answered by the
message center. Ask for the cardiology fellow on
call. Give the operator your full name and phone
number with the area code. The doctor will call you
back. If you live out of the area, please call 1-800-
323-8942.
Intravenous Therapy
Premedications for Needle Insertion [106327]
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 within 1 minute. Choice of medication should be based on patient’s previous
experience/preference, history of lidocaine allergy and ease of access.
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
Post-Op/Phase II
Page 7 of 10
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lidocaine (XYLOCAINE) 1% injection [39034] 0.1-0.4 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. Choice of medication should be based on
patient’s previous experience/preference, history of
lidocaine allergy and ease of access
Post-Op/Phase II
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. Choice of medication should be based on
patient’s previous experience/preference, history of
lidocaine allergy and ease of access
Post-Op/Phase II
IV Fluids [97936]
sodium chloride 0.9% infusion [64367] at 100 mL/hr, Intravenous, CONTINUOUS
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Starting today, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
Begin after IV discontinued
Infusion Agent
Eptifibatide - Normal Renal Function [21544]
50 mL/min/1.73 m2 or greaterofGFR For serum creatinine less than 2 mg/dL or
eptifibatide (INTEGRILIN) 75 mg in 100 mL
infusion - NOTE: Minimum infusion time 12
hours, maximum infusion time 18-24 hours.
(maximum 15 mg/hr) [59379]
2 mcg/kg/min, Intravenous, CONTINUOUS
Stop infusion at *** (date/time)
For serum creatinine less than 2 mg/dL or GFR of 50
mL/min/1.73 m2 or greater the recommended dose is
2 mcg/kg/min (maximum 15 mg/hr). Minimum
infusion time 12 hours, maximum infusion time 18-24
hours
Eptifibatide - Renal Impairment [21612]
m249 mL/min/1.73 -4 mg/dL or GFR 20-serum creatinine 2 For
eptifibatide (INTEGRILIN) 75 mg in 100 mL
infusion - NOTE: Minimum infusion time 12
hours, maximum infusion time 18-24 hours.
(maximum 7.5 mg/hr) [59379]
1 mcg/kg/min, Intravenous, CONTINUOUS
Stop infusion at *** (date/time)
For serum creatinine 2 - 4 mg/dL or GFR 20-49
mL/min/1.73 m2 the recommended dose is 1
mcg/kg/min (maximum 7.5mg/hr). Minimum infusion
time 12 hours, maximum infusion time 18-24 hours.
Medications - General
Mediations [122952]
aspirin chew tab [720014] 81 mg, Oral, 1 X DAILY
aspirin chew tab [720014] 162 mg, Oral, 1 X DAILY
clopidogrel (PLAVIX) tab [58345] 75 mg, Oral, 1 X DAILY
clopidogrel (PLAVIX) tab [58345] 300 mg, Oral, ONCE For 1 Doses
clopidogrel (PLAVIX) tab [58345] 600 mg, Oral, ONCE For 1 Doses
atorvastatin (LIPITOR) tab [720017] 40 mg, Oral, 1 X DAILY (HS)
atorvastatin (LIPITOR) tab [720017] 80 mg, Oral, 1 X DAILY (HS)
Page 8 of 10
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Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
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rosuvastatin (CRESTOR) tab [73638] 20 mg, Oral, 1 X DAILY (HS)
rosuvastatin (CRESTOR) tab [73638] 40 mg, Oral, 1 X DAILY (HS)
NOTE: Discontinue low molecular weight
heparins (LMWH) dalteparin (FRAGMIN),
enoxaparin (LOVENOX), fondaparinux
(ARIXTRA) [950018]
ONCE For 1 Doses
NOTE: Discontinue low molecular weight heparins
(LMWH) dalteparin (FRAGMIN), enoxaparin
(LOVENOX), fondaparinux (ARIXTRA)
Note: Discontinue heparin [950018] ONCE For 1 Doses
Discontinue heparin
Laboratory
For Patients on Eptifibatide (INTEGRILIN) [21647]
PLATELET COUNT [PLT] CONDITIONAL - RN COLLECT, Starting today,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw 4 hours after
eptifibatide (INTEGRILIN) bolus administration
Now and Every 6 Hours Times 3 or Until Peak [21648]
TROPONIN [GM2447] EVERY 6 HOURS, Starting today For 3 Occurrences,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Now and every 6
hours times 3 or until peak
Postprocedure Day 1 [21649]
CREATININE [CRET] NEXT AM 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 For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
HEMATOCRIT [HCT] NEXT AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
PLATELET COUNT [PLT] NEXT AM 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 Tests and Imaging
Studies [21650]
ECG - 12 Lead WITHOUT Rhythm-
Postprocedure Evaluation [EKG0008]
ONCE, Starting tomorrow For 1 Occurrences, Routine
Reason for exam:
ECG - 12 Lead WITHOUT Rhythm- PRN for
Chest Pain [EKG0008]
PRN, Starting today, STAT
Reason for exam: CHEST PAIN
ECG - 12 Lead WITHOUT Rhythm-
Postprocedure Evaluation [EKG0008]
ONCE, Starting today For 1 Occurrences, Routine
Reason for exam:
Consults
Consults [135721]
Page 9 of 10
Printed by LIND, JANNA S [JSL237] at 7/28/2016 9:07:43 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 07/2016CCKM@uwhealth.org

Order Consult Cardiac Rehab for the following Indications:
1. Diagnosis of clinically stable angina pectoris
2. Percutaneous transluminal coronary angioplasty (PTCA) or percutaneous coronary intervention
(PCI) within last 6 months, acute myocardial infarction (AMI) within last 12 months
3. Heart valve repair/replacement within last 6 months
4. CABG within last 12 months
5. Heart or heart-lung transplant within last 12 months
Consult Cardiac Rehab/Preventive Cardiology
(Inpatient) [CON0010]
ONCE, Starting today For 1 Occurrences, Routine
Reason for consult:
Can this consult be done via video?
Page 10 of 10
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Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 07/2016CCKM@uwhealth.org