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/clinical/cckm-tools/content/order-sets/inpatient/cardiologyct-surgery/name-98420-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 – Ventricular Assist Device – Adult – Discharge [3218]

IP – Ventricular Assist Device – Adult – Discharge [3218] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Cardiology/CT Surgery


IP - Ventricular Assist Device - Adult - Discharge [3218]
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 10/1/15, No Print
acetaMINOPHEN (TYLENOL) suppository [34153] 1 suppository, 1, starting 10/1/15, No Print
Blood Glucose Management [111710]
glucagon 1 mg injection kit [107799] 1 each, 1, starting 10/1/15, No Print
Glucose 40 % oral gel [118089] 1 Tube, 1, starting 10/1/15, 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 10/1/15, No Print
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bisacodyl (DULCOLAX) rectal suppository [35231] 1 suppository, 1, starting 10/1/15, No Print
Senna-Docusate Sodium 8.6-50 MG per tab [70181] 1 tab, 1, starting 10/1/15, No Print
polyethylene glycol (MIRALAX) oral powder [61353] 1 Bottle, 1, starting 10/1/15, No Print
phosphate (FLEET) enema [37517] 1 enema, 1, starting 10/1/15, No Print
Non-categorized Medications [111711]
guaifenesin-dextroMETHORPHAN (ROBITUSSIN DM)
syrup [51568]
1 Bottle, 1, starting 10/1/15, No Print
carbamide peroxide (DEBROX) 6.5% otic soln [35545] 1 Bottle, 1, starting 10/1/15 until 10/6/15, No Print
alum-mag-simeth (MYLANTA ES) susp [44073] 1 Bottle, 1, starting 10/1/15, No Print
Core Measure Documentation
Core Measure Documentation - Beta Blocker - This Does NOT Generate A Medication Order (Use Med Reconciliation
To Prescribe Medications) (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 - This Does NOT Generate A Medication Order (Use Med
Reconciliation To Prescribe Medications) (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)
Aspirin (Single Response) [100826]
Aspirin Already Ordered. This does NOT generate a
medication order. Please be sure you have ordered the
Aspirin in Med Record. [COR0037]
ONCE For 1 Occurrences, Routine
Aspirin Not Ordered [COR0033] ONCE For 1 Occurrences, Routine
Reason Not Ordered:
Core Measure Documentation - Statins (Single Response) [107377]
Statins Already Ordered. This does NOT generate a
medication order. Please be sure you have ordered the
Statin in Med Record. [COR0039]
ONCE For 1 Occurrences, Routine
Statins Not Ordered [COR0035] ONCE For 1 Occurrences, Routine
Reason Not Ordered:
Patient Care Orders
Reason for Hospitalization [130837]
Why You Were Hospitalized [NURCOM0073] Please complete in PATIENT FRIENDLY terms. This order
will appear on the patient's After Hospital Care Plan., Routine
Vital Signs [98059]
Measure Weight [NURMON0015] Routine
Frequency: Daily
Call VAD coordinator if you gain more than 3 pounds in a day
or 5 pounds total.
Measure Vital Signs [NURMON0060] Routine, Measure temperature, document VAD readings daily
and document on VAD readings sheets provided.
Activity [98174]
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
Walk 4 times a day, at the minimum.
Activity Restrictions [NURACT0011] Routine, - No bending at the waist.
- Pace activities and take periods of rest.
- No showering. Do not immerse VAD or incisions during
bathing.
- Avoid any activity with the potential for immersion into water.
This can cause pump failure.
- Avoid jumping up and down.
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- Do not sleep on your stomach.
Lifting Restrictions and Sternal Precautions
[NURACT0011]
Routine, - No lifting arms above your head or laying in bed
with your hands behind your head.
- No pushing or pulling with arms until cleared by cardiac
surgeon.
- No vacuuming until cleared by surgeon.
- No lifting greater than 8 lbs. until cleared by cardiac
surgeon.
Driving Instructions [103265]
Driving Restrictions [NURACT0011] Routine, No driving. Sit in back seat of vehicle and wear your
seat belt.
Nutrition [98058]
Diet: 2000 mg Sodium and 2 liter Fluid Restriction
[NUT0006]
Routine
General:
Liquids and Modified Consistency:
Fluid Restriction: 2 liters: See Health Facts for You #475
Sodium: 2000 mg Sodium: See Health Facts for You #180,
#201
Dysphagia:
Fat:
Renal:
Potassium:
Micronutrients:
Infant Formula Product:
Infant Formula Concentration:
No Added Salt Diet [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:
Renal:
Potassium:
Micronutrients:
Infant Formula Product:
Infant Formula Concentration:
Nutritional Supplement - Carnation Instant Breakfast
[NURDIE0013]
Routine, Drink 2 times a day
Nutritional Supplement - Protein Shake/Drink
[NURDIE0013]
Routine, Drink 1 can with each meal.
Wound Care [98595]
Sternal and Chest Tube Incisions [NURWND0015] Routine, Sternal dressing: Take off dressing tomorrow. Clean
with soap and water daily. Pat dry (do not rub). No ointments
or lotions to the incisions. Notify VAD team if there is new
drainage, warm to touch, new tenderness. You can leave
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these open to air unless there is drainage than apply a new
dressing daily until drainage stops.
Old chest tube sites: Clean with soap and water. Pat dry.
No ointments or lotions to the sites. Cover and change
dressing daily until first clinic appointment.
Driveline Site [NURWND0015] Routine, Sterile dressing change daily as instructed. Call
VAD coordinator with new drainage/ redness/ tenderness at
the driveline exit site, fever, chills, body aches.
VAD Device (Single Response) [132474]
Heartmate II [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This order
will appear on the patient's After Hospital Care Plan., Routine,
- Follow Health Facts for You #6440.
- Call for Pulsatility Index < 3 or >8 for 30 consecutive
minutes, Power > 8 (steady) and Flow < 3.5 (steady) for 30
minutes.
- Call if VAD flows +++ or --- for x 1hr or abnormal feelings.
- Call with any VAD alarms (not battery) or other concerns.
- Call with any new or worsening symptoms of heart failure-
swelling ankles, bloating, changes in waistline, shortness of
breath.
- Call with lightheadedness, chest pain, change in fatigue
level, decrease in activity level, pain not relieved by Tylenol or
pain medication, signs of infection, any other concerns.
- Call if no bowel movement in 3 days.
HeartMate III [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This order
will appear on the patient's After Hospital Care Plan., Routine,
- Call for Pulsatility Index < 2 or > 6 for 30 consecutive
minutes, Power > 6 (steady) and Flow < *** (steady) for 30
minutes.
- Call if VAD flows +++ or --- for x 1hr or abnormal feelings.
- Call with any VAD alarms (not battery) or other concerns.
- Call with any new or worsening symptoms of heart failure-
swelling ankles, bloating, changes in waistline, shortness of
breath.
- Call with lightheadedness, chest pain, change in fatigue
level, decrease in activity level, pain not relieved by Tylenol or
pain medication, signs of infection, any other concerns.
- Call if no bowel movement in 3 days.
Thoratec TLC-II [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This order
will appear on the patient's After Hospital Care Plan., Routine,
- Call if Flow < *** on Left and Flow < *** on Right.
- Call with any new or worsening symptoms of heart failure-
swelling ankles, bloating, changes in waistline, shortness of
breath.
- Call with lightheadedness, chest pain, change in fatigue
level, decrease in activity level, pain not relieved by Tylenol or
pain medication, signs of infection, any other concerns.
- Call if VAD flows are equal.
- Call if unable to see a flash test (no light on the other side of
the VAD) or empty light not flashing.
- Call if there are any alarms except battery.
- Call if continued fill alarms despite changes in position and
changing of fill cable.
- Call if no bowel movement in 3 days.
- Follow Health Facts For You #6674.
LEFT Ventricular Assist Device Checks - Heartware
[NURVENT0024]
Routine, - Call for Flow < *** (steady) for 30 minutes.
- Call for Power > *** (steady) for 30 minutes.
- Call for abnormal feelings.
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- Call with any VAD alarms (not battery) or other concerns.
- Call with any new or worsening symptoms of heart failure-
swelling ankles, bloating, changes in waistline, shortness of
breath.
- Call with lightheadedness, chest pain, change in fatigue
level, decrease in activity level, pain not relieved by Tylenol or
pain medication, signs of infection, any other concerns.
- Call if no bowel movement in 3 days.
RIGHT Ventricular Assist Device Checks - Heartware
[NURVENT0025]
Routine, - Call for Flow < *** (steady) for 30 minutes.
- Call for Power > *** (steady) for 30 minutes.
- Call for abnormal feelings.
- Call with any VAD alarms (not battery) or other concerns.
- Call with any new or worsening symptoms of heart failure-
swelling ankles, bloating, changes in waistline, shortness of
breath.
- Call with lightheadedness, chest pain, change in fatigue
level, decrease in activity level, pain not relieved by Tylenol or
pain medication, signs of infection, any other concerns.
- Call if no bowel movement in 3 days.
Bowel Care [123363]
Bowel Care [NURELM0068] Routine
Bladder Care [123381]
Bladder Care [NURELM0067] Routine
Other Patient Care Instructions [123396]
Call VAD Coordinator With Decreased Appetite
[NURDIE0013]
Routine
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
When to Call Your Doctor [130838]
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 the Following Numbers with Questions or
Concerns:
If symptoms worsen contact VAD coordinator/NP at 608-261-
0962 or 608-262-0773 or 608-263-4786 during business
hours.
After hours or on weekends/holidays: call 608-263-6400 or
608-262-0486 and ask for heart failure attending on call.
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').
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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
Follow-Up Appointments - Cardiac Rehab (Single Response) [101247]
Outpatient Cardiac Rehab is recommended. Please select one of the following.
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 Appointments - Cardiac Rehab [101248]
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?
Follow-Up Appointments [98061]
Schedule Follow-up Appointment with Ventricular Assist
Device APP 2-4 Days after Discharge [NURCOM0026]
Reason for Appointment: Postoperative Follow-Up
When do you want appointment: 2-4 Days
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Which Clinic or Specialty: VAD APP
Which Provider (Optional):
Joint Appointment with Heart Failure Physician Group
and VAD APP 8 Weeks after Discharge [NURCOM0026]
Reason for Appointment: Heart Failture and Status Post
Ventricular Assist Device Insertion
When do you want appointment: 8 Weeks Postoperative
Which Clinic or Specialty: Heart Failure Physician and VAD
APP
Which Provider (Optional):
Joint Appointment with Cardiac Surgeon and VAD APP
4 Weeks after Discharge [NURCOM0026]
Reason for Appointment: 4-Week Ventricular Assist Device
Postoperative Follow-Up
When do you want appointment: 4 Weeks Postoperative
Which Clinic or Specialty: Cardiac Surgeon and VAD APP
Which Provider (Optional):
Echocardiogram 1 month post VAD implant at the joint
appointment with cardiac surgeon and VAD APP
Indication: other s/p 1 month post LVAD standard protocol no
bubble test
ABO antibody test 4 weeks after VAD implant at appointment
with cardiac surgeon
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.)
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
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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.,
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.
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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 Appointments [20230]
Schedule Appointment With Physical Therapy
[NURCOM0026]
Reason for Appointment:
When do you want appointment:
Which Clinic or Specialty: Physical Therapy
Which Provider (Optional):
Schedule Appointment With Occupational Therapy
[NURCOM0026]
Reason for Appointment:
When do you want appointment:
Which Clinic or Specialty: Occupational Therapy
Which Provider (Optional):
Schedule Appointment With Speech Therapy
[NURCOM0026]
Reason for Appointment:
When do you want appointment:
Which Clinic or Specialty: Speech Therapy
Which Provider (Optional):
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):
Schedule Appointment [NURCOM0026] Reason for Appointment:
When do you want appointment:
Which Clinic or Specialty:
Which Provider (Optional):
Patient to Schedule Appointment [NURCOM0056] Routine
Purpose:
With whom:
For when:
Diagnostic Tests and Imaging [98070]
Transthoracic Resting Echocardiogram [ECH0003] Status: Future, Expected:10/22/15, Expires: 11/26/15,
Normal, Routine, s/p 1 month post VAD Implant {RIGHT OR
LEFT:18776}. VAD standard protocol; no bubble test.
Status post VAD evaluation assess LV and RV function and
VAD settings.
Perform at cardiothoracic surgery follow up appointment.
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)
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison

 

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.
(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
Laboratory - To Be Drawn At Cardiothoracic Surgeon Follow-Up Visit [103266]
These lab orders should only be used if the current Attending Provider or Consulting Provider will be responsible for the
result of the lab.
ANTIBODY SCREEN [ABSCR] Status: Future, Expected:10/22/15, Expires: 11/26/15,
Normal, Routine, To be drawn at cardiothoracic surgeon
follow-up appointment (approximately 1 month postoperative)
C REACTIVE PROTEIN [CRPN] Status: Standing, Expires:10/8/15 MANUAL,Count:1, Normal,
Routine, To be drawn at VAD/Heart Failure NP follow-up visit
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Pr i nt ed by LIND, JANNA S [JSL237] at 10/1/2015 9:46:27 AM
Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison