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/clinical/cckm-tools/content/order-sets/inpatient/cardiologyct-surgery/name-98421-en.cckm

201712341

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 - Postoperative [3194]

IP - Ventricular Assist Device - Adult - Postoperative [3194] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Cardiology/CT Surgery


IP - Ventricular Assist Device - Adult - Postoperative [3194]
for Adult Patients OnlyIntended
Admission Status
Thoratec, HeartMate, needs to be admitted on Cardiac transplant service if they have a Abiomed, Patient
or CentriMag VAD.
Level of Care (Single Response) [187519]
*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 [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 [97509]
Page 1 of 32
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Admit To Inpatient [ADT0001] Attending:
Admitting Resident:
Requested Floor: B4/5
Service: CARDIAC TRANSPLANT
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.
C - CLEAR DIAGNOSIS:
E - EVALUATIONS PLANNED:
R - RESULTS EXPECTED:
T - TREATMENTS ORDERED:
Post-Op/Phase II
Admission Status [125508]
Admit To Inpatient [ADT0001] Attending:
Admitting Resident:
Requested Floor: B4/5
Service: CARDIAC TRANSPLANT
Rationale for LOS greater than 2 midnights:
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
Anticoagulation Ventricular Assist Device Heparin -patient Order Set 4999 -to InRefer
VTE Prophylaxis (Single Response) [144143]
Caprini VTE Risk Assessment URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/hematology-and-
coagulation/related/name-97521-en.cckm
High VTE Risk with Low Bleed Risk [130117]
enoxaparin (LOVENOX) subcutaneous injection
[800040]
40 mg, Subcutaneous, EVERY 24 HOURS, Post-
Op/Phase II
heparin subcutaneous injection [800290] 5,000 units, Subcutaneous, EVERY 12 HOURS,
Post-Op/Phase II
heparin subcutaneous injection [800290] 5,000 units, Subcutaneous, EVERY 8 HOURS
Starting tomorrow at 6:00 AM
Begin Postoperative Day 1
Post-Op/Phase II
Sequential Compression Device (SCD)
(TREATMENT) [NURTRT0028]
CONTINUOUS, Routine
Left/Right/Bilateral? Bilateral
Sequential Compression Device (SCD) / Foot
Pump (SUPPLY) [EQP0023]
CONTINUOUS, Routine
Left/Right/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
Post-Op/Phase II
Page 2 of 32
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Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

High VTE Risk with High Bleed Risk [129757]
Sequential Compression Device (SCD)
(TREATMENT) [NURTRT0028]
CONTINUOUS, Routine
Left/Right/Bilateral? Bilateral
Sequential Compression Device (SCD) / Foot
Pump (SUPPLY) [EQP0023]
CONTINUOUS, Routine
Left/Right/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
Post-Op/Phase II
No VTE Prophylaxis [130084]
VTE Prophylaxis - Reason Not Ordered
[COR0008]
ONCE, Routine
Reason Not Ordered:
Post-Op/Phase II
VTE Prophylaxis (Single Response) [150210]
Caprini VTE Risk Assessment URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/hematology-and-
coagulation/related/name-97521-en.cckm
High VTE Risk with Low Bleed Risk [130117]
enoxaparin (LOVENOX) subcutaneous injection
[800040]
40 mg, Subcutaneous, EVERY 24 HOURS, Post-
Op/Phase II
heparin subcutaneous injection [800290] 5,000 units, Subcutaneous, EVERY 12 HOURS,
Post-Op/Phase II
heparin subcutaneous injection [800290] 5,000 units, Subcutaneous, EVERY 8 HOURS
Starting tomorrow at 6:00 AM
Begin Postoperative Day 1
Post-Op/Phase II
Sequential Compression Device (SCD)
(TREATMENT) [NURTRT0028]
CONTINUOUS, Routine
Left/Right/Bilateral? Bilateral
Sequential Compression Device (SCD) / Foot
Pump (SUPPLY) [EQP0023]
CONTINUOUS, Routine
Left/Right/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
Post-Op/Phase II
High VTE Risk with High Bleed Risk [129757]
Sequential Compression Device (SCD)
(TREATMENT) [NURTRT0028]
CONTINUOUS, Routine
Left/Right/Bilateral? Bilateral
Sequential Compression Device (SCD) / Foot
Pump (SUPPLY) [EQP0023]
CONTINUOUS, Routine
Left/Right/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
Post-Op/Phase II
No VTE Prophylaxis [130084]
VTE Prophylaxis - Reason Not Ordered
[COR0008]
ONCE, Routine
Reason Not Ordered:
Post-Op/Phase II
Patient Care Orders
Vital Signs [87678]
Page 3 of 32
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 12:44:53 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

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 while on ICU status. Every 4
hours while on intermediate care (IMC) or general
care status., Post-Op/Phase II
Patient Monitoring [89873]
Measure Arterial Line - Continuous
[NURMON0019]
CONTINUOUS, Starting today, Routine
BP Source: Invasive (Arterial Line)
BP Location:
BP Position:
BP Restrictions:
Post-Op/Phase II
Measure Central Venous Pressure - Continuous
[NURMON0002]
CONTINUOUS, Starting today, Routine, Post-
Op/Phase II
Measure Pulmonary Artery Pressure - Continuous
[NURMON0023]
CONTINUOUS, Starting today, Routine
Pulmonary Artery Systolic Pressure (mmHg): Other
(Comment)
Pulmonary Artery Diastolic Pressure (mmHg): Other
(Comment)
Pulmonary Artery Mean Pressure (mmHg): Other
(Comment)
Pulmonary Artery Wedge Pressure (mmHg):
Central Venous Pressure (mmHg):
Central Venous Pressure (mmH2O):
Cardiac Output:
Cardiac Output Method:
Cardiac Index:
Systemic Vascular Resistance:
Pulmonary Vascular Resistance:
Pulmonary Vascular Resistance Index:
Stroke Volume (mL/beat):
Stroke Volume Index:
Systemic Vascular Resistance Index:
Left Cardiac Work Index:
Right Cardiac Work Index:
Left Ventricular Stroke Work Index:
Right Ventricular Stroke Work Index:
Pulmonary Capillary Wedge Pressure (mmHg):
Measure with FloTrac? No
Continuous, Post-Op/Phase II
Page 4 of 32
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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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12/2017CCKM@uwhealth.org

Measure Hemodynamic Parameters - Every 4
Hours [NURMON0023]
CONTINUOUS, Routine
Pulmonary Artery Systolic Pressure (mmHg):
Pulmonary Artery Diastolic Pressure (mmHg):
Pulmonary Artery Mean Pressure (mmHg):
Pulmonary Artery Wedge Pressure (mmHg):
Central Venous Pressure (mmHg):
Central Venous Pressure (mmH2O):
Cardiac Output: Every 4 hours
Cardiac Output Method:
Cardiac Index: Every 4 hours
Systemic Vascular Resistance: Every 4 hours
Pulmonary Vascular Resistance: Every 4 hours
Pulmonary Vascular Resistance Index:
Stroke Volume (mL/beat):
Stroke Volume Index:
Systemic Vascular Resistance Index:
Left Cardiac Work Index:
Right Cardiac Work Index:
Left Ventricular Stroke Work Index:
Right Ventricular Stroke Work Index:
Pulmonary Capillary Wedge Pressure (mmHg):
Measure with FloTrac? No
Measure cardiac output, cardiac index, systemic
vascular resistance, and pulmonary artery resistance
every 4 hours., Post-Op/Phase II
Neurovascular Checks [NURMON0045] EVERY 2 HOURS, Starting today, Routine
Location:
Until awake, Post-Op/Phase II
Assess Neurologic Status [NURMON0006] EVERY 2 HOURS, Starting today, Routine, Until
awake, Post-Op/Phase II
Cardiac Rhythm Monitoring - Adult
[NURMON0010]
CONTINUOUS, Routine
Indication: Other (Comment Required)
Notify Provider: Symptomatic Change in
Rhythm,Serious Arrhythmia
Functional Cardiac Defibrillator Present:
Post-Op/Phase II
Activity [125668]
Activity Bedrest While Intubated [NURACT0008] SEE COMMENTS, Starting today For 1 Weeks,
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:
Increase activity to dangle once patient is extubated.,
Post-Op/Phase II
Elevate Head Of Bed Unless Chest Is Open
[NURACT0002]
Equal to (degrees): 30
Greater than (degrees):
Less than (degrees):
Other options:
Routine, CONTINUOUS, Starting today, Post-
Op/Phase II
Page 5 of 32
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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

High Fowler's Position During Weaning
[NURACT0011]
CONTINUOUS, Starting today, Post-Op/Phase II
Dangle With Leg Extension Exercises After
Extubation [NURACT0008]
CONTINUOUS, Starting today, Routine
AD LIB:
AMBULATE:
CHAIR:
DANGLE: 3x daily
BEDREST:
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Once extubated, increase activity to dangle., Post-
Op/Phase II
Activity Chair [NURACT0008] CONTINUOUS, Routine
AD LIB:
AMBULATE:
CHAIR: 3x daily
DANGLE:
BEDREST:
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
To chair if tolerate dangling, Post-Op/Phase II
Activity Ambulate [NURACT0008] CONTINUOUS, Routine
AD LIB:
AMBULATE: 4x daily
CHAIR:
DANGLE:
BEDREST:
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Once pulmonary catheter is removed, Post-Op/Phase
II
Reposition Patient [NURACT0005] Type:
Routine, SEE COMMENTS, Starting today, Every 2
hours., Post-Op/Phase II
Sternal Precautions [PRECAU0010] CONTINUOUS, Starting today, Routine, Sternal
Precautions:
No lifting greater than 8 pounds.
No pushing/pulling with arms during transfers.
No shoulder elevation past 90 degrees., Post-
Op/Phase II
Nutrition [89875]
Page 6 of 32
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NPO Except Medications & Fluid Restriction
[NUT9999]
EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: NPO
NPO: NPO except Medications
Bedside Meal Instructions:
Room Service Class:
Fluid Restriction Total: 2000 mL (1000 mL from
Dietary), Post-Op/Phase II
Measure Caloric Intake - Starting Postoperative
Day 3 [NURDIE0011]
1X DAILY, Starting 12/10/17 For 7 Days, Routine,
Post-Op/Phase II
Respiratory [89876]
Respiratory Therapy per Protocol [RT0035] Routine
Protocol Type:
Post-Op/Phase II
Pulse Oximetry [NURMON0009] CONTINUOUS, Starting today, Routine, Continuous
while on ICU status. Every 4 hours while on
intermediate care (IMC) or general care status., Post-
Op/Phase II
Suction Airway [NURTAD0017] PRN, Starting today, Routine
Location: Tracheal
Suction endotracheal tube as needed for removal of
secretions., Post-Op/Phase II
Mechanical Ventilation - Adult [195594]
Provide Manual Resuscitator at Bedside
[RT0039]
CONTINUOUS, Routine, Post-Op/Phase II
Mechanical Ventilation [RT0028] Routine, For ADULT patients order chlorihexidene
gluconate (PERIDEX) 0.12% soln 15 mL to swab
oral cavity 2x daily while on ventilation.
Ventilator Management: Per MD
Wean: Per Cardiothoracic Surgery Algorithm
Mode:
Set Rate/Min:
Tidal Volume Multiplier: 6
PEEP (cmH2O):
FiO2 (%) Titrate to Keep Sats >/= to ___%:
Pressure Support:
Pressure Control:
P High (cmH20):
P Low (PEEP) (cmH20):
T High (sec):
T Low (T PEEP) (sec):
PS above P High (cmH2O):
PS above PEEP (cmH2O):
NAVA Level (µV):
Refer to Cardiac Surgery, Transplant, and VAD Early
Extubation Algorithm, Post-Op/Phase II
chlorhexidine (PERIDEX) 0.12 % soln
MULTIDOSE [792004]
15 mL, Mouth/Throat, 2 X DAILY Starting today
Use to swab oral cavity. Discontinue when patient no
longer on ventilation.
Post-Op/Phase II
Respiratory - Post Extubation [89877]
Page 7 of 32
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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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12/2017CCKM@uwhealth.org

Oxygen Therapy [RT0032] CONTINUOUS, Starting today, Routine
FiO2 (%) Titrate to Keep Sats >/= to ___%:
Liter Flow:
Titrate oxygen to maintain O2 sat at (%): 90
O2 Delivery Device: Nasal Cannula
Attempt to Wean Off Oxygen? Yes
Post-extubation, Post-Op/Phase II
Cough And Deep Breathe [NURTRT0019] EVERY 1 HOUR, Starting today, Routine, Every 1
hour while awake and every 4 hours while asleep,
post-extubation, Post-Op/Phase II
Incentive Spirometry [NURTRT0018] EVERY 1 HOUR, Starting today, Routine, Every 1
hour while awake and every 4 hours while asleep,
post-extubation, Post-Op/Phase II
Wound/Procedure Site Care [89878]
Incision Care (Chest) [NURWND0015] CONTINUOUS, Starting today, Routine
Wound Type: Open
Wound Site: Chest
Wound Location:
Assess Frequency: EVERY 8 HOURS
Care Frequency:
Wash With:
Irrigate/Rinse With:
Apply (Must also enter separate medication order to
obtain drug):
Primary Dressing: Other (Comment) (Ioban)
Secondary Dressing:
Provider to perform dressing change if patient's chest
is still open., Post-Op/Phase II
Wound Care - Closed Incision (Adult)
[NURWND0055]
CONTINUOUS, Routine
Wound Site:
Wound Location:
Assess Frequency: EVERY 8 HOURS
Incision Closed With: Other (Comment) (Dermabond)
Maintain OR Dressing: Minimum of 48 hours
Remove OR Dressing after 48 hours: Yes
Removal of OR Dressing performed by: RN
Cleansing with Removal of OR Dressing: CHG
Primary Dressing (after 48 hours): Dry Gauze
Incision Care (after 48 hours): Cleanse daily with CHG
If dressing becomes saturated in 48 hours, sterile
dressing change? Yes - Notify provider
Post-Op/Phase II
Wound Care [NURWND0015] CONTINUOUS, Routine
Wound Type: Other (Comment)
Wound Site: Abdomen
Wound Location: Anterior
Assess Frequency: EVERY 4 HOURS
Care Frequency: 1X DAILY
Wash With:
Irrigate/Rinse With: Do Not Irrigate
Apply (Must also enter separate medication order to
obtain drug):
Primary Dressing:
Secondary Dressing:
Follow daily dressing process as outlined in the
Mechanical Circulatory Device Guideline., Post-
Op/Phase II
Page 8 of 32
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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

Chest Tube Care [89880]
Maintain Chest Tube -20 cm Wall Suction
[NURTAD0001]
CONTINUOUS, Starting today For Until specified,
Routine
Location:
Position: N/A - Single Location
Drainage Options: -20 cm wall suction
Site Assessment Frequency: EVERY 8 HOURS
Care Frequency: 1 X DAILY
Wash With:
Primary Dressing: Gauze
Secondary Dressing:
Assess site for erythema, edema, or drainage. No
Vaseline gauze while chest tube in place., Post-
Op/Phase II
Measure Chest Tube Output [NURTAD0013] SEE COMMENTS, Routine, 15 minutes times 4, then
every 30 minutes times 4, then every hour while on
ICU status. Every 4 hours while on intermediate care
(IMC) or general care status., Post-Op/Phase II
Wound Care - Closed Incision (Adult)
[NURWND0055]
CONTINUOUS, Routine
Wound Site:
Wound Location:
Assess Frequency: EVERY 8 HOURS
Incision Closed With: Sutures
Maintain OR Dressing: Minimum of 48 hours
Remove OR Dressing after 48 hours: Yes
Removal of OR Dressing performed by: RN
Cleansing with Removal of OR Dressing: CHG
Primary Dressing (after 48 hours): Dry Gauze
Incision Care (after 48 hours): Cleanse daily with CHG
If dressing becomes saturated in 48 hours, sterile
dressing change? Yes - Notify provider
Post-Op/Phase II
Ventricular Assist Device Care [89879]
Ventricular Assist Device Care [NURVENT0010] CONTINUOUS, Starting today, Routine, Post-
Op/Phase II
Ventricular Assist Device Emergency Care
[NURVENT0011]
CONTINUOUS, Starting today, Routine, Post-
Op/Phase II
CentriMag - Device Checks [97513]
Page 9 of 32
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 12:44:53 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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12/2017CCKM@uwhealth.org

RIGHT Ventricular Assist Device Checks -
CentriMag [NURVENT0015]
CONTINUOUS, Starting today For 1 Occurrences,
Routine
Set Speed (RPM):
Document Speed: Every hour for 24 hours, then every
2 hours while on ICU status, then every 4 hours while
in IMC/general care status
Document Flow (L/min): Every hour for 24 hours, then
every 2 hours while on ICU status, then every 4 hours
while in IMC/general care status
Assess and Document Presence of Chatter or Clots:
Every hour for 24 hours, then every 2 hours while on
ICU status, then every 4 hours while in IMC/general
care status
Set Low Flow Limit (L/min):
Document Low Flow Limit: Every 8 Hours
Set High Flow Limit (L/min):
Document High Flow Limit: Every 8 Hours
Move Flow Probe 1 Centimeter: Every 8 Hours
Document Presence of Emergency Equipment at
Bedside: Every 8 Hours
Check Tubing Connections are Secure: Every 8 Hours
Check Tubing for Kinks or Sharp Turns: Every 8 Hours
Tubing Secured to Patient in Large Loops: Every 8
Hours
Turn on Back-up Console and Verify Battery is
Charged: Every 8 Hours
Check Pump Locking Screw Engaged Correctly: Every
8 Hours
Notify Provider If:
Chatter of the VAD system; RVAD flows greater than
LVAD flows; Clot in chamber; VAD failure; RVAD
flows less than *** L/min., Post-Op/Phase II
Page 10 of 32
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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

LEFT Ventricular Assist Device Checks -
CentriMag [NURVENT0016]
CONTINUOUS, Starting today For 1 Occurrences,
Routine
Set Speed (RPM):
Document Speed: Every hour for 24 hours, then every
2 hours while on ICU status, then every 4 hours while
in IMC/general care status
Document Flow (L/min): Every hour for 24 hours, then
every 2 hours while on ICU status, then every 4 hours
while in IMC/general care status
Assess and Document Presence of Chatter or Clots:
Every hour for 24 hours, then every 2 hours while on
ICU status, then every 4 hours while in IMC/general
care status
Set Low Flow Limit (L/min):
Document Low Flow Limit: Every 8 Hours
Set High Flow Limit (L/min):
Document High Flow Limit: Every 8 Hours
Move Flow Probe 1 Centimeter: Every 8 Hours
Document Presence of Emergency Equipment at
Bedside: Every 8 Hours
Check Tubing Connections are Secure: Every 8 Hours
Check Tubing for Kinks or Sharp Turns: Every 8 Hours
Tubing Secured to Patient in Large Loops: Every 8
Hours
Turn on Back-up Console and Verify Battery is
Charged: Every 8 Hours
Check Pump Locking Screw Engaged Correctly: Every
8 Hours
Notify Provider If:
Chatter of the VAD system; RVAD flows greater than
LVAD flows; Clot in chamber; VAD failure; LVAD flows
less than *** L/min., Post-Op/Phase II
Heartware - Device Checks [154550]
Mean Arterial Pressure [NURVENT0017] ONCE, Starting today For 1 Occurrences, Keep MAP
65-85, Post-Op/Phase II
Hematocrit Setting [NURVENT0017] ONCE, Starting today For 1 Occurrences, Change
hematocrit setting in Heartware monitor with every
hematocrit value, Post-Op/Phase II
LEFT Ventricular Assist Device Checks -
Heartware [NURVENT0024]
CONTINUOUS, Starting today, Routine
Speed (rpm) Set speed to keep CI > 2.5:
Document Speed: Every hour for 24 hours, then every
2 hours while on ICU status, then every 4 hours while
in IMC/general care status
Document Flow (L\Min): Every hour for 24 hours, then
every 2 hours while on ICU status, then every 4 hours
while in IMC/general care status
Document Power (w): Every 2 hours while on ICU
status, then every 4 hours while in IMC/general care
status
Document High Power Alarm Setting: Every 4 hours
Low Flow Alarm Setting: Every 4 hours
Assess VAD Waveforms: Every hour for 24 hours,
then every 2 hours while on ICU status, then every 4
hours while in IMC/general care status
Post-Op/Phase II
Page 11 of 32
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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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12/2017CCKM@uwhealth.org

RIGHT Ventricular Assist Device Checks -
Heartware [NURVENT0025]
CONTINUOUS, Starting today, Routine
Speed (rpm) Set speed to keep CI > 2.5:
Document Speed:
Document Flow (L\Min):
Document Power (w):
Document High Power Alarm Setting:
Low Flow Alarm Setting:
Assess VAD Waveforms:
Post-Op/Phase II
HeartMate II - Device Checks [97511]
Ventricular Assist Device Checks - HeartMate II
[NURVENT0001]
CONTINUOUS, Starting today, Routine
Mode: Fixed
Record Mode: Every hour for 24 hours, then every 2
hours while in ICU status, then every 4 hours while in
IMC / General Care status.
Fixed Speed (RPM):
Record Speed (RPM): Every hour for 24 hours, then
every 2 hours while on ICU status, then every 4 hours
while in IMC/general care status
Record Flow (Liters/Minutes): Every hour for 24 hours,
then every 2 hours while on ICU status, then every 4
hours while in IMC/general care status
Record Power (Watts): Every hour for 24 hours, then
every 2 hours while on ICU status, then every 4 hours
while in IMC/general care status
Record Pulsatility Index (PI): Every hour for 24 hours,
then every 2 hours while on ICU status, then every 4
hours while in IMC/general care status
Notify Provider If:
VAD Failure; VAD flow less than 3.5 L/min or greater
than 8 L/min; Power greater than 8 watts; Red heart
alarm sounds; Pulsatility Index less than 3 and greater
than 8., Post-Op/Phase II
HeartMate 3 - Device Checks [197158]
Ventricular Assist Device Checks - HeartMate 3
[NURVENT0001]
CONTINUOUS, Starting today, Routine
Pulse Mode: Pulse Mode
Record Mode: Every hour for 24 hours, then every 2
hours while in ICU status, then every 4 hours while in
IMC / General Care status.
Fixed Speed (RPM):
Record Speed (RPM): Every hour for 24 hours, then
every 2 hours while on ICU status, then every 4 hours
while in IMC/general care status
Record Flow (Liters/Minutes): Every hour for 24 hours,
then every 2 hours while on ICU status, then every 4
hours while in IMC/general care status
Record Power (Watts): Every hour for 24 hours, then
every 2 hours while on ICU status, then every 4 hours
while in IMC/general care status
Record Pulsatility Index (PI): Every hour for 24 hours,
then every 2 hours while on ICU status, then every 4
hours while in IMC/general care status
Notify Provider If:
VAD Failure; VAD flow less than 3.5 L/min or greater
than 8 L/min; Power greater than 8 watts; Red heart
alarm sounds; Pulsatility Index less than 2 and greater
than 6., Post-Op/Phase II
Page 12 of 32
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12/2017CCKM@uwhealth.org

Hematocrit Setting [NURVENT0017] CONTINUOUS, Starting today, Change hematocrit
setting in HeartMate 3 monitor with every hematocrit
value., Post-Op/Phase II
Call VAD Coordinator with communication fault,
system controller hardware fault, LVAD fault,
driveline power fault, driveline communication
fault, red heart alarm, VAD failure.
[NURCOM0022]
CONTINUOUS, Starting today, Post-Op/Phase II
Thoratec - Device Checks [97515]
RIGHT Ventricular Assist Device Checks -
Thoratec [NURVENT0003]
CONTINUOUS, Starting today, Routine
Select Mode:
Document Mode: Every hour for 24 hours, then every
2 hours while on ICU status, then every 4 hours while
in IMC/general care status
Document Flow (L/min): Every hour for 24 hours, then
every 2 hours while on ICU status, then every 4 hours
while in IMC/general care status
Fixed Rate/Back-up Rate in Volume Mode (BPM):
Document Fixed Rate/Back-up Rate in Volume Mode:
Every hour for 24 hours, then every 2 hours while on
ICU status, then every 4 hours while in IMC/general
care status
Eject Time (msec):
Record Eject Time: Every hour for 24 hours, then
every 2 hours while on ICU status, then every 4 hours
while in IMC/general care status
Drive/Eject Pressure (mmHg):
Record Drive/Eject Pressure: Every hour for 24 hours,
then every 2 hours while on ICU status, then every 4
hours while in IMC/general care status
Vacuum (mmHg):
Record Stroke Volume: Every hour for 24 hours, then
every 2 hours while on ICU status, then every 4 hours
while in IMC/general care status
Percent Systole (%):
Record Percent Systole: Every hour for 24 hours, then
every 2 hours while on ICU status, then every 4 hours
while in IMC/general care status
Record Flash Test or Flashing Empty Light on Signal
Processor: Every hour for 24 hours, then every 2
hours while on ICU status, then every 4 hours while in
IMC/general care status
Record Fill Light Status: Every hour for 24 hours, then
every 2 hours while on ICU status, then every 4 hours
while in IMC/general care status
Notify Provider If:
VAD failure; RVAD flow less than *** L/min; LVAD flow
0.5 liters less than or equal to RVAD flow or LVAD
flow greater than RVAD flow; VAD unable to fill; VAD
unable to eject., Post-Op/Phase II
Page 13 of 32
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12/2017CCKM@uwhealth.org

LEFT Ventricular Assist Device Checks -
Thoratec [NURVENT0013]
CONTINUOUS, Starting today, Routine
Select Mode:
Document Mode: Every hour for 24 hours, then every
2 hours while on ICU status, then every 4 hours while
in IMC/general care status
Document Flow (L/min): Every hour for 24 hours, then
every 2 hours while on ICU status, then every 4 hours
while in IMC/general care status
Fixed Rate/Back-up Rate in Volume Mode (BPM):
Document Fixed Rate/Back-up Rate in Volume Mode:
Every hour for 24 hours, then every 2 hours while on
ICU status, then every 4 hours while in IMC/general
care status
Eject Time (msec):
Record Eject Time: Every hour for 24 hours, then
every 2 hours while on ICU status, then every 4 hours
while in IMC/general care status
Drive/Eject Pressure (mmHg):
Record Drive/Eject Pressure: Every hour for 24 hours,
then every 2 hours while on ICU status, then every 4
hours while in IMC/general care status
Vacuum (mmHg):
Record Stroke Volume: Every hour for 24 hours, then
every 2 hours while on ICU status, then every 4 hours
while in IMC/general care status
Percent Systole (%):
Record Percent Systole: Every hour for 24 hours, then
every 2 hours while on ICU status, then every 4 hours
while in IMC/general care status
Record Flash Test or Flashing Empty Light on Signal
Processor: Every hour for 24 hours, then every 2
hours while on ICU status, then every 4 hours while in
IMC/general care status
Record Fill Light Status: Every hour for 24 hours, then
every 2 hours while on ICU status, then every 4 hours
while in IMC/general care status
Notify Provider If:
VAD failure; LVAD flow less than *** or greater than
*** L/min; LVAD flow 0.5 liters less than or equal to
RVAD flow or LVAD flow greater than RVAD flow;
VAD unable to fill; VAD unable to eject., Post-
Op/Phase II
Intake and Output [87689]
Measure Intake And Output [NURMON0005] SEE COMMENTS, Starting today, Routine, Every 15
minutes times 4, then every 30 minutes times 4, then
every hour while on ICU status. Every 4 hours while
on intermediate care (IMC) or general care status.,
Post-Op/Phase II
Non-Categorized Patient Care Orders [89885]
Measure Weight [NURMON0015] 1X DAILY, Starting today, Routine
Weigh With?
Weigh when?
Weigh daily at 6 a.m., Post-Op/Phase II
OG Tube Placement - Adult [120995]
Page 14 of 32
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Insert and Maintain Orogastric Tube
[NURTAD0015]
CONTINUOUS, Routine
Options: Low, Continuous Suction
Flush with:
Flush Frequency: EVERY 8 HOURS
Check Residual:
Does this need to be inserted/placed?
Device Status: Ready For Use
No anti-reflux valve. Confirm placement prior to use.
Refer to Policy 2.20 Enteral Tubes Used for
Instillation of Fluids, Medications, or Feeding., Post-
Op/Phase II
X-RAY ABDOMEN AP VIEW (KUB) [R74000] CONDITIONAL For 3 Days, Routine
Radiology Specialty Area: GENERAL IMAGING
Current signs and symptoms? Orogastric tube
placement
What specific question(s) would you like answered
by this exam? Evaluate orogastric tube placement
Relevant recent/past history? Cardiac Surgery
Is patient pregnant?
If being performed remotely, where?
Last patient weight? (will auto pull in value and date
in comment):
Transport Method: Floor Determined/Entered
If Conditional, What Condition? Evaluate orogastric
tube placement. The location of orogastric tube
should be confirmed prior to the instillation of fluids,
medications, or feedings. Refer to Policy 2.20
Enteral Tubes Used for Instillation of Fluids,
Medications, or Feeding
Post-Op/Phase II
Insert and Maintain Urinary Catheter
[NURELM0013]
CONTINUOUS, Starting today, Routine, To
discontinue this order, enter a new order for
"Discontinue Urinary Catheter".
To modify this order, enter a new order for "Maintain
Urinary Catheter" and make the necessary changes in
the new order.
Type: Indwelling Single Lumen
Indication for Placement: Postoperative Requirements
of Specific Procedure
Initiate Urinary Catheter Removal Protocol? (NP/PA
Must Select "No"):
Details: To Dependent Drainage
Does this need to be inserted/placed?
Post-Op/Phase II
Apply Ice Pack to Affected Area [NURTRT0008] SEE COMMENTS, Starting today, Routine
Site: Other (Comment)
Cooling blanket or ice bags for temperature greater
than 38.8 Celsius., Post-Op/Phase II
Use Warm Air Blanket [NURTRT0027] SEE COMMENTS, Starting today, Routine, As needed
for temperature less than 36.0 degrees Celsius
immediately postoperatively., Post-Op/Phase II
Initiate B4/5 Insulin Infusion Protocol
[NURMON0062]
CONTINUOUS, Starting today, Routine, Post-
Op/Phase II
Maintain active Type and Screen while on ICU
status. Contact provider for order.
[NURCOM0022]
ONCE, Post-Op/Phase II
Contingency Parameters [89886]
Page 15 of 32
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Notify Provider [NURCOM0001] Provider to Notify: Provider
If systolic blood pressure > (mmHg):
If systolic blood pressure < (mmHg):
If diastolic blood pressure > (mmHg):
If diastolic blood pressure < (mmHg):
If temperature > (C): 38.5
If temperature < (C):
If heart rate > (bpm):
If heart rate < (bpm):
If respiratory rate >:
If respiratory rate <:
If blood glucose > (mg/dL): 400
If blood glucose < (mg/dL): 40
If pain score >:
Pulse Oximetry < (%): 90
If urine output < (mL): 30 milliliters/hour time 2 hours
Other: Mean arterial pressure less than 60 or greater
than 85 mmHg,Cardiac index less than 2
Liters/minute/square meter,Change in cardiac
rhythm,Rigors lasting longer than 5 minutes,Chest
tube output greater than 150 milliliter/hour,Oxygen
requirements above 6 Liters/minute,Hematocrit less
than 25%,Potassium less than 3.5 mmol/L,Magnesium
less than 1.5 mg/dL,Creatinine greater than 2.5 mg/dL
or increased more than 2 times preoperative
baseline,Wound with purulent drainage, excessive
serous drainage, and/or separate edges,More than 1
temperature spike,Ventricular ectopy,Systemic
vascular resistance less than 700 or greater than
1400,PaO2 less than 60,PaCO2 greater than 50,pH
less than 7.3 or greater than 7.5
Post-Op/Phase II
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 immediate.
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
Post-Op/Phase II
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 16 of 32
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12/2017CCKM@uwhealth.org

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.
Post-Op/Phase II
IV Fluids [89888]
dextrose 5%-NaCl 0.2% infusion [51615] at 5 mL/hr, Intravenous, CONTINUOUS
Per CVP port
Post-Op/Phase II
Cap unused peripheral intravenous
catheters/triple lumen catheters/PICCs and
pulmonary artery catheters (Swan-Ganz)
[NURVAD0053]
CONTINUOUS, Starting today, Post-Op/Phase II
Medications
Anti-infectives (Single Response) [144476]
Patients who are 40-120 kg [231525]
cefuroxime (ZINACEF) intraVENOUS [800030] 1.5 g, Intravenous, EVERY 12 HOURS For 3 Doses,
Post-Op/Phase II
vancomycin (VANCOCIN) intraVENOUS
[800084]
15 mg/kg, Intravenous, EVERY 12 HOURS For 3
Doses, Post-Op/Phase II
Patients who are 120 kg or greater [231528]
cefuroxime (ZINACEF) intraVENOUS [800030] 3 g, Intravenous, EVERY 12 HOURS For 3 Doses,
Post-Op/Phase II
vancomycin (VANCOCIN) intraVENOUS
[800084]
15 mg/kg, Intravenous, EVERY 12 HOURS For 3
Doses, Post-Op/Phase II
Analgesics [87696]
HYDROmorphone PF (DILAUDID) injection
RANGE [750050]
0.2-0.8 mg, Intravenous, EVERY 1 HOUR PRN For 24
Hours, pain
See Pain Management Algorithm for the Selection of
As-Needed Analgesics
for 3 Minutes, Post-Op/Phase II
acetaMINOPHEN (TYLENOL) tab [34150] 1,000 mg, Oral, 4 X DAILY For 5 Days, Post-
Op/Phase II
acetaMINOPHEN (TYLENOL) suppository
[34153]
650 mg, Rectal, EVERY 4 HOURS PRN, pain
See Pain Management Algorithm for the Selection of
As-Needed Analgesics
No more than 4 grams acetaminophen per 24 hours
for adults or 15mg/kg per dose for peds <40kg.
If unable to tolerate oral medications
Post-Op/Phase II
oxycodone tab RANGE [750032] 5-15 mg, Oral, EVERY 3 HOURS PRN For 5 Days,
pain
See Pain Management Algorithm for the Selection of
As-Needed Analgesics
Post-Op/Phase II
Analgesics [181405]
HYDROmorphone PF (DILAUDID) injection
RANGE [750050]
0.2-0.5 mg, Intravenous, EVERY 1 HOUR PRN For 24
Hours, pain
See Pain Management Algorithm for the Selection of
As-Needed Analgesics
for 3 Minutes, Post-Op/Phase II
acetaMINOPHEN (TYLENOL) tab [34150] 1,000 mg, Oral, 4 X DAILY For 5 Days, Post-
Op/Phase II
Page 17 of 32
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12/2017CCKM@uwhealth.org

oxycodone tab RANGE [750032] 5-10 mg, Oral, EVERY 3 HOURS PRN For 5 Days,
pain
See Pain Management Algorithm for the Selection of
As-Needed Analgesics
Post-Op/Phase II
Anti-emetics [89893]
ondansetron (ZOFRAN) injection [800202] 4 mg, Intravenous, EVERY 24 HOURS PRN,
nausea/vomiting
Use if unable to take orally
Post-Op/Phase II
ondansetron (ZOFRAN ODT) disintegrating tab
[64224]
4 mg, Oral, EVERY 24 HOURS PRN,
nausea/vomiting, Post-Op/Phase II
Anti-platelets [194592]
aspirin EC delayed release tab [34794] 81 mg, Oral, 1 X DAILY, Post-Op/Phase II
aspirin EC delayed release tab [49098] 325 mg, Oral, 1 X DAILY, Post-Op/Phase II
Anti-arrhythmics [89894]
amiodarone (CORDARONE) BOLUS - NOTE: Do
NOT order if patient received in OR [800123]
150 mg, Intravenous, ONCE For 1 Doses, Post-
Op/Phase II
amiodarone (CORDARONE) non- PVC infusion
[700135]
1 mg/min, Intravenous, CONTINUOUS For 6 Hours,
Post-Op/Phase II
amiodarone (CORDARONE) non- PVC infusion
[700135]
0.5 mg/min, Intravenous, CONTINUOUS For 18
Hours, Post-Op/Phase II
amiodarone (CORDARONE) tab [44131] 400 mg, Oral, 2 X DAILY Starting tomorrow For 7
Days, Post-Op/Phase II
amiodarone (CORDARONE) tab [44131] 400 mg, Oral, 1 X DAILY Starting 12/15/17 For 7
Days, Post-Op/Phase II
amiodarone (CORDARONE) tab [44131] 200 mg, Oral, 1 X DAILY Starting 12/22/17 For 90
Days, Post-Op/Phase II
Bowel Management [144116]
senna-docusate (SENOKOT-S) 8.6-50 mg per tab
[60530]
2 tab, Oral, 2 X DAILY Starting tomorrow
Hold for loose stool or suspected obstruction. Use
rescue therapy after first 48hrs if inadequate response
to scheduled bowel management.
Post-Op/Phase II
bisacodyl (DULCOLAX) rectal suppository
[35231]
10 mg, Rectal, 1 X DAILY PRN Starting tomorrow,
constipation, First Line Therapy, Post-Op/Phase II
bisacodyl (DULCOLAX) rectal suppository -
NOTE: Give on POD#2 [35231]
10 mg, Rectal, ONCE Starting 12/9/17 For 1 Doses
Hold for loose stools
NOTE: Give on POD#2
Post-Op/Phase II
phosphate (FLEET) enema [37517] 1 enema, Rectal, 1 X DAILY PRN, constipation
Use as second line therapy if no response to first line
therapy within 24 hours and notify Primary Team.
Post-Op/Phase II
Gastric (Single Response) [89896]
pantoprazole (PROTONIX) susp [780113] 40 mg, Oral Gastric Tube, 1 X DAILY, Post-Op/Phase
II
Potassium Supplementation (Single Response) [87702]
Page 18 of 32
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potassium chloride 20 mEq/ 50 mL bag
CENTRAL LINE ONLY [46256]
20 mEq, Intravenous, PRN, Potassium
Supplementation
For potassium level between 3.8 - 4.0 mmol/L give 20
mEq x1
For potassium level between 3.5 - 3.7 mmol/L give 20
mEq x2
For potassium level between 3.2 - 3.4 mmol/L give 20
mEq x3
for 60 Minutes, Post-Op/Phase II
potassium chloride 10 mEq/100 mL bag - NOTE:
Order for patients with renal impairment (CrCl
less than 30 mL/min) [46253]
10 mEq, Intravenous, PRN - NOTIFY PHARMACY
WHEN NEEDED, potassium supplementation - See
Administration Instructions
For potassium level between 3.5 - 3.7 mmol/L give 10
mEq x1
For potassium level between 3.2 - 3.4 mmol/L give 10
mEq x2
Order for patients with renal impairment (CrCl less
than 30 mL/min)
for 60 Minutes, Post-Op/Phase II
Magnesium Supplementation (Single Response) [87703]
Magnesium Supplemental Scale [950039] PRN - NOTIFY PHARMACY WHEN NEEDED, PRN
comment: magnesium supplementation - See
Administration Instructions
Non-cardiac patients: For serum magnesium 1.6-1.8
mg/dL - do not replace
Cardiac patients: For serum magnesium 1.6-1.8
mg/dL give 0.05 g/kg IV x1
For serum magnesium 1.0-1.5 mg/dL give 0.1 g/kg IV
x1
For serum magnesium less than 1 mg/dL give 0.15
g/kg IV x1
Administer each 2 gram bag over 3 hours at a
frequency of one bag every 4 hours.
Maximum 6 grams per replacement dose
Reminder: Pharmacist to adjust per UWHC Renal
Dosing Protocol if applicable
Post-Op/Phase II
Page 19 of 32
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Magnesium Supplemental Scale - NOTE: Order in
patients with RENAL impairment (CrCl <30
mL/min) [950039]
PRN - NOTIFY PHARMACY WHEN NEEDED, PRN
comment: magnesium supplementation - See
Administration Instructions
Non-cardiac patients: For serum magnesium 1.6-1.8
mg/dL - do not replace
Cardiac patients: For serum magnesium 1.6-1.8
mg/dL give 0.025 g/kg IV x1
For serum magnesium 1.0-1.5 mg/dL give 0.05 g/kg IV
x1
For serum magnesium less than 1 mg/dL give 0.075
g/kg IV x1
Administer each 2 gram bag over 3 hours at a
frequency of one bag every 4 hours.
Maximum 6 grams per replacement dose
Reminder: Pharmacist to adjust per UWHC Renal
Dosing Protocol if applicable
NOTE: Order in patients with RENAL impairment
(CrCl < 30 mL/min)
Post-Op/Phase II
Phosphate SODIUM (Single Response) [193032]
phosphate-potassium & sodium (PHOS-NAK) oral
packet - For normal renal function [112317]
2 packet, Oral, PRN, phosphate supplementation -
See Admin Instructions
For serum phosphate 1.6 - 2.4 mg/dL, give 2 packets
every 4 hours while awake x 3 doses;
For serum phosphate 1.0 - 1.5 mg/dL, give 2 packets
every 4 hours while awake x 4 doses
For serum phosphate less than 1.0 mg/dL, call
provider for IV dosing.
Post-Op/Phase II
phosphorus (K-PHOS NEUTRAL) tab - For renal
dysfunction [45503]
1 tab, Oral, PRN, phosphate supplementation - See
Admin Instructions
For serum phosphate 1.6 - 2.4 mg/dL give 1 tablet
every 4 h while awake x 3 doses
For serum phosphate 1.0 - 1.5 mg/dL give 1 tablet
every 4 h while awake x 4 doses
For serum phosphate less than 1.0 mg/dL, call
provider
Post-Op/Phase II
Vasoactive Agents [125822]
DOPamine (INTROPIN) 800 mg in dextrose 5%
250 mL infusion [50506]
2 mcg/kg/min, Intravenous, CONTINUOUS, Post-
Op/Phase II
DOBUTamine (DOBUTREX) 1000mg in dextrose
5% 250 mL infusion [51747]
Intravenous, CONTINUOUS, Post-Op/Phase II
milrinone 20mg in dextrose 5% 100 mL
(PRIMACOR) infusion [175995]
Intravenous, CONTINUOUS, Post-Op/Phase II
epINEPHrine infusion [700197] Intravenous, CONTINUOUS, Post-Op/Phase II
norepinephrine (LEVOPHED) infusion [700247] Intravenous, CONTINUOUS, Post-Op/Phase II
vasopressin (PITRESSIN) 20 units in dextrose 5
% 100 mL infusion (SEPTIC SHOCK) [700977]
0.04-0.06 Units/min, Intravenous, CONTINUOUS,
Post-Op/Phase II
nitroglycerin 50 mg in dextrose 5% 250 mL
infusion [51611]
0.2-3 mcg/kg/min, Intravenous, CONTINUOUS, Post-
Op/Phase II
Non-categorized [89902]
Page 20 of 32
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hydrALAZINE (APRESOLINE) injection RANGE
[750049]
10-20 mg, Intravenous, EVERY 2 HOURS PRN,
hypertension, Administer for MAP measured by
Doppler of greater than 85. If you give 3 doses in any
8 hour period, notify provider.
.
Post-Op/Phase II
lidocaine (XYLOCAINE-CARDIAC) 20 mg/mL
injection [39041]
75 mg, Intravenous, PRN, symptomatic ventricular
arrhythmias, symptomatic hypotension, decreased
level of consciousness, chest pain, shortness of
breath or ventricular tachycardia lasting greater than
30 seconds , Post-Op/Phase II
meperidine (DEMEROL) injection [800195] 25 mg, Intravenous, ONCE PRN For 1 Doses, rigors,
Post-Op/Phase II
propofol (DIPRIVAN) 10 mg/mL infusion [800260] 5-50 mcg/kg/min, Intravenous, CONTINUOUS
Initiate at 10 mcg/kg/min or current rate. Titrate in 5-10
mcg/kg/min increments every 5 minutes to achieve
Richmond Agitation-Sedation Score (RASS) of 0.
Post-Op/Phase II
albumin human 5% infusion [44038] Intravenous, PRN For 48 Hours, For systolic blood
pressure less than 80 mmHg, Post-Op/Phase II
sodium chloride 0.9% flush 10 mL injection
[785055]
Flush, PRN, flush/line care
Flush per VAD guidelines
Post-Op/Phase II
sodium chloride 0.9% infusion [64367] at 4 mL/hr, Intravenous, CONTINUOUS
Per intraflow for arterial line, Swan-Ganz distal port,
and Central Venous Pressure port
Post-Op/Phase II
Glucose Management
Glucose Management [119808]
Subcutaneous Correction Insulin [193143]
Glucose, POC [IPGLUCOSE] EVERY 6 HRS IF NPO/ CONT. TUBE FEEDING/
OR TPN, Starting tomorrow For Until specified,
Routine, Glucose, POC should always be ordered in
conjunction with orders for hypoglycemia
management and monitoring as indicated in the
Hypoglycemia Management (Adult) panel.
If Conditional, What Condition?
Post-Op/Phase II
Glucose, POC [IPGLUCOSE] EVERY 2 HOURS, Starting today For 24 Hours,
Routine, Glucose, POC should always be ordered in
conjunction with orders for hypoglycemia
management and monitoring as indicated in the
Hypoglycemia Management (Adult) panel.
If Conditional, What Condition? Draw until patient
begins on clear liquids
Draw until patient begins on clear liquids, Post-
Op/Phase II
Glucose, POC [IPGLUCOSE] BEFORE MEALS AND BEDTIME, Starting
tomorrow, Routine, Glucose, POC should always be
ordered in conjunction with orders for hypoglycemia
management and monitoring as indicated in the
Hypoglycemia Management (Adult) panel.
If Conditional, What Condition? If patient eating or
drinking
If patient eating or drinking, Post-Op/Phase II
Page 21 of 32
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Glucose, POC [IPGLUCOSE] AS NEEDED FOR SIGNS AND SYMPTOMS OF
HYPOGLYCEMIA, Routine, Glucose, POC should
always be ordered in conjunction with orders for
hypoglycemia management and monitoring as
indicated in the Hypoglycemia Management (Adult)
panel.
If Conditional, What Condition?
Post-Op/Phase II
Glucose, POC [IPGLUCOSE] AFTER PROVIDING HYPOGLYCEMIA
TREATMENT, Routine, Glucose, POC should
always be ordered in conjunction with orders for
hypoglycemia management and monitoring as
indicated in the Hypoglycemia Management (Adult)
panel.
If Conditional, What Condition?
Per hypoglycemia treatment algorithm: Recheck
glucose 15 minutes after providing treatment until
glucose is greater than or equal to 70 mg/dL. If
patient has been critically low (i.e., glucose less than
40 mg/dL), recheck glucose after 1 hour to ensure
glucose remains greater than or equal to 70mg/dL.
After resolution of mild hypoglycemia (i.e., glucose
40-69 mg/dL), consider rechecking after 1 hour if
patient has signs/symptoms of hypoglycemia or is at
risk for a subsequent hypoglycemic event (e.g.,
previously administered insulin still active, altered
renal status, altered mental status, NPO or
interrupted nutrition, or any other condition that
increases hypoglycemia risk)., Post-Op/Phase II
insulin lispro (human) 100 UNIT/ML injection -
NOTE: CORRECTION insulin POD#0-1 [53264]
2-10 units, Subcutaneous, EVERY 4 HOURS PRN
For 1 Days, POD#0-1 Hyperglycemia - See
Administration Instructions
For blood glucose 151-200 mg/dL give 2 units; For
blood glucose 201-250 mg/dL give 4 units; For blood
glucose 251-300 mg/dL give 6 units; For blood
glucose 301-350 mg/dL give 8 units; For blood
glucose 351-400 mg/dL give 10 units; Give even if
NPO or meals skipped. Do NOT give more often
than 4 hours when NPO
Post-Op/Phase II
insulin lispro (human) 100 UNIT/ML injection -
CORRECTION Insulin POD#2 [53264]
2-10 units, Subcutaneous, 3 X DAILY PRN Starting
tomorrow, Starting POD#2 Hyperglycemia - See
Administration Instructions
Daytime hyperglycemia dosing
For blood glucose 151-200 mg/dL give 2 units;
For blood glucose 201-250 mg/dL give 4 units;
For blood glucose 251-300 mg/dL give 6 units;
For blood glucose 301-350 mg/dL give 8 units;
For blood glucose 351-400 mg/dL give 10 units;
Give even if NPO or meals skipped. Do NOT give
more often than 4 hours when NPO.
Post-Op/Phase II
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12/2017CCKM@uwhealth.org

insulin lispro (human) 100 UNIT/ML injection -
BEDTIME 1-4 UNITS [53264]
1-4 units, Subcutaneous, 1 X DAILY (HS) PRN
Starting tomorrow, Starting POD#2 Hyperglycemia -
See Administration Instructions
For blood glucose 201-250 mg/dL give 1 units;
For blood glucose 251-300 mg/dL give 2 units;
For blood glucose 301-350 mg/dL give 3 units;
For blood glucose 351-400 mg/dL give 4 units;
Give even if NPO
Post-Op/Phase II
Hypoglycemia Treatment for blood glucose less
than 40 mg/dL and patient able to eat/swallow
safely [NURCOM0022]
CONDITIONAL
If Conditional, What Condition? If blood glucose less
than 40mg/dL and patient able to eat/swallow safely.
Give 30 grams of carbohydrate (8 oz. of fruit juice).
Repeat treatment until glucose is 70 mg/dL or
greater., Post-Op/Phase II
Hypoglycemia Treatment for blood glucose
between 40 to 69 mg/dL and patient able to
eat/swallow safely [NURCOM0022]
CONDITIONAL
If Conditional, What Condition? If glucose is 40-69
mg/dL and patient able to eat/swallow safely
Give 15 grams of carbohydrate (4 oz of fruit juice).
Repeat treatment until glucose is 70 mg/dL or
greater., Post-Op/Phase II
glucose-vitamin C chew tab [50690] 16 g, Oral, EVERY 15 MINUTES PRN,
hypoglycemia, For blood glucose 40-69 mg/dL
Use in patients able to safely eat/swallow but unable
to tolerate volume of fruit juice or per patient
preference. Repeat every 15 minutes until blood
glucose is 70 mg/dL or greater
Post-Op/Phase II
glucose-vitamin C chew tab [50690] 32 g, Oral, EVERY 15 MINUTES PRN,
hypoglycemia, For blood glucose less than 40 mg/dL
Use in patients able to safely eat/swallow but unable
to tolerate volume of fruit juice or per patient
preference. Repeat every 15 minutes until blood
glucose is 70 mg/dL or greater
Post-Op/Phase II
dextrose injection [800233] 12.5 g, Intravenous, PRN, For blood glucose 40-69
mg/dL and patient unable to eat/swallow safely AND
has IV access
Repeat every 15 minutes until blood glucose is 70
mg/dL or greater. See Adult Hypoglycemia Algorithm
Post-Op/Phase II
dextrose injection [800233] 25 g, Intravenous, PRN, For blood glucose less than
40 mg/dL and patient unable to eat/swallow safely
AND has IV access
Repeat every 15 minutes until blood glucose is 70
mg/dL or greater. See Adult Hypoglycemia Algorithm
Post-Op/Phase II
Laboratory
Upon Arrival to ICU [89905]
PTT [PTT] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Upon arrival to ICU, Post-Op/Phase II
Page 23 of 32
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ELECTROLYTES [LYTE] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Upon arrival to ICU, Post-Op/Phase II
BUN [BUN] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Upon arrival to ICU, Post-Op/Phase II
CREATININE [CRET] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Upon arrival to ICU, Post-Op/Phase II
GLUCOSE [GLU] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Upon arrival to ICU, Post-Op/Phase II
CALCIUM [CA] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Upon arrival to ICU, Post-Op/Phase II
CBC WITHOUT DIFFERENTIAL [HEMO] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Upon arrival to ICU, Post-Op/Phase II
MAGNESIUM [MAG] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Upon arrival to ICU, Post-Op/Phase II
PHOSPHATE [PHOS] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Upon arrival to ICU, Post-Op/Phase II
PROTHROMBIN TIME/INR [PT] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Upon arrival to ICU, Post-Op/Phase II
BLOOD GASES AND O2 SATURATION
[HCBGASOS]
STAT For 1 Occurrences, Routine
If source is OTHER, indicate here:
Indicate FIO2: Per RN
Upon arrival to ICU, Post-Op/Phase II
Postoperative Day 1 [89907]
ELECTROLYTES [LYTE] 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?
Post-Op/Phase II
Page 24 of 32
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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?
Post-Op/Phase II
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?
Post-Op/Phase II
GLUCOSE [GLU] 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?
Post-Op/Phase II
CALCIUM [CA] 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?
Post-Op/Phase II
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?
Post-Op/Phase II
PHOSPHATE [PHOS] 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?
Post-Op/Phase II
ALKALINE PHOSPHATASE [ALKP] 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?
Post-Op/Phase II
BILIRUBIN, TOTAL [TBIL] 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?
Post-Op/Phase II
AST/SGOT [AST] 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?
Post-Op/Phase II
Page 25 of 32
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ALT/SGPT [ALT] 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?
Post-Op/Phase II
LD, TOTAL [LDH] 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?
Post-Op/Phase II
CBC WITHOUT DIFFERENTIAL [HEMO] 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?
Post-Op/Phase II
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?
Post-Op/Phase II
PTT [PTT] 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?
Post-Op/Phase II
PREALBUMIN [XPRALB] 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?
Post-Op/Phase II
C REACTIVE PROTEIN [CRPN] 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?
Post-Op/Phase II
Conditional Labs [97519]
MAGNESIUM [MAG] CONDITIONAL, Starting today For 4 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? 1 hour after IV
supplementation,4 hours after oral
supplementation,Daily while patient on diuretics,If
patient experiences arrhythmias
Post-Op/Phase II
Page 26 of 32
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POTASSIUM [K] CONDITIONAL, Starting today For 4 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw postoperative
hour 6, 12 and 18,1 hour after IV supplementation,4
hours after oral supplementation,Daily while patient on
diuretics,If patient experiences arrhythmias
Post-Op/Phase II
PROTHROMBIN TIME/INR [PT] CONDITIONAL For 4 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? 1 hour after plasma
infusion,Daily while patient on warfarin,If chest tube
output is greater than 150 mL/hour
Post-Op/Phase II
HEMATOCRIT [HCT] CONDITIONAL For 4 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw postoperative
hour 6, 12 and 18,1 hour after red blood cell
transfusion,If chest tube output is greater than 150
mL/hour
Post-Op/Phase II
PTT [PTT] CONDITIONAL For 4 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? If chest tube output is
greater than 150 mL/hour,1 hour after plasma infusion
Post-Op/Phase II
PLATELET COUNT [PLT] CONDITIONAL For 4 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? If chest tube output is
greater than 150 mL/hour
Post-Op/Phase II
PHOSPHATE [PHOS] CONDITIONAL, Starting today For 4 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? If patient experiences
arrhythmias
Post-Op/Phase II
BLOOD GASES AND O2 SATURATION
[HCBGASOS]
CONDITIONAL, Starting today For 4 Days, STAT
If source is OTHER, indicate here:
Indicate FIO2: Per RN
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw postoperative
hour 6, 12 and 18,After vent changes or for changes in
respiratory status
Post-Op/Phase II
BLOOD GASES AND O2 SATURATION
[HCBGASOS]
CONDITIONAL, Starting today For 7 Days, STAT
Indicate FIO2:
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? For Cardiac Index less
than 2.0
Post-Op/Phase II
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12/2017CCKM@uwhealth.org

GLUCOSE [GLU] CONDITIONAL, Starting today For 4 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw if blood glucose
<40 or >400 mg/dL
Draw if blood glucose <40 or >400 mg/dL, Post-
Op/Phase II
CALCIUM [CA] CONDITIONAL, Starting today For 4 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? If patient experiences
arrhythmias
Post-Op/Phase II
LACTATE [GM2255] CONDITIONAL, Starting today For 48 Hours, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? For pH less than 7.3
Post-Op/Phase II
Diagnostic Tests and Imaging
Diagnostic Tests and Imaging [89921]
X-RAY CHEST AP VIEW - Upon Arrival to ICU
[R71010]
ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, Routine
Current signs and symptoms? Status post ventricular
assist device
What specific question(s) would you like answered by
this exam? Evaluate ET tube and line placement
Relevant recent/past history? Postoperative
Ventricular Assist Device placement
Is patient pregnant?
If being performed remotely, where?
Transport Method: Floor Determined/Entered
Upon arrival to ICU, Post-Op/Phase II
X-RAY CHEST AP VIEW - Postoperative Day 1
[R71010]
ONCE-ON SPECIFIC DATE, Starting tomorrow For 1
Occurrences, Routine
Current signs and symptoms? Status post ventricular
assist device
What specific question(s) would you like answered by
this exam? Evaluate for pulmonary infiltrate
Relevant recent/past history? Postoperative
Ventricular Assist Device placement
Is patient pregnant?
If being performed remotely, where?
Transport Method: Floor Determined/Entered
Post-Op/Phase II
Page 28 of 32
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X-RAY CHEST AP VIEW - Postoperative Day 2
[R71010]
ONCE-ON SPECIFIC DATE, Starting 12/9/17 For 1
Occurrences, Routine
Current signs and symptoms? Status post ventricular
assist device
What specific question(s) would you like answered by
this exam? Evaluate for pulmonary infiltrate
Relevant recent/past history? Postoperative
Ventricular Assist Device placement
Is patient pregnant?
If being performed remotely, where?
Transport Method: Floor Determined/Entered
Post-Op/Phase II
X-RAY CHEST AP VIEW - Postoperative Day 3
[R71010]
ONCE-ON SPECIFIC DATE, Starting 12/10/17 For 1
Occurrences, Routine
Current signs and symptoms? Status post ventricular
assist device
What specific question(s) would you like answered by
this exam? Evaluate for pulmonary infiltrate
Relevant recent/past history? Postoperative
Ventricular Assist Device placement
Is patient pregnant?
If being performed remotely, where?
Transport Method: Floor Determined/Entered
Post-Op/Phase II
Ventricular Assist Device Coordinator to Perform
6-Minute Walk Test on Postoperative Day 6
[NURVENT0017]
ONCE, Starting 12/13/17 For 1 Occurrences, Evaluate
functional status, Post-Op/Phase II
ECG - 12 Lead [EKG0008] ONCE, Routine
Reason for exam: Other (enter comments)
Comment: s/p ventricular assist device implementation
Disclaimer for University Hospital Only: A Stat status
for an ECG is in reference to the timing of the ECG.
The goal is to perform a STAT ECG within 10 minutes
of the order being placed. It is the responsibility of the
ordering provider to review the STAT ECGs. All ECGs
(stat or routine) will be formally reviewed within one
business day.
Hold if patient is paced, Post-Op/Phase II
Transthoracic Resting Echocardiogram
[ECH0003]
ONCE, Starting 12/12/17 For 1 Occurrences, Routine
Reason for exam: VAD IMPLANT, LEFT
Do you want Agitated Bubble Study? No
Is patient mechanically ventilated?
Is patient ICU status?
Does patient need continuous monitoring?
Page VAD provider at #4504 prior to initiating
echocardiogram., Post-Op/Phase II
Consults
Consults [89923]
Consult Cardiac Rehab/Preventive Cardiology
(Inpatient) [CON0010]
ONCE, Starting today For 1 Occurrences, Routine
Reason for consult: Other (Comment) (Exercise
evaluation and instruction)
Post-Op/Phase II
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Consult Nutrition (Inpatient) [CON0043] ONCE, Starting today For 1 Occurrences, Routine
Reason for Consult: Nutrition Assessment w/
Recommendations
Delegate to Initiate and Manage Tube Feeding:
Delegate to Manage Diet Order/Supplement Order:
Delegate to Dysphagia Diet Order Progression:
Can this consult be done via video?
Post-Op/Phase II
Consult Cardiothoracic ICU (Inpatient) [CON0210] ONCE
Intent: Consult and Recommend (Write Orders)
Concern or Specific Question or Task to be Addressed
(Symptom, Sign, or Diagnosis): Postoperative ICU
management
Can this consult be done via video?
Post-Op/Phase II
Diabetes Consult Order Panel (Adult) [188497]
Diabetes Management Service : Will provide management or treatment recommendations for
patients with hyperglycemia and/or those who report outpatient use of insulin or other diabetes
medications. Patients should be expected to remain inpatient > 24 hrs from time of consult.
Consult is required for patients with insulin pumps or who use U-500 insulin. Consult Endocrine
for any non-diabetes-related endocrine questions.
Learning Center - Diabetes Education (Adult): Diabetes Education (Adult): Diabetes education
(meter/insulin skills/other diabetes survival skills) for patients/families with knowledge deficits
and/or need for diabetes knowledge assessment. Recommended for all new diagnoses or
patients with A1C > 9.
Diabetes Education – Nutrition : Diabetes nutrition therapy including nutrition assessment,
carbohydrate education (consistent carbohydrate meals, use of insulin-to-carbohydrate ratio),
and/or individualized, nutritious meal planning for carbohydrates, portions, or considering other
comorbidities. Recommended for all new diagnoses or patients with A1C > 9
Consult Diabetes Management Service (DMS)
(Inpatient) [CON0022]
ONCE
Can this consult be done via video?
Call back number:
Intent: Consult and Recommend (Write Orders)
Concern or Specific Question or Task to be
Addressed (Symptom, Sign, or Diagnosis):
Post-Op/Phase II
Page 30 of 32
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Consult Learning Center - Diabetes Education
(Adult) [CON0021]
ONCE, Routine, - If patient is newly diagnosed or is
new to insulin, provide 24 hours notice to allow
adequate time for education,
- Indicate diabetes medication/treatment plan if
known.
- Consults requested after 1600 on Fridays may not
be seen until following Monday. Learning Center
available Mon-Sat 0800-1630 (only 1 RN available
on Saturday for CSC and AFCH).
- Staff may be contacted by Pager 7927 on
weekdays and Pager 3276 on weekends.
- Learning Center staff are not available on holidays.
Type of Education: Diabetes Self-Management
Education
Reason For Consult:
Expected Discharge Date:
Diabetes management / treatment plan:
Can this consult be done via video?
Post-Op/Phase II
Consult Diabetes Education - Nutrition (Inpatient)
[CON0126]
ONCE, Routine, · If your patient is newly diagnosed
and/or is new to insulin therapy, provide 24 hours
notice to allow adequate time for nutrition education.
· Indicate diabetes medication/treatment plan if
known.
· Consults requested after 1300 on Friday may not
be completed until the following Monday.
· If you are placing a consult on a weekend day for a
patient who will be discharging that weekend, please
have the Paging Center contact the on-call dietitian
to help you facilitate the diabetes nutrition education
session prior to the patient's discharge.
Type of Education: Diabetes Self-Management
Education
Reason For Consult:
Expected Discharge Date:
Diabetes management / treatment plan:
Can this consult be done via video?
Post-Op/Phase II
Consult Congestive Heart Failure Service
(Inpatient) [CON0017]
ONCE
Intent: Consult and Recommend (Write Orders)
Concern or Specific Question or Task to be Addressed
(Symptom, Sign, or Diagnosis): Status post ventricular
assist device
Can this consult be done via video?
Post-Op/Phase II
Consult Occupational Therapy (Inpatient) Eval
and Treat [CON0046]
ONCE, Starting today For 1 Occurrences, Routine
Reason for Occupational Therapy Consult: ADL
Training
Post-Op/Phase II
Consult Physical Therapy (Inpatient) Eval and
Treat [CON0061]
ONCE, Starting today For 1 Occurrences, Routine
Reason for Physical Therapy Consult: Mobility
Training
Post-Op/Phase II
BestPractice
No Hospital Problems have yet been identified [107363]
Page 31 of 32
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Specify Hospital Problem(s) [COR0018] You will be prompted to specify a hospital problem on
signing., Post-Op/Phase II
Page 32 of 32
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