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

IP – Heart Failure – Adult – Discharge [1411]

IP – Heart Failure – Adult – Discharge [1411] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Cardiology/CT Surgery


IP - Heart Failure - Adult - Discharge [1411]
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 1/15/15, No Print
acetaMINOPHEN (TYLENOL) suppository [34153] 1 suppository, 1, starting 1/15/15, No Print
Blood Glucose Management [111710]
glucagon 1 mg injection kit [107799] 1 each, 1, starting 1/15/15, No Print
Glucose 40 % oral gel [118089] 1 Tube, 1, starting 1/15/15, 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 1/15/15, No Print
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bisacodyl (DULCOLAX) rectal suppository [35231] 1 suppository, 1, starting 1/15/15, No Print
Senna-Docusate Sodium 8.6-50 MG per tab [70181] 1 tab, 1, starting 1/15/15, No Print
polyethylene glycol (MIRALAX) oral powder [61353] 1 Bottle, 1, starting 1/15/15, No Print
phosphate (FLEET) enema [37517] 1 enema, 1, starting 1/15/15, No Print
Non-categorized Medications [111711]
guaifenesin-dextroMETHORPHAN (ROBITUSSIN DM)
syrup [51568]
1 Bottle, 1, starting 1/15/15, No Print
carbamide peroxide (DEBROX) 6.5% otic soln [35545] 1 Bottle, 1, starting 1/15/15 until 1/20/15, No Print
alum-mag-simeth (MYLANTA ES) susp [44073] 1 Bottle, 1, starting 1/15/15, No Print
CHF Assessment
NYHA Class at Discharge [19498]
NYHA Class at Discharge: I - No Symptoms and No
Limitations in Ordinary Physical Activity [DC0011]
Routine
NYHA Class at Discharge: I (No symptoms and no limitation
in ordinary physical activity)
NYHA Class at Discharge: II - Mild Symptoms/Slight
Limitation with Normal Activity. Comfortable at Rest
[DC0011]
Routine
NYHA Class at Discharge: II (Mild symptoms/slight limitation
with normal activity. Comfortable at rest)
NYHA Class at Discharge: III - Symptoms with Minimal
Activity [DC0011]
Routine
NYHA Class at Discharge: III (Symptoms with minimal
activity)
NYHA Class at Discharge: IV - Experiences Symptoms
Even While at Rest [DC0011]
Routine
NYHA Class at Discharge: IV (Experiences symptoms even
while at rest)
Discharge Status [19499]
Discharge Status - Home [DC0017] ONCE, Starting today For 1 Occurrences, Routine
Discharge Disposition: Home - Self Care
Discharge Status - Skilled Nursing Facility [DC0017] ONCE, Starting today For 1 Occurrences, Routine
Discharge Disposition: Skilled Nursing Facility
Discharge Status - Transfer to Outside Hospital
[DC0017]
ONCE, Starting today For 1 Occurrences, Routine
Discharge Disposition: Long-Term Care Hospital
Discharge Status - Other (Specify) [DC0017] ONCE, Starting today For 1 Occurrences, Routine
Discharge Disposition:
Heart Failure Core Measures Data [19501]
Smoking Status - Never Smoked [DC0012] Routine
Smoking Status: Never
Smoking Status - Quit Over 12 Months Ago [DC0012] Routine
Smoking Status: Quit Over 12 Months Ago
Smoking Status - Quit Within 12 Months [DC0012] Routine
Smoking Status: Quit Within 12 Months
Smoking Status - Current Smoker [DC0012] Routine
Smoking Status: Current Smoker
Counseled by Whom:
Ejection Fraction Assessment (Cannot Defer to Another
Provider) [DC0013]
Routine
This Admission Assessment Ejection Fraction (%):
This Admission Test Date:
Previous Test Assessment Ejection Fraction (%):
Previous Test Date:
Scheduled Date:
Not Able to Assess:
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
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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)
Inpatient Care Orders
Follow-Up Appointments [19502]
Schedule Appointment - Heart Failure Follow-Up
Appointment [NURCOM0026]
Reason for Appointment:
When do you want appointment:
Which Clinic or Specialty:
Title:
Which Provider (Optional):
Schedule Appointment - Heart Failure Follow-Up
Appointment [NURCOM0026]
Reason for Appointment:
When do you want appointment:
Which Clinic or Specialty:
Title:
Which Provider (Optional):
Schedule Appointment - Other Follow-Up Appointment
[NURCOM0026]
Reason for Appointment:
When do you want appointment:
Which Clinic or Specialty:
Title:
Which Provider (Optional):
Follow-Up Labs
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
Current Attending Provider Non-UW Health Lab Outside Lab Order
Current Consulting Provider UW Health Lab Specific lab orders with authorizing provider changed to consultant
Current Consulting Provider Non-UW Health Lab Outside Lab Order with authorizing provider changed to consultant
Another Provider UW Health Lab Recommended Discharge Labs
Another Provider Non-UW Health Lab Recommended Discharge Labs
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.
OUTSIDE LAB ORDER:
This order 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. The patient will receive a paper order to
take with them to the lab.
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.
Recommended Discharge Labs [NURCOM0075] Details
Outside Discharge Lab Order [LABDCOUT] Status: Future, Expires: 5/17/15, Normal, Routine, Qty-1
Follow-Up Labs [19503]
These lab orders should only be used if the current Attending Provider or Consulting Provider will be responsible for the
result of the lab.
MAGNESIUM [MAG] Status: Standing, Expires:5/17/15 MANUAL,Count:1, Normal,
Routine
BUN [BUN] Status: Standing, Expires:5/17/15 MANUAL,Count:1, Normal,
Routine
CREATININE [CRET] Status: Standing, Expires:2/16/16 MANUAL,Count:1, Normal,
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Routine
ELECTROLYTES [LYTE] Status: Standing, Expires:5/17/15 MANUAL,Count:1, Normal,
Routine
CBC WITH DIFFERENTIAL [CBC] Status: Standing, Expires:5/17/15 MANUAL,Count:1, Normal,
Routine
PROTHROMBIN TIME/INR [PT] Status: Standing, Expires:2/16/16 MANUAL,Count:1, Normal,
Routine
B-TYPE NATRIURETIC PEPTIDE [XBNP] Status: Standing, Expires:5/17/15 MANUAL,Count:1, Normal,
Routine
Follow-Up Referrals
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
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
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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.
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
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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.
Discharge Orders
Reason for Hospitalization [130591]
Why You Were Hospitalized [NURCOM0073] Please complete in PATIENT FRIENDLY terms. This order
will appear on the patient's After Hospital Care Plan., Routine,
You were hospitalized for heart failure management.
Dietary Guidelines (Check all that Apply) [19504]
2 Gram Sodium Diet [NUT0006] Routine
General:
Liquids and Modified Consistency:
Fluid Restriction:
Sodium: 2000 mg Sodium: See Health Facts for You #180,
#201
Dysphagia:
Fat:
Renal:
Potassium:
Micronutrients:
Infant Formula Product:
Infant Formula Concentration:
Fluid Restriction 2 liters [NUT0006] Routine
General:
Liquids and Modified Consistency:
Fluid Restriction: 2 liters: See Health Facts for You #475
Sodium:
Dysphagia:
Fat:
Renal:
Potassium:
Micronutrients:
Infant Formula Product:
Infant Formula Concentration:
Nourishments & Supplements [NURDIE0013] Routine
Vital Signs [19505]
Measure and Record Weight Daily [NURMON0015] Routine
Frequency:
Measure and Record Blood Pressure Daily
[NURMON0019]
Routine
Measure and Record Pulse Daily [NURMON0008] Routine
Activity (Single Response) [19506]
Activity Restrictions [NURACT0008] Routine
Discharge Activity: See Instructions
Exercise every day: we recommend walking for a few minutes
several times a day. Increase your time walking by a minute
or two each week to build up your strength and endurance.
No lifting or carrying more than 30 pounds.
Wound Care [123401]
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Wound Care [NURWND0015] Routine
Bowel Care [123357]
Bowel Care [NURELM0068] Routine
Bladder Care [123375]
Bladder Care [NURELM0067] Routine
Other Patient Care Instructions [123390]
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
Work Restrictions [NURACT0011] Routine
When to Call Your Doctor [130592]
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
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