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/clinical/cckm-tools/content/order-sets/inpatient/cardiologyct-surgery/name-98428-en.cckm

20180109

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UWHC,UWMF,

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

IP – Cardiac Surgery – Pediatric – Postoperative [2951]

IP – Cardiac Surgery – Pediatric – Postoperative [2951] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Cardiology/CT Surgery


IP - Cardiac Surgery - Pediatric - Postoperative [2951]
Admission Status
Level of Care (Single Response) [187485]
*An admit patient order has already been written, but the level of care at which the patient
should be placed still needs to be identified.
Place Patient on General Care [ADT0018] General Care, has already been signed. This order
will ensure that the patient is placed at the appropriate
level of care.
Place Patient on Intermediate Care (IMC)
[ADT0018]
Intermediate Care, has already been signed. This
order will ensure that the patient is placed at the
appropriate level of care.
Place Patient on Intensive Care (ICU) [ADT0018] Intensive Care, has already been signed. This order
will ensure that the patient is placed at the appropriate
level of care.
Admit to Inpatient (Single Response) [188296]
Admit To Inpatient [ADT0001] Attending:
Admitting Resident:
Requested Floor:
Service:
I certify that an inpatient stay is medically necessary
because of either an anticipated LOS >2 midnights,
complexity and/or severity of illness, an inpatient-
only surgery, or a previously-authorized inpatient
stay. Rationale listed below. Yes
C - CLEAR DIAGNOSIS:
E - EVALUATIONS PLANNED:
R - RESULTS EXPECTED:
T - TREATMENTS ORDERED:
Post-Op/Phase II
Admit to Observation (Single Response)
[188297]
Admit To Observation [ADT0002] Attending:
Admitting Resident:
Requested Floor:
Service:
Post-Op/Phase II
Admit to Outpatient Short Stay (Single
Response) [188298]
Admit To Outpatient Short Stay [ADT0003] Attending:
Admitting Resident:
Requested Floor:
Service:
Post-Op/Phase II
Admission Status [98934]
Page 1 of 16
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Admit To Inpatient [ADT0001] Attending: ANAGNOSTOPOULOS, PETROS V
Admitting Resident:
Requested Floor: PICU
Service: PEDIATRIC CARDIAC SURGERY
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
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
Admission Status [84059]
Admit To Inpatient [ADT0001] Attending:
Admitting Resident:
Requested Floor:
Service:
I certify that an inpatient stay is medically necessary
because of either an anticipated LOS >2 midnights,
complexity and/or severity of illness, an inpatient-only
surgery, or a previously-authorized inpatient stay.
Rationale listed below. Yes
C - CLEAR DIAGNOSIS:
E - EVALUATIONS PLANNED:
R - RESULTS EXPECTED:
T - TREATMENTS ORDERED:
Post-Op/Phase II
Admit To Observation [ADT0002] Attending:
Admitting Resident:
Requested Floor:
Service:
Post-Op/Phase II
Admit To Outpatient Short Stay [ADT0003] Attending:
Admitting Resident:
Requested Floor:
Service:
Post-Op/Phase II
Transfer Status
Transfer Status [114716]
Transfer Patient [ADT0005] PEDIATRIC CARDIAC SURGERY, Post-Op/Phase II
Patient Care Orders
Patient Monitoring [90989]
Page 2 of 16
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Vital Signs [NURMON0013] SEE COMMENTS, Starting today For Until specified,
Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Every 15 minutes times 4, then every hour., Post-
Op/Phase II
Four Extremity Blood Pressure [NURCOM0022] SEE COMMENTS, Starting today For Until specified,
Every 8 hours, Post-Op/Phase II
Measure Central Venous Pressure
[NURMON0002]
EVERY 1 HOUR, Starting today For Until specified,
Routine, Post-Op/Phase II
Measure Arterial Pressure [NURMON0060] EVERY 1 HOUR, Starting today For Until specified,
Post-Op/Phase II
Measure Cerebral and Somatic Oximetry
[NURMON0060]
CONTINUOUS, Starting today For Until specified,
Post-Op/Phase II
Measure Left Atrial Pressure [NURMON0060] EVERY 1 HOUR, Starting today For Until specified, If
line is infusing medication, please pause infusion to
obtain accurate pressure measurement every 1 hour.,
Post-Op/Phase II
Measure Right Atrial Pressure [NURMON0060] EVERY 1 HOUR, Starting today For Until specified, If
line is infusing medication, please pause infusion to
obtain accurate pressure measurement every 1 hour.,
Post-Op/Phase II
Activity [90990]
Bedrest [NURACT0008] CONTINUOUS, Starting today For Until specified,
Routine
AD LIB:
AMBULATE:
CHAIR:
DANGLE:
BEDREST: strict bedrest
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Post-Op/Phase II
Elevate Head Of Bed [NURACT0002] Equal to (degrees): 30
Greater than (degrees):
Less than (degrees):
Other options:
Routine, CONTINUOUS, Starting today For Until
specified, Post-Op/Phase II
Sternal Precautions [PRECAU0010] CONTINUOUS, Routine, Sternal Precautions:
No lifting greater than 8 pounds.
No pushing/pulling with arms during transfers.
No shoulder elevation past 90 degrees., For infants
and children, lift patient in a scooping motion rather
than under the armpits.
No lifting greater than 8 pounds.
No pushing/pulling with arms during transfers.
No shoulder elevation past 90 degrees, Post-
Op/Phase II
Page 3 of 16
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Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
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Nutrition [90991]
Strict NPO [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Pediatric
Diet Type: NPO
NPO Diet: Strict NPO
Bedside Meal Instructions:
Room Service Class:
Post-Op/Phase II
Glucose Point of Care (POC) [203284]
Pediatric Hypoglycemia Treatment Algorithm URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/diabetes-and-
endocrinology/related/name-97515-en.cckm
Glucose, POC [IPGLUCOSE] CONDITIONAL - RN COLLECT, Starting today For 4
Days, 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? Every one hour times
2, then every 2 hours times 2
Post-Op/Phase II
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?
Post-Op/Phase II
Respiratory [90992]
Pulse Oximetry [NURMON0009] CONTINUOUS, Starting today For Until specified,
Routine, Post-Op/Phase II
Oxygen Therapy [RT0032] CONTINUOUS, Starting today For Until specified,
Routine
FiO2 (%) Titrate to Keep Sats >/= to ___%:
Liter Flow:
Titrate oxygen to maintain O2 sat at (%):
O2 Delivery Device: Nasal Cannula
Attempt to Wean Off Oxygen? No
Maintain oxygen while chest tubes are in place, Post-
Op/Phase II
Incentive Spirometry [NURTRT0018] EVERY 2 HOURS, Starting today For Until specified,
Routine, While awake., Post-Op/Phase II
Blow Bubbles [NURTRT0047] EVERY 2 HOURS, Starting today For Until specified,
Routine, While awake., Post-Op/Phase II
Provide Manual Resuscitator at Bedside [RT0039] CONTINUOUS, Routine, Post-Op/Phase II
Chest Tube Care [146098]
Page 4 of 16
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Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Maintain Chest Tube [NURTAD0001] CONTINUOUS, Starting today, Routine
Location: Right Pleura
Position: N/A - Single Location
Drainage Options:
Site Assessment Frequency:
Care Frequency:
Wash With:
Primary Dressing:
Secondary Dressing:
Measure chest tube output every 15 minutes times 4,
then every hour.
Maintain Chest Tube [NURTAD0001] CONTINUOUS, Starting today, Routine
Location: Mediastinal
Position: N/A - Single Location
Drainage Options:
Site Assessment Frequency:
Care Frequency:
Wash With:
Primary Dressing:
Secondary Dressing:
Measure chest tube output every 15 minutes times 4,
then every hour.
Maintain Chest Tube [NURTAD0001] CONTINUOUS, Starting today, Routine
Location: Left Pleura
Position: N/A - Single Location
Drainage Options:
Site Assessment Frequency:
Care Frequency:
Wash With:
Primary Dressing:
Secondary Dressing:
Measure chest tube output every 15 minutes times 4,
then every hour.
Wound Care [90993]
Wound Care [NURWND0015] CONTINUOUS, Starting today For Until specified,
Routine
Wound Type: Closed - Incision
Wound Site: Chest
Wound Location: Anterior
Assess Frequency: EVERY 1 HOUR (For bleeding)
Care Frequency: 1X DAILY (And as needed)
Wash With: Other (Comment) (Chlorhexidene)
Irrigate/Rinse With:
Apply (Must also enter separate medication order to
obtain drug):
Primary Dressing: Gauze (Tegaderm or Tape)
Secondary Dressing:
Assess dressing for bleeding every hour.
NOTIFY PEDIATRIC CARDIOVASCULAR TEAM IF
DRESSING SATURATED.
LEAVE OPERATIVE DRESSING IN PLACE X 72
HOURS.
INITIAL DRESSING CHANGE BY PEDIATRIC
CARDIOVASCULAR TEAM., Post-Op/Phase II
Do Not Remove Dressings - Chest Not Closed
[NURWND0018]
CONTINUOUS, Starting today For Until specified,
Post-Op/Phase II
Intake and Output [90994]
Page 5 of 16
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Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Measure Intake And Output [NURMON0005] EVERY 1 HOUR, Starting today For Until specified,
Routine, Post-Op/Phase II
Epicardial Pacemaker Settings [90995]
Epicardial Pacemaker Settings [NURTRT0083] CONTINUOUS, Starting today For Until specified,
Routine
Mode:
Ventricular Voltage (Milliamperes):
Ventricular Sensitivity (Millivolts):
Ventricular Rate (Beats/Min):
Atrial Voltage (Milliamperes):
Atrial Sensitivity (Millivolts):
Atrial Rate (Beats/Min):
Battery Change:
Post-Op/Phase II
Non-Categorized Patient Care Orders [90996]
Cardio-Respiratory Monitor - Pediatric - With
Rhythm [139419]
Cardio-Respiratory Monitor - Pediatric - With
Rhythm [NURMON0014]
CONTINUOUS, Routine, Most pediatric patients do
NOT require rhythm analysis. Please complete the
Notify Provider order below, including specification
for apnea > *** seconds. If indicated, order pulse
oximetry separately.
Device Present:
Device Mode:
Device Low Rate Limit (BPM):
Notify Provider: Symptomatic Change in
Rhythm,Serious Arrhythmia
Post-Op/Phase II
Notify [NURCOM0001] Provider to Notify: Provider
Notify based on:
Notify provider for apnea > 20 seconds, Post-
Op/Phase II
Measure Weight [NURMON0015] 1X DAILY, Starting today at 6:00 AM For Until
specified, Routine
Weigh With?
Weigh when? AM
Weigh daily at 6 am, Post-Op/Phase II
Measure Height [NURMON0052] EVERY 7 DAYS, Routine, Post-Op/Phase II
Measure Head Circumference [NURMON0038] EVERY 7 DAYS, Routine, Post-Op/Phase II
Maintain Urinary Catheter [NURELM0013] CONTINUOUS, Starting today For Until specified,
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: Other (Comment Required)
(Monitoring of Urine Output)
Initiate Urinary Catheter Removal Protocol?
Details: To Dependent Drainage
Does this need to be inserted/placed?
Post-Op/Phase II
Page 6 of 16
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Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
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Maintain Arterial Line [NURVAD0001] CONTINUOUS, Starting today For Until specified,
Routine
Device Status:
Flush Solution:
Site:
Post-Op/Phase II
Maintain Non-Tunneled Central Catheter
[NURVAD0017]
CONTINUOUS, Starting today For Until specified,
Routine
Device Status: Ready For Use
Post-Op/Phase II
Use Radiant Warmer [NURTRT0026] CONDITIONAL, Starting today For Until specified,
Routine
If Conditional, What Condition? As needed for
temperature less than 36.5 degrees Celsius.
Post-Op/Phase II
Use Warm Air Blanket [NURTRT0027] CONDITIONAL, Starting today For Until specified,
Routine
If Conditional, What Condition? As needed for
temperature less than 36.5 degrees Celsius.
Post-Op/Phase II
Maintain Nasogastric Tube [NURTAD0014] CONTINUOUS, Starting today For Until specified,
Routine
Options: Low, Continuous Suction
Flush with:
Flush Frequency:
Clamp NG Tube:
Check Residual:
Does this need to be inserted/placed?
Device Status: Ready For Use
Post-Op/Phase II
Measure Nasogastric Tube Output
[NURTAD0037]
EVERY 4 HOURS, Starting today For Until specified,
Routine, Post-Op/Phase II
Sequential Compression Device (SCD) Panel
(TREATMENT AND SUPPLY) [206111]
Sequential Compression Device (SCD)
(TREATMENT) [NURTRT0028]
CONTINUOUS, Routine
Left/Right/Bilateral? Bilateral
Post-Op/Phase II
Sequential Compression Device (SCD) / Foot
Pump (SUPPLY) [EQP0023]
CONTINUOUS, Routine
Left/Right/Bilateral?
Type: Knee High
Post-Op/Phase II
Contingency Parameters [90997]
Notify [NURCOM0001] Provider to Notify: Provider
Notify based on:
Post-Op/Phase II
Chest Tube Parameters [NURCOM0022] CONTINUOUS, Starting today For Until specified, -
Notify provider for sanguineous chest tube output
greater than or equal to 5 mL/kg/hr for 1 hour
- Notify provider for acute decrease in chest tube
output or no output over 2 hours., Post-Op/Phase II
Intravenous Therapy
IV Maintenance [103480]
Page 7 of 16
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Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Starting today For Until specified,
Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
Post-Op/Phase II
IV Fluids [90999]
dextrose 5%-NaCl 0.45% infusion [51613] Intravenous, CONTINUOUS, Post-Op/Phase II
dextrose 5%-NaCl 0.2% infusion [51615] Intravenous, CONTINUOUS, Post-Op/Phase II
dextrose 10%-NaCl 0.2% infusion [710000] Intravenous, CONTINUOUS
Equivalent to dextrose 10%-NaCl 0.2%
Post-Op/Phase II
Note: Total IV Fluids [950004] 4 X DAILY (NOTE ACKNOWLEDGE)
Total intravenous fluids infuse at *** mL/hr (two-thirds
maintenance)
Post-Op/Phase II
Flushes [151600]
heparin 1 unit/ml in sodium chloride 0.9 % 50 mL
patency line - Arterial Line IV Flush [700923]
at 1 mL/hr, Intraarterial, CONTINUOUS
For Pediatric Arterial Lines
Post-Op/Phase II
heparin in sodium chloride 0.9 % 50 mL patency
line - Left Arterial Line Flush [700923]
at 1 mL/hr, Intraarterial, CONTINUOUS
For Left Arterial Line Flush
Post-Op/Phase II
heparin in sodium chloride 0.9 % 50 mL patency
line - Central Venous Pressure (CVP) Line Flush
[700923]
at 1 mL/hr, Intravenous, CONTINUOUS
For Pediatric Central Venous Pressure (CVP) Lines
Post-Op/Phase II
heparin in sodium chloride 0.9% 50 mL patency
line - For Right Artial Line Flush [700923]
at 1 mL/hr, Intraarterial, CONTINUOUS
For Right Atrial Line Flush
Post-Op/Phase II
Medications - Anti-infectives
First Line (Single Response) [145831]
cefazolin (ANCEF) intraVENOUS - Maxmim Dose
= 2000 mg [800000]
30 mg/kg, Intravenous, EVERY 8 HOURS For 5
Doses, Post-Op/Phase II
cefuroxime (ZINACEF) intraVENOUS - NOTE:
Order for patients with open chest post-
operatively Maximum Dose = 1500 mg [800030]
50 mg/kg, Intravenous, EVERY 8 HOURS For 5
Doses, Post-Op/Phase II
MRSA/Documented History of MRSA [145866]
both cefazolin and vancomycinChoose
Cefazolin - Vancomycin [203277]
cefazolin (ANCEF) intraVENOUS [800000] Intravenous
vancomycin (VANCOCIN) intraVENOUS
[800084]
Intravenous
Patients with Immediate/Severe Reaction to Penicillin or Known Cephalosporin Allergies (Single
Response) [145867]
vancomycin (VANCOCIN) intraVENOUS [800084] 15 mg/kg, Intravenous, EVERY 8 HOURS For 5
Doses, Post-Op/Phase II
Medications
Supplemental" -Pediatric -Diabetes Management Without Pump -For insulin orders, refer to "IP
Order Set.
Analgesics - Scheduled - Non-opioid (Single Response) [91012]
acetaMINOPHEN alcohol free (TYLENOL) oral
suspension - NOTE: Suggested dose 15
mg/kg/dose (Maximum 650 mg/dose) [800005]
15 mg/kg, Oral, EVERY 4 HOURS
Administer first dose on admission to Pediatric ICU
Post-Op/Phase II
Page 8 of 16
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acetaMINOPHEN (TYLENOL) suppository -
NOTE: Suggested dose 15 mg/kg/dose
(Maximum 650 mg/dose) [43994]
Rectal, EVERY 4 HOURS
Administer first dose on admission to Pediatric ICU
NOTE: Suggested dose 15 mg/kg/dose (Maximum
650 mg/dose)
Post-Op/Phase II
acetaMINOPHEN (TYLENOL) tab - NOTE:
Suggested dose 15 mg/kg/dose (Maximum 650
mg/dose) [34149]
Oral, EVERY 4 HOURS
Administer first dose in on admission to Pediatric ICU.
No more than 4 grams acetaminophen per 24 hours
for adults or 15mg/kg per dose for peds <40kg.
Post-Op/Phase II
Analgesics - Scheduled - Opioid [203286]
FENTanyl (SUBLIMAZE) infusion PEDS [800143] 1 mcg/kg/hr, Intravenous, CONTINUOUS
Titrate per PICU Sedation and Analgesia Protocol
Post-Op/Phase II
Analgesics - PRN Mild Pain or Fever [91013]
acetaMINOPHEN alcohol free (TYLENOL) oral
suspension [800005]
15 mg/kg, Oral, EVERY 4 HOURS PRN, pain/fever,
PRN mild pain or fever greater than 38.5 degrees
Celsius, multimodal therapy, first line therapy, Post-
Op/Phase II
acetaMINOPHEN (TYLENOL) suppository -
NOTE: Suggested dose 15 mg/kg/dose
(Maximum 650 mg/dose) [43994]
Rectal, EVERY 4 HOURS PRN, pain/fever, PRN mild
pain or fever greater than 38.5 degrees Celsius,
multimodal therapy, second line agent, use if unable to
tolerate oral acetaminophen
NOTE: Suggested dose 15 mg/kg/dose (Maximum
650 mg/dose)
Post-Op/Phase II
Analgesics - PRN Severe Pain (Single Response) [185247]
MORPHine PF injection RANGE [750057] 0.05-0.1 mg/kg, Intravenous, EVERY 2 HOURS PRN,
pain, Severe pain, for 4 Minutes, Post-Op/Phase II
FENTanyl PF injection [800187] 1 mcg/kg, Intravenous, EVERY 2 HOURS PRN,
Severe pain
NOTE: Suggested dose 1 mcg/kg/dose
Post-Op/Phase II
Anti-emetics [91014]
ondansetron (ZOFRAN) injection [800202] 0.1 mg/kg, Intravenous, EVERY 8 HOURS PRN,
nausea/vomiting, Post-Op/Phase II
Gastric [91016]
famotidine (PEPCID) intraVENOUS - Note:
Maximum Dose = 20 mg [800279]
0.25 mg/kg, Intravenous, EVERY 12 HOURS, Post-
Op/Phase II
pantoprazole (PROTONIX) intraVENOUS - Order
if on a proton pump inhibitor (PPI) prior to
admission. Maximum Dose - 80 mg [800119]
1 mg/kg, Intravenous, 1 X DAILY
Bowel Management - Scheduled [114711]
polyethylene glycol (MIRALAX) oral packet
[61829]
Oral, 1 X DAILY
Dissolve in 8 ounces of liquid. Hold for loose stools
Post-Op/Phase II
Bowel Management - PRN Suppository (Single Response) [203287]
glycerin (PEDIATRIC) rectal suppository [153728] 1 suppository, Rectal, 1 X DAILY PRN, constipation,
Post-Op/Phase II
glycerin (ADULT) rectal suppository [106612] 1 suppository, Rectal, 1 X DAILY PRN, constipation,
Post-Op/Phase II
bisacodyl (DULCOLAX) rectal suppository
[35231]
10 mg, Rectal, 1 X DAILY PRN, constipation, Post-
Op/Phase II
Anti-Arrhythmics [91009]
Page 9 of 16
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Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
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amiodarone (CORDARONE) BOLUS [800123] 5 mg/kg, Intravenous, ONCE For 1 Doses
Administer with 0.2 or 0.22 micron filter
Max concentration 6mg/mL--Central administration
only
Post-Op/Phase II
amiodarone infusion PEDS [800131] 5-15 mcg/kg/min, Intravenous, CONTINUOUS
Administer with a 0.2 or 0.22 micron filter
Concentration: > 2 mg/mL per central line (2-6 mg/mL)
Maximum 15 mcg/kg/minute
Post-Op/Phase II
lidocaine (XYLOCAINE-CARDIAC) injection
[760348]
1 mg/kg, Intravenous, ONCE For 1 Doses, Post-
Op/Phase II
lidocaine infusion PEDS [800152] 20-50 mcg/kg/min, Intravenous, CONTINUOUS
Initiate at 20 mcg/kg/min or current rate. Adjust dose
per MD direction.
Post-Op/Phase II
Vasoactive Agents [203288]
esmolol (BREVIBLOC) infusion PEDS [800141] 25-500 mcg/kg/min, Intravenous, CONTINUOUS
Initiate at 50 mcg/kg/min. Adjust dose per MD
direction. Maximum dose 500 mcg/kg/min
Post-Op/Phase II
nicardipine (CARDENE) infusion PEDS [800157] Intravenous, CONTINUOUS, Post-Op/Phase II
Sedatives [91015]
lorazepam (ATIVAN) injection [800053] 0.05-0.1 mg/kg, Intravenous, ONCE For 1 Doses,
Post-Op/Phase II
midazolam (VERSED) injection [800197] 0.05 mg/kg, Intravenous, EVERY 1 HOUR PRN,
sedation, Post-Op/Phase II
midazolam (VERSED) infusion PEDS [800154] 0.05-0.1 mg/kg/hr, Intravenous, CONTINUOUS
Titrate per PICU Sedation and Analgesia Protocol
Post-Op/Phase II
dexmedetomidine (PRECEDEX) infusion PEDS
[800135]
0.1-0.9 mcg/kg/hr, Intravenous, CONTINUOUS
Titrate per Peds ICU Analgesia/Sedation protocol.
Initiate per protocol or current rate and titrate to
sedation goal.
Post-Op/Phase II
Neuromuscular Blocking Agents [91011]
Ensure patient is adequately sedated before and during -Blocking Agents Neuromuscular
administration of Neuromuscular blocking agents.
vecuronium (NORCURON) vial [46843] 0.1 mg/kg, Intravenous, EVERY 1 HOUR PRN,
asynchronous ventilation or movement, Post-
Op/Phase II
vecuronium (NORCURON) infusion PEDS
[800171]
0.05-0.2 mg/kg/hr, Intravenous, CONTINUOUS
Start at 0.1 mg/kg/hr. Titrate per MD direction.
Post-Op/Phase II
Electrolyte Supplements [91004]
potassium chloride intraVENOUS PEDS
CENTRAL - Maximum Dose = 20 mEq [800209]
1 mEq/kg, Intravenous, PRN, potassium replacement -
see Admin Instructions
For potassium less than 3.5 mmol/liter
Post-Op/Phase II
calcium GLUConate injection 50 mg/kg [800105] 50 mg/kg, Intravenous, PRN, calcium replacement -
see Admin Instructions
For ionized calcium less than 4.8 mg/dL.
Must discuss with provider prior to administration if no
central line available. Administer over 20 minutes.
Post-Op/Phase II
Page 10 of 16
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magnesium sulfate intraVENOUS (PEDS) -
Maximum Dose = 1000 mg [800194]
25 mg/kg, Intravenous, PRN, magnesium replacement
- see Admin Instructions
For magnesium less than 2.0 mg/dL Magnesium
sulfate should be administered over 2-4 hours
Post-Op/Phase II
Sucrose for Oral Analgesia [110668]
sucrose (SWEET-EASE) 24% buccal soln
[794009]
Oral, PRN, pain, mild pain or potentially painful
procedures. See Admin Instructions, Post-Op/Phase II
Laboratory
STAT [91018]
CBC WITHOUT DIFFERENTIAL [HEMO] STAT - RN COLLECT, Starting today For 1
Occurrences, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
HEMOGLOBIN, WHOLE BLOOD [HCWBHGB] STAT - RN COLLECT For 1 Occurrences, STAT
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] STAT - RN COLLECT, Starting today For 1
Occurrences, STAT
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] STAT - RN COLLECT, Starting today 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
SODIUM, WHOLE BLOOD [HCWBNA] STAT - RN COLLECT, Starting today For 1
Occurrences, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
POTASSIUM, WHOLE BLOOD [HCWBK] STAT - RN COLLECT, Starting today For 1
Occurrences, STAT
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, IONIZED, WHOLE BLOOD
[HCWBICA]
STAT - RN COLLECT, Starting today For 1
Occurrences, STAT
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 11 of 16
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BUN [BUN] STAT - RN COLLECT, Starting today For 1
Occurrences, STAT
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] STAT - RN COLLECT, Starting today For 1
Occurrences, STAT
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, WHOLE BLOOD [HCWBGLU] STAT - RN COLLECT, Starting today For 1
Occurrences, STAT
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] STAT - RN COLLECT, Starting today For 1
Occurrences, STAT
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] STAT - RN COLLECT, Starting today For 1
Occurrences, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
LACTATE [GM2255] STAT - RN COLLECT, Starting today For 1
Occurrences, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
BLOOD GASES AND O2 SATURATION -
ARTERIAL [HCBGASOS]
STAT - RN COLLECT, Starting today For 1
Occurrences, STAT
Indicate FIO2: Per RN
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
BLOOD GASES AND O2 SATURATION - MIXED
VENOUS [HCBGASOS]
STAT - RN COLLECT, Starting today For 1
Occurrences, STAT
Indicate FIO2: Per RN
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
ALBUMIN [ALB] STAT - RN COLLECT, Starting today 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
Every One Hour Times 2, Then Every Two Hours Times 2 [114715]
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BLOOD GASES AND O2 SATURATION -
ARTERIAL [HCBGASOS]
CONDITIONAL - RN COLLECT, Starting today For 1
Days, STAT
Indicate FIO2: Per RN
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Every one hour x2, then every 2 hours x2, Post-
Op/Phase II
LACTATE [GM2255] CONDITIONAL - RN COLLECT For 1 Days, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Every one hour x2, then every 2 hours x2, Post-
Op/Phase II
HEMOGLOBIN, WHOLE BLOOD [HCWBHGB] CONDITIONAL - RN COLLECT For 1 Days, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Every one hour x2, then every 2 hours x2, Post-
Op/Phase II
POTASSIUM, WHOLE BLOOD [HCWBK] CONDITIONAL - RN COLLECT For 1 Days, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Every one hour x2, then every 2 hours x2, Post-
Op/Phase II
SODIUM, WHOLE BLOOD [HCWBNA] CONDITIONAL - RN COLLECT For 1 Days, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Every one hour x2, then every 2 hours x2, Post-
Op/Phase II
CALCIUM, IONIZED, WHOLE BLOOD
[HCWBICA]
CONDITIONAL - RN COLLECT For 1 Days, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Every one hour x2, then every 2 hours x2, Post-
Op/Phase II
Postoperative Day #1 [114713]
PROTHROMBIN TIME/INR [PT] NEXT AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
Daily x 3 Days [114714]
CBC WITHOUT DIFFERENTIAL [HEMO] NEXT AM, Starting today For 3 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
ELECTROLYTES, WHOLE BLOOD
[HCWBLYTS]
NEXT AM, Starting today For 3 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
Page 13 of 16
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Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
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BUN [BUN] NEXT AM For 3 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 For 3 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, WHOLE BLOOD [HCWBGLU] NEXT AM, Starting today For 3 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
CALCIUM, IONIZED, WHOLE BLOOD
[HCWBICA]
NEXT AM, Starting today For 3 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
MAGNESIUM [MAG] NEXT AM For 3 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 For 3 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
BLOOD GASES AND O2 SATURATION -
ARTERIAL [HCBGASOS]
NEXT AM For 3 Occurrences, STAT
Indicate FIO2: Per RN
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
LACTATE [GM2255] NEXT AM For 3 Occurrences, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
ALBUMIN [ALB] NEXT AM For 3 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 [91020]
CALCIUM, IONIZED, WHOLE BLOOD
[HCWBICA]
CONDITIONAL - RN COLLECT, Starting today For 7
Days, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? One hour after calcium
supplement given
Post-Op/Phase II
Page 14 of 16
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Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
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MAGNESIUM [MAG] CONDITIONAL - RN COLLECT For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? One hour after
magnesium supplement given.
Post-Op/Phase II
POTASSIUM, WHOLE BLOOD [HCWBK] CONDITIONAL - RN COLLECT, Starting today For 7
Days, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? One hour after
potassium supplement given
Post-Op/Phase II
GLUCOSE, WHOLE BLOOD [HCWBGLU] CONDITIONAL - RN COLLECT, Starting today For 7
Days, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw if blood glucose
is less than 40 mg/dL or greater than 400 mg/dL.
Post-Op/Phase II
GLUCOSE, WHOLE BLOOD [HCWBGLU] CONDITIONAL - RN COLLECT, Starting 1/15/18 For
7 Days, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw if blood glucose
is less than 40 mg/dL or greater than 400 mg/dL.
Post-Op/Phase II
Diagnostic Tests and Imaging
Studies [91022]
ECG - 12 Lead (PEDS) - Chest Closed
[EKG0014]
ONCE, Starting today For 1 Occurrences, Routine
Reason for exam: CONGENITAL HEART DISEASE
Post-Op/Phase II
ECG - 12 Lead (PEDS) - Chest Open [EKG0014] ONCE For 1 Occurrences, Routine
Reason for exam: CONGENITAL HEART DISEASE
Post-Op/Phase II
X-RAY CHEST SINGLE VIEW - POD 1 [R71045] ONCE-RAD NEXT AVAILABLE, Starting tomorrow at
6:00 AM For 1 Occurrences, Routine
Current signs and symptoms?
What specific question(s) would you like answered by
this exam? Evaluate heart size, lung fields and lines
Relevant recent/past history?
Is patient pregnant?
If being performed remotely, where? Bedside
Last patient weight? (will auto pull in value and date in
comment):
Transport Method: Floor Determined/Entered
POD 1, Post-Op/Phase II
Page 15 of 16
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Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
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X-RAY CHEST SINGLE VIEW - On Arrival to
PICU [R71045]
ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, Routine
Current signs and symptoms?
What specific question(s) would you like answered by
this exam? Evaluate heart size, lung fields and lines
Relevant recent/past history?
Is patient pregnant?
If being performed remotely, where? Bedside
Last patient weight? (will auto pull in value and date in
comment):
Transport Method: Floor Determined/Entered
Now, on arrival to Pediatric Intensive Care Unit, if not
performed in operating room., Post-Op/Phase II
Consults
Consults [91024]
Consult Cardiology (Inpatient) [CON0012] ONCE
Intent: Consult and Recommend (No Orders)
Concern or Specific Question or Task to be Addressed
(Symptom, Sign, or Diagnosis): Postoperative
Congenital Heart Disease
Post-Op/Phase II
Consult Physical Therapy (Inpatient) Eval and
Treat [CON0061]
ONCE, Routine
Reason for Physical Therapy Consult:
Post-Op/Phase II
Consult Occupational Therapy (Inpatient) Eval
and Treat [CON0046]
ONCE, Routine
Reason for Occupational Therapy Consult:
Post-Op/Phase II
Consult Speech Therapy (Inpatient) Eval and
Treat [CON0077]
ONCE, Routine
Patient Type:
Post-Op/Phase II
Consult Child Life Specialist (Inpatient)
[CON0014]
ONCE, Routine
Activity Level:
Reason for Consult:
Can this consult be done via video?
Post-Op/Phase II
Consult Social Work (Inpatient) [CON0076] ONCE For 1 Occurrences, Routine
Reason for Consult: OTHER (Birth to 3)
Post-Op/Phase II
Consult Case Management (Inpatient) [CON0013] ONCE, Routine
Reason for Consult: OTHER (Respigam)
Consult American Family Children's Hospital (AFCH)
Specialty Clinic if patient is AFCH patient., Post-
Op/Phase II
BestPractice
No Hospital Problems have yet been identified [107363]
Specify Hospital Problem(s) [COR0018] You will be prompted to specify a hospital problem on
signing., Post-Op/Phase II
Page 16 of 16
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Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org