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201611312

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ED - CLINICAL DECISION UNIT - CELLULITIS - ADULT [5805]

ED - CLINICAL DECISION UNIT - CELLULITIS - ADULT [5805] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Emergency Medicine


ED - Clinical Decision Unit - Cellulitis - Adult [5805]
Inclusion Criteria for this Order Set:
1. Cellulitis without abscess or with abscess drained in the Emergency Department
Exclusion Criteria for this Order Set:
1.Septic or toxic patients - clinical appearance, evidence of severe sepsis (Temperature > 40,
Systolic Blood Pressure > 100 mmHg, Heart Rate > 100 bmp, *acute organ dysfunction,
lactate> 2 mmoL, L).
2. Complicated cellulitis - diabetic foot infections; infections proximate to a prosthesis,
percutaneous catheter or indwelling device; extensive tissue sloughing; suspicion of
osteomyelitis or deep wound infection.
Prior to Observation Admission
1. Outline area of cellulitis to be observed.
2. Obtain, CBC, Basic Metabolic Panel, and lactate.
3. Consider MRSA swab or other culture collection drawn prior to antibiotics
Admission Status
Admission Status [210332]
Admit to CDU (ED Observation) [ADT0019] Patient Class: Observation
Accommodation Code, if IMC request, please enter
Comments in field to the right: OSS/OBS
Will the patient require special placement due to
ISOLATION Precautions?
Is the patient currently a Department of Corrections
(DOC) Inmate?
Is a nursing assessment for CONSTANT
OBSERVATION recommended?
Is the patient currently a resident of CWC or Mendota
Mental Health (MMHI)?
Will the patient go directly to the OR from the ED?
Could this patient have ACS/MI?
Does the patient require CARDIAC MONITORING for
transport?
Admitting Provider?
Attending Provider?
CDU Protocol: Cellulitis
Family History:
Expected Treatment/Procedures:
Medications
Analgesics - Acetaminophen PRN [212885]
acetaMINOPHEN (TYLENOL) tab [34149] 325-650 mg, Oral, EVERY 4 HOURS PRN, pain, Mild
to Moderate Pain
Analgesics - NSAIDS PRN [212887]
ibuprofen (MOTRIN) tab [38353] 200-400 mg, Oral, EVERY 6 HOURS PRN, pain, Mild
to Moderate Pain
Analgesics - Opioids - Oral PRN (Single Response) [212888]
hydrocodone-acetaMINOPHEN (NORCO) 5-325
MG per tab [71425]
1-2 tab, Oral, EVERY 4 HOURS PRN, pain
oxycodone tab [45976] 5-10 mg, Oral, EVERY 4 HOURS PRN, pain, Severe
Pain
Analgesics - Opioids - Injection PRN (Single Response) [212890]
MORPHine PF injection [800122] 1-2 mg, Intravenous, EVERY 2 HOURS PRN, pain
For severe pain if unable to tolerate oral medications.
Page 1 of 4
Printed by STRAKA, KEVIN F [KFS1] at 11/4/2016 12:40:16 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

HYDROmorphone PF (DILAUDID) injection
[800120]
0.2-0.4 mg, Intravenous, EVERY 2 HOURS PRN
For severe pain if unable to tolerate oral medications.
Antibiotics [207295]
cefazolin (ANCEF) intraVENOUS [800000] 2 g, Intravenous, EVERY 8 HOURS
clindamycin (CLEOCIN) intraVENOUS [800033] 600 mg, Intravenous, EVERY 8 HOURS
oxacillin intraVENOUS [800065] 2 g, Intravenous, EVERY 4 HOURS
Patient Care Orders
Vital Signs [208640]
Vital Signs [NURMON0013] SEE COMMENTS, Starting today, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Every *** Hours, STAT
Activity [212530]
Activity [NURACT0008] CONTINUOUS, Routine
AD LIB:
AMBULATE:
CHAIR:
DANGLE:
BEDREST:
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Nutrition [208641]
Diet - Custom [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Room Service Class:
Diet Type: Diet Modifications
Diet Modifications:
Bedside Meal Instructions:
Diet - General [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: General (no Modifications)
Bedside Meal Instructions:
Room Service Class:
Diet - NPO Except Medications [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: NPO
NPO: NPO except Medications
Bedside Meal Instructions:
Room Service Class:
Page 2 of 4
Printed by STRAKA, KEVIN F [KFS1] at 11/4/2016 12:40:16 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Diet - Adult Renal [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: Diet Modifications
Diet Modifications: Renal
Sodium:
Potassium:
Phosphorus:
Fluid Restriction Total mLs/24H (IV/PO):
Protein:
Bedside Meal Instructions:
Room Service Class:
Respiratory [209070]
Respiratory Therapy per Protocol [RT0035] CONTINUOUS, Routine
Protocol Type:
Oxygen Therapy [RT0032] CONTINUOUS, 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?
Respiratory Therapy per Protocol [RT0035] CONTINUOUS, Routine
Protocol Type:
CPAP Overnight and Nap [RT0063] OVERNIGHT AND NAP, Routine
Therapy Settings: Per RT
CPAP Level (cm H2O):
Oxygen (LPM or %):
Self Administered (Only RT may document in this box
after patient assessment): RT Approval Required
Contingency Parameters [208659]
Notify Provider [NURCOM0001] Provider to Notify: Provider
If systolic blood pressure > (mmHg): 180
If systolic blood pressure < (mmHg): 100
If diastolic blood pressure > (mmHg): 95
If diastolic blood pressure < (mmHg): 60
If temperature > (C): 38
If temperature < (C): 36
If heart rate > (bpm): 120
If heart rate < (bpm): 50
If respiratory rate >:
If respiratory rate <:
If blood glucose > (mg/dL): 300
If blood glucose < (mg/dL): 80
If pain score >:
Pulse Oximetry < (%): 92
If urine output < (mL):
Other:
Disposition Criteria
Home [209072]
Disposition Criteria - Home [NURCOM0022] CONTINUOUS, 1. Improvement or no progression of
cellulitis.
2. Vital signs stable for 8 hours.
3. Able to tolerate oral medications.
Hospital [209073]
Page 3 of 4
Printed by STRAKA, KEVIN F [KFS1] at 11/4/2016 12:40:16 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Disposition Criteria - Hospital [NURCOM0022] CONTINUOUS, 1. Progression of cellulitis with
increased skin involvement.
2. Inability to tolerate oral medications.
3. Fever within 8 hours of discharge or unstable vital
signs.
4. Inability to perform adequate wound care, if
necessary, at home.
Page 4 of 4
Printed by STRAKA, KEVIN F [KFS1] at 11/4/2016 12:40:16 PM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org