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/clinical/cckm-tools/content/order-sets/inpatient/emergency-medicine/name-109976-en.cckm

20180104

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UWHC,UWMF,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,Emergency Medicine

ED - Asthma - Pediatric - Discharge [5759]

ED - Asthma - Pediatric - Discharge [5759] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Emergency Medicine


ED - Asthma - Pediatric - Discharge [5759]
UW Health Diagnosis and Management of
Asthma Clinical Practice Guideline
URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/respiratory/name-97737-
en.cckm
Patient Care Orders
Reason for Emergency Department Visit [208217]
Why You Were Seen in the Emergency
Department [NURCOM0073]
Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care
Plan., Routine, @FNAME@ was seen in the
Emergency Department for an asthma exacerbation.
@CAPHIS@ care included albuterol, steroids, and
teaching about asthma.
Other Patient Care Instructions [208218]
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
Smoking Cessation [195223]
Provide Patient Education - Quit Smoking
[NURCOM0025]
ONCE, Starting today For 1 Occurrences, Routine,
Provide patient with the following patient education:
3096
When to Call Your Doctor [198051]
OR if the patient is allergy or pulmonary was consulted during the emergency department visit If
related questions should be directed to the followed by allergy or pulmonary, then any asthma
pulmonologist.allergist or
When to Call Your Doctor - PCP Managing
Asthma [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, Please refer to your Asthma Action
Plan.
If @FNAME@ has any of the following or you have
general pediatric questions or concerns please call
your Primary Care Provider, @PCP@, at @PCPPH@.
- In yellow zone for longer than 5-7 days or per your
Asthma Action Plan
- If back in your green zone BUT using your albuterol
more than 2 times per week, please call your PCP.
- ***
If you cannot reach a provider and you have a serious
medical concern, call 911 or bring your child to the
nearest emergency department.
Page 1 of 5
Printed by STRAKA, KEVIN F [KFS1] at 1/3/2018 1:35:52 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

When to Call Your Doctor - Allergy/Pulmonary
Managing Asthma [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, If @FNAME@ has any of the
following please call the {UWIP PEDS
ALLERGY/PULMONARY CONTACT INFO:3003799}.
- In yellow zone for longer than 5 days or per your
Asthma Action Plan.
- Back in green zone and using albuterol more than 2
times per week
- ***
For urgent asthma related concerns after 4:30 PM,
before 8 AM, or on weekends call 608-263-6400 and
ask for the pediatric {UWIP
ALLERGY/PULMONARY:300398} provider on call. If
you cannot reach a provider and you have a serious
medical concern, call 911 or bring your child to the
nearest emergency department.
For non-asthma related general pediatric concerns
please call @FNAME@'s Primary Care Provider,
@PCP@, at @PCPPH@.
When to Call Your Doctor - Subspecialties
[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, Your child received care from a
pediatric subspecialist during their hospitalization. To
Contact a provider from the pediatric specialty team
Monday-Friday 8:00 a.m. to 4:30 p.m., use the phone
numbers listed below:
{subspecialty phone numbers:3022232}
For urgent subspecialist medica needs during
evenings and weekends, call 608-263-6400 and ask
for the Pediatric *** Provider on-call.
If you cannot reach a provider, and you have a serious
medical concern, call 911 or bring your child to the
nearest emergency department.
If when you are in your green zone and you require
your albuterol for more than 2 times per week, please
call your pulmonologist or allergist.
Page 2 of 5
Printed by STRAKA, KEVIN F [KFS1] at 1/3/2018 1:35:52 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

When to Return to ED (or call 911)
[NURCOM0071]
Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care
Plan., Routine, - Increased trouble breathing and
albuterol does not help.
- Requiring albuterol more frequently than every 4
hours.
- Vomiting and unable to drink fluids.
- Other concerns.
Medications
Medication Instructions [208653]
Systemic Steroid [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care
Plan., Routine, {Systemic Steriod:2000944} Take as
directed for 4 days.
Rescue Medications [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care
Plan., Routine, {Rescue Medications:2000945} Take
*** puffs every *** hours for *** days, then *** puffs for
*** days.
Inhaled Corticosteriods [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care
Plan., Routine, {Inhaled Corticosteriods:2000946}
Take *** puffs *** times per day.
Inhaled Corticosteroid / Long Acting Muscarinic
Antagonist Medication [NURCOM0071]
Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care
Plan., Routine, {Inhaled Corticosteriods/Long Acting
Muscarinic Antagonist:2000947} Take as directed
Long Acting Muscarinic Antagonists
[NURCOM0071]
Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care
Plan., Routine, {Long Acting Muscarinic
Antagonist :2000948} Take as directed.
Leukotriene Modifiers [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care
Plan., Routine, {Leukotriene Modifier:2000949} Take
as directed
Systemic Steriods (Single Response) [208643]
burst is a total of 5 days, but may need a prolonged taper up to Recommended
Attending/Consultant
dexamethasone (DECADRON) 2 MG tab - NOTE:
Maximum Dose = 10 mg [36590]
0.6 mg/kg, starting 1/3/18, Normal
prednisolone (PRELONE) 15 MG/5ML syrup -
NOTE: Suggested dose 1-2mg/kg/day given 1-2
times per day (Maximum 30 mg/dose) [46299]
starting 1/3/18, Normal
prednisone (DELTASONE) 10 MG tab -
Suggested dose 1-2mg/kg/day given 1-2 times
per day (Maximum 30 mg/dose) [41278]
starting 1/3/18, Normal
prednisone (DELTASONE) 20 MG tab -
Suggested dose 1-2mg/kg/day given 1-2 times
per day (Maximum 30 mg/dose) [41280]
starting 1/3/18, Normal
prednisolone (ORAPRED ODT) 10 MG
disintegrating tab - NOTE: Order only if unable to
tolerate syrup. Suggested dose 1-2mg/kg/day
given 1-2 times per day (Maximum 30 mg/dose)
[115119]
starting 1/3/18, Normal
Page 3 of 5
Printed by STRAKA, KEVIN F [KFS1] at 1/3/2018 1:35:52 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

prednisolone (ORAPRED ODT) 15 MG
disintegrating tab - NOTE: Order only if unable to
tolerate syrup. Suggested dose 1-2mg/kg/day
given 1-2 times per day (Maximum 30 mg/dose)
[113825]
starting 1/3/18, Normal
prednisolone (ORAPRED ODT) 30 MG
disintegrating tab - NOTE: Order only if unable to
tolerate syrup. Suggested dose 1-2mg/kg/day
given 1-2 times per day (Maximum 30 mg/dose)
[115120]
starting 1/3/18, Normal
Rescue Medications [196238]
albuterol HFA 108 (90 BASE) MCG/ACT inhaler
[53730]
1 Inhaler, , starting 1/3/18, Normal
albuterol HFA (PROAIR HFA) 108 (90 BASE)
MCG/ACT inhaler [113635]
1 Inhaler, , starting 1/3/18, Normal
albuterol 1.25 MG/3ML neb soln [68326] starting 1/3/18, Normal
albuterol 2.5 mg/0.5 mL neb soln [34315] starting 1/3/18, Normal
albuterol (2.5 MG/3ML) 0.083% neb soln [34314] starting 1/3/18, Normal
ipratropium (ATROVENT HFA) 17 MCG/ACT
inhaler [107267]
1 Inhaler, , starting 1/3/18, Normal
ipratropium (ATROVENT) 0.02 % neb soln
[47883]
starting 1/3/18, Normal
Ipratropium-Albuterol (COMBIVENT RESPIMAT)
Inhaler [152615]
1 Inhaler, , starting 1/3/18, Normal
ipratropium-albuterol (DUO-NEB) 0.5-2.5 (3)
MG/3ML neb soln [67220]
starting 1/3/18, Normal
Inhaled Cortcosteroids (ICS) [208644]
ICS and LAMA medication chart URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/respiratory/related/name-97743-
en.cckm
fluticasone HFA (FLOVENT HFA) 44 MCG/ACT
Inhaler [106425]
starting 1/3/18, Normal
fluticasone HFA (FLOVENT HFA) 110 MCG/ACT
Inhaler [106426]
starting 1/3/18, Normal
fluticasone HFA (FLOVENT HFA) 220 MCG/ACT
Inhaler [106427]
starting 1/3/18, Normal
budesonide (PULMICORT) 0.25 MG/2ML neb
susp [65363]
starting 1/3/18, Normal
budesonide (PULMICORT) 0.5 MG/2ML neb susp
[65364]
starting 1/3/18, Normal
beclomethasone (QVAR) 40 MCG/ACT inhaler
[65596]
starting 1/3/18, Normal
beclomethasone (QVAR) 80 MCG/ACT inhaler
[65597]
starting 1/3/18, Normal
Inhaled cortcosteroids (ICS) / Long Acting Muscarinic Antagonists (LAMA) [208200]
ICS and LAMA medication chart URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/respiratory/related/name-97743-
en.cckm
Mometasone Furo-Formoterol Fum 100-5
MCG/ACT inhaler [141893]
1 Inhaler, , starting 1/3/18, Normal
Mometasone Furo-Formoterol Fum 200-5
MCG/ACT inhaler [141894]
1 Inhaler, , starting 1/3/18, Normal
budesonide-formoterol (SYMBICORT) 80-4.5
MCG/ACT inhaler [117728]
1 Inhaler, , starting 1/3/18, Normal
budesonide-formoterol (SYMBICORT) 160-4.5
MCG/ACT inhaler [117729]
1 Inhaler, , starting 1/3/18, Normal
Page 4 of 5
Printed by STRAKA, KEVIN F [KFS1] at 1/3/2018 1:35:52 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

fluticasone-salmeterol (ADVAIR HFA) 45-21
MCG/ACT Inhaler [113962]
1 Inhaler, , starting 1/3/18, Normal
fluticasone-salmeterol (ADVAIR HFA) 115-21
MCG/ACT Inhaler [113963]
1 Inhaler, , starting 1/3/18, Normal
fluticasone-salmeterol (ADVAIR HFA) 230-21
MCG/ACT Inhaler [113964]
1 Inhaler, , starting 1/3/18, Normal
Long Acting Muscarinic Antagonists [208645]
tiotropium (SPIRIVA) 18 MCG inhalant cap
[75472]
30 cap, , starting 1/3/18, Normal
Tiotropium Bromide Monohydrate 2.5 MCG/ACT
AERS [165878]
1 Inhaler, , starting 1/3/18, Normal
Leukotriene Modifier [208646]
montelukast (SINGULAIR) 10 MG tab - NOTE:
Order for adolescents greater than or equal to 15
years [58729]
30 tab, , starting 1/3/18, Normal
montelukast (SINGULAIR) 4 MG chew tab -
NOTE: Order for children >= 2 to < 6 years
[63727]
30 tab, , starting 1/3/18, Normal
montelukast (SINGULAIR) 5 MG chew tab -
NOTE: Order for children >= 6 to < 15 years
[58730]
30 tab, , starting 1/3/18, Normal
montelukast (SINGULAIR) 4 MG oral packet -
NOTE: Order for children >= 1 to < 2 years
[73012]
30 each, , starting 1/3/18, Normal
Follow-Up Care
Referrals [208647]
CONSULT TO PEDS PULMONARY [1009205] What question regarding the patient's medical care
would you like the specialist to answer? (REQUIRED):
CONSULT TO PEDS ALLERGY CLINIC
[1009089]
What question regarding the patient's medical care
would you like the specialist to answer? (REQUIRED):
Page 5 of 5
Printed by STRAKA, KEVIN F [KFS1] at 1/3/2018 1:35:52 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org