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/clinical/cckm-tools/content/order-sets/inpatient/emergency-medicine/name-124582-en.cckm

20180126

page

100

UWHC,UWMF,

Tools,

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

ED - Suspected Sepsis Treatment - Adult - [5510]

ED - Suspected Sepsis Treatment - Adult - [5510] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Emergency Medicine


ED - SUSPECTED SEPSIS TREATMENT - ADULT [5510]
Laboratory
Labs [183369]
BASIC METABOLIC PANEL [BMET] STAT, Starting today For 1 Occurrences, Routine,
Test includes Sodium; Potassium; Chloride; Carbon
Dioxide, Total; Anion Gap; Glucose; BUN; Creatinine;
and Calcium.
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
CBC WITH DIFFERENTIAL [CBC] STAT, 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?
Lactate for Suspected Sepsis [207960]
LACTATE [GM2255] STAT For 1 Occurrences, STAT
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition?
LACTATE [GM2255] CONDITIONAL, 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? Repeat in 3 hours if
previous lactate >2
URINALYSIS WITH MICROSCOPY [UA] STAT, 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?
CULTURE, URINE [URC] STAT, Starting today For 1 Occurrences, STAT
Does patient have an indwelling urinary catheter?
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
CULTURE, BLOOD, BACTERIA/YEAST (2
SITES) [116728]
.Practices for Blood Culturing Best This order equals 2 sites (4 bottles). See link below for
CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
NEXT DRAW, Routine, For optimum diagnosis of
sepsis, sample 3-4 sites only on the first day of a
septic episode. Cultures on subsequent days are of
minimal diagnostic value. Culture detects bacteria,
Candida and Cryptococcus. If filamentous fungi are
suspected see Culture, Blood, Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition?
Page 1 of 10
Printed by STRAKA, KEVIN F [KFS1] at 1/22/2018 1:48:41 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
NEXT DRAW, Routine, For optimum diagnosis of
sepsis, sample 3-4 sites only on the first day of a
septic episode. Cultures on subsequent days are of
minimal diagnostic value. Culture detects bacteria,
Candida and Cryptococcus. If filamentous fungi are
suspected see Culture, Blood, Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition?
ALBUMIN [ALB] STAT, 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?
ALKALINE PHOSPHATASE [ALKP] STAT, 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?
ALT/SGPT [ALT] STAT, 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?
AST/SGOT [AST] STAT, 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?
BILIRUBIN, TOTAL [TBIL] STAT, 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?
PROTEIN, TOTAL [TP] STAT, 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?
PROTHROMBIN TIME/INR [PT] STAT, 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?
TROPONIN [GM2447] STAT, 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?
Page 2 of 10
Printed by STRAKA, KEVIN F [KFS1] at 1/22/2018 1:48:41 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

PROCALCITONIN [HCPRCTON] STAT, Starting today For 1 Occurrences, Routine,
Accepted uses:
1. Diagnosis of community acquired pneumonia
2. Antibiotic de-escalation/discontinuation in patients
improving from bacterial pneumonia or culture-
negative sepsis
It should NOT be ordered in the following conditions:
1. Evaluation of aspiration as it cannot differentiate
chemical from bacterial pneumonitis
2. Immunosuppressed patients
3. Culture-positive septicemia
4. Decompensated heart failure
5. Infectious disease syndromes other than
pneumonia or sepsis
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Diagnostic Tests and Imaging
Cardiology [183370]
ECG - 12 Lead [EKG0008] ONCE, Starting today For 1 Occurrences, Routine
Reason for exam: Other (enter comments)
Comment: Suspected Sepsis
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.
General Radiology [183371]
X-RAY CHEST SINGLE VIEW [R71045] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, STAT
Current signs and symptoms? Suspected sepsis
What specific question(s) would you like answered by
this exam? Suspected sepsis
Relevant recent/past history?
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
Intravenous Therapy
IV Fluids [183372]
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
sodium chloride 0.9% IV BOLUS [730003] 1,000 mL, Intravenous, ONCE For 1 Doses
sodium chloride 0.9% IV BOLUS [730003] 500 mL, Intravenous, EVERY 15 MINUTES PRN,
CVP less than 8 mmHg
Wide open to gravity or Pressure bag (not on pump)
lactated ringers BOLUS [730001] Intravenous, ONCE For 1 Doses
lactated ringers infusion [38890] Intravenous, CONTINUOUS
Medications
Undifferentiated (Single Response) [139988]
Page 3 of 10
Printed by STRAKA, KEVIN F [KFS1] at 1/22/2018 1:48:41 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Cefepime - Vancomycin [234669]
cefepime (MAXIPIME) intraVENOUS [800016] 2 g, Intravenous, ONCE For 1 Doses
vancomycin (VANCOCIN) intraVENOUS
(Maximum Dose 2 grams) [800084]
25 mg/kg, Intravenous, ONCE For 1 Doses
Maximum concentration: peripheral 5 mg/mL; central
line 10 mg/mL
Maximum dose 2 grams
Vancomycin - Piperacillin/Tazobactam [234670]
vancomycin (VANCOCIN) intraVENOUS
(Maximum dose 2 grams) [800084]
25 mg/kg, Intravenous, ONCE For 1 Doses
Maximum concentration: peripheral 5 mg/mL; central
line 10 mg/mL
Maximum dose 2 grams
piperacillin/tazobactam (ZOSYN) intraVENOUS
[800074]
4.5 g, Intravenous, ONCE For 1 Doses
For Severely Ill patients (ADD-ON) (Single Response) [139971]
tobramycin (NEBCIN) intraVENOUS [800081] 7 mg/kg, Intravenous, ONCE For 1 Doses
Vasoactive Agents [95594]
Intensive Care Vasoactive Continuous Infusion
Titration - Adult - delegation protocol
URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/?path=/content/delegationpractice-
protocols/inpatient-delegation-protocols/name-
97289-en.cckm
norepinephrine (LEVOPHED) infusion [700247] 0.01-2 mcg/kg/min, Intravenous, CONTINUOUS
Titrate per Intensive Care Vasoactive Continuous
Infusion Titration - Adult - delegation protocol. Initiate
at 0.01 mcg/kg/min or current rate and titrate to
maintain SBP greater than *** mmHg and MAP
greater than *** mmHg
Sepsis of Unknown Origin
Diagnosis and Management of Sepsis - Adult -
Emergency Department/Inpatient Clinical Practice
Guideline
URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/?path=/content/cpg/infection-and-
isolation/name-97553-en.cckm
Use of Procalcitonin Monitoring Related To The
Diagnosis and Treatment of Respiratory Track
Infections and Emerging Sepsis - Adult - Inpatient
Clinical Practice Guideline
URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/?
path=/content/cpg/laboratory/name-97554-
en.cckm
Anti-infectives: Treatment of Patients With
Reported Allergies to Beta-Lactam Antibiotics -
Adult - Inpatient Clinical Practice Guideline
URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/?path=/content/cpg/infection-and-
isolation/name-97535-en.cckm
Treatment of Patients with Reported Allergies to
Beta-Lactam Antibiotics – Adult – Inpatient –
Clinical Practice Guideline
URL:
High Suspicion for Apiration Pneumonia (vancomycin AND piperacillin/tazobactam, optional
tobramycin) [226658]
Vancomycin (Maximum Dose = 2000 mg) and
Piperacillin/Tazobactam 4.5 grams [243903]
vancomycin (VANCOCIN) intraVENOUS
[800084]
25 mg/kg, Intravenous, ONCE For 1 Doses
Note: Vancomycin Dosing Per Pharmacy
[950027]
CONTINUOUS
piperacillin-tazobactam (ZOSYN) 4.5 g vial +
minibag [54251]
4.5 g, Intravenous, ONCE For 1 Doses, for .5 Hours
piperacillin-tazobactam (ZOSYN) 4.5 g vial +
minibag [54251]
4.5 g, Intravenous, EVERY 8 HOURS
Note: Run piperacillin-tazobactam (ZOSYN) over
4 hours [950048]
EVERY 8 HOURS
If Patient is in Septic Shock (add to above
options) [243909]
Page 4 of 10
Printed by STRAKA, KEVIN F [KFS1] at 1/22/2018 1:48:41 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

tobramycin (NEBCIN) intraVENOUS [800081] 7 mg/kg, Intravenous, EVERY 24 HOURS
Note: Tobramycin Level Per Pharmacy [950025] ONCE For 1 Doses
High suspicion for urinary tract infection source (vancomycin AND cefepime, optional tobramycin)
[227059]
Vancomycin and Prolonged Cefepime Infusion
[243888]
vancomycin (VANCOCIN) intraVENOUS -
(Maximum Dose = 2000 mg) [800084]
25 mg/kg, Intravenous, ONCE For 1 Doses
Note: Vancomycin Dosing Per Pharmacy
[950027]
CONTINUOUS
cefepime (MAXIPIME) in dextrose 5 % 50 mL
bag [700167]
2 g, Intravenous, ONCE For 1 Doses
cefepime (MAXIPIME) in dextrose 5 % 50 mL
bag [700167]
2 g, Intravenous, EVERY 8 HOURS
Start 6 hours after initial one-time order
Note: Run cefepime (MAXIPIME) over 4 hours
[950056]
EVERY 8 HOURS
If Patient is in Septic Shock (add to above
options) [243891]
tobramycin (NEBCIN) intraVENOUS [800081] 5 mg/kg, Intravenous, EVERY 24 HOURS
Note: Tobramycin Level Per Pharmacy [950025] ONCE For 1 Doses
High suspicion for intra-abdominal source (vancomycin AND piperacillin/tazobactam, optional
tobramycin) [227073]
Vancomycin (Maximum Dose = 2000 mg) and
Piperacillin/Tazobactam 4.5 grams [234744]
vancomycin (VANCOCIN) intraVENOUS
[800084]
25 mg/kg, Intravenous, ONCE For 1 Doses
Note: Vancomycin Dosing Per Pharmacy
[950027]
CONTINUOUS
piperacillin-tazobactam (ZOSYN) 4.5 g vial +
minibag [54251]
4.5 g, Intravenous, ONCE For 1 Doses, for .5 Hours
piperacillin-tazobactam (ZOSYN) 4.5 g vial +
minibag [54251]
4.5 g, Intravenous, EVERY 8 HOURS
Note: Run piperacillin-tazobactam (ZOSYN) over
4 hours [950048]
EVERY 8 HOURS
If Patient is in Septic Shock (add to above
options) [234751]
tobramycin (NEBCIN) intraVENOUS [800081] 5 mg/kg, Intravenous, EVERY 24 HOURS
Note: Tobramycin Level Per Pharmacy [950025] ONCE For 1 Doses
Any of the above indications and patients with a history of drug-resistant organisms at the likely
infection site OR who have received cefepime and/or piperacillin/tazobactam in the last 90 days
(vancomycin AND meropenem, optional tobramycin) [226662]
Meropenem is ideal only for patients with exposure to cefepime and piperacillin/tazobactam
within the last 90 days. Selection of meropenem requires ID approval, pager: 3333
Vancomycin and Meropenem [234755]
vancomycin (VANCOCIN) intraVENOUS
[800084]
25 mg/kg, Intravenous, ONCE For 1 Doses
Note: Vancomycin Dosing Per Pharmacy
[950027]
CONTINUOUS
meropenem (MERREM) 500 mg vial + minibag
[53238]
500 mg, Intravenous, ONCE For 1 Doses, for .5
Hours
Page 5 of 10
Printed by STRAKA, KEVIN F [KFS1] at 1/22/2018 1:48:41 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

meropenem (MERREM) 500 mg vial + minibag
[53238]
500 mg, Intravenous, EVERY 6 HOURS For 96
Hours
Start 6 hours after initial one-time order
for 3 Hours
Note: Run meropenem (MERREM) over 3 hours
[950049]
EVERY 6 HOURS
Tobramycin - Drug Level [234759]
tobramycin (NEBCIN) intraVENOUS - Use ideal
body weight to dose, If patient is greater then
20% of ideal body weightt, use adjusted body
weight [800081]
7 mg/kg, Intravenous, EVERY 24 HOURS
Note: Tobramycin Level Per Pharmacy [950025] ONCE For 1 Doses
CULTURE, BLOOD, BACTERIA/YEAST (2
SITES) [234636]
.Practices for Blood Culturing Best This order equals 2 sites (4 bottles). See link below for
CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
STAT For 1 Occurrences, Routine, For optimum
diagnosis of sepsis, sample 3-4 sites only on the first
day of a septic episode. Cultures on subsequent
days are of minimal diagnostic value. Culture
detects bacteria, Candida and Cryptococcus. If
filamentous fungi are suspected see Culture, Blood,
Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition?
CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
STAT For 1 Occurrences, Routine, For optimum
diagnosis of sepsis, sample 3-4 sites only on the first
day of a septic episode. Cultures on subsequent
days are of minimal diagnostic value. Culture
detects bacteria, Candida and Cryptococcus. If
filamentous fungi are suspected see Culture, Blood,
Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition?
Culture, Sputum with Gram Stain (Expectorated
with Conditional Induction) [117211]
CULTURE, SPUTUM WITH GRAM STAIN
[HCSPUCS]
NEXT AM For 1 Occurrences, Routine, For patients
with an ET tube or tracheostomy, quantitative mini-
BAL by RT or bronchoscopic BAL are the preferred
methods of specimen collection.
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition?
If unable to obtain expectorated sputum within 4
hours, contact RT to induce sputum
RT To Induce Sputum [RT0043] ONCE, Routine, If patient unable to expectorate
sputum within 4 hours, RT to induce sputum
MRSA by PCR for Pneumonia (Nares and
Throat) [234639]
1. Only order MRSA by PCR tests if the patient is receiving anti-MRSA therapy.
2. The negative predictive value of MRSA by PCR testing exceeds 90% when both Nares and
Throat specimens are ordered.
Page 6 of 10
Printed by STRAKA, KEVIN F [KFS1] at 1/22/2018 1:48:41 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

MRSA by PCR- Nares, Left and Right [HCMRSA] ONCE For 1 Occurrences, Routine, There is no
need to obtain repeated surveillance tests to clear
patients from MRSA isolation. Once a patient is
flagged as MRSA positive it will remain in the
HealthLink header indefinitely.
For NICU patients: left and right nares only.
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition?
Consider if patient unable to provide respiratory
sample.
MRSA by PCR- Throat [HCMRSA] ONCE For 1 Occurrences, Routine, There is no
need to obtain repeated surveillance tests to clear
patients from MRSA isolation. Once a patient is
flagged as MRSA positive it will remain in the
HealthLink header indefinitely.
For NICU patients: left and right nares only.
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition?
Consider if patient unable to provide respiratory
sample.
MRSA by PCR for SSTI/Cellulitis (Nares and
Pooled Axilla/Groin) [234641]
1. Only order MRSA by PCR tests if the patient is receiving anti-MRSA therapy.
2. The negative predictive value of MRSA by PCR testing exceeds 90% when both Nares and
Pooled Axilla/Groin specimens are ordered.
MRSA by PCR- Nares, Left and Right [HCMRSA] ONCE For 1 Occurrences, Routine, There is no
need to obtain repeated surveillance tests to clear
patients from MRSA isolation. Once a patient is
flagged as MRSA positive it will remain in the
HealthLink header indefinitely.
For NICU patients: left and right nares only.
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition?
Consider if the suspected source is skin.
MRSA by PCR- Pooled Axilla/Groin [HCMRSA] ONCE For 1 Occurrences, Routine, There is no
need to obtain repeated surveillance tests to clear
patients from MRSA isolation. Once a patient is
flagged as MRSA positive it will remain in the
HealthLink header indefinitely.
For NICU patients: left and right nares only.
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition?
Consider if the suspected source is skin.
LACTATE [GM2255] ONCE, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Page 7 of 10
Printed by STRAKA, KEVIN F [KFS1] at 1/22/2018 1:48:41 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

URINALYSIS WITH MICROSCOPY [UA] 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?
CULTURE, URINE [URC] NEXT AM For 1 Occurrences, Routine
Does patient have an indwelling urinary catheter?
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
STREP PNEUMONIAE AG, URINE [GM4545] ONCE, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
LEGIONELLA URINARY AG [GM4910] ONCE, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
PROCALCITONIN [HCPRCTON] ADD ON For 1 Occurrences, Routine, Accepted uses:
1. Diagnosis of community acquired pneumonia
2. Antibiotic de-escalation/discontinuation in patients
improving from bacterial pneumonia or culture-
negative sepsis
It should NOT be ordered in the following conditions:
1. Evaluation of aspiration as it cannot differentiate
chemical from bacterial pneumonitis
2. Immunosuppressed patients
3. Culture-positive septicemia
4. Decompensated heart failure
5. Infectious disease syndromes other than
pneumonia or sepsis
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Add to next scheduled draw for this patient today
Any of the above indications and patients with severe reaction or immediate IgE mediated allergy to
beta-lactams [226665]
3333of linezolid requires ID approval after first dose, Pager: Selection
Choose one gram positive agent (vancomycin or
linezold) [240006]
linezolid (ZYVOX) intraVENOUS [800110] 600 mg, Intravenous, EVERY 12 HOURS For 96
Hours
Vancomycin - Vancomycin Note [240007]
vancomycin (VANCOCIN) intraVENOUS
[800084]
25 mg/kg, Intravenous, ONCE For 1 Doses
Note: Vancomycin Dosing Per Pharmacy
[950027]
CONTINUOUS
Add one gram negative agent (aztreonam,
tobramycin or ciprofloxacin) [234714]
aztreonam (AZACTAM) intraVENOUS [800013] 2 g, Intravenous, EVERY 8 HOURS For 96 Hours
Tobramycin - IV and Drug Level [234767]
tobramycin (NEBCIN) intraVENOUS [800081] Intravenous, EVERY 24 HOURS
Note: Tobramycin Level Per Pharmacy [950025] ONCE For 1 Doses
ciprofloxacin (CIPRO) intraVENOUS [800031] 600 mg, Intravenous, EVERY 12 HOURS
Page 8 of 10
Printed by STRAKA, KEVIN F [KFS1] at 1/22/2018 1:48:41 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Choose 1 additional gram negative agent to the
above options if patient is in septic shock
(aztreonam, tobramycin or ciprofloxacin)
[234716]
aztreonam (AZACTAM) intraVENOUS [800013] 2 g, Intravenous, EVERY 8 HOURS For 96 Hours
Tobramycin - IV and Drug Level [243896]
tobramycin (NEBCIN) intraVENOUS [800081] Intravenous, EVERY 24 HOURS
Note: Tobramycin Level Per Pharmacy [950025] ONCE For 1 Doses
ciprofloxacin (CIPRO) intraVENOUS [800031] 600 mg, Intravenous, EVERY 12 HOURS
Add to the above options if concerned for intra-
abdominal source (metRONIDazole) [226716]
metRONIDazole (FLAGYL) intraVENOUS
[800062]
500 mg, Intravenous, EVERY 8 HOURS
Patient Care Orders
Vital Signs [183376]
Vital Signs [NURMON0013] EVERY 1 HOUR, STAT
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Patient Monitoring [183377]
Cardiac Rhythm Monitoring - Adult
[NURMON0010]
ONCE, Routine
Indication:
Notify Provider:
Functional Cardiac Defibrillator Present:
Measure Central Venous Pressure
[NURMON0002]
EVERY 8 HOURS, Routine
Maintain Arterial Line [NURVAD0001] CONTINUOUS, Routine
Device Status:
Flush Solution:
Site:
Maintain Central Venous Access [NURVAD0023] CONTINUOUS, Routine
Device Status:
Insert and Maintain Urinary Catheter
[NURELM0013]
CONTINUOUS, 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:
Indication for Placement:
Details: To Dependent Drainage
Does this need to be inserted/placed?
Respiratory [183378]
Pulse Oximetry on Room Air - Once
[NURMON0009]
ONCE For 1 Occurrences, STAT
Pulse Oximetry [NURMON0009] ONCE, Routine
Oxygen Therapy [RT0032] CONTINUOUS, Routine
FiO2 (%) Titrate to Keep Sats >/= to ___%:
Liter Flow:
Titrate oxygen to maintain O2 sat at (%):
O2 Delivery Device:
Attempt to Wean Off Oxygen?
Non-Categorized Patient Care Orders [183379]
Page 9 of 10
Printed by STRAKA, KEVIN F [KFS1] at 1/22/2018 1:48:41 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

NG Tube Placement - Adult [120994]
Insert and Maintain Nasogastric Tube
[NURTAD0014]
CONTINUOUS, Routine
Options:
Flush with:
Flush Frequency: EVERY 8 HOURS
Clamp NG Tube:
Check Residual:
Does this need to be inserted/placed?
Device Status:
Refer to Policy 2.20 Enteral Tubes Used for
Instillation of Fluids, Medications, or Feeding
Recommendations for flush quantity:
For adult patients, 30 mLs of fluid should be
sufficient.
lidocaine-oxymetazoline 4%-0.05% (ADULT)
nasal spray [785081]
2 spray, Nasal, ONCE For 1 Doses
For numbing prior to feeding tube insertion.
Slowly spray the chosen nostril once, if required may
repeat x1 in opposite nostril. Angle toward back of
throat spraying the anterior nostril and wait 30-60
seconds before introducing more local
anesthetic into the nostril. Caution: Entire bottle
should not be used for insertion of tube. Discard
excess solution when procedure completed.
X-RAY ABDOMEN SINGLE VIEW [R74018] CONDITIONAL For 3 Days, Routine
Radiology Specialty Area: GENERAL IMAGING
Current signs and symptoms?
What specific question(s) would you like answered
by this exam? Evaluate nasogastric tube placement
Relevant recent/past history?
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 nasogastric
tube placement. The location of nasogastric tube
should be confirmed prior to the instillation of fluids
Central Line Tray [NURCOM0022] ONCE
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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