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/clinical/cckm-tools/content/order-sets/inpatient/emergency-medicine/name-98367-en.cckm

201709272

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UWHC,UWMF,

Tools,

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

ED - GU Complaint - Adult [649]

ED - GU Complaint - Adult [649] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Emergency Medicine


ED - GU Complaint - Adult [649]
Laboratory
Labs [6631]
URINALYSIS WITH MICROSCOPY [UA] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
HCG, QUALITATIVE, URINE [UPREG] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
C TRACHOMATIS AND N GONORRHOEAE BY
AMPLIFIED PROBE TECHNIQUE [HCCGAPT]
STAT For 1 Occurrences, Routine, Unacceptable
sources include throat (or any oropharyngeal sites),
rectal and eye.
If the specimen is urine, then the patient should not
urinate for at least one hour prior to the collection of
urine specimen. Collect the first 10-50 mL into a urine
container.
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
VAGINITITIS/VAGINOSIS WORKUP [131622]
CULTURE, YEAST, VAGINAL WITH SMEAR
[HCYSTCS]
STAT For 1 Occurrences, Routine, Simultaneous
Testing for Culture, Trichmonas with Wet Prep;
Culture, Yeast, Vaginal with Smear; and Gram Stain
for Bacterial Vaginosis is highly recommended.
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition?
TRICHOMONAS VAGINALIS BY AMPLIFIED
PROBE TECHNIQUE [TVAPT]
STAT For 1 Occurrences, Routine, This test is for
vaginal, endocervical and urine specimens. For
male urethral specimens see Trichomonas vaginalis
by TMA [UTVTMA].
If the specimen is urine, then the patient should not
urinate for at least one hour prior to the collection of
urine specimen. Collect the first 10-50 mL into a
urine container.
Simultaneous testing for Trichomonas vaginalis by
Amplified Probe Technique; Culture, Yeast, Vaginal
with Smear and Gram Stain for Bacterial Vaginosis
is highly recommended.
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition?
GRAM STAIN VAGINAL FOR BACTERIAL
VAGINOSIS [HCGSVG]
STAT For 1 Occurrences, Routine, Simultaneous
Testing for Culture, Trichmonas with Wet Prep;
Culture, Yeast, Vaginal with Smear; and Gram Stain
for Bacterial Vaginosis is highly recommended.
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition?
Page 1 of 5
Printed by STRAKA, KEVIN F [KFS1] at 9/27/2017 9:54:57 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
09/2017CCKM@uwhealth.org

Set up for Bimanual Pelvic Exam
[NURCOM0022]
ONCE
HIV Ab/Ag Combo [HIVABAG] STAT For 1 Occurrences, Routine, I, the ordering
provider, have verified that the patient/patient's
authorized representative was:
1. Notified that the patient will be subjected to an HIV
test unless the patient/rep declines the test;
2. Given educational materials on HIV and HIV testing;
3. Notified that they may decline the test and health
care providers may not use the fact that the
patient/rep declined an HIV test as a basis for denying
other services; and
4. Provided an opportunity to ask questions and to
decline the HIV test.
The ordering provider verifies:
5. The patient/patient's authorized representative
understands that an HIV test will be performed; and
6. The decision of the patient/rep regarding whether to
have an HIV test performed was not coerced or
involuntary.
Pt/Pt's Rep did not opt out. Steps listed in instructions
taken. If test is declined, type ".HIVTESTDECLINE" in
progress note.
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
CULTURE, URINE [URC] STAT 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?
CBC WITH DIFFERENTIAL [CBC] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
BASIC METABOLIC PANEL [BMET] STAT 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?
LIPASE [LIPS] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
HCG, QUANTITATIVE [BHCG] STAT For 1 Occurrences, Routine, This test is not
intended for aiding in the diagnosis of cancer or for
monitoring the treatment of cancer patients.
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Page 2 of 5
Printed by STRAKA, KEVIN F [KFS1] at 9/27/2017 9:54:57 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
09/2017CCKM@uwhealth.org

PROTHROMBIN TIME/INR [PT] STAT 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 For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
TYPE AND SCREEN [HCTS] STAT For 1 Occurrences, Routine, As good clinical
practice and for patient safety, the Transfusion Service
will automatically crossmatch 2 packed RBCs on all
patients with antibodies to ensure blood would be
available in the event it is needed. If you would like to
opt out of this automatic order for this patient please
contact the UWHC Blood Bank at (608) 263-8367 or
The American Center Lab at (608) 234-6600 as
appropriate.
Diagnostic Tests and Imaging
General Radiology [6579]
X-RAY ABDOMEN >= 2 VIEWS [R74020] ONCE-RAD NEXT AVAILABLE For 1 Occurrences,
Routine
Current signs and symptoms?
What specific question(s) would you like answered by
this exam?
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
X-RAY ABDOMEN AP VIEW (KUB) [R74000] ONCE-RAD NEXT AVAILABLE For 1 Occurrences,
Routine
Radiology Specialty Area: GENERAL IMAGING
Current signs and symptoms?
What specific question(s) would you like answered by
this exam?
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
Page 3 of 5
Printed by STRAKA, KEVIN F [KFS1] at 9/27/2017 9:54:57 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
09/2017CCKM@uwhealth.org

CT FLANK PAIN [R99992] ONCE-RAD NEXT AVAILABLE For 1 Occurrences,
Routine
Current signs and symptoms?
What specific question(s) would you like answered by
this exam?
Relevant recent/past history?
Is patient pregnant?
For scheduling purposes, does the patient require
general anesthesia, sedation or anxiolytics? Note:
ordering provider is responsible for prescribing oral
anxiolytics or arranging peds anesthesia / sedation
services. See reference link above.
Last patient weight? (will auto pull in value and date in
comment):
Transport Method:
US PELVIS [R76856] ONCE-RAD NEXT AVAILABLE For 1 Occurrences,
Routine
Radiology Specialty Area: ULTRASOUND
Current signs and symptoms?
What specific question(s) would you like answered by
this exam?
Relevant recent/past history?
For scheduling purposes, does the patient require
general anesthesia, sedation or anxiolytics? Note:
ordering provider is responsible for prescribing oral
anxiolytics or arranging peds anesthesia / sedation
services. See reference link above.
If being performed remotely, where?
Transport Method: Floor Determined/Entered
US TESTICLES/ PENIS [R76870] ONCE-RAD NEXT AVAILABLE For 1 Occurrences,
Routine
Current signs and symptoms?
What specific question(s) would you like answered by
this exam?
Relevant recent/past history?
For scheduling purposes, does the patient require
general anesthesia, sedation or anxiolytics? Note:
ordering provider is responsible for prescribing oral
anxiolytics or arranging peds anesthesia / sedation
services. See reference link above.
If being performed remotely, where?
Transport Method: Floor Determined/Entered
Intravenous Therapy
IV Fluids [133198]
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Starting today, STAT
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
sodium chloride 0.9 % infusion BOLUS [730003] 1,000 mL, Intravenous, ONCE For 1 Doses
sodium chloride 0.9 % infusion [64367] at 125 mL/hr, Intravenous, CONTINUOUS
Medications
Analgesics - NSAIDS (Single Response) [140798]
ibuprofen (MOTRIN) tab [38353] 600 mg, Oral, ONCE For 1 Doses
Page 4 of 5
Printed by STRAKA, KEVIN F [KFS1] at 9/27/2017 9:54:57 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
09/2017CCKM@uwhealth.org

ketOROLAC (TORADOL) injection - - NOTE: Do
NOT order for patients 65 years or older, 50 kg or
less and serum creatinine greater than 0.5 mg/dL
[800050]
15 mg, Intravenous, ONCE For 1 Doses
ketOROLAC (TORADOL) injection - - NOTE: Do
NOT order for patients 65 years or older, 50 kg or
less and serum creatinine greater than 0.5 mg/dL
[800050]
30 mg, Intramuscular, ONCE For 1 Doses
Analgesics - Parenteral Opioids (Single Response) [140799]
MORPHine PF injection [800122] 4 mg, Intravenous, ONCE For 1 Doses
MORPHine PF injection [800122] 8 mg, Intravenous, ONCE For 1 Doses
HYDROmorphone PF (DILAUDID) injection
[800120]
0.5 mg, Intravenous, ONCE For 1 Doses
HYDROmorphone PF (DILAUDID) injection
[800120]
1 mg, Intravenous, ONCE For 1 Doses
Analgesics - Miscellaneous [140802]
acetaMINOPHEN (TYLENOL) tab [34149] 650 mg, Oral, ONCE For 1 Doses
Antiemetics [133253]
ondansetron (ZOFRAN ODT) disintegrating tab
[64224]
4 mg, Oral, ONCE For 1 Doses
1st line therapy
ondansetron (ZOFRAN) injection [800202] 4 mg, Intravenous, ONCE For 1 Doses
2nd line therapy. Administer if patient unable to
tolerate orally.
metoclopramide (REGLAN) injection [800059] 10 mg, Intravenous, ONCE For 1 Doses
Patient Care Orders
Vital Signs [6745]
Vital Signs [NURMON0013] EVERY 1 HOUR, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Nutrition [140732]
Diet NPO except medications [NURDIE0012] CONTINUOUS, Routine
Diet: NPO (Except medications)
Non-Categorized Patient Care [133371]
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?
Page 5 of 5
Printed by STRAKA, KEVIN F [KFS1] at 9/27/2017 9:54:57 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
09/2017CCKM@uwhealth.org