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/clinical/cckm-tools/content/order-sets/inpatient/general-surgery/name-113246-en.cckm

201709248

page

100

UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,General Surgery

IP - Thyroid/Parathyroid Surgery - Adult - Discharge [5056]

IP - Thyroid/Parathyroid Surgery - Adult - Discharge [5056] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, General Surgery


IP - Thyroid/Parathyroid Surgery - Adult - Discharge [5056]
Skilled Nursing Facility Orders
This Patient is going to a skilled nursing facilty, directly below is a group of orders commonly
associated with this patient population. Please review the orders below and select the appropriate
ones for this patient. If this patient is not going to a SNF, contact Case Management to update the
discharge plan. Updating the discharge plan will remove this set of SNF orders from the order set.
Skilled Nursing Facility Certification Statement [114940]
Facility Certification Statement [NURCOM0069] Routine
Skilled Nursing Facility Certification Statement [118260]
Facility Certification Statement [NURCOM0069] Routine
Skilled Nursing Facility Admit Order [114941]
Admit to Skilled Nursing Facility [ADT0015] Routine
Skilled Nursing Facility Admit Order [118261]
Admit to Skilled Nursing Facility [ADT0015] Routine
Skilled Nursing Facility Patient Care Orders [111713]
For dyspnea, Oxygen at 2 L/minute per nasal
canula; If this is an acute change for the patient
call PCP with assessment ASAP after oxygen is
started. Suction PRN to clear airways.
[NURCOM0022]
Routine
DME - Home Oxygen [1009468] Patient's O2 Requirements Assessed and Meets
Criteria for Home O2:
Delivery Device:
Equipment Needed:
Continuous (liters/min):
Continuous (FiO2):
With Activity (liters/min):
With Activity (FiO2):
With Sleep (liters/min):
With Sleep (FiO2):
Length of Need:
Vendor:
DME - CPAP [1009443] Formal Sleep Study Completed:
Diagnosis:
CPAP Pressure (cmH2O):
Oxygen Bleed-In (Liters/min):
Oxygen Bleed-In (FiO2):
If New Prescription for Oxygen Bleed-In, Patient's O2
Requirements Assessd and Meets Criteria for Home
O2:
Vendor:
Vendor City:
Vendor Phone:
Vendor Fax:
Page 1 of 12
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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2017CCKM@uwhealth.org

DME - BiPAP (S) [1009441] Patient Has Been Assessed and Meets Criteria for
Home BiPAP (S):
Diagnosis:
BiPAP Pressure - IPAP - Inspiratory Pressure
(cmH2O):
BiPAP Pressure - EPAP - Expiratory Pressure
(cmH2O):
Oxygen Bleed-In (Liters/min):
Oxygen Bleed-In (FiO2):
If New Prescription for Oxygen Bleed-In, Patient's O2
Requirements Assessd and Meets Criteria for Home
O2:
Vendor:
Vendor City:
Vendor Phone:
Vendor Fax:
DME - BiPAP (S/T) [1009442] Patient Has Been Assessed and Meets Criteria for
Home BiPAP (S/T):
Diagnosis:
Respiratory Rate:
BiPAP Pressure - IPAP - Inspiratory Pressure
(cmH2O):
BiPAP Pressure - EPAP - Expiratory Pressure
(cmH2O):
Oxygen Bleed-In (Liters/min):
Oxygen Bleed-In (FiO2):
If New Prescription for Oxygen Bleed-In, Patient's O2
Requirements Assessd and Meets Criteria for Home
O2:
Vendor:
Vendor City:
Vendor Phone:
Vendor Fax:
Patient may self administer medication per RN
assessment [NURCOM0022]
Routine
Patient medications (per Skilled Nursing Facility
policy) may be left at bedside [NURCOM0022]
Routine
Facility Therapy Needs [113391]
Physical Therapy to Evaluate and Treat at Next
Facility [NURCOM0022]
Routine
Occupational Therapy to Evaluate and Treat at
Next Facility [NURCOM0022]
Routine
Speech Therapy to Evaluate and Treat at Next
Facility [NURCOM0022]
Routine
Communicable Diseases [111717]
State Law requires at least one of the following statements be checked for your patient. May check both if
applicable
DHS 132.52 URL: http://docs.legis.wisconsin.gov/code/admin_code/dhs/110/132/V/52
Patient has been screened for TB within the last
90 days prior to admission and does not have any
other clinically apparent communicable diseases.
[NURCOM0022]
Routine
Patient has been found to have a communicable
disease, procedures to treat and limit the spread
of the disease have been ordered.
[NURCOM0022]
Routine
Page 2 of 12
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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
09/2017CCKM@uwhealth.org

Communicable Diseases [118262]
State Law requires at least one of the following statements be checked for your patient. May check both if
applicable
DHS 132.52 URL: http://docs.legis.wisconsin.gov/code/admin_code/dhs/110/132/V/52
Patient has been screened for TB within the last
90 days prior to admission and does not have any
other clinically apparent communicable diseases.
[NURCOM0022]
Routine
Patient has been found to have a communicable
disease, procedures to treat and limit the spread
of the disease have been ordered.
[NURCOM0022]
Routine
Analgesics [111708]
acetaMINOPHEN (TYLENOL) tab [34149] 650 mg, 1 tab, 1, starting 9/1/17, No Print
acetaMINOPHEN (TYLENOL) suppository
[34153]
650 mg, 1 suppository, 1, starting 9/1/17, No Print
Blood Glucose Management [111710]
glucagon 1 mg injection kit [107799] 1 mg, 1 each, 1, starting 9/1/17, No Print
Glucose 40 % oral gel [118089] 10 g, 1 Tube, 1, starting 9/1/17, No Print
Nursing Communication [NURCOM0022] Routine, Notify {Notify for Blood Glucose:3004146} if
blood glucose is greater than 400 mg/dL or less than
40 mg/dL
Diabetes Care Instructions [NURCOM0112] Routine, - Patient's blood glucose goal range before
meals is *** mg/dL.
- Monitor patient's blood glucose {Glucose Monitoring
Frequency:25242}.
- If your patient's blood glucoses are uncontrolled
contact provider.
- "Uncontrolled" blood glucoses mean:
* Blood glucose above 150 mg/dL more than half the
time during a week.
* Blood glucose over *** mg/dL.
* Blood glucose less than 70 mg/dL two or more times
per week (or if having signs/symptoms of low blood
glucose such as shaking, sweating, or light-
headedness).
Bowel Management [111709]
bisacodyl (DULCOLAX) rectal suppository
[35231]
10 mg, 1 suppository, 1, starting 9/1/17, No Print
Senna-Docusate Sodium 8.6-50 MG per tab
[70181]
1-2 tab, 1 tab, 1, starting 9/1/17, No Print
magnesium hydroxide (MILK OF MAGNESIA)
susp [65443]
30 mL, 1 Bottle, 1, starting 9/1/17, No Print
polyethylene glycol (MIRALAX) oral powder
[61353]
17 g, 1 Bottle, 1, starting 9/1/17, No Print
Non-categorized Medications [111711]
guaifenesin-dextroMETHORPHAN (ROBITUSSIN
DM) syrup [51568]
10 mL, 1 Bottle, 1, starting 9/1/17, No Print
carbamide peroxide (DEBROX) 6.5% otic soln
[35545]
3 drop, 1 Bottle, 1, starting 9/1/17 until 9/6/17, No Print
alum-mag-simeth (MYLANTA ES) susp [44073] 30 mL, 1 Bottle, 1, starting 9/1/17, No Print
Patient Care Orders
Confirmed Discharge Date/Time [151653]
Page 3 of 12
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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
09/2017CCKM@uwhealth.org

Confirmed Discharge Date/Time [ADT0013] Confirmed Discharge Date:
Confirmed Discharge Time:
Conditions for Discharge:
Provider to be Present at Discharge?
Reason For Hospitalization [135013]
Why You Were Hospitalized [NURCOM0073] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care
Plan., Routine, You were admitted for post-operative
monitoring following your thyroid/parathyroid
procedure.
Activity [135014]
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
- Most people return to work within one week.
- Avoid straining or extreme bending of your neck.
- Do not lift more than 20 pounds for the first week.
- Avoid strenuous activity for one week.
- Do NOT drive or operate any machinery until you are
no longer taking opioid pain pills and can turn your
head to the side 90 degrees with ease.
Nutrition [135017]
Diet [NUT8888] Routine
General:
Diet Modifications:
Other Diet Modifications:
Wound Care (Single Response) [135024]
Wound Care - Closure With Dermabond
[NURWND0015]
Routine, - Your wound is closed with glue and tape.
The glue is waterproof, so it is OK to shower or get it
wet.
- The glue and tape will start to peel off in 10-14 days.
- If the edges curl up prior to your next appointment, it
is OK to trim them with a small scissors.
- You will have pieces of tape over the glue, leave
them on until your next appointment (10-14 days).
- NO swimming or soaking in water for 14 days after
surgery
- Do NOT use ointments, powders, or creams on the
wound.
Wound Care - Closure With Removable Suture
[NURWND0015]
Routine, - Your wound is closed with sutures (that
need to be removed), tape, and a clear dressing. The
dressing is waterproof, so it is OK to shower or get it
wet.
- Small pieces of tape are used to reinforce the
incision. The pieces of tape should remain in place
until your next appointment (6-8 days).
- If the edges curl up prior to your next appointment, it
is ok to trim them with a small scissors.
- The tape over your incision may be covered with a
clear dressing. If a clear dressing is present, it may be
removed in 2 days.
- No swimming or soaking in water for 14 days after
surgery.
- Do NOT use ointments, powders, or creams on the
wound.
Wound Care [NURWND0015] Routine
Bladder Care [135025]
Page 4 of 12
Printed by O'BRIEN, RYLEY P [RPO249] at 9/1/2017 1:21:08 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
09/2017CCKM@uwhealth.org

Bladder Care [NURELM0067] Routine
Bowel Care [135026]
Bowel Care [NURELM0068] Routine
Other Patient Care Instructions [135027]
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
Please provide patient with appropriate HFFY
(e.g. Thyroid Surgery, Minimally Invasive
Parathyroid Surgery) prior to discharge.
[NURCOM0022]
ONCE
Medication Instructions [NURCOM0022] Routine, If you develop numbness and tingling in your
face, lips, fingertips, or toes take four (4) TUMS 500
mg tablets (2000mg Calcium Carbonate). The
numbness and tingling should go away in 30 minutes.
If the numbness and tingling do not go away after 30
minutes take an additional 2000mg of TUMS (four
500mg tablets). If the numbness and tingling still do
not go away 30 minutes after the second dose of
TUMS, please call us.
When to Call Your Doctor [135028]
When to Call Your Doctor [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 you have any of the following
symptoms contact The American Center Specialty
Clinic at 608-440-6300 (this is a 24 hour number).
- You have Nausea or vomiting lasting more than 24
hours
- You have not had a bowel movement in 3 days
- You have a temperature above 101degrees F
- You have excess swelling or bleeding
- You have increase redness and/or warmth at the
incision site
- You have pus-like drainage
- You have pain not relieved by pain pills
- You have rapid or excess bruising (some bruising is
normal)
- You have sudden shortness of breath or cough
- You have cramping/swelling to leg
- You have dark urine
- You have numbness and/or tingling of your
fingertips, face, lips or toes that does not resolve with
2 doses of TUMS
- Any other symptoms that concern you
- This is rare, but if you are panicked due to trouble
breathing, sudden swelling in your throat, or are
unable to swallow, call 911.
Heart Failure Recommended Care
Page 5 of 12
Printed by O'BRIEN, RYLEY P [RPO249] at 9/1/2017 1:21:08 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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09/2017CCKM@uwhealth.org

These order groups are showing because either your patient has an EF < 40% documented or
has Heart Failure on their problem list.
UW Health HF guideline URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/cardiovascular/name-97485-
en.cckm
Heart Failure Discharge Instructions [190359]
Weigh yourself daily or as directed
[NURCOM0071]
Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care
Plan., Routine
When to Call Your Doctor [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, Call your doctor if you have any of
these symptoms as they may indicate worsening
Heart Failure:
- Increased shortness of breath
- Cough or chest congestion
- Swelling in your abdomen or legs
- Any increase or decrease in weight of more than 3
pounds in a day or 5 pounds total
If you do not have a scheduled return
appointment, please schedule an appointment
with your primary physician [NURCOM0071]
Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care
Plan., Routine
Core Measure Documentation - ACE Inhibitor/ARB (Single Response) [150651]
Core Measures - This Does NOT Generate A Medication Order (Use Med Reconciliation To
Prescribe Medications)
ACE Inhibitor/ARB Reason Not Ordered
[COR0001]
ONCE, Starting today For 1 Occurrences, Routine
Reason Not Ordered:
ACE Inhibitor/ARB Already Ordered [COR0001] ONCE, Starting today For 1 Occurrences, Routine
Reason Not Ordered: Other (Comments required for
not ordering BOTH an ACEI and an ARB)
Follow-Up Care
Follow-Up Appointments [135029]
Verify Patient's Scheduled Appointment
[NURCOM0026]
Reason for Hospital Follow Up Appointment: Postop
visit
Which Provider: Patient's Specific PCP/Care Team
When do you want appointment:
Which Clinic or Specialty: Attending Surgeon
Follow Up Appointments - Diabetes (Single Response) [148552]
*** RESPONSE REQUIRED *** This order facilitates documentation (only) about follow-up
appointments for patients with diabetes. Scheduling an appointment before discharge with a
provider who will manage a patient’s diabetes care (e.g., primary care physician, endocrinologist,
etc.) is a Joint Commission requirement. Exclusions are allowed based upon patient situation
(e.g., discharge to a skilled nursing facility, patient refusal, etc.). Only select “Appointment
Scheduled” if an appointment has already been scheduled, and use the Schedule Appointment
order as needed to request assistance in scheduling
Page 6 of 12
Printed by O'BRIEN, RYLEY P [RPO249] at 9/1/2017 1:21:08 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
09/2017CCKM@uwhealth.org

No appointment: Patient does not have diabetes
[COR0064]
ONCE, Starting today For 1 Occurrences, Routine
Documentation (required): No appointment: Patient
does not have diabetes
1. This order facilitates documentation (only) about
follow-up appointments for patients with diabetes.
2. Scheduling an appointment before discharge with a
provider who will manage a patient's diabetes care
(e.g., primary care physician, endocrinologist, etc.) is a
Joint Commission requirement. Exclusions are
allowed based upon patient situation (e.g., patient
discharging to a skilled nursing facility, patient refusal,
etc.)
3. Only select "Appointment Scheduled" if an
appointment has already been scheduled with a
provider who can manage patient's diabetes.
4. Use the Schedule Appointment order as needed to
request assistance in scheduling an appointment.
Appointment scheduled (with provider who can
manage diabetes) [COR0064]
ONCE, Starting today For 1 Occurrences, Routine
Documentation (required): Appointment scheduled
(with provider who can manage diabetes)
1. This order facilitates documentation (only) about
follow-up appointments for patients with diabetes.
2. Scheduling an appointment before discharge with a
provider who will manage a patient's diabetes care
(e.g., primary care physician, endocrinologist, etc.) is a
Joint Commission requirement. Exclusions are
allowed based upon patient situation (e.g., patient
discharging to a skilled nursing facility, patient refusal,
etc.)
3. Only select "Appointment Scheduled" if an
appointment has already been scheduled with a
provider who can manage patient's diabetes.
4. Use the Schedule Appointment order as needed to
request assistance in scheduling an appointment.
Appointment scheduled per patient report
(ENTER DATE IN COMMENTS) [COR0064]
ONCE, Starting today For 1 Occurrences, Routine
Documentation (required): Appointment scheduled per
patient report (ENTER DATE IN COMMENTS)
1. This order facilitates documentation (only) about
follow-up appointments for patients with diabetes.
2. Scheduling an appointment before discharge with a
provider who will manage a patient's diabetes care
(e.g., primary care physician, endocrinologist, etc.) is a
Joint Commission requirement. Exclusions are
allowed based upon patient situation (e.g., patient
discharging to a skilled nursing facility, patient refusal,
etc.)
3. Only select "Appointment Scheduled" if an
appointment has already been scheduled with a
provider who can manage patient's diabetes.
4. Use the Schedule Appointment order as needed to
request assistance in scheduling an appointment.
Page 7 of 12
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09/2017CCKM@uwhealth.org

Appointment pending: patient discharged on
weekend; follow-up information provided
[COR0064]
ONCE, Starting today For 1 Occurrences, Routine
Documentation (required): Appointment pending:
patient discharged on weekend; follow-up information
provided
1. This order facilitates documentation (only) about
follow-up appointments for patients with diabetes.
2. Scheduling an appointment before discharge with a
provider who will manage a patient's diabetes care
(e.g., primary care physician, endocrinologist, etc.) is a
Joint Commission requirement. Exclusions are
allowed based upon patient situation (e.g., patient
discharging to a skilled nursing facility, patient refusal,
etc.)
3. Only select "Appointment Scheduled" if an
appointment has already been scheduled with a
provider who can manage patient's diabetes.
4. Use the Schedule Appointment order as needed to
request assistance in scheduling an appointment.
Free clinic information provided [COR0064] ONCE, Starting today For 1 Occurrences, Routine
Documentation (required): Free clinic information
provided
1. This order facilitates documentation (only) about
follow-up appointments for patients with diabetes.
2. Scheduling an appointment before discharge with a
provider who will manage a patient's diabetes care
(e.g., primary care physician, endocrinologist, etc.) is a
Joint Commission requirement. Exclusions are
allowed based upon patient situation (e.g., patient
discharging to a skilled nursing facility, patient refusal,
etc.)
3. Only select "Appointment Scheduled" if an
appointment has already been scheduled with a
provider who can manage patient's diabetes.
4. Use the Schedule Appointment order as needed to
request assistance in scheduling an appointment.
No appointment: Patient discharging to a facility
(e.g., skilled nursing facility, correctional facility,
etc.) [COR0064]
ONCE, Starting today For 1 Occurrences, Routine
Documentation (required): No appointment: Patient
discharging to a facility (e.g., skilled nursing facility,
correctional facility, etc.)
1. This order facilitates documentation (only) about
follow-up appointments for patients with diabetes.
2. Scheduling an appointment before discharge with a
provider who will manage a patient's diabetes care
(e.g., primary care physician, endocrinologist, etc.) is a
Joint Commission requirement. Exclusions are
allowed based upon patient situation (e.g., patient
discharging to a skilled nursing facility, patient refusal,
etc.)
3. Only select "Appointment Scheduled" if an
appointment has already been scheduled with a
provider who can manage patient's diabetes.
4. Use the Schedule Appointment order as needed to
request assistance in scheduling an appointment.
Page 8 of 12
Printed by O'BRIEN, RYLEY P [RPO249] at 9/1/2017 1:21:08 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
09/2017CCKM@uwhealth.org

No appointment: Patient refusal [COR0064] ONCE, Starting today For 1 Occurrences, Routine
Documentation (required): No appointment: Patient
refusal
1. This order facilitates documentation (only) about
follow-up appointments for patients with diabetes.
2. Scheduling an appointment before discharge with a
provider who will manage a patient's diabetes care
(e.g., primary care physician, endocrinologist, etc.) is a
Joint Commission requirement. Exclusions are
allowed based upon patient situation (e.g., patient
discharging to a skilled nursing facility, patient refusal,
etc.)
3. Only select "Appointment Scheduled" if an
appointment has already been scheduled with a
provider who can manage patient's diabetes.
4. Use the Schedule Appointment order as needed to
request assistance in scheduling an appointment.
Discharge Labs [134929]
Page 9 of 12
Printed by O'BRIEN, RYLEY P [RPO249] at 9/1/2017 1:21:08 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
09/2017CCKM@uwhealth.org

Please use the table below to determine what type of order to use to place discharge lab
orders.
Discharge Labs Workflow URL: https://uconnect.wisc.edu/growth/training--
education/health-link/10-minutes/inpatient-
discharge-consult/resources/name-82993-en.file
Recommended Discharge Labs [NURCOM0075] Details
Who is Responsible for the
Result?
Where Will Labs be
Completed?
What Order Should You
Use?
Current Attending Provider UW Health Lab Specific lab orders (A)
Non-UW Health Lab
Specific lab orders with order
class changed to OUTSIDE
(B)
Current Consulting Provider
UW Health Lab
Specific lab orders with
AUTHORIZING PROVIDER
CHANGED TO
CONSULTANT (A)
Non-UW Health Lab
Specific lab orders with order
class changed to OUTSIDE
and AUTHORIZING
PROVIDER CHANGED TO
CONSULTANT (B)
Another Provider
UW Health Lab
Recommended Discharge
Labs (C)
Non-UW Health Lab
Recommended Discharge
Labs (C)
(A) SPECIFIC LAB ORDERS:
These orders should be used if the CURRENT ATTENDING OR CONSULTING PROVIDER
will be responsible for the result of the lab AND the patient will have the labs completed at a
UW HEALTH LAB.
If a CONSULTING PROVIDER currently involved in the patient's care will be responsible for the
result, you must change the AUTHORIZING PROVIDER on the order to the CONSULTING
PROVIDER before signing the order. To do this, click the Providers button near the top of the
Review, Sign & Hold tab of the discharge navigator. Update the authorizing provider to the
consulting provider.
(B) SPECIFIC LAB ORDER WITH ORDER CLASS CHANGED TO OUTSIDE:
These orders should be used if the CURRENT ATTENDING OR CONSULTING PROVIDER
will be responsible for the result of the lab AND the patient will have labs completed at a NON-
UW HEALTH LAB.
If a CONSULTING PROVIDER currently involved in the patient’s care will be responsible for the
result, you must change the AUTHORIZING PROVIDER on the order to the CONSULTING
PROVIDER before signing the order. To do this, click the Providers button near the top of the
Review, Sign & Hold tab of the discharge navigator. Update the authorizing provider to the
consulting provider.
The patient will receive a paper order to take to the lab.
(C) RECOMMENDED DISCHARGE LABS:
This order should be used to recommend to another provider labs that a patient should have
completed after discharge. The provider designated in the 'Send Recommendations To' field is
responsible for PLACING the lab orders AND will be responsible for the RESULTS of any
ordered labs.
Page 10 of 12
Printed by O'BRIEN, RYLEY P [RPO249] at 9/1/2017 1:21:08 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
09/2017CCKM@uwhealth.org

Discharge Medications
Medications - Prescriptions - Analgesics [226987]
oxycodone 5 MG tab - 1-2t q4h prn [45976] 5-10 mg, 20 tab, 0, starting 9/1/17, Normal
oxycodone-acetaminophen (PERCOCET) 5-325
mg per tab - 1-2t q4h prn [40668]
1-2 tab, 20 tab, 0, starting 9/1/17, Normal
hydrocodone-acetaMINOPHEN (NORCO) 5-325
mg per tab - 1-2t q4h prn [71425]
1-2 tab, 20 tab, 0, starting 9/1/17, Normal
oxycodone 5 MG/5ML soln [45975] 5-10 mg, 100 mL, 0, starting 9/1/17, Normal
traMADOL (ULTRAM) 50 MG tab [50258] 25-50 mg, 20 tab, 0, starting 9/1/17, Normal
acetaMINOPHEN (TYLENOL) 325 MG tab
[34149]
325-650 mg, 20 tab, , starting 9/1/17, Normal
Medications - Levothyroxine [226988]
For MALIGNANT disease: Suggested dose is 2 mcg/kg.
For BENIGN disease: Suggested dose is based on patient's BMI (see below). BMI can be found
in the Outpatient chart (Snapshot/Ambulatory Vitals) or the Inpatient Doc Flowsheet.
levothyroxine (SYNTHROID) 25 MCG tab [39001] 25 mcg, 30 tab, 2, starting 9/1/17, Normal
levothyroxine (SYNTHROID) 50 MCG tab [39002] 50 mcg, 30 tab, 2, starting 9/1/17, Normal
levothyroxine (SYNTHROID) 75 MCG tab [39003] 75 mcg, 30 tab, 2, starting 9/1/17, Normal
levothyroxine (SYNTHROID) 88 MCG tab [45544] 88 mcg, 30 tab, 2, starting 9/1/17, Normal
levothyroxine (SYNTHROID) 100 MCG tab
[39004]
100 mcg, 30 tab, 2, starting 9/1/17, Normal
levothyroxine (SYNTHROID) 112 MCG tab
[45545]
112 mcg, 30 tab, 2, starting 9/1/17, Normal
levothyroxine (SYNTHROID) 125 MCG tab
[39005]
125 mcg, 30 tab, 2, starting 9/1/17, Normal
levothyroxine (SYNTHROID) 137 MCG tab
[45546]
137 mcg, 30 tab, 2, starting 9/1/17, Normal
levothyroxine (SYNTHROID) 150 MCG tab
[39006]
150 mcg, 30 tab, 2, starting 9/1/17, Normal
levothyroxine (SYNTHROID) 175 MCG tab
[45547]
175 mcg, 30 tab, 2, starting 9/1/17, Normal
levothyroxine (SYNTHROID) 200 MCG tab
[39007]
200 mcg, 30 tab, 2, starting 9/1/17, Normal
Medications - Calcitriol and Calcium Carbonate [226989]
BMI mcg/kg
Male Female
Less than 21 2.1 1.8
22-26 1.9 1.7
27-32 1.7 1.6
33-40 1.5 1.4
Greater than
40
1.3 1.2
Page 11 of 12
Printed by O'BRIEN, RYLEY P [RPO249] at 9/1/2017 1:21:08 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
09/2017CCKM@uwhealth.org

All parathyroid patients: Order calcium carbonate 1000 mg, 2 X Daily.
For total thyroid patients:
If PACU PTH>20, no scheduled calcium carbonate unless patient has Graves' disease.
If PACU PTH is 10 - 20 or for patients with Graves' disease, order calcium carbonate 1000 mg, 3
X daily.
If PACU PTH is 2 - 9 give calcitriol 0.25 mcg, 2 X daily and calcium carbonate 1000 mg, 3X daily.
If PACU PTH is <2, order calcitriol 0.5 mcg, 2 X daily and calcium carbonate 1000 mg 3X daily.
All total thyroid and parathyroid patients need an order for PRN calcium carbonate.
calcitriol (ROCALTROL) 0.25 MCG cap [44439] 0.25 mcg, 60 cap, 3, starting 9/1/17, Normal
calcitriol (ROCALTROL) 0.5 MCG cap [44440] 0.5 mcg, 60 cap, 3, starting 9/1/17, Normal
Calcium Carbonate 1000mg two times daily
[52229]
1,000 mg, 60 tab, 3, starting 9/1/17, Normal
Calcium Carbonate 1000mg three times daily
[52229]
1,000 mg, 60 tab, 3, starting 9/1/17, Normal
Calcium Carbonate 2000mg PRN [52229] 60 tab, 3, starting 9/1/17, Normal
Medications - Prescriptions - Non-Categorized [226990]
senna-docusate (SENOKOT S) 8.6-50 MG per
tab [60530]
2 tab, 20 tab, 0, starting 9/1/17, Normal
Page 12 of 12
Printed by O'BRIEN, RYLEY P [RPO249] at 9/1/2017 1:21:08 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
09/2017CCKM@uwhealth.org