/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/order-sets/,/clinical/cckm-tools/content/order-sets/inpatient/,/clinical/cckm-tools/content/order-sets/inpatient/general-surgery/,

/clinical/cckm-tools/content/order-sets/inpatient/general-surgery/name-113735-en.cckm

201712341

page

100

UWHC,UWMF,

Tools,

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

IP - Emergency General Surgery (EGS) - Adult - Postoperative [5280]

IP - Emergency General Surgery (EGS) - Adult - Postoperative [5280] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, General Surgery


IP - Emergency General Surgery (EGS) - Adult - Postoperative [5280]
for Adult Patients OnlyIntended
Admission Status
Level of Care (Single Response) [187485]
*An admit patient order has already been written, but the level of care at which the patient
should be placed still needs to be identified.
Place Patient on General Care [ADT0018] General Care, has already been signed. This order
will ensure that the patient is placed at the appropriate
level of care.
Place Patient on Intermediate Care (IMC)
[ADT0018]
Intermediate Care, has already been signed. This
order will ensure that the patient is placed at the
appropriate level of care.
Place Patient on Intensive Care (ICU) [ADT0018] Intensive Care, has already been signed. This order
will ensure that the patient is placed at the appropriate
level of care.
Admit to Inpatient (Single Response) [188296]
Admit To Inpatient [ADT0001] Attending:
Admitting Resident:
Requested Floor:
Service:
I certify that an inpatient stay is medically necessary
because of either an anticipated LOS >2 midnights,
complexity and/or severity of illness, an inpatient-
only surgery, or a previously-authorized inpatient
stay. Rationale listed below. Yes
C - CLEAR DIAGNOSIS:
E - EVALUATIONS PLANNED:
R - RESULTS EXPECTED:
T - TREATMENTS ORDERED:
Post-Op/Phase II
Admit to Observation (Single Response)
[188297]
Admit To Observation [ADT0002] Attending:
Admitting Resident:
Requested Floor:
Service:
Post-Op/Phase II
Admit to Outpatient Short Stay (Single
Response) [188298]
Admit To Outpatient Short Stay [ADT0003] Attending:
Admitting Resident:
Requested Floor:
Service:
Post-Op/Phase II
Admission Status [95528]
Page 1 of 21
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Admit To Inpatient [ADT0001] Attending:
Admitting Resident:
Requested Floor:
Service:
I certify that an inpatient stay is medically necessary
because of either an anticipated LOS >2 midnights,
complexity and/or severity of illness, an inpatient-only
surgery, or a previously-authorized inpatient stay.
Rationale listed below. Yes
C - CLEAR DIAGNOSIS:
E - EVALUATIONS PLANNED:
R - RESULTS EXPECTED:
T - TREATMENTS ORDERED:
Post-Op/Phase II
Admit To Outpatient Short Stay [ADT0003] Attending:
Admitting Resident:
Requested Floor:
Service:
Post-Op/Phase II
Admission Status [84059]
Admit To Inpatient [ADT0001] Attending:
Admitting Resident:
Requested Floor:
Service:
I certify that an inpatient stay is medically necessary
because of either an anticipated LOS >2 midnights,
complexity and/or severity of illness, an inpatient-only
surgery, or a previously-authorized inpatient stay.
Rationale listed below. Yes
C - CLEAR DIAGNOSIS:
E - EVALUATIONS PLANNED:
R - RESULTS EXPECTED:
T - TREATMENTS ORDERED:
Post-Op/Phase II
Admit To Observation [ADT0002] Attending:
Admitting Resident:
Requested Floor:
Service:
Post-Op/Phase II
Admit To Outpatient Short Stay [ADT0003] Attending:
Admitting Resident:
Requested Floor:
Service:
Post-Op/Phase II
Venous Thromboembolism (VTE) Prophylaxis
VTE Prophylaxis (Single Response) [131999]
Caprini VTE Risk Assessment URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/hematology-and-
coagulation/related/name-97521-en.cckm
Low VTE Risk [130084]
VTE Prophylaxis - Reason Not Ordered
[COR0008]
ONCE, Routine
Reason Not Ordered: Low Risk
Post-Op/Phase II
Moderate VTE Risk with Low Bleed Risk (Single
Response) [209954]
Page 2 of 21
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enoxaparin (LOVENOX) subcutaneous injection
[800040]
40 mg, Subcutaneous, EVERY 24 HOURS, Post-
Op/Phase II
heparin subcutaneous injection [800290] 5,000 units, Subcutaneous, EVERY 12 HOURS,
Post-Op/Phase II
High VTE with Low Bleed Risk [211018]
enoxaparin (LOVENOX) subcutaneous injection
[800040]
40 mg, Subcutaneous, EVERY 24 HOURS, Post-
Op/Phase II
heparin subcutaneous injection [800290] 5,000 units, Subcutaneous, EVERY 8 HOURS, Post-
Op/Phase II
Sequential Compression Device (SCD)
(TREATMENT) [NURTRT0028]
CONTINUOUS, Routine
Left/Right/Bilateral? Bilateral
Sequential Compression Device (SCD) / Foot
Pump (SUPPLY) [EQP0023]
CONTINUOUS, Routine
Left/Right/Bilateral?
Type: Knee High
High Bleed Risk [129757]
Sequential Compression Device (SCD)
(TREATMENT) [NURTRT0028]
CONTINUOUS, Routine
Left/Right/Bilateral? Bilateral
Sequential Compression Device (SCD) / Foot
Pump (SUPPLY) [EQP0023]
CONTINUOUS, Routine
Left/Right/Bilateral?
Type: Knee High
Apply and Maintain Anti-Embolism Stocking
[NURTRT0039]
CONTINUOUS, Routine
Does this need to be inserted/placed?
Left/Right/Bilateral? Bilateral
Type: Knee high
Post-Op/Phase II
No VTE Prophylaxis [130084]
VTE Prophylaxis - Reason Not Ordered
[COR0008]
ONCE, Routine
Reason Not Ordered:
Post-Op/Phase II
VTE Prophylaxis (Single Response) [150176]
Caprini VTE Risk Assessment URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/hematology-and-
coagulation/related/name-97521-en.cckm
Low VTE Risk [130084]
VTE Prophylaxis - Reason Not Ordered
[COR0008]
ONCE, Routine
Reason Not Ordered: Low Risk
Post-Op/Phase II
Moderate VTE Risk with Low Bleed Risk (Single
Response) [209954]
enoxaparin (LOVENOX) subcutaneous injection
[800040]
40 mg, Subcutaneous, EVERY 24 HOURS, Post-
Op/Phase II
heparin subcutaneous injection [800290] 5,000 units, Subcutaneous, EVERY 12 HOURS,
Post-Op/Phase II
High VTE with Low Bleed Risk [211018]
enoxaparin (LOVENOX) subcutaneous injection
[800040]
40 mg, Subcutaneous, EVERY 24 HOURS, Post-
Op/Phase II
heparin subcutaneous injection [800290] 5,000 units, Subcutaneous, EVERY 12 HOURS,
Post-Op/Phase II
Sequential Compression Device (SCD)
(TREATMENT) [NURTRT0028]
CONTINUOUS, Routine
Left/Right/Bilateral? Bilateral
Sequential Compression Device (SCD) / Foot
Pump (SUPPLY) [EQP0023]
CONTINUOUS, Routine
Left/Right/Bilateral?
Type: Knee High
High Bleed Risk [129757]
Page 3 of 21
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12/2017CCKM@uwhealth.org

Sequential Compression Device (SCD)
(TREATMENT) [NURTRT0028]
CONTINUOUS, Routine
Left/Right/Bilateral? Bilateral
Sequential Compression Device (SCD) / Foot
Pump (SUPPLY) [EQP0023]
CONTINUOUS, Routine
Left/Right/Bilateral?
Type: Knee High
Apply and Maintain Anti-Embolism Stocking
[NURTRT0039]
CONTINUOUS, Routine
Does this need to be inserted/placed?
Left/Right/Bilateral? Bilateral
Type: Knee high
Post-Op/Phase II
No VTE Prophylaxis [130084]
VTE Prophylaxis - Reason Not Ordered
[COR0008]
ONCE, Routine
Reason Not Ordered:
Post-Op/Phase II
PACU Normoglycemia Management
Normoglycemia Management (Single Response) [217140]
Patients withOUT Diabetes and NOT on Insulin
Infusion [228192]
Glucose, POC [IPGLUCOSE] ONCE For 1 Occurrences, Routine, Glucose, POC
should always be ordered in conjunction with orders
for hypoglycemia management and monitoring as
indicated in the Hypoglycemia Management (Adult)
panel.
If Conditional, What Condition?
PACU
If Glucose POC 200 mg/dL or Greater Initiate
Perioperative Normoglycemia for Surgical
Patients Adult Delegation Protocol
[NURMON0167]
CONTINUOUS For 24 Hours, Routine, Use order set
Perioperative Normoglycemia for Surgical Patients
Delegation Protocol order set [6133] to place orders,
PACU
Patients WITH Diabetes and NOT on Insulin
Infusion [228194]
Glucose, POC [IPGLUCOSE] ONCE For 1 Occurrences, Routine, Glucose, POC
should always be ordered in conjunction with orders
for hypoglycemia management and monitoring as
indicated in the Hypoglycemia Management (Adult)
panel.
If Conditional, What Condition?
PACU
If Glucose POC is 180 mg/dL or Greater Initiate
Perioperative Normoglycemia for Surgical
Patients Adult Delegation Protocol
[NURMON0167]
ONCE For 1 Occurrences, Routine, Use order set
Perioperative Normoglycemia for Surgical Patients
Delegation Protocol order set [6133] to place orders,
PACU
Patient ON Insulin Infusion [217180]
insulin infusionSupplemental order set [1345] to order -Adult -Insulin Infusion -IP Use
Confirm Time and Value of Last Glucose POC
and Insulin Infusion Column [NURCOM0022]
ONCE, PACU
Hypoglycemia Management [216855]
URL:
Hypoglycemia Management (Adult) [191576]
Page 4 of 21
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12/2017CCKM@uwhealth.org

Glucose, POC [IPGLUCOSE] AS NEEDED FOR SIGNS AND SYMPTOMS OF
HYPOGLYCEMIA, Starting today For Until specified,
Routine, Glucose, POC should always be ordered in
conjunction with orders for hypoglycemia
management and monitoring as indicated in the
Hypoglycemia Management (Adult) panel.
If Conditional, What Condition?
PACU
Glucose, POC [IPGLUCOSE] AFTER PROVIDING HYPOGLYCEMIA
TREATMENT, Starting today For Until specified,
Routine, Glucose, POC should always be ordered in
conjunction with orders for hypoglycemia
management and monitoring as indicated in the
Hypoglycemia Management (Adult) panel.
If Conditional, What Condition?
Per hypoglycemia treatment algorithm Recheck
glucose 15 minutes after providing treatment until
glucose is greater than or equal to 70 mg/dL. If
patient has been critically low (i.e., glucose less than
40 mg/dL), recheck glucose after 1 hour to ensure
glucose remains greater than or equal to 70mg/dL.
After resolution of mild hypoglycemia (i.e., glucose
40-69 mg/dL), consider rechecking after 1 hour if
patient has signs/symptoms of hypoglycemia or is at
risk for a subsequent hypoglycemic event (e.g.,
previously administered insulin still active, altered
renal status, altered mental status, NPO or
interrupted nutrition, or any other condition that
increases hypoglycemia risk), PACU
Notify Provider [NURCOM0001] Provider to Notify: Provider
Notify based on: Blood Glucose,Other
If blood glucose > (mg/dL): 400
If blood glucose < (mg/dL): 40
Other: Nutritional status changes
PACU
Hypoglycemia Treatment for blood glucose less
than 40 mg/dL and patient able to eat/swallow
safely [NURCOM0022]
CONDITIONAL, Starting today For Until specified
If Conditional, What Condition? If blood glucose less
than 40mg/dL and patient able to eat/swallow safely.
Give 30 grams of carbohydrate (8 oz. of fruit juice).
Repeat treatment until glucose is 70 mg/dL or
greater., PACU
Hypoglycemia Treatment for blood glucose
between 40 to 69 mg/dL and patient able to
eat/swallow safely [NURCOM0022]
CONDITIONAL, Starting today For Until specified
If Conditional, What Condition? If glucose is 40-69
mg/dL and patient able to eat/swallow safely
Give 15 grams of carbohydrate (4 oz of fruit juice).
Repeat treatment until glucose is 70 mg/dL or
greater., PACU
glucose-vitamin C chew tab [50690] 16 g, Oral, EVERY 15 MINUTES PRN,
hypoglycemia, Hypoglycemia, For blood glucose 40-
69 mg/dL
Use in patients able to safely eat/swallow but unable
to tolerate volume of fruit juice or per patient
preference. Repeat every 15 minutes until blood
glucose is 70 mg/dL or greater.
PACU
Page 5 of 21
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glucose-vitamin C chew tab [50690] 32 g, Oral, EVERY 15 MINUTES PRN,
hypoglycemia, Hypoglycemia, For blood glucose
less than 40 mg/dL
Use in patients able to safely eat/swallow but unable
to tolerate volume of fruit juice or per patient
preference. Repeat every 15 minutes until blood
glucose is 70 mg/dL or greater.
PACU
glucagon injection kit [107799] 1 mg, Subcutaneous, PRN, For blood glucose less
than 69 mg/dL and patient unable to eat/swallow
safely AND has NO IV access
Repeat every 15 minutes until blood glucose is 70
mg/dL or greater. See Adult Hypoglycemia Algorithm
PACU
dextrose injection [800233] 12.5 g, Intravenous, PRN, For blood glucose 40-69
mg/dL and patient unable to eat/swallow safely AND
has IV access
Repeat every 15 minutes until blood glucose is 70
mg/dL or greater. See Adult Hypoglycemia Algorithm
PACU
dextrose injection [800233] 25 g, Intravenous, PRN, For blood glucose less than
40 mg/dL and patient unable to eat/swallow safely
AND has IV access.
Repeat every 15 minutes until blood glucose is 70
mg/dL or greater. See Adult Hypoglycemia Algorithm
PACU
GLUCOSE, WHOLE BLOOD [HCWBGLU] CONDITIONAL, Starting today For 7 Days, STAT
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition? Draw if blood
glucose is less than 40 mg/dL or greater than 400
mg/dL.
PACU
GLUCOSE, WHOLE BLOOD [HCWBGLU] CONDITIONAL, Starting 12/15/17 For 7 Days, STAT
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition? Draw if blood
glucose is less than 40 mg/dL or greater than 400
mg/dL.
PACU
Post-OP Normoglycemia Management
Normoglycemia Management (Single Response) [216839]
Patients withOUT Diabetes and NOT on Insulin
Infusion [228199]
Glucose, POC [IPGLUCOSE] CONDITIONAL For 8 Hours, Routine, Glucose, POC
should always be ordered in conjunction with orders
for hypoglycemia management and monitoring as
indicated in the Hypoglycemia Management (Adult)
panel.
If Conditional, What Condition?
Check once on arrival if PACU Glucose POC is >/=
180 mg/dL
Recheck in 4 hours if initial floor Glucose POC is
180-199 mg/dL, Post-Op/Phase II
Page 6 of 21
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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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12/2017CCKM@uwhealth.org

Glucose Monitoring and Response
[NURCOM0022]
ONCE For 1 Occurrences, If Glucose POC obtained
on arrival is:
< 180 mg/dL - no further action needed.
180-199 mg/dL - recheck and contact provider to
order the following: if patient is NPO, provider to
order glucose POC every 6 hours; if eating glucose
POC before meals and at bedtime. Provider should
order an A1c if not performed in the last 90 days.
200 mg/dL or greater - initiate Perioperative
Normoglycemia Delegation Protocol, Post-Op/Phase
II
If Glucose POC is 200 mg/dL or Greater Initiate
Perioperative Normoglycemia for Surgical
Patients Adult Delegation Protocol
[NURMON0167]
CONTINUOUS For 24 Hours, Routine, Use order set
Perioperative Normoglycemia for Surgical Patients
Delegation Protocol order set [6133] to place orders,
Post-Op/Phase II
Patients WITH Diabetes and NOT on Insulin
Infusion [228200]
Glucose, POC [IPGLUCOSE] ONCE For 1 Occurrences, Routine, Glucose, POC
should always be ordered in conjunction with orders
for hypoglycemia management and monitoring as
indicated in the Hypoglycemia Management (Adult)
panel.
If Conditional, What Condition?
Post-Op/Phase II
Glucose Monitoring and Response
[NURCOM0022]
ONCE For 1 Occurrences, If Glucose POC obtained
on arrival is:
<180 mg/dL - contact provider to order the following:
if patient is NPO, provider to order glucose POC
every 6 hours; if eating glucose POC before meals
and at bedtime. Provider should order an A1c if not
performed in the last 90 days.
180 mg/dL or greater - initiate Perioperative
Normoglycemia Delegation Protocol, Post-Op/Phase
II
If Glucose POC 180 mg/dL or Greater Initiate
Perioperative Normoglycemia for Surgical
Patients Adult Delegation Protocol
[NURMON0167]
CONTINUOUS, Routine, Use order set Perioperative
Normoglycemia for Surgical Patients Delegation
Protocol order set [6133] to place orders, Post-
Op/Phase II
Patient ON Insulin Infusion [217180]
insulin infusionSupplemental order set [1345] to order -Adult -Insulin Infusion -IP Use
Confirm Time and Value of Last Glucose POC
and Insulin Infusion Column [NURCOM0022]
ONCE, Post-Op/Phase II
Hypoglycemia Management [217170]
Hypoglycemia Management (Adult) [191576]
Glucose, POC [IPGLUCOSE] AS NEEDED FOR SIGNS AND SYMPTOMS OF
HYPOGLYCEMIA, Starting today For Until specified,
Routine, Glucose, POC should always be ordered in
conjunction with orders for hypoglycemia
management and monitoring as indicated in the
Hypoglycemia Management (Adult) panel.
If Conditional, What Condition?
Post-Op/Phase II
Page 7 of 21
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 12:04:19 PM
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12/2017CCKM@uwhealth.org

Glucose, POC [IPGLUCOSE] AFTER PROVIDING HYPOGLYCEMIA
TREATMENT, Starting today For Until specified,
Routine, Glucose, POC should always be ordered in
conjunction with orders for hypoglycemia
management and monitoring as indicated in the
Hypoglycemia Management (Adult) panel.
If Conditional, What Condition?
Per hypoglycemia treatment algorithm Recheck
glucose 15 minutes after providing treatment until
glucose is greater than or equal to 70 mg/dL. If
patient has been critically low (i.e., glucose less than
40 mg/dL), recheck glucose after 1 hour to ensure
glucose remains greater than or equal to 70mg/dL.
After resolution of mild hypoglycemia (i.e., glucose
40-69 mg/dL), consider rechecking after 1 hour if
patient has signs/symptoms of hypoglycemia or is at
risk for a subsequent hypoglycemic event (e.g.,
previously administered insulin still active, altered
renal status, altered mental status, NPO or
interrupted nutrition, or any other condition that
increases hypoglycemia risk), Post-Op/Phase II
Notify Provider [NURCOM0001] Provider to Notify: Provider
Notify based on: Blood Glucose,Other
If blood glucose > (mg/dL): 400
If blood glucose < (mg/dL): 40
Other: Nutritional status changes
Post-Op/Phase II
Hypoglycemia Treatment for blood glucose less
than 40 mg/dL and patient able to eat/swallow
safely [NURCOM0022]
CONDITIONAL, Starting today For Until specified
If Conditional, What Condition? If blood glucose less
than 40mg/dL and patient able to eat/swallow safely.
Give 30 grams of carbohydrate (8 oz. of fruit juice).
Repeat treatment until glucose is 70 mg/dL or
greater., Post-Op/Phase II
Hypoglycemia Treatment for blood glucose
between 40 to 69 mg/dL and patient able to
eat/swallow safely [NURCOM0022]
CONDITIONAL, Starting today For Until specified
If Conditional, What Condition? If glucose is 40-69
mg/dL and patient able to eat/swallow safely
Give 15 grams of carbohydrate (4 oz of fruit juice).
Repeat treatment until glucose is 70 mg/dL or
greater., Post-Op/Phase II
glucose-vitamin C chew tab [50690] 16 g, Oral, EVERY 15 MINUTES PRN,
hypoglycemia, Hypoglycemia, For blood glucose 40-
69 mg/dL
Use in patients able to safely eat/swallow but unable
to tolerate volume of fruit juice or per patient
preference. Repeat every 15 minutes until blood
glucose is 70 mg/dL or greater.
Post-Op/Phase II
glucose-vitamin C chew tab [50690] 32 g, Oral, EVERY 15 MINUTES PRN,
hypoglycemia, Hypoglycemia, For blood glucose
less than 40 mg/dL
Use in patients able to safely eat/swallow but unable
to tolerate volume of fruit juice or per patient
preference. Repeat every 15 minutes until blood
glucose is 70 mg/dL or greater.
Post-Op/Phase II
Page 8 of 21
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 12:04:19 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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12/2017CCKM@uwhealth.org

glucagon injection kit [107799] 1 mg, Subcutaneous, PRN, For blood glucose less
than 69 mg/dL and patient unable to eat/swallow
safely AND has NO IV access
Repeat every 15 minutes until blood glucose is 70
mg/dL or greater. See Adult Hypoglycemia Algorithm
Post-Op/Phase II
dextrose injection [800233] 12.5 g, Intravenous, PRN, For blood glucose 40-69
mg/dL and patient unable to eat/swallow safely AND
has IV access
Repeat every 15 minutes until blood glucose is 70
mg/dL or greater. See Adult Hypoglycemia Algorithm
Post-Op/Phase II
dextrose injection [800233] 25 g, Intravenous, PRN, For blood glucose less than
40 mg/dL and patient unable to eat/swallow safely
AND has IV access.
Repeat every 15 minutes until blood glucose is 70
mg/dL or greater. See Adult Hypoglycemia Algorithm
Post-Op/Phase II
GLUCOSE, WHOLE BLOOD [HCWBGLU] CONDITIONAL, Starting today For 7 Days, STAT
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition? Draw if blood
glucose is less than 40 mg/dL or greater than 400
mg/dL.
Post-Op/Phase II
GLUCOSE, WHOLE BLOOD [HCWBGLU] CONDITIONAL, Starting 12/15/17 For 7 Days, STAT
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition? Draw if blood
glucose is less than 40 mg/dL or greater than 400
mg/dL.
Post-Op/Phase II
Patient Care Orders
Vital Signs [153627]
Vital Signs [NURMON0013] SEE COMMENTS, Starting today For Until specified,
Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Every 1 hour times 2, then every 2 hours times 2, then
every 4 hours, Post-Op/Phase II
Vital Signs [NURMON0013] EVERY 8 HOURS, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Post-Op/Phase II
Orthostatic Vital Signs [NURMON0007] ONCE, Starting today For 1 Occurrences, Routine,
Post-Op/Phase II
Activity [153628]
Page 9 of 21
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Ambulate 3x Daily With Assistance Starting Day
of Procedure [NURACT0008]
CONTINUOUS, Starting today For Until specified,
Routine
AD LIB:
AMBULATE: with assistance,3x daily
CHAIR:
DANGLE:
BEDREST:
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Post-Op/Phase II
Abdominal Binder [NURTRT0014] CONTINUOUS, Routine
Type: Abdominal Binder
Wearing schedule: When out of bed
Chair [NURACT0008] CONTINUOUS, Routine
CHAIR: other (comment)
Nutrition [153629]
NPO With Sips and Chips [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: NPO
NPO: NPO with Ice Chips/Sips of Water
Bedside Meal Instructions:
Room Service Class:
Post-Op/Phase II
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:
Post-Op/Phase II
Clear Liquid Diet [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: Diet Modifications
Diet Modifications: Liquid
Liquid: Clear Liquid
No Red or Purple Dye:
Liquid Thickness: Thin
Bedside Meal Instructions:
Room Service Class:
Post-Op/Phase II
Full Liquid Diet [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: Diet Modifications
Diet Modifications: Liquid
Liquid: Full Liquid
No Red or Purple Dye:
Liquid Thickness: Thin
Bedside Meal Instructions:
Room Service Class:
Post-Op/Phase II
Page 10 of 21
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12/2017CCKM@uwhealth.org

General Diet [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: General (no Modifications)
Bedside Meal Instructions:
Room Service Class:
Post-Op/Phase II
Measure Caloric Intake [NURDIE0011] CONTINUOUS For 7 Days, Routine
Respiratory [153630]
Oxygen Therapy [RT0032] CONTINUOUS, Starting today For Until specified,
Routine
FiO2 (%) Titrate to Keep Sats >/= to ___%:
Liter Flow:
Titrate oxygen to maintain O2 sat at (%): 92
O2 Delivery Device: Nasal Cannula
Attempt to Wean Off Oxygen? Yes
Post-Op/Phase II
Pulse Oximetry [NURMON0009] SEE COMMENTS, Starting today, Routine, Every 1
hour times 2, then every 2 hours times 2, then every 4
hours, Post-Op/Phase II
Pulse Oximetry [NURMON0009] CONTINUOUS, Routine
Cough And Deep Breathe [NURTRT0019] EVERY 1 HOUR, Starting today For Until specified,
Routine, While awake., Post-Op/Phase II
Incentive Spirometry [NURTRT0018] EVERY 1 HOUR, Starting today For Until specified,
Routine, While awake., Post-Op/Phase II
Respiratory Therapy per Protocol [RT0035] Routine
Protocol Type:
Wound Care [153631]
Wound Care - Closed Incision with
Sutures/Staples [NURWND0055]
CONTINUOUS, Routine
Wound Site:
Wound Location:
Assess Frequency: EVERY 8 HOURS
Incision Closed With: Other (Comment)
(Sutures/Staples)
Maintain OR Dressing: Minimum of 48 hours
Remove OR Dressing after 48 hours: Yes
Removal of OR Dressing performed by: RN
Cleansing with Removal of OR Dressing: CHG
Primary Dressing (after 48 hours): Dry Gauze
Incision Care (after 48 hours): Cleanse daily with CHG
If dressing becomes saturated in 48 hours, sterile
dressing change? Yes - Notify provider
Post-Op/Phase II
Wound Care - Closed Incision with
Dermabond/Other [NURWND0055]
CONTINUOUS, Routine
Wound Site:
Wound Location:
Assess Frequency: EVERY 8 HOURS
Incision Closed With:
Post-Op/Phase II
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Wound Care - Open Wound [NURWND0015] CONTINUOUS, Routine
Wound Type: Open
Wound Site:
Wound Location: Other (Comment) (not applicable)
Assess Frequency: EVERY 8 HOURS
Care Frequency: 2X DAILY
Wash With:
Irrigate/Rinse With:
Apply (Must also enter separate medication order to
obtain drug):
Primary Dressing:
Secondary Dressing:
Post-Op/Phase II
Ostomy Care [229791]
Ostomy Care [229790]
Notify Provider for Ileostomy output > 500mL per
8 hours or > 1,500mL per 24 hours
[NURCOM0022]
CONTINUOUS, Post-Op/Phase II
Consult Ostomy Care Service (Inpatient)
[CON0052]
ONCE, Routine
Reason for Consult:
Can this consult be done via video?
Consult Nutrition (Inpatient) [CON0043] ONCE, Routine
Reason for Consult:
Delegate to Initiate and Manage Tube Feeding:
Delegate to Manage Diet Order/Supplement Order:
Delegate to Dysphagia Diet Order Progression:
Can this consult be done via video?
Intake and Output [153632]
Measure Intake And Output [NURMON0005] EVERY 4 HOURS, Starting today For Until specified,
Routine, Post-Op/Phase II
Non-Categorized Patient Care Orders [153633]
Maintain Urinary Catheter [NURELM0013] CONTINUOUS, Starting today For Until specified,
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: Indwelling Single Lumen
Indication for Placement: Postoperative Requirements
of Specific Procedure
Initiate Urinary Catheter Removal Protocol? (NP/PA
Must Select "No"):
Details: To Dependent Drainage
Does this need to be inserted/placed?
Post-Op/Phase II
Maintain nasogastric tube [NURTAD0040] CONTINUOUS, Routine
Status:
Flush With:
Flush Volume (mL):
Flush Frequency:
Do not manipulate or replace NG tube
[NURCOM0022]
ONCE
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Maintain Drain [NURTAD0003] CONTINUOUS, Routine
Type: Closed Suction (Jackson-Pratt)
Site:
Location:
Drainage Options: Bulb
Irrigate Frequency:
Irrigate With:
Irrigant Volume (mL):
Strip:
Strip For:
Dressing Change Frequency:
Dressing Type:
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
Post-Op/Phase II
Contingency Parameters [153634]
Notify Provider [NURCOM0001] Provider to Notify: Provider
If systolic blood pressure > (mmHg): 170
If systolic blood pressure < (mmHg): 90
If diastolic blood pressure > (mmHg): 100
If diastolic blood pressure < (mmHg): 60
If temperature > (C): 38.5
If temperature < (C):
If heart rate > (bpm): 120
If heart rate < (bpm): 60
If respiratory rate >: 30
If respiratory rate <: 8
If blood glucose > (mg/dL):
If blood glucose < (mg/dL):
If pain score >:
Pulse Oximetry < (%): 90
If urine output < (mL): 30 mL/h for 4 hours
Other: Pain not controlled with ordered analgesics or
ordered interventions.
Post-Op/Phase II
Intravenous Therapy
Premedications for Needle Insertion [153635]
Use lidocaine topical dressing kit for stable patient, no lidocaine allergies, have at least 30
minutes time prior to needing to use IV
Sodium chloride (bacteriostatic) 0.9% intradermal: Useful for patients requiring urgent IV
access; onset is immediate.
lidocaine (LMX) 4% topical dressing kit [66882] Topical, EVERY 1 HOUR PRN, peripheral line
insertion - see Admin Instructions
Do NOT apply to area greater than 200 square
centimeters (maximum 2.5 g/site; maximum 4 sites
per hour, 6 times per day). Do NOT leave on longer
than 2 hours. Use for stable patient, no allergies to
lidocaine, with at least 30 minutes time prior to IV use
Post-Op/Phase II
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sodium chloride (bacteriostatic) 0.9 % injection
[50585]
0.05-0.1 mL, Intradermal, PRN, peripheral line
insertion - see Admin Instructions
Use an insulin or TB syringe with a 25-30 gauge
needle to inject solution and create a wheal. Wait 30
seconds to 1 minute then insert IV catheter into center
of wheal. Use if IV is needed within 30 minutes.
Post-Op/Phase II
IV Fluids [153621]
dextrose 5%-NaCl 0.45% with KCl 20 mEq/L
infusion [44910]
Intravenous, CONTINUOUS, Post-Op/Phase II
dextrose 5%-NaCl 0.45% infusion [51613] Intravenous, CONTINUOUS, Post-Op/Phase II
lactated ringers infusion [38890] Intravenous, CONTINUOUS, Post-Op/Phase II
Medications - Anti-infectives - Therapeutic
Appendectomy (Single Response) [153601]
perforated appendix. -No Antibiotics need to be ordered for non
Perforated [228292]
cefoxitin (MEFOXIN) intraVENOUS [800022] 2 g, Intravenous, EVERY 12 HOURS For 5 Days,
Post-Op/Phase II
Severe Perforated, Immediate/Severe Reaction
to Penicillin or Known Cephalosporin [228293]
ciprofloxacin (CIPRO) intraVENOUS - NOTE:
Order for patients with severe or immediate IgE-
mediatied beta-lactam allergy or intolerance
[800031]
400 mg, Intravenous, EVERY 12 HOURS For 5
Days, Post-Op/Phase II
metRONIDazole (FLAGYL) intraVENOUS
[800062]
500 mg, Intravenous, EVERY 8 HOURS For 5 Days,
Post-Op/Phase II
Cholecystectomy (Single Response) [153614]
No antibiotics need to be ordered for non-infected cholecystectomy.
ampicillin/sulbactam (UNASYN) intraVENOUS -
First Line [800010]
3 g, Intravenous, EVERY 6 HOURS For 5 Days, Post-
Op/Phase II
clindamycin (CLEOCIN) intraVENOUS -
Immediate/Severe Reaction to Penicillin or Known
Cephalosporin Allergies [800033]
600 mg, Intravenous, EVERY 8 HOURS For 5 Days,
Post-Op/Phase II
Diverticulitis (s/p Hartmann's) (Single Response) [153603]
Cefoxitin - Ceftriaxone - Metronidazole [224186]
cefoxitin (MEFOXIN) intraVENOUS [800022] 2 g, Intravenous, EVERY 12 HOURS, Post-
Op/Phase II
ceftriaxone (ROCEPHIN) intraVENOUS [800027] 2 g, Intravenous, EVERY 24 HOURS For 5 Days,
Post-Op/Phase II
metRONIDazole (FLAGYL) intraVENOUS
[800062]
500 mg, Intravenous, EVERY 8 HOURS, Post-
Op/Phase II
Severe/Complicated [224188]
ciprofloxacin (CIPRO) intraVENOUS - NOTE:
Order for patients with severe or immediate IgE-
mediatied beta-lactam allergy or intolerance
[800031]
400 mg, Intravenous, EVERY 12 HOURS, Post-
Op/Phase II
metRONIDazole (FLAGYL) intraVENOUS
[800062]
500 mg, Intravenous, EVERY 8 HOURS, Post-
Op/Phase II
Multiple Allergies - SELECT 2 ANTIBIOTICS.
Note: Use of these orders requires notification of
Attending Surgeon [224200]
ciprofloxacin (CIPRO) intraVENOUS - NOTE:
Order for patients with severe or immediate IgE-
mediatied beta-lactam allergy or intolerance
[800031]
400 mg, Intravenous, EVERY 12 HOURS, Post-
Op/Phase II
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clindamycin (CLEOCIN) intraVENOUS [800033] 600 mg, Intravenous, EVERY 8 HOURS, Post-
Op/Phase II
gentamicin (GARAMYCIN) intraVENOUS
[800049]
5 mg/kg, Intravenous, EVERY 24 HOURS, Post-
Op/Phase II
Gastric or Duodenal Ulcer Perforation (Single Response) [153605]
First Line [228287]
cefoxitin (MEFOXIN) intraVENOUS [800022] 2 g, Intravenous, EVERY 12 HOURS, Post-
Op/Phase II
Multiple Allergies - SELECT 2 ANTIBIOTICS -
Note: Use of these orders requires notification of
Attending Surgeon [228289]
ciprofloxacin (CIPRO) intraVENOUS - NOTE:
Order for patients with severe or immediate IgE-
mediatied beta-lactam allergy or intolerance
[800031]
400 mg, Intravenous, EVERY 12 HOURS, Post-
Op/Phase II
clindamycin (CLEOCIN) intraVENOUS [800033] 600 mg, Intravenous, EVERY 8 HOURS, Post-
Op/Phase II
gentamicin (GARAMYCIN) intraVENOUS
[800049]
5 mg/kg, Intravenous, EVERY 24 HOURS, Post-
Op/Phase II
Gastric or Duodenal Ulcer Perforation (SEVERE/COMPLICATED) (Single Response) [190290]
species. Empiric alternative regimens do not provide reliable coverage for Enterococcus The
acquired or complicated infection. -communityEnterococcal coverage is not recommended for
care associated infections or for infections -necessary for healthEnterococcal coverage may be
enterococcus is isolated by culture.where
Ceftriaxone - meTRONIDazole - Fluconazole
[228324]
ceftriaxone (ROCEPHIN) intraVENOUS [800027] 2 g, Intravenous, EVERY 24 HOURS For 5 Days,
Post-Op/Phase II
metRONIDazole (FLAGYL) intraVENOUS
[800062]
500 mg, Intravenous, EVERY 8 HOURS For 15
Doses, Post-Op/Phase II
fluconazole (DIFLUCAN) intraVENOUS [800044] 400 mg, Intravenous, EVERY 24 HOURS For 5
Days
Cefepime - meTRONIDazole - Fluconazole
[228325]
cefepime (MAXIPIME) in dextrose 5 % 50 mL
bag [700167]
2 g, Intravenous
cefepime (MAXIPIME) in dextrose 5 % 50 mL
bag [700167]
2 g, Intravenous
Note: Run cefepime (MAXIPIME) over 4 hours
[950056]
EVERY 8 HOURS For 5 Days
metRONIDazole (FLAGYL) intraVENOUS
[800062]
500 mg, Intravenous, EVERY 8 HOURS For 15
Doses, Post-Op/Phase II
fluconazole (DIFLUCAN) intraVENOUS [800044] 400 mg, Intravenous, EVERY 24 HOURS For 5
Days, Post-Op/Phase II
Ciprofloxacin - meTRONIDazole - Fluconazole
[228326]
ciprofloxacin (CIPRO) intraVENOUS - NOTE:
Order for patients with severe or immediate IgE-
mediatied beta-lactam allergy or intolerance
[800031]
400 mg, Intravenous, EVERY 12 HOURS For 5
Days, Post-Op/Phase II
metRONIDazole (FLAGYL) intraVENOUS
[800062]
500 mg, Intravenous, EVERY 8 HOURS For 15
Doses, Post-Op/Phase II
fluconazole (DIFLUCAN) intraVENOUS [800044] 400 mg, Intravenous, EVERY 24 HOURS For 5
Days, Post-Op/Phase II
Other perforated viscus (Single Response) [153664]
First Line [228290]
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cefoxitin (MEFOXIN) intraVENOUS [800022] 2 g, Intravenous, EVERY 12 HOURS, Post-
Op/Phase II
Multiple Allergies - SELECT 2 ANTIBIOTICS -
Note: Use of these orders requires notification of
Attending Surgeon [228291]
ciprofloxacin (CIPRO) intraVENOUS - NOTE:
Order for patients with severe or immediate IgE-
mediatied beta-lactam allergy or intolerance
[800031]
400 mg, Intravenous, EVERY 12 HOURS, Post-
Op/Phase II
clindamycin (CLEOCIN) intraVENOUS [800033] 600 mg, Intravenous, EVERY 8 HOURS, Post-
Op/Phase II
gentamicin (GARAMYCIN) intraVENOUS
[800049]
5 mg/kg, Intravenous, EVERY 24 HOURS, Post-
Op/Phase II
Other perforated viscus (SEVERE/COMPLICATED) (Single Response) [190313]
species. Empiric alternative regimens do not provide reliable coverage for Enterococcus The
acquired or complicated infection. -communityEnterococcal coverage is not recommended for
care associated infections or for infections -necessary for healthEnterococcal coverage may be
enterococcus is isolated by culture.where
Ceftriaxone - meTRONIDazole - Fluconazole
[228327]
ceftriaxone (ROCEPHIN) intraVENOUS [800027] 2 g, Intravenous, EVERY 24 HOURS For 5 Days,
Post-Op/Phase II
metRONIDazole (FLAGYL) intraVENOUS
[800062]
500 mg, Intravenous, EVERY 8 HOURS For 15
Doses, Post-Op/Phase II
fluconazole (DIFLUCAN) intraVENOUS [800044] 400 mg, Intravenous, EVERY 24 HOURS For 5
Days
Cefepime - meTRONIDazole - Fluconazole
[228329]
cefepime (MAXIPIME) in dextrose 5 % 50 mL
bag [700167]
2 g, Intravenous
cefepime (MAXIPIME) in dextrose 5 % 50 mL
bag [700167]
2 g, Intravenous
Note: Run cefepime (MAXIPIME) over 4 hours
[950056]
EVERY 8 HOURS For 5 Days
metRONIDazole (FLAGYL) intraVENOUS
[800062]
500 mg, Intravenous, EVERY 8 HOURS For 15
Doses, Post-Op/Phase II
fluconazole (DIFLUCAN) intraVENOUS [800044] 400 mg, Intravenous, EVERY 24 HOURS For 5
Days, Post-Op/Phase II
Ciprofloxacin - meTRONIDazole - Fluconazole
[228330]
ciprofloxacin (CIPRO) intraVENOUS - NOTE:
Order for patients with severe or immediate IgE-
mediatied beta-lactam allergy or intolerance
[800031]
400 mg, Intravenous, EVERY 12 HOURS For 5
Days, Post-Op/Phase II
metRONIDazole (FLAGYL) intraVENOUS
[800062]
500 mg, Intravenous, EVERY 8 HOURS For 15
Doses, Post-Op/Phase II
fluconazole (DIFLUCAN) intraVENOUS [800044] 400 mg, Intravenous, EVERY 24 HOURS For 5
Days, Post-Op/Phase II
Necrotizing soft tissue infection or Necrotizing fasciitis (Single Response) [153607]
species. Empiric alternative regimens do not provide reliable coverage for Enterococcus The
acquired or complicated infection. -communityEnterococcal coverage is not recommended for
care associated infections or for infections -necessary for healthEnterococcal coverage may be
enterococcus is isolated by culture.where
Ceftriaxone - meTRONIDazole - Fluconazole -
Vancomycin - Clindamycin [228321]
ceftriaxone (ROCEPHIN) intraVENOUS [800027] 2 g, Intravenous, EVERY 24 HOURS For 5 Days,
Post-Op/Phase II
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metRONIDazole (FLAGYL) intraVENOUS
[800062]
500 mg, Intravenous, EVERY 8 HOURS For 15
Doses, Post-Op/Phase II
fluconazole (DIFLUCAN) intraVENOUS [800044] 400 mg, Intravenous, EVERY 24 HOURS For 5
Days, Post-Op/Phase II
vancomycin (VANCOCIN) intraVENOUS
[800084]
1 g, Intravenous, EVERY 12 HOURS For 5 Days,
Post-Op/Phase II
clindamycin (CLEOCIN) intraVENOUS [800033] 600 mg, Intravenous, EVERY 8 HOURS For 5 Days,
Post-Op/Phase II
Cefepime - meTRONIDazole - Fluconazole -
Vancomycin - Clindamycin [228322]
cefepime (MAXIPIME) in dextrose 5 % 50 mL
bag [700167]
2 g, Intravenous
cefepime (MAXIPIME) in dextrose 5 % 50 mL
bag [700167]
2 g, Intravenous
Note: Run cefepime (MAXIPIME) over 4 hours
[950056]
EVERY 8 HOURS For 5 Days
For additional information please refer to the UWHC
Guidelines for the Treatment of Gram Negative
Infections in Adults
metRONIDazole (FLAGYL) intraVENOUS
[800062]
500 mg, Intravenous, EVERY 8 HOURS For 15
Doses, Post-Op/Phase II
fluconazole (DIFLUCAN) intraVENOUS [800044] 400 mg, Intravenous, EVERY 24 HOURS For 5
Days, Post-Op/Phase II
vancomycin (VANCOCIN) intraVENOUS
[800084]
1 g, Intravenous, EVERY 12 HOURS For 5 Days,
Post-Op/Phase II
clindamycin (CLEOCIN) intraVENOUS [800033] 600 mg, Intravenous, EVERY 8 HOURS For 5 Days,
Post-Op/Phase II
Ciprofloxacin-meTRONIDazole-Fluconazole-
Vancomycin-Clindamycin - Pts with severe or
immediate IgE-medicated beta-lactam allergy or
intolerance [228323]
ciprofloxacin (CIPRO) intraVENOUS - NOTE:
Order for patients with severe or immediate IgE-
mediatied beta-lactam allergy or intolerance
[800031]
400 mg, Intravenous, EVERY 12 HOURS For 5
Days, Post-Op/Phase II
metRONIDazole (FLAGYL) intraVENOUS
[800062]
500 mg, Intravenous, EVERY 8 HOURS For 15
Doses, Post-Op/Phase II
fluconazole (DIFLUCAN) intraVENOUS [800044] 400 mg, Intravenous, EVERY 24 HOURS For 5
Days, Post-Op/Phase II
vancomycin (VANCOCIN) intraVENOUS
[800084]
1 g, Intravenous, EVERY 12 HOURS For 5 Days,
Post-Op/Phase II
clindamycin (CLEOCIN) intraVENOUS [800033] 600 mg, Intravenous, EVERY 8 HOURS For 5 Days,
Post-Op/Phase II
Medications - General
Analgesics - Acetaminophen - PRN (Single Response) [153618]
acetaMINOPHEN (TYLENOL) tab [34149] 650 mg, Oral, EVERY 4 HOURS PRN, pain/fever
Fever greater than 38.2 degrees C or See Pain
Management Algorithm for the Selection of As-
Needed Analgesics. No more than 4 grams
acetaminophen per 24 hours for adults or 15mg/kg per
dose for peds <40kg.
Post-Op/Phase II
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acetaMINOPHEN (TYLENOL) suppository
[34153]
650 mg, Rectal, EVERY 4 HOURS PRN, pain/fever
Fever greater than 38.2 degrees C or See Pain
Management Algorithm for the Selection of As-
Needed Analgesics.. No more than 4 grams
acetaminophen per 24 hours for adults or 15mg/kg per
dose for peds <40kg.
Post-Op/Phase II
Analgesics - NSAIDS - Scheduled [224028]
ketOROLAC (TORADOL) injection - NOTE: Do
NOT order ketorolac if patient 65 years or older,
50 kg or less, or serum creatinine 1.2 mg/dL or
more [800050]
15 mg, Intravenous, EVERY 6 HOURS For 24 Hours,
Post-Op/Phase II
Analgesics - Opioids - Oral - PRN [224029]
hydrocodone-acetaminophen (NORCO) 5-325
MG per tab [750021]
1-2 tab, Oral, EVERY 4 HOURS PRN, pain
See Pain Management Algorithm for the Selection of
As-Needed Analgesics.
No more than 4 grams acetaminophen per 24 hours
for adults or 15mg/kg per dose for peds <40kg
Post-Op/Phase II
Analgesics - Opioids - Intravenous - PRN (Single Response) [153619]
MORPHine PF injection [750057] 1-4 mg, Intravenous, EVERY 2 HOURS PRN For 24
Hours, pain
See Pain Management Algorithm for the Selection of
As-Needed Analgesics
for 4 Minutes, Post-Op/Phase II
HYDROmorphone PF (DILAUDID) injection
[750050]
0.2-0.8 mg, Intravenous, EVERY 2 HOURS PRN For
24 Hours, pain
See Pain Management Algorithm for the Selection of
As-Needed Analgesics
for 3 Minutes, Post-Op/Phase II
Anti-emetics [153624]
Adult - Standard - Anti-emetics [241948]
ondansetron (ZOFRAN ODT) disintegrating tab
[64224]
4 mg, Oral, EVERY 6 HOURS PRN,
nausea/vomiting
Use first line
Post-Op/Phase II
ondansetron (ZOFRAN) injection [800202] 4 mg, Intravenous, EVERY 6 HOURS PRN,
nausea/vomiting
Use first line if unable to take medications by mouth
or enteral tube OR if immediate effect is needed.
Post-Op/Phase II
prochlorperazine (COMPAZINE) tab [41372] 10 mg, Oral, EVERY 6 HOURS PRN,
nausea/vomiting
Use second line if there is inadequate response to
first line anti-emetic within 30 minutes. If there is no
response to second line therapy within 30 minutes,
notify provider
Post-Op/Phase II
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prochlorperazine (COMPAZINE) injection [41369] 10 mg, Intravenous, EVERY 6 HOURS PRN,
nausea/vomiting
Use second line. Use if there is inadequate
response to first line anti-emetic within 30 minutes
and if unable to take medications by mouth or
enteral tube OR if immediate effect is needed. If
there is no response to second line therapy within 30
minutes, notify provider
Post-Op/Phase II
Bowel Management [153625]
Adult - Bowel Management - Scheduled
[241951]
senna-docusate (SENOKOT S) 8.6-50 MG per
tab [60530]
2 tab, Oral, 2 X DAILY, Post-Op/Phase II
Adult - Bowel Management - As Needed
[241952]
polyethylene glycol (MIRALAX) oral packet
[61829]
17 g, Oral, 1 X DAILY PRN, constipation
First Line Therapy
Post-Op/Phase II
magnesium hydroxide (MILK OF MAGNESIA)
susp [65443]
30 mL, Oral, 1 X DAILY PRN, constipation
Second line therapy, if no response to first line
therapy within 12 hours
Post-Op/Phase II
bisacodyl (DULCOLAX) rectal suppository
[35231]
10 mg, Rectal, 1 X DAILY PRN, constipation
If unable to take medications by mouth or enteral
tube OR if need immediate laxation OR if failure of
second line agent after 6 hours
Post-Op/Phase II
Non-categorized [153626]
naloxone (NARCAN) injection [800199] 0.1 mg, Intravenous, PRN, opioid overdose
Laboratory
Postoperative Day 1 [153636]
CBC WITHOUT DIFFERENTIAL [HEMO] NEXT AM, Starting tomorrow at 5:00 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?
Post-Op/Phase II
CREATININE [CRET] NEXT AM, Starting tomorrow at 5:00 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?
Post-Op/Phase II
ELECTROLYTES [LYTE] NEXT AM, Starting tomorrow at 5:00 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?
Post-Op/Phase II
GLUCOSE [GLU] NEXT AM, Starting tomorrow at 5:00 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?
Post-Op/Phase II
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BUN [BUN] NEXT AM, Starting tomorrow at 5:00 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?
Post-Op/Phase II
CALCIUM [CA] NEXT AM, Starting tomorrow at 5:00 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?
Post-Op/Phase II
MAGNESIUM [MAG] NEXT AM, Starting tomorrow at 5:00 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?
Post-Op/Phase II
PHOSPHATE [PHOS] NEXT AM, Starting tomorrow at 5:00 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?
Post-Op/Phase II
Additional Labs for Cholecystectomy [153648]
ALKALINE PHOSPHATASE [ALKP] NEXT AM, Starting tomorrow at 5:00 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?
Post-Op/Phase II
AMYLASE [AMYL] NEXT AM, Starting tomorrow at 5:00 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?
Post-Op/Phase II
AST/SGOT [AST] NEXT AM, Starting tomorrow at 5:00 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?
Post-Op/Phase II
BILIRUBIN, TOTAL [TBIL] NEXT AM, Starting tomorrow at 5:00 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?
Post-Op/Phase II
GGT [GGT] NEXT AM, Starting tomorrow at 5:00 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?
Post-Op/Phase II
BestPractice
Page 20 of 21
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 12:04:19 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

No Hospital Problems have yet been identified [153637]
Specify Hospital Problem(s) [COR0018] You will be prompted to specify a hospital problem on
signing., Post-Op/Phase II
Page 21 of 21
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 12:04:19 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org