/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-98345-en.cckm

201711325

page

100

UWHC,UWMF,

Tools,

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

IP - CRS - Enhanced Recovery After Surgery - Adult - Postoperative [4735]

IP - CRS - Enhanced Recovery After Surgery - Adult - Postoperative [4735] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, General Surgery


IP - CRS - Enhanced Recovery After Surgery - Adult - Postoperative [4735]
for Adult Patients OnlyIntended
Admission Status
Admission Status [135984]
Admit To Inpatient [ADT0001] Attending:
Admitting Resident:
Requested Floor:
Service: GENERAL SURGERY
Rationale for LOS greater than 2 midnights:
Post-Op/Phase II
Isolation Status
orders section below.patient requires Isolation, please search for isolation in the additional If
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]
enoxaparin (LOVENOX) subcutaneous
injection [800040]
40 mg, Subcutaneous, EVERY 24 HOURS, Post-
Op/Phase II
heparin PF 5000 UNIT/0.5ML injection
[156571]
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 PF 5000 UNIT/0.5ML injection
[156571]
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]
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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
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
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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
Patient Care Orders
Vital Signs [135986]
Page 3 of 13
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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 4, then every 2 hours times 2,
then every 4 hours times 2, then every 8 hours.,
Post-Op/Phase II
Activity [135987]
Activity - Day 0 [NURACT0008] CONTINUOUS, Starting today, Routine
AMBULATE: 3x daily
Mobilization within 6 hours postoperatively for 2
hours or more, Post-Op/Phase II
Activity - Day 1 and 2 starting
"Tomorrow" [NURACT0008]
CONTINUOUS, Starting tomorrow, Routine
Location:
Mobilization for 8 hours or more
- Ambulation 4 or more times mandatory
- All meals in chair
- In chair when not ambulating
- Restrict bedrest to around 2 hour naps x2, Post-
Op/Phase II
Nutrition [135988]
Low Fiber [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: Diet Modifications
Diet Modifications: Fiber
Fiber: Low Fiber
Bedside Meal Instructions:
Room Service Class:
Post-Op/Phase II
Nourishments & Supplements [NUT0005] EFFECTIVE NOW, Starting today, Routine
Medical Food / Oral Supplement(s):
Nourishment / Snack Item(s):
Schedule: BREAKFAST, LUNCH, DINNER
Post-Op/Phase II
Respiratory [135989]
Pulse Oximetry [NURMON0009] SEE COMMENTS, Starting today For Until specified,
Routine, Every 1 hour times 4, then every 2 hours
times 2, then every 4 hours times 2, then every 8
hours, Post-Op/Phase II
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
Wound Care [135990]
Page 4 of 13
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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
Purse String Instructions [NURCOM0022] ONCE, MDs will discontinue packing postop day 1.
Do not pack once packing has been removed.
Gauze dressing to site while draining. Discontinue
gauze dressing if it is no longer draining., Post-
Op/Phase II
Abdominoperineal Resection Instructions
[NURCOM0022]
ONCE, - Patient should not sit on perineal (bottom)
wound for more than 10 minutes at a time 3 times
per day.
- Head of bed less than 30 degrees
- Patient may sit to transition from laying to
standing, but do not extend the amount of time
that patient is sitting for longer than needed.
- Patient may stand and ambulate as much as
he/she can tolerate.
- When patient is laying, please frequently
reposition patient to avoid placing pressure on
patient's bottom for an extended period of time.
- Keep wound clean and dry. Cover with an
absorbent dressing at all times to wick moisture.
Change this pad/dressing frequently.
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?
Page 5 of 13
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11/2017CCKM@uwhealth.org

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 [135991]
Measure Intake And Output [NURMON0005] EVERY 4 HOURS, Starting today For Until specified,
Routine, Post-Op/Phase II
Non-Categorized Patient Care Orders [135998]
Maintain Drain [NURTAD0003] CONTINUOUS, Starting today For Until specified,
Routine
Type: Closed Suction (Jackson-Pratt)
Site: Abdomen
Location: Anterior
Drainage Options: Bulb
Irrigate Frequency:
Irrigate With:
Irrigant Volume (mL):
Strip:
Strip For:
Dressing Change Frequency:
Dressing Type:
Empty every 8 hours. Drain care every 12 hours.,
Post-Op/Phase II
Initiate Bladder Management Protocol
[NURELM0014]
CONTINUOUS, Starting today, Routine, Post-
Op/Phase II
Contingency Parameters [136003]
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 < (%): 88
If urine output < (mL): 200 mL for 8 hours
Other: Pain not controlled with ordered analgesics
or ordered interventions,Patient requires more than
4 liters/minute of oxygen to maintain oxygen
saturation of 90%
Post-Op/Phase II
Intravenous Therapy
IV Fluids [135979]
Insert and Maintain Peripheral IV
[NURVAD0013]
CONTINUOUS, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
Page 6 of 13
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dextrose 5%-NaCl 0.45% with KCl 20 mEq/L
infusion [44910]
at 20 mL/hr, Intravenous, CONTINUOUS
Discontinue when tolerating orals
Post-Op/Phase II
General Medications
Analgesics - Acetaminophen - PRN [135980]
acetaMINOPHEN (TYLENOL) tab [34150] 1,000 mg, Oral, EVERY 6 HOURS, Post-Op/Phase II
Analgesics - NSAIDS - Scheduled [229301]
Analgesics - NSAIDS - Scheduled [239011] "Followed by" Linked Panel
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
First dose of ibuprofen should NOT be given until
6 hours after the last ketOROLAC dose
Post-Op/Phase II
ibuprofen (MOTRIN) tab [38353] 600 mg, Oral, EVERY 6 HOURS Starting H+24
Hours
First dose of ibuprofen should be given 6 hours
after last ketOROLAC dose.
Post-Op/Phase II
Analgesics - Opioids - PRN [229302]
oxycodone tab RANGE [750032] 5-10 mg, Oral, EVERY 3 HOURS PRN, pain, Severe
pain, Post-Op/Phase II
Anti-emetics [88574]
ondansetron (ZOFRAN) injection [800202] 4 mg, Intravenous, EVERY 24 HOURS PRN, nausea
First line when unable to tolerate orally
Post-Op/Phase II
ondansetron (ZOFRAN ODT) disintegrating tab
[64224]
4 mg, Oral, EVERY 24 HOURS PRN, nausea/vomiting
First Line
Post-Op/Phase II
prochlorperazine (COMPAZINE) tab [41372] 10 mg, Oral, EVERY 6 HOURS PRN, nausea/vomiting
Second line if no response to first line therapy
within 30 minutes.
Post-Op/Phase II
prochlorperazine (COMPAZINE) injection
[41369]
10 mg, Intravenous, EVERY 6 HOURS PRN,
nausea/vomiting
Second line if no response to first line therapy
within 30 minutes and unable to take orally.
If ordered IV: push slowly, max rate 5 mg/minute.
Post-Op/Phase II
Stress Ulcer Prophylaxis (Single Response) [135981]
ranitidine (ZANTAC) tab [720131] 150 mg, Oral, 2 X DAILY, Post-Op/Phase II
famotidine (PEPCID) intraVENOUS [800279] 20 mg, Intravenous, EVERY 12 HOURS, Post-
Op/Phase II
pantoprazole (PROTONIX) delayed release tab
[62661]
40 mg, Oral, 1 X DAILY, Post-Op/Phase II
pantoprazole (PROTONIX) intraVENOUS
[800119]
40 mg, Intravenous, 1 X DAILY, Post-Op/Phase II
Hypnotics (Single Response) [229303]
traZODONE (DESYREL) tab [720150] 50 mg, Oral, 1 X DAILY (HS) PRN, sleep
Offer only after failure of non-pharmacologic
interventions (see RN Care Problem Sleep/Rest
Disturbance Adult)
Post-Op/Phase II
Page 7 of 13
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melatonin tab [119466] 3 mg, Oral, 1 X DAILY (HS) PRN, sleep
Offer only after failure of non-pharmacologic
interventions (see RN Care Problem Sleep/Rest
Disturbance Adult)
Post-Op/Phase II
Trazodone - Melatonin [227765] "And" Linked Panel
traZODONE (DESYREL) tab [720150] 50 mg, Oral, 1 X DAILY (HS) PRN, sleep
Use first line.
Offer only after failure of non-pharmacologic
interventions (see RN Care Problem Sleep/Rest
Disturbance Adult)
Post-Op/Phase II
melatonin tab [119466] 3 mg, Oral, 1 X DAILY (HS) PRN, sleep
Use second line if failure to respond to trazodone
within 60 minutes
Offer only after failure of non-pharmacologic
interventions (see RN Care Problem Sleep/Rest
Disturbance Adult)
Post-Op/Phase II
Laboratory
Upon arrival to PACU [87161]
ELECTROLYTES [LYTE] COLLECT UPON ADMISSION, 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?
PACU
GLUCOSE [GLU] COLLECT UPON ADMISSION, 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?
PACU
BUN [BUN] COLLECT UPON ADMISSION, 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?
PACU
CREATININE [CRET] COLLECT UPON ADMISSION, 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?
PACU
CALCIUM [CA] COLLECT UPON ADMISSION, 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?
PACU
Page 8 of 13
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11/2017CCKM@uwhealth.org

MAGNESIUM [MAG] COLLECT UPON ADMISSION, 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?
PACU
PHOSPHATE [PHOS] COLLECT UPON ADMISSION, 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?
PACU
ALBUMIN [ALB] COLLECT UPON ADMISSION, 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?
PACU
PROTEIN, TOTAL [TP] COLLECT UPON ADMISSION, 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?
PACU
BILIRUBIN, TOTAL [TBIL] COLLECT UPON ADMISSION, 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?
PACU
AST/SGOT [AST] COLLECT UPON ADMISSION, 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?
PACU
ALT/SGPT [ALT] COLLECT UPON ADMISSION, 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?
PACU
ALKALINE PHOSPHATASE [ALKP] COLLECT UPON ADMISSION, 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?
PACU
PROTHROMBIN TIME/INR [PT] COLLECT UPON ADMISSION, 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?
PACU
Page 9 of 13
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HEMATOCRIT [HCT] COLLECT UPON ADMISSION, 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?
PACU
CBC WITHOUT DIFFERENTIAL [HEMO] COLLECT UPON ADMISSION, 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?
PACU
Draw Postoperative Day 1 at 0500 [87162]
ELECTROLYTES [LYTE] NEXT AM, 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?
Post-Op/Phase II
GLUCOSE [GLU] NEXT AM, 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?
Post-Op/Phase II
BUN [BUN] NEXT AM, 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?
Post-Op/Phase II
CREATININE [CRET] 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?
Post-Op/Phase II
CALCIUM [CA] 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?
Post-Op/Phase II
MAGNESIUM [MAG] 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?
Post-Op/Phase II
PHOSPHATE [PHOS] 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?
Post-Op/Phase II
ALBUMIN [ALB] 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?
Post-Op/Phase II
Page 10 of 13
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PROTEIN, TOTAL [TP] 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?
Post-Op/Phase II
BILIRUBIN, TOTAL [TBIL] 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?
Post-Op/Phase II
AST/SGOT [AST] 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?
Post-Op/Phase II
ALT/SGPT [ALT] 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?
Post-Op/Phase II
ALKALINE PHOSPHATASE [ALKP] 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?
Post-Op/Phase II
PROTHROMBIN TIME/INR [PT] 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?
Post-Op/Phase II
HEMATOCRIT [HCT] 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?
Post-Op/Phase II
CBC WITHOUT DIFFERENTIAL [HEMO] 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?
Post-Op/Phase II
Consults
Consults [136020]
Consult Ostomy Care Service (Inpatient)
[CON0052]
ONCE, Starting today For 1 Occurrences, Routine
Reason for Consult:
Can this consult be done via video?
Post-Op/Phase II
Diabetes Consult Order Panel (Adult) [188497]
Page 11 of 13
Printed by O'BRIEN, RYLEY P [RPO249] at 11/20/2017 4:37:09 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

Diabetes Management Service : Will provide management or treatment recommendations
for patients with hyperglycemia and/or those who report outpatient use of insulin or other
diabetes medications. Patients should be expected to remain inpatient > 24 hrs from time of
consult. Consult is required for patients with insulin pumps or who use U-500 insulin.
Consult Endocrine for any non-diabetes-related endocrine questions.
Learning Center - Diabetes Education (Adult): Diabetes Education (Adult): Diabetes
education (meter/insulin skills/other diabetes survival skills) for patients/families with
knowledge deficits and/or need for diabetes knowledge assessment. Recommended for
all new diagnoses or patients with A1C > 9.
Diabetes Education – Nutrition : Diabetes nutrition therapy including nutrition assessment,
carbohydrate education (consistent carbohydrate meals, use of insulin-to-carbohydrate
ratio), and/or individualized, nutritious meal planning for carbohydrates, portions, or
considering other comorbidities. Recommended for all new diagnoses or patients with
A1C > 9
Consult Diabetes Management Service (DMS)
(Inpatient) [CON0022]
ONCE
Can this consult be done via video?
Call back number:
Intent: Consult and Recommend (Write Orders)
Concern or Specific Question or Task to be
Addressed (Symptom, Sign, or Diagnosis):
Consult Learning Center - Diabetes Education
(Adult) [CON0021]
ONCE, Routine, - If patient is newly diagnosed or
is new to insulin, provide 24 hours notice to allow
adequate time for education,
- Indicate diabetes medication/treatment plan if
known.
- Consults requested after 1600 on Fridays may
not be seen until following Monday. Learning
Center available Mon-Sat 0800-1630 (only 1 RN
available on Saturday for CSC and AFCH).
- Staff may be contacted by Pager 7927 on
weekdays and Pager 3276 on weekends.
- Learning Center staff are not available on
holidays.
Type of Education: Diabetes Self-Management
Education
Reason For Consult:
Expected Discharge Date:
Diabetes management / treatment plan:
Can this consult be done via video?
Post-Op/Phase II
Page 12 of 13
Printed by O'BRIEN, RYLEY P [RPO249] at 11/20/2017 4:37:09 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

Consult Diabetes Education - Nutrition
(Inpatient) [CON0126]
ONCE, Routine, ·  If your patient is newly
diagnosed and/or is new to insulin therapy,
provide 24 hours notice to allow adequate time
for nutrition education.
·  Indicate diabetes medication/treatment plan if
known.
·  Consults requested after 1300 on Friday may not
be completed until the following Monday.
·  If you are placing a consult on a weekend day
for a patient who will be discharging that
weekend, please have the Paging Center contact
the on-call dietitian to help you facilitate the
diabetes nutrition education session prior to the
patient's discharge.
Type of Education: Diabetes Self-Management
Education
Reason For Consult:
Expected Discharge Date:
Diabetes management / treatment plan:
Can this consult be done via video?
Post-Op/Phase II
Consult Ace/Geriatric (Inpatient) [CON0001] ONCE, Routine
Reason for Consult:
Can this consult be done via video?
Post-Op/Phase II
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?
Post-Op/Phase II
Consult Case Management (Inpatient)
[CON0013]
ONCE, Routine
Location?
Can this consult be done via video?
Post-Op/Phase II
CONSULT TO PRIMARY CARE BEHAVIORAL
HEALTH CLINICIAN [1009498]
Post-Op/Phase II
Page 13 of 13
Printed by O'BRIEN, RYLEY P [RPO249] at 11/20/2017 4:37:09 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org