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201608214

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Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,GI/Renal

IP – Percutaneous Endoscopic Gastrostomy/Jejunostomy – Adult – Preprocedure [1025]

IP – Percutaneous Endoscopic Gastrostomy/Jejunostomy – Adult – Preprocedure [1025] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, GI/Renal


IP - Percutaneous Endoscopic Gastrostomy/Jejunostomy - Adult - Preprocedure
[1025]
for Adult Patients OnlyIntended
Patient Care Orders
Nutrition [103146]
NPO for Procedure - Hold Diet [DIE0007] EFFECTIVE MIDNIGHT, Starting today For 1
Occurrences, Routine
NPO For Which Procedure? Percutaneous
Endoscopic Gastrostomy/Jejunostomy
Modifiers: NPO EXCEPT MEDICATIONS
Hold Nasogastric Tube Feeding After Midnight
[NURDIE0013]
ONCE, Starting today For 1 Occurrences
Respiratory [14034]
Oxygen On Call to Procedure (Include
CPAP/BIPAP if Applicable) [RT0073]
ONCE, Starting today For 1 Occurrences, Routine
Contingency Parameters [14036]
Notify GI Fellow On Call [NURCOM0001] Provider to Notify: Other (Comment)
If systolic blood pressure > (mmHg):
If systolic blood pressure < (mmHg):
If diastolic blood pressure > (mmHg):
If diastolic blood pressure < (mmHg):
If temperature > (C):
If temperature < (C):
If heart rate > (bpm):
If heart rate < (bpm):
If respiratory rate >:
If respiratory rate <:
If blood glucose > (mg/dL):
If blood glucose < (mg/dL):
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL):
Other: International normalized ratio (INR) is greater
than 1.4,Platelet count less than 50,000/microliter
Intravenous Therapy
IV Fluids [12979]
dextrose 5%-NaCl 0.45% infusion [51613] Intravenous, CONTINUOUS
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Starting today For Until specified,
Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
Medications - Preprocedure
Medications - Preprocedure [12984]
No antacids after midnight prior to percutaneous
endoscopic gastrostomy [NURCOM0022]
ONCE For 1 Occurrences
Surgical Prophylaxis
First Line (Single Response) [208923]
cefazolin (ANCEF) intraVENOUS - NOTE:
Patients who are less than 40 kg [800000]
30 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op
Day Of Procedure
cefazolin (ANCEF) intraVENOUS - NOTE:
Patients who are 40 - 120 kg [800000]
2 g, Intravenous, ONCE For 1 Doses, Pre-Op Day Of
Procedure
Page 1 of 2
Printed by O'BRIEN, RYLEY P [RPO249] at 8/1/2016 8:14:10 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2016CCKM@uwhealth.org

cefazolin (ANCEF) intraVENOUS - NOTE:
Patients who are greater than 121 kg [800000]
3 g, Intravenous, ONCE For 1 Doses, Pre-Op Day Of
Procedure
MRSA/Documented MRSA History (Single Response) [208924]
Patients who are less than 40 kg - Cefazolin +
Vancomycin [208927]
cefazolin (ANCEF) intraVENOUS [800000] 30 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op
Day Of Procedure
vancomycin (VANCOCIN) intraVENOUS
[800084]
15 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op
Day Of Procedure
Patients who are 40 - 120 kg - Cefazolin -
Vancomycin [208930]
cefazolin (ANCEF) intraVENOUS [800000] 2 g, Intravenous, ONCE For 1 Doses, Pre-Op Day
Of Procedure
vancomycin (VANCOCIN) intraVENOUS
[800084]
20 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op
Day Of Procedure
Patients who are greater than 121 kg - Cefazolin
+ Vancomycin [208933]
cefazolin (ANCEF) intraVENOUS [800000] 3 g, Intravenous, ONCE For 1 Doses, Pre-Op Day
Of Procedure
vancomycin (VANCOCIN) intraVENOUS
[800084]
20 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op
Day Of Procedure
Immediate/Severe Reactions to Penicillin or Known Cephalosporin Allergies (Single Response)
[208940]
vancomycin (VANCOCIN) intraVENOUS -
Patients who are less than 40 kg [800084]
15 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op
Day Of Procedure
vancomycin (VANCOCIN) intraVENOUS -
Patients who are greater than 40 kg [800084]
20 mg/kg, Intravenous, ONCE For 1 Doses, Pre-Op
Day Of Procedure
Laboratory
Draw Day of Procedure [15688]
PROTHROMBIN TIME/INR [PT] NEXT DRAW, 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?
Draw on Day of Procedure
PLATELET COUNT [PLT] NEXT DRAW, 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?
Draw on Day of Procedure
Page 2 of 2
Printed by O'BRIEN, RYLEY P [RPO249] at 8/1/2016 8:14:10 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2016CCKM@uwhealth.org