/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/hospital-wide/,

/clinical/cckm-tools/content/order-sets/inpatient/hospital-wide/name-102699-en.cckm

201708220

page

100

UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,Hospital-wide

IP - Eating Disorders - Adult - Admission [6075]

IP - Eating Disorders - Adult - Admission [6075] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Hospital-wide


IP - Eating Disorders - Adult - Admission [6075]
Eating Disorders Clinical Practice Guideline URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/nutrition/name-97703-en.cckm
FAQs During Admissions for Medical Stabilization
of an Eating Disorder
URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/nutrition/related/name-97712-
en.cckm
Admission Meals (Evening/Weekends) for
Patients with an Eating Disorder
URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/nutrition/related/name-97711-
en.cckm
Quick Guide for Inpatient Management of Patients
with an Eating Disorder
URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/nutrition/related/name-97710-
en.cckm
Admission Status
Level of Care (Single Response) [187515]
*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:
Admit to Observation (Single Response)
[188297]
Admit To Observation [ADT0002] Attending:
Admitting Resident:
Requested Floor:
Service:
Admit to Outpatient Short Stay (Single
Response) [188298]
Admit To Outpatient Short Stay [ADT0003] Attending:
Admitting Resident:
Requested Floor:
Service:
Admission Status (Single Response) [82665]
Page 1 of 8
Printed by STRAKA, KEVIN F [KFS1] at 8/8/2017 10:34:34 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org

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:
Admit To Observation [ADT0002] Attending:
Admitting Resident:
Requested Floor:
Service:
Admit To Outpatient Short Stay [ADT0003] Attending:
Admitting Resident:
Requested Floor:
Service:
Admission Status [206435]
Admit To Inpatient [ADT0001] Attending:
Admitting Resident:
Requested Floor: D4/4
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.
C - CLEAR DIAGNOSIS:
E - EVALUATIONS PLANNED:
R - RESULTS EXPECTED:
T - TREATMENTS ORDERED:
Admit To Observation [ADT0002] Attending:
Admitting Resident:
Requested Floor:
Service:
Admit To Outpatient Short Stay [ADT0003] Attending:
Admitting Resident:
Requested Floor:
Service:
Patient Care Orders
Vital Signs [140969]
Orthostatic Vital Signs [NURMON0007] DAILY, Routine
Activity [140970]
Page 2 of 8
Printed by STRAKA, KEVIN F [KFS1] at 8/8/2017 10:34:34 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org

Activity - Bedrest [NURACT0008] CONTINUOUS, Routine
AD LIB:
AMBULATE:
CHAIR:
DANGLE:
BEDREST: strict bedrest
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Patient may sit in bed and walk to bathroom,
supervised.
Bathroom Privileges [NURCOM0022] SEE COMMENTS, Patient cannot use bathroom for 1
hour post-meal or snack. Or, patient may have
supervised use of bathroom to ensure no purging.
Room Rest [NURCOM0022] SEE COMMENTS, Patient may sit in bed but not in a
chair and may not stand frequently, walk around, or
any other physical activity. If patient would like to
attend hospital activities outside of the room, she/he
must be escorted in a wheelchair. Patient must be on
cardiac monitoring at all times, including out of room
until discontinued by primary team per provider
direction.
Diet [206088]
Nutrition Guideline URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/nutrition/related/name-97711-
en.cckm
Diet - Custom [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: Diet Modifications
Diet Modifications: Miscellaneous
Miscellaneous: Eating Disorder
Eating Disorder Instructions:
Meal Schedule:
Snack Schedule:
Bedside Meal Instructions:
Room Service Class: RS2-ROOM SERVICE ASSIST
800 Calories (Initial Admission Calorie Level)
Bedside Tray [NURCOM0022] CONTINUOUS, Keep bedside tray empty aside from
meal at all meal and snack times.
RN Diet Communication [NURCOM0022] CONTINUOUS, Remove cans of oral nutrition
supplement from tray and confirm tray contents match
ticket before delivery to patient. If a tray is late, page
Clinical Nutrition. Patient is required to eat 100% of
the food on their tray within 30 minutes (meals) or 20
minutes (snacks). If patient eats < 100% of a meal or
snack, patient should be offered volume of oral
nutrition supplement in unlabeled cup. Oral nutrition
supplement must be consumed within 15 minutes of
offering. Patient requests for extra food to be
discussed with Clinical Nutrition.
Page 3 of 8
Printed by STRAKA, KEVIN F [KFS1] at 8/8/2017 10:34:34 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org

Strict Calorie Count [NURCOM0022] CONTINUOUS, The RN should keep all meal and
snack tickets. Record the percentage of each food
consumed directly on the ticket and make note of any
additional volume of oral nutrition supplement
consumed. To receive credit for eating 100% of a
meal/snack, patient must eat all foods including
calorie-containing beverages and condiments. At the
end of the day, send all tray tickets to Tube Station
214.
Total Daily Fluid Goal [NURCOM0022] CONTINUOUS, Minimum = *** mL/day (1 X
maintenance). Maximum = *** mL/day (1.5 X
maintenance). Maintenance fluids come with trays.
Water bottles on trays must be consumed prior to the
arrival of the next tray. The RN may provide up to ***
mL/day (0.5 X maintenance) from the unit.
Family Eating in Room [NURCOM0022] CONTINUOUS, Family may eat in room, but no
sharing food with patient and no disposing of food
within room (all trash cans to be removed).
Measure Caloric Intake [NURDIE0011] CONTINUOUS For 7 Days, Routine
Patient Monitoring [206436]
Assess Neurologic Status [NURMON0006] EVERY 4 HOURS, Routine
Measure Intake And Output [NURMON0005] EVERY 4 HOURS, Routine
Cardiac Rhythm Monitoring - Adult
[NURMON0010]
ONCE, Routine
Indication:
Notify Provider:
Functional Cardiac Defibrillator Present:
Measure Weight [NURMON0015] ONCE For 1 Occurrences, Routine
Weigh With?
Weigh when?
Upon Admission. Must use same scale every day.
Do not discuss weight with patient. Weigh in gown
and underwear, with dry hair (before shower) facing
away from the scale.
Measure Weight [NURMON0015] 1X DAILY, Routine
Weigh With?
Weigh when?
First AM, post-void, daily weights in gown and
underwear, no bra, with dry hair (before shower)
facing away from the scale. Must be taken prior to
eating or drinking anything. Must use the same scale
every day. Do not discuss weight with patient.
Measure Height [NURMON0052] ONCE For 1 Occurrences, Routine, Upon Admission
Purging Precautions [NURCOM0022] CONTINUOUS, Remove all loose trash cans from
room.
Clutter-Free Room [NURCOM0022] CONTINUOUS, Patient's room should be kept as free
of clutter as possible to ensure safety and ease of
patient monitoring. If patient on strict bedrest, nurse
should assist patient in retrieving belongings that are
out of reach.
Contingency Parameters [206437]
Page 4 of 8
Printed by STRAKA, KEVIN F [KFS1] at 8/8/2017 10:34:34 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org

Notify Provider [NURCOM0001] Provider to Notify: Provider
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:
Intravenous Therapy
Premedications for Needle Insertion [124125]
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 within 1 minute. Choice of medication should be based on patient’s previous
experience/preference, history of lidocaine allergy and ease of access.
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
lidocaine (XYLOCAINE) 1% injection [39034] 0.1-0.4 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.
Choice of medication should be based on patient’s
previous experience/preference, history of lidocaine
allergy and ease of access
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.
Choice of medication should be based on patient’s
previous experience/preference, history of lidocaine
allergy and ease of access
IV Fluids [140967]
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
Page 5 of 8
Printed by STRAKA, KEVIN F [KFS1] at 8/8/2017 10:34:34 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org

sodium chloride 0.9% BOLUS - NOTE:
Suggested dose 10-20 mL/kg [730003]
Intravenous, CONTINUOUS
Medications - General
Non-Categorized [206429]
polyethylene glycol (MIRALAX) oral packet
[61829]
17 g, Oral, 1 X DAILY
Give with a meal
lidocaine (LMX) 4% topical dressing kit [66882] Topical, ONCE PRN For 1 Doses
phosphate-potassium & sodium (PHOS-NAK) oral
packet [112317]
1 packet, Oral, 1 X DAILY
sodium chloride (bacteriostatic) 0.9 % injection
[50585]
0.05-0.1 mL, Intravenous, ONCE For 1 Doses
Once on Admission
sodium chloride (bacteriostatic) 0.9 % injection
[50585]
0.05-0.1 mL, Intravenous, PRN
multivitamin with mineral tab [800240] 1 tab, Oral, 1 X DAILY
thiamine (VITAMIN B-1) injection [800077] 100 mg, Intravenous, 1 X DAILY
Laboratory
Admission [140974]
ALKALINE PHOSPHATASE [ALKP] NEXT DRAW For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
ALT/SGPT [ALT] NEXT DRAW For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
AST/SGOT [AST] NEXT DRAW For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
BUN [BUN] NEXT DRAW For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
CALCIUM [CA] NEXT DRAW For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
CREATININE [CRET] NEXT DRAW For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
ELECTROLYTES [LYTE] NEXT DRAW For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
MAGNESIUM [MAG] NEXT DRAW For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
PHOSPHATE [PHOS] NEXT DRAW For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Page 6 of 8
Printed by STRAKA, KEVIN F [KFS1] at 8/8/2017 10:34:34 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org

PROTEIN, TOTAL [TP] NEXT DRAW For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
HCG, QUANTITATIVE [BHCG] NEXT DRAW For 1 Occurrences, Routine, This test is
not intended for aiding in the diagnosis of cancer or for
monitoring the treatment of cancer patients.
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
CBC WITH DIFFERENTIAL [CBC] NEXT DRAW For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
GLUCOSE [GLU] NEXT DRAW For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
BILIRUBIN, TOTAL [TBIL] NEXT DRAW 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 Daily [140986]
SPECIFIC GRAVITY, URINE [HCSG] CONDITIONAL - RN COLLECT, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? If concern regarding
water loading or to assess hydration status.
Draw Daily Days 1-3 [140975]
ELECTROLYTES [LYTE] EVERY 12 HOURS, Starting tomorrow For 3 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
MAGNESIUM [MAG] EVERY 12 HOURS, Starting tomorrow For 3 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
PHOSPHATE [PHOS] EVERY 12 HOURS, Starting tomorrow For 3 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Draw Daily Beginning Day 4 [134631]
ELECTROLYTES [LYTE] NEXT AM, Starting 8/12/17 For 7 Occurrences,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
MAGNESIUM [MAG] NEXT AM, Starting 8/12/17 For 7 Occurrences,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Page 7 of 8
Printed by STRAKA, KEVIN F [KFS1] at 8/8/2017 10:34:34 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org

PHOSPHATE [PHOS] NEXT AM, Starting 8/12/17 For 7 Occurrences,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Diagnostic Tests and Imaging
Diagnostic Tests and Imaging [206438]
ECG - 12 Lead With Rhythm Strip [EKG0009] ONCE For 1 Occurrences, Routine
Reason for exam:
Consults
Consults [206439]
Consult Nutrition [CON0043] ONCE For 1 Occurrences, Routine
Reason for Consult: Nutrition Assessment w/
Recommendations
Delegate to Initiate and Manage Tube Feeding: Yes
Delegate to Manage Diet Order/Supplement Order:
Yes
Delegate to Dysphagia Diet Order Progression:
Can this consult be done via video?
Consult Health Psychology (Inpatient) [CON0033] ONCE, Routine, Please notify consulting provider if
patient needs to be seen same day (Monday-Friday)
or if special assessment needs.
Intent for Consult: Other (Eating Disorder Consult)
Concern or Specific Question or Task to be Addressed
(Symptom, Sign, or Diagnosis): Eating Disorder
Can this consult be done via video? No
Consult Social Work [CON0076] ONCE For 1 Occurrences, Routine
Reason for Consult: COUNSELING
Can this consult be done via video? No
Evaluate for Constant Observation [CON0199] ONCE For 1 Occurrences, Routine
Reason for Request:
Attempted Alternatives:
Consult Spiritual Care (Inpatient) [CON0056] ONCE For 1 Occurrences, Routine
Reason for Consult: Evaluate and Treat
Can this consult be done via video? No
Consult Addictive Disorders (Inpatient)
[CON0003]
ONCE, Routine, This order is for ADULT patients.
Please use the Consult Adolescent/Pediatric AODA
Counselor order for adolescent/pediatric patients
instead.
Intent for Consult:
Concern or Specific Question or Task to be Addressed
(Symptom, Sign, or Diagnosis):
Can this consult be done via video?
Page 8 of 8
Printed by STRAKA, KEVIN F [KFS1] at 8/8/2017 10:34:34 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org