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/clinical/cckm-tools/content/order-sets/inpatient/hospital-wide/name-119602-en.cckm

201711332

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UWHC,UWMF,

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

IP - Eating Disorders - Pediatric - Admission [5036]

IP - Eating Disorders - Pediatric - Admission [5036] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Hospital-wide


IP - Eating Disorders - Pediatric - Admission [5036]
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:
ADT-ADMISSION STATUS (NOT REQUIRED) - IP (PRESELECT)-P5-UWIP [141500]
Page 1 of 8
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Admit To Inpatient [ADT0001] Attending:
Admitting Resident:
Requested Floor: P5
Service: PEDIATRIC HOSPITALIST RED
Rationale for LOS greater than 2 midnights:
Admit To Observation [ADT0002] Attending:
Admitting Resident:
Requested Floor:
Service:
Admit To Outpatient Short Stay [ADT0003] Attending:
Admitting Resident:
Requested Floor:
Service:
ADT-ADMISSION STATUS (NOT REQUIRED)-IP-P5-UWIP [141503]
Admit To Inpatient [ADT0001] Attending:
Admitting Resident:
Requested Floor: P5
Service: PEDIATRIC HOSPITALIST RED
Rationale for LOS greater than 2 midnights:
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]
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 [140973]
Page 2 of 8
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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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08/2017CCKM@uwhealth.org

Nutrition Guideline URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/nutrition/related/name-97711-
en.cckm
Diet - Eating Disorder [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Pediatric
Diet Type: Diet Modifications
Diet Modifications: 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.
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
981.
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 [140965]
High Fall Risk Precautions [PRECAU0020] CONTINUOUS, Routine
High Fall Risk Interventions:
Ambulation Interventions:
Assistive Devices:
Toileting Interventions:
Equipment Used for Transfer:
Individualized Patient Specific Interventions /
Comments:
Assess Neurologic Status [NURMON0006] EVERY 4 HOURS, Routine
Measure Intake And Output [NURMON0005] EVERY 4 HOURS, Routine
Page 3 of 8
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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org

Cardio-Respiratory Monitor - Pediatric - With
Rhythm [139419]
Cardio-Respiratory Monitor - Pediatric - With
Rhythm [NURMON0014]
CONTINUOUS, Routine, Most pediatric patients do
NOT require rhythm analysis. Please complete the
Notify Provider order below, including specification
for apnea > *** seconds. If indicated, order pulse
oximetry separately.
Device Present:
Device Mode:
Device Low Rate Limit (BPM):
Notify Provider: Symptomatic Change in
Rhythm,Serious Arrhythmia
Patient must be on telemetry monitoring at all times,
including when out of the room, until all ECG and
electrolyte abnormalities resolved x 24 hours per
primary team.
Notify [NURCOM0001] Provider to Notify: Provider
Notify based on:
Notify provider for apnea > 20 seconds. Notify
House Officer if changes in rhythm on EKG.
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 [140966]
Page 4 of 8
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08/2017CCKM@uwhealth.org

Notify Provider [NURCOM0001] Provider to Notify: Provider
If systolic blood pressure > (mmHg):
If systolic blood pressure < (mmHg): 90
If diastolic blood pressure > (mmHg):
If diastolic blood pressure < (mmHg):
If temperature > (C): 38
If temperature < (C):
If heart rate > (bpm):
If heart rate < (bpm): 40
If respiratory rate >:
If respiratory rate <:
If blood glucose > (mg/dL):
If blood glucose < (mg/dL):
If pain score >:
Pulse Oximetry < (%): 92%
If urine output < (mL):
Other:
Intravenous Therapy
Premedication for Needle Insertion (Single Response) [141411]
Lidocaine [152737]
lidocaine (LMX) 4% topical dressing kit [66882] Topical, EVERY 1 HOUR PRN, prior to needle sticks
to reduce pain. See "LMX Use Instructions" order in
Active Orders report or the Admin Instructions for
application details
FOR PATIENTS 5 Kg OR LESS: Do NOT apply to
area greater than 100 square centimeters.
(maximum 1 g/site; maximum 1 site per hour, 6
times per day).
FOR PATIENTS 5.1-10 Kg: Do NOT apply to area
greater than 100 square centimeters. (maximum 1
g/site; maximum 2 sites per hour, 6 times per day).
FOR PATIENTS GREATER THAN 10 Kg: Do NOT
apply to area greater than 200 square centimeters.
(maximum 2.5 g/site; maximum 4 sites per hour, 6
times per day).
For patients less than 1 year old do NOT leave on
longer than 1 hour. For patients 1 year or older do
NOT leave on longer than 2 hours
LMX Use Instructions for Premedication Prior to
Needle Insertion [NURCOM0095]
Details
IV Fluids [140967]
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
sodium chloride 0.9% BOLUS - NOTE:
Suggested dose 10-20 mL/kg [730003]
Intravenous, CONTINUOUS
Medications - General
Non-Categorized [140968]
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
Page 5 of 8
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08/2017CCKM@uwhealth.org

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
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?
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?
Page 6 of 8
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08/2017CCKM@uwhealth.org

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 8/8/17 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 8/8/17 For 7 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
PHOSPHATE [PHOS] NEXT AM, Starting 8/8/17 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 [134632]
ECG - 12 Lead With Rhythm Strip (PEDS)
[EKG0018]
ONCE For 1 Occurrences, Routine
Reason for exam:
Consults
Consults [140976]
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:
Delegate to Dysphagia Diet Order Progression:
Can this consult be done via video?
Page 7 of 8
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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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08/2017CCKM@uwhealth.org

Consult Pediatric Health Psychology (Inpatient)
[CON0202]
ONCE, Routine, Please notify consulting provider if
patient needs to be seen same day (Monday-Friday)
or if special assessment needs.
Reason for Consult: Evaluate and treat
Consult Social Work [CON0076] ONCE For 1 Occurrences, Routine
Reason for Consult: COUNSELING
Constult to Adolescent Medicine (Inpatient)
[CON0357]
ONCE
Intent: Consult and Recommend (Write Orders)
Concern or Specific Question or Task to be Addressed
(Symptom, Sign, or Diagnosis):
Consult Adolescent/Pediatric AODA Counselor
(Inpatient) [CON0175]
ONCE For 1 Occurrences, Routine
Reason for Consult: Other (Evaluate and Treat)
Consult Child Psychiatry (Inpatient) [CON0170] ONCE
Intent: Consult and Recommend (Write Orders)
Concern or Specific Question or Task to be Addressed
(Symptom, Sign, or Diagnosis): Eating Disorder
Consult School [CON0153] ONCE, Routine, The consulting provider needs to be
verbally notified of this order. A link to Web Paging is
available below.
Reason for Consult: Evaluate and Treat
The consulting provider needs to be verbally notified
of this order.
Consult Spiritual Care (Inpatient) [CON0056] ONCE For 1 Occurrences, Routine
Reason for Consult: Evaluate and Treat
Page 8 of 8
Printed by STRAKA, KEVIN F [KFS1] at 8/4/2017 1:43:35 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org