/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-98176-en.cckm

201712349

page

100

UWHC,UWMF,

Tools,

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

IP – Alcohol Withdrawal – Adult – Supplemental [3538]

IP – Alcohol Withdrawal – Adult – Supplemental [3538] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Hospital-wide


IP - Alcohol Withdrawal - Adult - Supplemental [3538]
These orders should not be used in intubated patients.
UW Health Guidelines for Alcohol Withdrawal
Management
URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/alcohol-and-tobacco/name-
97478-en.cckm
Patient Care Orders
Non-Categorized Patient Care Orders [103992]
Cardiac Rhythm Monitoring - Adult
[NURMON0010]
ONCE, Starting today, Routine
Notify Provider: Symptomatic Change in
Rhythm,Serious Arrhythmia
Functional Cardiac Defibrillator Present:
Contingency Parameters [103995]
Notify Provider [NURCOM0001] Provider to Notify: Provider
If systolic blood pressure > (mmHg): 180
If systolic blood pressure < (mmHg): 100
If diastolic blood pressure > (mmHg): 100
If diastolic blood pressure < (mmHg):
If temperature > (C): 38.2
If temperature < (C):
If heart rate > (bpm): 120
If heart rate < (bpm): 60
If respiratory rate >: 30
If respiratory rate <: 12
If blood glucose > (mg/dL):
If blood glucose < (mg/dL):
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL):
Other: The patient has seizure activity,You suspect
the CIWA score is not related to alcohol
withdrawal,The CIWA score is greater than 20 for 2
consecutive measurements,The Adult Sedation score
is greater or equal to 4,The patient becomes
disoriented to person, place, and time and this is a
change from baseline,The patient presents severe
agitation or loss of control,3 doses of lorazepam are
given without response,You believe patient needs to
be evaluated for a change in level of care
Intravenous Therapy
IV Fluids (Single Response) [10056]
sodium chloride 0.9 % infusion [64367] at 125 mL/hr, Intravenous, CONTINUOUS
sodium chloride 0.45% infusion [42187] at 125 mL/hr, Intravenous, CONTINUOUS
lactated ringers infusion [38890] at 125 mL/hr, Intravenous, CONTINUOUS
dextrose 5%-NaCl 0.45% infusion [51613] at 125 mL/hr, Intravenous, CONTINUOUS
Give thiamine IM or IV prior to dextrose infusion
dextrose 5%-NaCl 0.45% with KCl 20 mEq/L
infusion [44910]
at 125 mL/hr, Intravenous, CONTINUOUS
Give thiamine IM or IV prior to dextrose infusion
Alcohol Withdrawal Symptom Management
Consider using the REDUCED-dose regimens in patients:
- With advanced liver disease (cirrhosis/acute hepatitis)
- With advanced pulmonary disease (O2 dependent COPD, severe sleep apnea)
- With brain injury
- Age 65 years or older
- With a history of significant narcotic use prior to admission
Alcohol Withdrawal STANDARD Dosing [127353]
Page 1 of 7
Printed by BENNETT, SARA J [SJB008] at 12/15/2017 10:54:10 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2017CCKM@uwhealth.org

Alcohol Withdrawal - Standard Dosing [127362]
Initiate Alcohol Withdrawal Management
Algorithm - Standard Dosing [NURELM0065]
CONTINUOUS, Routine, Refer to standard dosing
table
lorazepam (ATIVAN) tab RANGE [750026] 1-4 mg, Oral, EVERY 1 HOUR PRN, agitation,
alcohol withdrawal - see Admin Instructions
For CIWA score between 10-15 give 1 mg and
reassess in 2 hours;
For CIWA score between 16-20 give 2 mg and
reassess in 1 hour;
For CIWA score greater than 20 give 4 mg and
reassess in 1 hour.
Notify provider if CIWA score is greater than 20 for 2
consecutive measurements.
lorazepam (ATIVAN) injection RANGE [750075] 1-4 mg, Intravenous, EVERY 1 HOUR PRN For 4
Days, agitation, alcohol withdrawal - see Admin
Instructions
Use if patient unable to tolerate PO;
For CIWA score between 10-15 give 1 mg and
reassess in 2 hours;
For CIWA score between 16-20 give 2 mg and
reassess in 1 hour;
For CIWA score greater than 20 give 4 mg and
reassess in 1 hour
If ordered IV: push rate 2 mg/minute.
lorazepam (ATIVAN) injection RANGE [750075] 1-4 mg, Intramuscular, EVERY 1 HOUR PRN For 4
Days, agitation, alcohol withdrawal - see Admin
Instructions
Use if patient unable to tolerate PO and IV;
For CIWA score between 10-15 give 1 mg and
reassess in 2 hours;
For CIWA score between 16-20 give 2 mg and
reassess in 1 hour;
For CIWA score greater than 20 give 4 mg and
reassess in 1 hour
If ordered IV: push rate 2 mg/minute.
Adjunct Treatment For Behavioral Management -
Standard Dosing - NOTE: Do NOT order for
patients with Parkinsons [242233]
haloperidol (HALDOL) tab RANGE [750019] 1-2 mg, Oral, EVERY 4 HOURS PRN,
hallucinations/delirium/agitation
Do NOT administer unless benzodiazepine is given
due to risk of seizure.
haloperidol lactate (HALDOL) injection RANGE
[750048]
1-2 mg, Intravenous, EVERY 4 HOURS PRN,
agitation, hallucinations/delirium/agitation
Do NOT administer unless benzodiazepine is given
due to risk of seizure.
Use if patient unable to tolerate PO.
haloperidol lactate (HALDOL) injection RANGE
[750048]
1-2 mg, Intramuscular, EVERY 4 HOURS PRN,
agitation, hallucinations/delirium/agitation
Do NOT administer unless benzodiazepine is given
due to risk of seizure.
Use if patient unable to tolerate PO and IV.
Alcohol Withdrawal REDUCED Dosing [127354]
Alcohol Withdrawal - Reduced Dosing [126852]
Initiate Alcohol Withdrawal Management
Algorithm - Reduced Dosing [NURELM0066]
CONTINUOUS, Routine, Refer to reduced dosing
table
Page 2 of 7
Printed by BENNETT, SARA J [SJB008] at 12/15/2017 10:54:10 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

lorazepam (ATIVAN) tab RANGE [750026] 0.5-2 mg, Oral, EVERY 1 HOUR PRN For 4 Days,
agitation, alcohol withdrawal - see Admin
Instructions
For CIWA score between 10-15 give 0.5 mg and
reassess in 2 hours;
For CIWA score between 16-20 give 1 mg and
reassess in 1 hour;
For CIWA score greater than 20 give 2 mg and
reassess in 1 hour.
Notify provider if CIWA score is greater than 20 for 2
consecutive measurements.
lorazepam (ATIVAN) injection RANGE [750075] 0.5-2 mg, Intravenous, EVERY 1 HOUR PRN For 4
Days, agitation, alcohol withdrawal - see Admin
Instructions
Use if patient unable to tolerate PO;
For CIWA score between 10-15 give 0.5 mg and
reassess in 2 hours;
For CIWA score between 16-20 give 1 mg and
reassess in 1 hour;
For CIWA score greater than 20 give 2 mg and
reassess in 1 hour
If ordered IV: push rate 2 mg/minute.
lorazepam (ATIVAN) injection RANGE [750075] 0.5-2 mg, Intramuscular, EVERY 1 HOUR PRN For
4 Days, agitation, alcohol withdrawal - see Admin
Instructions
Use if patient unable to tolerate PO and IV;
For CIWA score between 10-15 give 0.5 mg and
reassess in 2 hours;
For CIWA score between 16-20 give 1 mg and
reassess in 1 hour;
For CIWA score greater than 20 give 2 mg and
reassess in 1 hour
If ordered IV: push rate 2 mg/minute.
Adjunct Treatment For Behavioral Management -
NOTE: Do NOT order for patients with
Parkinsons [242235]
haloperidol (HALDOL) tab RANGE [750019] 1-2 mg, Oral, EVERY 4 HOURS PRN For 96 Hours,
hallucinations/delirium/agitation
Do NOT administer unless benzodiazepine is given
due to risk of seizure
haloperidol lactate (HALDOL) injection RANGE
[750048]
1-2 mg, Intravenous, EVERY 4 HOURS PRN For 96
Hours, agitation, hallucinations/delirium/agitation
Do NOT administer unless benzodiazepine is given
due to risk of seizure.
Use if patient unable to tolerate PO.
haloperidol lactate (HALDOL) injection RANGE
[750048]
1-2 mg, Intramuscular, EVERY 4 HOURS PRN For
96 Hours, agitation, hallucinations/delirium/agitation
Do NOT administer unless benzodiazepine is given
due to risk of seizure.
Use if patient unable to tolerate PO and IV.
Medications
Anti-emetics [10059]
ondansetron (ZOFRAN) tab [45939] 4 mg, Oral, EVERY 12 HOURS PRN For 96 Hours,
nausea/vomiting
Use first line.
Page 3 of 7
Printed by BENNETT, SARA J [SJB008] at 12/15/2017 10:54:10 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

ondansetron (ZOFRAN) injection [800202] 4 mg, Intravenous, EVERY 12 HOURS PRN For 96
Hours, nausea/vomiting
Use first line if unable to take medications by mouth
or enteral tube OR if immediate effect is needed.
Notify provider if there is insufficient response within
30 minutes.
Non-categorized [10060]
multivitamin with mineral tab [800240] 1 tab, Oral, 1 X DAILY
thiamine (VITAMIN B-1) intraVENOUS [800261] 100 mg, Intravenous, ONCE For 1 Doses
May give IM if unable to give IV. Give prior to any
dextrose-containing solutions. Patient should be
discharged with thiamine prescription/recommendation
to be taken daily for six weeks.
thiamine (VITAMIN B-1) intraMUSCULAR
[800077]
100 mg, Intramuscular, ONCE PRN For 1 Doses, If
unable to give IV
Contact Pharmacy if needed Give prior to any
dextrose-containing solutions. Patient should be
discharged with thiamine prescription/recommendation
to be taken daily for six weeks.
thiamine (VITAMIN B-1) tab [43659] 100 mg, Oral, 1 X DAILY Starting tomorrow
May give IV if unable to tolerate PO. Patient should be
discharged with thiamine prescription/recommendation
to be taken daily for six weeks.
thiamine (VITAMIN B-1) intraVENOUS [800261] 100 mg, Intravenous, 1 X DAILY PRN Starting
tomorrow, if unable to take PO
Contact Pharmacy if needed Give prior to any
dextrose-containing solutions. Patient should be
discharged with thiamine prescription/recommendation
to be taken daily for six weeks.
Note: If dextrose-containing maintenance IV fluid,
administer first dose of thiamine prior to starting
infusion [950018]
ONCE For 1 Doses
Laboratory
Draw Now (If Not Completed in ED) [7386]
All the following tests are necessary. Please order if not completed in the ED.
ELECTROLYTES [LYTE] 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?
BUN [BUN] 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?
CREATININE [CRET] 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?
GLUCOSE [GLU] 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?
Page 4 of 7
Printed by BENNETT, SARA J [SJB008] at 12/15/2017 10:54:10 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

CALCIUM [CA] 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?
BILIRUBIN, TOTAL [TBIL] 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?
PROTEIN, TOTAL [TP] 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?
ALBUMIN [ALB] 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?
ALKALINE PHOSPHATASE [ALKP] 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?
AST/SGOT [AST] 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?
ALT/SGPT [ALT] 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?
ALCOHOL [GM2440] 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?
PAIN MANAGEMENT PROFILE [HCUPAIN] ONCE For 1 Occurrences, Routine, This test screens
and confirms the presence of the following drugs
substances: Drugs of Abuse- Amphetamine, Cocaine,
Heroin, Methamphetamine, MDMA (Ecstasy), MDA;
Benzodiazepines- Alprazolam, Clonazepam,
Diazepam, Lorazepam, Midazolam, Oxazepam,
Temazepam; Opioids- Buprenorphine, Codeine,
Fentanyl, Hydrocodone, Hydromorphone, Methadone,
Morphine, Meperidine, Naloxone, Naltrexone,
Oxycodone, Oxymorphone, Tramadol, Tapentadol.
Call the UWHC Toxicology Laboratory at (608) 263-
7029 with questions.
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Page 5 of 7
Printed by BENNETT, SARA J [SJB008] at 12/15/2017 10:54:10 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

HCG, QUALITATIVE, URINE [UPREG] ONCE, 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?
MAGNESIUM [MAG] 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?
PHOSPHATE [PHOS] 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?
CBC WITH DIFFERENTIAL [CBC] 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?
FOLATE [FOL] 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?
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?
VITAMIN B12 [B12] 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?
Consults
Consults [7387]
Behavioral Health Consults (select below)
[210281]
amp, transplant), - adjustment, protocol (eg. burn, trauma, rehab, pre-Psychology Health
noncompliance, grief, pain
Addictive Disorders - alcohol or drug related problems (eg. treatment recommendations,
withdrawal mgmt)
Psychiatry - safety, agitation, capacity, med mgmt, psychotropic SE
ACE - 60 and older - delirium, dementia, depression, decisional capacity, sleep (also for non-
behavioral geriatric syndromes; overall geriatric evaluation, mobility/falls, functional decline,
social/caregiver issues, disposition, medication management)
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:
Concern or Specific Question or Task to be
Addressed (Symptom, Sign, or Diagnosis):
Can this consult be done via video?
Page 6 of 7
Printed by BENNETT, SARA J [SJB008] at 12/15/2017 10:54:10 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

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: Assess alcohol and substance
use History
Concern or Specific Question or Task to be
Addressed (Symptom, Sign, or Diagnosis):
Determine if outpatient treatment is needed.
Consult Psychiatry (Inpatient) [CON0064] ONCE
Intent for Consult:
Concern or Specific Question or Task to be
Addressed (Symptom, Sign, or Diagnosis):
Can this consult be done via video?
Call back number:
Consult Ace/Geriatric (Inpatient) [CON0001] ONCE, Routine
Reason for Consult:
Can this consult be done via video?
Page 7 of 7
Printed by BENNETT, SARA J [SJB008] at 12/15/2017 10:54:10 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org