/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-98210-en.cckm

20180101

page

100

UWHC,UWMF,

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

IP - General Care - Adult - Admission [692]

IP - General Care - Adult - Admission [692] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Hospital-wide


IP - General Care - Adult - Admission [692]
for Adult Patients OnlyIntended
SetSpecific Treatment Can Be Found At the Bottom of the Order Disease
Admission Status
Level of Care (Single Response) [186484]
*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]
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 (Single Response) [20869]
Page 1 of 17
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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2017CCKM@uwhealth.org

Admit To Inpatient Status [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 Status [ADT0002] Attending:
Admitting Resident:
Requested Floor:
Service:
Admit To Outpatient Short Stay [ADT0003] Attending:
Admitting Resident:
Requested Floor:
Service:
Discharge When Medically Ready - Family Medicine [236247]
Discharge When Medically Ready - Family Medicine
[236242]
Afebrile [ADT0101] Details
Ambulating or Plan [ADT0107] Details
CIWA <10 for 12 Hours [ADT0115] Details
Consultant Recommendations [ADT0123] Details
Hypoxia Resolved/Managed [ADT0114] Details
Lab Value [ADT0112] Specify Lab and Value:
Lab Value [ADT0112] Specify Lab and Value:
Off IV Antibiotics or Managed [ADT0122] Details
Other [ADT0105] Other Criteria:
Other [ADT0105] Other Criteria:
Pain Controlled With Oral Medication [ADT0108] Details
Procedures Completed [ADT0125] Details
Tolerating PO [ADT0100] Details
Vital Signs Stable [ADT0106] Details
Venous Thromboembolism (VTE) Prophylaxis
VTE Prophylaxis (Single Response) [150156]
Padua VTE Risk Assessment URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/hematology-and-
coagulation/related/name-97520-en.cckm
Low VTE Risk [130084]
VTE Prophylaxis - Reason Not Ordered [COR0008] ONCE, Routine
Reason Not Ordered: Low Risk
High VTE Risk with Low Bleed Risk (Single Response)
[129777]
enoxaparin (LOVENOX) subcutaneous injection [800040] 40 mg, Subcutaneous, EVERY 24 HOURS
heparin subcutaneous injection [800290] 5,000 units, Subcutaneous, EVERY 12 HOURS
High Bleed Risk with High VTE 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
No VTE Prophylaxis [130084]
VTE Prophylaxis - Reason Not Ordered [COR0008] ONCE, Routine
Reason Not Ordered:
Page 2 of 17
Printed by WILLIAMS, HEATHER R [HRS0] at 12/29/2017 10:51:03 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2017CCKM@uwhealth.org

VTE Prophylaxis (Single Response) [130119]
Padua VTE Risk Assessment URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/hematology-and-
coagulation/related/name-97520-en.cckm
Low VTE Risk [130084]
VTE Prophylaxis - Reason Not Ordered [COR0008] ONCE, Routine
Reason Not Ordered: Low Risk
High VTE Risk with Low Bleed Risk (Single Response)
[129777]
enoxaparin (LOVENOX) subcutaneous injection [800040] 40 mg, Subcutaneous, EVERY 24 HOURS
heparin subcutaneous injection [800290] 5,000 units, Subcutaneous, EVERY 12 HOURS
High Bleed Risk with High VTE 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
No VTE Prophylaxis [130084]
VTE Prophylaxis - Reason Not Ordered [COR0008] ONCE, Routine
Reason Not Ordered:
Patient Care Orders
Vital Signs [7482]
Vital Signs [NURMON0013] EVERY 8 HOURS, Starting today, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Vital Signs [NURMON0013] SEE COMMENTS, Starting today with First Occurrence As
Scheduled, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Every 4 hours for 12 hours, then every 8 hours.
Patient Monitoring [146142]
Cardiac Rhythm Monitoring - Adult [NURMON0010] ONCE, Routine
Notify Provider: Symptomatic Change in Rhythm,Serious
Arrhythmia
Functional Cardiac Defibrillator Present:
Activity [7483]
Mobilize Patients EarlyREMINDER:
Chair Three Times Daily [NURACT0008] CONTINUOUS, Starting today, Routine
AD LIB:
AMBULATE:
CHAIR: 3x daily
DANGLE:
BEDREST:
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Page 3 of 17
Printed by WILLIAMS, HEATHER R [HRS0] at 12/29/2017 10:51:03 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2017CCKM@uwhealth.org

Ambulate Three Times Daily [NURACT0008] CONTINUOUS, Starting today, Routine
AD LIB:
AMBULATE: 3x daily
CHAIR:
DANGLE:
BEDREST:
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Ambulate Ad Lib [NURACT0008] CONTINUOUS, Starting today, Routine
AD LIB:
AMBULATE: ad lib
CHAIR:
DANGLE:
BEDREST:
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Chair Ad Lib [NURACT0008] CONTINUOUS, Starting today, Routine
AD LIB:
AMBULATE:
CHAIR: ad lib
DANGLE:
BEDREST:
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Activity - Other [NURACT0008] CONTINUOUS, Routine
Location:
Nutrition [7484]
#1406Tube Feeding Orders, Refer to Tube Feeding Order Set, For
General Diet [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: General (no Modifications)
Bedside Meal Instructions:
Room Service Class:
General Diet - Sodium Controlled NAS [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Room Service Class:
Diet Type: Diet Modifications
Bedside Meal Instructions:
Diet Modifications: Sodium Controlled
Sodium: NAS (2400 mg)
Diabetes Meal Plan [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: Diet Modifications
Diet Modifications: Diabetes
Bedside Meal Instructions:
Room Service Class:
Diet - Clear Liquid [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: Diet Modifications
Diet Modifications: Liquid
Liquid: Clear Liquid
No Red or Purple Dye:
Liquid Thickness: Thin
Bedside Meal Instructions:
Room Service Class:
Page 4 of 17
Printed by WILLIAMS, HEATHER R [HRS0] at 12/29/2017 10:51:03 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2017CCKM@uwhealth.org

NPO Except Medications [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: NPO
NPO: NPO except Medications
Bedside Meal Instructions:
Room Service Class:
Respiratory [146144]
Oxygen Therapy [RT0032] CONTINUOUS, Starting today, Routine
FiO2 (%) Titrate to Keep Sats >/= to ___%:
Liter Flow:
Titrate oxygen to maintain O2 sat at (%): 92
O2 Delivery Device: Nasal Cannula
Attempt to Wean Off Oxygen? Yes
Respiratory Therapy per Protocol [RT0035] Routine
Protocol Type:
CPAP Overnight and Nap [RT0063] OVERNIGHT AND NAP, Routine
Therapy Settings: Per RT
CPAP Level (cm H2O):
Oxygen (LPM or %):
Self Administered (Only RT may document in this box after
patient assessment): RT Approval Required
Incentive Spirometry [NURTRT0018] EVERY 2 HOURS, Starting today, Routine, While awake.
Cough And Deep Breathe [NURTRT0019] EVERY 2 HOURS, Starting today, Routine, While awake.
Intake and Output [7486]
Measure Intake And Output [NURMON0005] EVERY 8 HOURS, Starting today, Routine
Measure Weight [NURMON0015] 1X DAILY, Starting today, Routine
Weigh With? Portable Scale
Weigh when?
Standing preferred.
Contingency Parameters [238576]
Notify Provider [NURCOM0001] Provider to Notify: Provider
If systolic blood pressure > (mmHg): 180
If systolic blood pressure < (mmHg): 95
If diastolic blood pressure > (mmHg):
If diastolic blood pressure < (mmHg):
If temperature > (C): 38.3
If temperature < (C):
If heart rate > (bpm): 115
If heart rate < (bpm): 45
If respiratory rate >: 26
If respiratory rate <: 8
If blood glucose > (mg/dL):
If blood glucose < (mg/dL):
If pain score >:
Pulse Oximetry < (%): 88% RA
If urine output < (mL):
Other:
Intravenous Therapy
Premedications for Needle Insertion [106310]
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
immediate.
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
Page 5 of 17
Printed by WILLIAMS, HEATHER R [HRS0] at 12/29/2017 10:51:03 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2017CCKM@uwhealth.org

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.
IV Fluids/Venous Access [12597]
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
sodium chloride 0.9 % infusion [64367] Intravenous, CONTINUOUS
dextrose 5%-NaCl 0.45% infusion [51613] Intravenous, CONTINUOUS
dextrose 5%-NaCl 0.45% with KCl 20 mEq/L infusion
[44910]
Intravenous, CONTINUOUS
lactated ringers infusion [38890] Intravenous, CONTINUOUS
Medications - General
Analgesics (Single Response) [240079]
acetaMINOPHEN (TYLENOL) tab [34149] 650 mg, Oral, EVERY 4 HOURS PRN, pain/fever
See Pain management Algorithm for the Selection of As-
Needed Analgesics
No more than 4 grams acetaminophen per 24 hours for adults
or 15mg/kg per dose for peds <40kg.
acetaMINOPHEN (TYLENOL) tab [34149] 1,000 mg, Oral, EVERY 6 HOURS PRN, pain/fever
See Pain management Algorithm for the Selection of As-
Needed Analgesics
No more than 4 grams acetaminophen per 24 hours for adults
or 15mg/kg per dose for peds <40kg.
acetaMINOPHEN (TYLENOL) tab - CIRRHOTIC DOSING
- 2 G Daily MAX [34149]
650 mg, Oral, EVERY 8 HOURS PRN, pain/fever
See Pain management Algorithm for the Selection of As
Needed Analgesics
No more than 2 grams acetaminophen per 24 hours for adult
with cirrhotic liver disease
Antiemetics [240080]
Adult - Standard - Anti-emetics [240445]
ondansetron (ZOFRAN ODT) disintegrating tab [64224] 4 mg, Oral, EVERY 6 HOURS PRN, nausea/vomiting
Use first line
ondansetron (ZOFRAN) injection [800202] 4 mg, Intravenous, EVERY 6 HOURS PRN, nausea/vomiting
Use first line if unable to take medications by mouth or
enteral tube OR if immediate effect is needed.
prochlorperazine (COMPAZINE) tab [41372] 10 mg, Oral, EVERY 6 HOURS PRN, nausea/vomiting
Use second line if there is inadequate response to first line
anti-emetic within 30 minutes. If there is no response to
second line therapy within 30 minutes, notify provider
prochlorperazine (COMPAZINE) injection [41369] 10 mg, Intravenous, EVERY 6 HOURS PRN,
nausea/vomiting
Use second line. Use if there is inadequate response to first
line anti-emetic within 30 minutes and if unable to take
medications by mouth or enteral tube OR if immediate effect
is needed. If there is no response to second line therapy
within 30 minutes, notify provider
Bowel Management - Scheduled [147657]
senna-docusate (SENOKOT-S) 8.6-50 mg per tab [60530] 2 tab, Oral, 2 X DAILY
Bowel Management - As Needed [242124]
Adult - Bowel Management - As Needed [240448]
polyethylene glycol (MIRALAX) oral packet [61829] 17 g, Oral, 1 X DAILY PRN, constipation
First Line Therapy
magnesium hydroxide (MILK OF MAGNESIA) susp
[65443]
30 mL, Oral, 1 X DAILY PRN, constipation
Second line therapy, if no response to first line therapy within
12 hours
bisacodyl (DULCOLAX) rectal suppository [35231] 10 mg, Rectal, 1 X DAILY PRN, constipation
If unable to take medications by mouth or enteral tube OR if
need immediate laxation OR if failure of second line agent
after 6 hours
Hypnotics (Single Response) [228331]
Page 6 of 17
Printed by WILLIAMS, HEATHER R [HRS0] at 12/29/2017 10:51:03 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2017CCKM@uwhealth.org

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)
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)
Trazodone - Melatonin [227992] "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)
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)
Hypnotics (Single Response) [228334]
traZODONE (DESYREL) tab [720150] 25 mg, Oral, 1 X DAILY (HS) PRN, sleep
Offer only after failure of non-pharmacologic interventions (see
RN Care Problem Sleep/Rest Disturbance Adult)
If needed, give prior to midnight if possible. May contribute to
sedation the following day.
melatonin tab [119466] 1 mg, Oral, 1 X DAILY (HS) PRN, sleep
Offer only after failure of non-pharmacologic interventions (see
RN Care Problem Sleep/Rest Disturbance Adult)
Anti-hypertensives (Single Response) [240139]
hydrALAZINE (APRESOLINE) injection RANGE [750049] 10-20 mg, Intravenous, EVERY 2 HOURS PRN, hypertension
Systolic Blood pressure > 180 mmHg
labetalol (NORMODYNE;TRANDATE) injection RANGE
[750053]
10-20 mg, Intravenous, EVERY 2 HOURS PRN, Hypertension
Systolic Blood Pressure > 180 mmHg. Hold for heart rate < 60
beats/minute
for 2 Minutes
cloNIDINE (CATAPRES) tab [720040] 0.1 mg, Oral, EVERY 2 HOURS PRN, hypertension
Systolic Blood Pressure > 180 mmHg. Maximum of 4 doses in
24 hours.
Laboratory
Add On Labs / Other Admission Labs [7489]
CBC WITH DIFFERENTIAL [CBC] ADD ON, Starting today For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen? Add to next scheduled draw for this pt
today
If Conditional, What Condition?
ELECTROLYTES [LYTE] ADD ON, Starting today For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen? Add to next scheduled draw for this pt
today
If Conditional, What Condition?
BUN [BUN] ADD ON, Starting today For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen? Add to next scheduled draw for this pt
today
If Conditional, What Condition?
CREATININE [CRET] ADD ON, Starting today For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen? Add to next scheduled draw for this pt
today
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 7 of 17
Printed by WILLIAMS, HEATHER R [HRS0] at 12/29/2017 10:51:03 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2017CCKM@uwhealth.org

CALCIUM [CA] ADD ON, Starting today For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen? Add to next scheduled draw for this pt
today
If Conditional, What Condition?
MAGNESIUM [MAG] ADD ON, Starting today For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen? Add to next scheduled draw for this pt
today
If Conditional, What Condition?
BILIRUBIN, TOTAL [TBIL] ADD ON, Starting today For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen? Add to next scheduled draw for this pt
today
If Conditional, What Condition?
PROTEIN, TOTAL [TP] ADD ON, Starting today For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen? Add to next scheduled draw for this pt
today
If Conditional, What Condition?
ALBUMIN [ALB] ADD ON, Starting today For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen? Add to next scheduled draw for this pt
today
If Conditional, What Condition?
ALKALINE PHOSPHATASE [ALKP] ADD ON, Starting today For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen? Add to next scheduled draw for this pt
today
If Conditional, What Condition?
AST/SGOT [AST] ADD ON, Starting today For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen? Add to next scheduled draw for this pt
today
If Conditional, What Condition?
ALT/SGPT [ALT] ADD ON, Starting today For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen? Add to next scheduled draw for this pt
today
If Conditional, What Condition?
PROTHROMBIN TIME/INR [PT] ADD ON, Starting today For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen? Add to next scheduled draw for this pt
today
If Conditional, What Condition?
TSH REFLEX FREE T4 [TSHT4] ADD ON, Starting today For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen? Add to next scheduled draw for this pt
today
If Conditional, What Condition?
TROPONIN [GM2447] EVERY 6 HOURS, Starting today For 3 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Draw in AM [7496]
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?
BUN [BUN] 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?
Page 8 of 17
Printed by WILLIAMS, HEATHER R [HRS0] at 12/29/2017 10:51:03 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2017CCKM@uwhealth.org

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?
ELECTROLYTES [LYTE] 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?
GLUCOSE [GLU] 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?
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?
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?
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?
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?
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?
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?
HCG, QUALITATIVE, URINE [UPREG] ONCE, Starting tomorrow For 1 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 [7497]
ECG - 12 Lead Without Rhythm [EKG0008] ONCE, Starting today For 1 Occurrences, Routine
Reason for exam:
Disclaimer for University Hospital Only: A Stat status for an
ECG is in reference to the timing of the ECG. The goal is to
perform a STAT ECG within 10 minutes of the order being
placed. It is the responsibility of the ordering provider to review
the STAT ECGs. All ECGs (stat or routine) will be formally
reviewed within one business day.
Consults
Consults [7498]
Consult Physical Therapy (Inpatient) Eval and Treat
[CON0061]
ONCE, Starting today For 1 Occurrences, Routine
Reason for Physical Therapy Consult:
Consult Occupational Therapy (Inpatient) Eval and Treat
[CON0046]
ONCE, Starting today For 1 Occurrences, Routine
Reason for Occupational Therapy Consult:
Cirrhosis Treatment
Spontaneous Bacterial Peritonitis - TREATMENT (Single Response) [23609]
ceftriaxone (ROCEPHIN) intraVENOUS [800027] 2 g, Intravenous, EVERY 24 HOURS For 5 Days
aztreonam (AZACTAM) intraVENOUS [800013] 1 g, Intravenous, EVERY 8 HOURS For 5 Days
Gastrointestinal Bleed (Single Response) [23782]
antibioticswith acute GI Bleed start on one of the following Cirrhotics
Page 9 of 17
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ceftriaxone (ROCEPHIN) intraVENOUS [800027] 2 g, Intravenous, EVERY 24 HOURS For 7 Days
Patient should be evaluated by prescriber daily for
appropriateness of conversion to cefpodoxime 400 mg orally 2
times a day. Total antibiotic duration not to exceed 7 days.
aztreonam (AZACTAM) intraVENOUS [800013] 1 g, Intravenous, EVERY 8 HOURS For 7 Days
Probiotic [200227]
spectrum -therapeutic broadconsider the use of probiotics in immunocompetent patients receiving Please
lactamase -lactam/beta-4th generation cephalosporins, betaantibiotics, such as fluoroquinolones, 3rd and
diarrhea clindamycin to prevent antibiotic associated inhibitors, and
lactobacillus rhamnosus GG (CULTURELLE) cap
[152674]
1 cap, Oral, 1 X DAILY
Proton Pump Inhibitors - For Patients With Upper Gastrointestinal Bleeding (Single Response) [23764]
Pantoprazole Injection (Single Response) [243215]
pantoprazole (PROTONIX) intraVENOUS [800119] 40 mg, Intravenous, 2 X DAILY
pantoprazole (PROTONIX) intraVENOUS [800119] 80 mg, Intravenous, 2 X DAILY
pantoprazole (PROTONIX) delayed release tab [62661] 40 mg, Oral, 2 X DAILY
For Patients With an Active Bleed [23766]
octreotide (SANDOSTATIN) injection [800200] 50 mcg, Intravenous, ONCE For 1 Doses
octreotide (SANDOSTATIN) infusion [700248] 50 mcg/hr, Intravenous, CONTINUOUS
If ordered separately, the drip usually arrives prior to bolus.
For Patients With Hepatorenal Syndrome [23767]
octreotide (SANDOSTATIN) injection [800200] 100 mcg, Subcutaneous, 3 X DAILY
midodrine (PROAMITINE) tab [45758] 5 mg, Oral, 3 X DAILY (AT MEALTIME)
albumin human 25% infusion [44037] Intravenous, 1 X DAILY
For Patients With Hepatic Encephalopathy [23768]
lactulose (CEPHULAC) soln [75426] 20 g, Oral, 3 X DAILY
rifaXIMIN (XIFAXAN) tab [140692] 550 mg, Oral, 2 X DAILY (AT MEALTIME)
Diagnostic Tests and Imaging [152335]
US KIDNEY & AORTA [R76770] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, Routine
Current signs and symptoms?
What specific question(s) would you like answered by this
exam? Assess for outflow obstruction
Relevant recent/past history?
For scheduling purposes, does the patient require general
anesthesia, sedation or anxiolytics? Note: ordering provider is
responsible for prescribing oral anxiolytics or arranging peds
anesthesia / sedation services. See reference link above.
If being performed remotely, where?
Transport Method: Floor Determined/Entered
Abdominal Paracentesis with Guidance [151739]
Page 10 of 17
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ABDOMINAL PARACENTESIS W GUIDANCE [R49083] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, Routine
Is this Diagnostic, Therapeutic, or Both?
Radiology Specialty Area: ULTRASOUND
If 2-3.9 liters of ascites fluid is removed, is albumin
administration indicated secondary to abnormal renal
function?
Current signs and symptoms?
What specific question(s) would you like answered by this
exam?
Relevant recent/past history?
For scheduling purposes, does the patient require general
anesthesia, sedation or anxiolytics? Note: ordering provider is
responsible for prescribing oral anxiolytics or arranging peds
anesthesia / sedation services. See reference link above.
For Scheduling purposes, is the patient claustrophobic or
require any form of sedation? Note: ordering provider is
responsible for prescribing oral anxiolytic or ordering sedation
services.
Is patient on anticoagulation therapy? If yes, specify
coagulation disorder and current medications in comments
box at bottom.
Transport Method: Floor Determined/Entered
CELL COUNT, PERITONEAL FLUID [HCPECC] ONCE, Starting today For 1 Occurrences, Routine
Indicate specimen source if other:
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
CULTURE, BODY FLUID, AER/ANA WITH GRAM STAIN
[HCWABF]
ONCE, Starting today For 1 Occurrences, Routine, UWHC
Only: Use blood culture bottles for peritoneal, pericardial,
pleural, synovial and dialysate fluids.
Indicate source if other:
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
US DEEP DOPPLER [R93975] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, Routine
Current signs and symptoms?
What specific question(s) would you like answered by this
exam?
Relevant recent/past history?
For scheduling purposes, does the patient require general
anesthesia, sedation or anxiolytics? Note: ordering provider is
responsible for prescribing oral anxiolytics or arranging peds
anesthesia / sedation services. See reference link above.
If being performed remotely, where?
Transport Method: Floor Determined/Entered
Labs [152338]
SODIUM, URINE [GM2670] 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?
COPD Exacerbation Treatment
Global Initiative for Chronic Obstructive Lung Disease
Guidelines
URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/respiratory/name-97739-en.cckm
Respiratory [81674]
(682)If patient uses tobacco, please refer to Tobacco Abstinence Order Set Note:
Respiratory Therapy per Protocol (Includes Inhaled
Medications) [RT0035]
Routine
Protocol Type:
Oxygen Therapy [RT0032] CONTINUOUS, Starting today, Routine
FiO2 (%) Titrate to Keep Sats >/= to ___%:
Liter Flow:
Titrate oxygen to maintain O2 sat at (%): 92
O2 Delivery Device: Nasal Cannula
Attempt to Wean Off Oxygen?
Page 11 of 17
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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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Corticosteroids (Single Response) [81316]
prednisone (DELTASONE) tab - Total recommended daily
dose = 40 mg [41277]
20 mg, Oral, 2 X DAILY (AT MEALTIME) For 5 Days
methylprednisolone sodium succ. (SOLU-MEDROL)
intraVENOUS - NOTE: Total recommended daily dose =
32 mg [800058]
16 mg, Intravenous, EVERY 12 HOURS For 5 Days
Beta 2 Agonists [81320]
albuterol 2.5 mg/0.5 mL neb soln [34315] 2.5 mg, Nebulization, RT 4 X DAILY
Anticholinergics [81325]
ipratropium (ATROVENT) neb soln [47883] 500 mcg, Nebulization, RT 4 X DAILY
Beta 2 Agonists - Anticholinergics [193444]
ipratropium-albuterol (DUO-NEB) 0.5-2.5 mg/3 mL neb
soln [67220]
3 mL, Nebulization, RT 4 X DAILY
ipratropium-albuterol (DUO-NEB) 0.5-2.5 mg/3 mL neb
soln [67220]
3 mL, Nebulization, EVERY 4 HOURS PRN, dyspnea
Anti-infectives (Single Response) [208474]
infectives: -for antiIndications
1) Sputum purulence PLUS either increased dyspnea or increased sputum volume
invasive ventilation -2) Requirement for invasive or non
Coverage of Pseudomonas aeruginosa should be considered in certain high risk patients (antibiotic use in the
morbidities). If possible, sputum should be -last 3 months, > 3 exacerbations in the last year, and multiple co
obtained for gram stain and culture.
ceftriaxone (ROCEPHIN) intraVENOUS [800027] 1 g, Intravenous, EVERY 24 HOURS
doxycycline hyclate tab [67296] 100 mg, Oral, 2 X DAILY (AT MEALTIME)
Azithromycin and Ceftriaxone [228573]
azithromycin (ZITHROMAX) intraVENOUS [800011] 500 mg, Intravenous, EVERY 24 HOURS
ceftriaxone (ROCEPHIN) intraVENOUS [800027] 1 g, Intravenous, EVERY 24 HOURS
amoxicillin-clavulanate (AUGMENTIN) 875-125 MG per
tab [70053]
1 tab, Oral, 2 X DAILY (AT MEALTIME)
ampicillin/sulbactam (UNASYN) intraVENOUS [800010] 3 g, Intravenous, EVERY 6 HOURS
Probiotic [200227]
spectrum -therapeutic broadconsider the use of probiotics in immunocompetent patients receiving Please
lactamase -lactam/beta-4th generation cephalosporins, betaantibiotics, such as fluoroquinolones, 3rd and
diarrhea clindamycin to prevent antibiotic associated inhibitors, and
lactobacillus rhamnosus GG (CULTURELLE) cap
[152674]
1 cap, Oral, 1 X DAILY
Draw Now [81677]
BLOOD GASES AND O2 SATURATION [HCBGASOS] NEXT DRAW, Starting today For 1 Occurrences, STAT
Indicate FIO2:
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
CULTURE, SPUTUM WITH GRAM STAIN [HCSPUCS] ONCE, Starting today For 1 Occurrences, Routine, For patients
with an ET tube or tracheostomy, quantitative mini-BAL by RT
or bronchoscopic BAL are the preferred methods of specimen
collection.
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
General Radiography [81680]
X-RAY CHEST 2 VIEWS [R71046] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, Routine
Radiology Specialty Area:
Current signs and symptoms?
What specific question(s) would you like answered by this
exam?
Relevant recent/past history?
Is patient pregnant?
If being performed remotely, where?
Last patient weight? (will auto pull in value and date in
comment):
Transport Method: Floor Determined/Entered
Page 12 of 17
Printed by WILLIAMS, HEATHER R [HRS0] at 12/29/2017 10:51:03 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2017CCKM@uwhealth.org

X-RAY CHEST SINGLE VIEW [R71045] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, Routine
Current signs and symptoms?
What specific question(s) would you like answered by this
exam?
Relevant recent/past history?
Is patient pregnant?
If being performed remotely, where? Bedside
Last patient weight? (will auto pull in value and date in
comment):
Transport Method: Floor Determined/Entered
Consults [81681]
Consult Pulmonary Medicine (Inpatient) [CON0065] ONCE
Intent:
Concern or Specific Question or Task to be Addressed
(Symptom, Sign, or Diagnosis): COPD exacerbation
Gastrointestinal Bleed Treatment
IV Fluids [151746]
Insert and Maintain Peripheral IV - Insert Two 18 Gauge
IV Catheters [NURVAD0013]
CONTINUOUS, Routine
Peripheral IV Size: 18 Gauge
Does this need to be inserted/placed?
Proton Pump Inhibitors - Single Select (Single Response) [151611]
pantoprazole (PROTONIX) intraVENOUS - NOTE:
Moderate to Low Risk Upper GI Bleed [800119]
40 mg, Intravenous, 2 X DAILY
Very High Risk Upper GI Bleed [151750]
pantoprazole (PROTONIX) intraVENOUS [800119] 80 mg, Intravenous, 2 X DAILY
Labs [26987]
Hemoglobin - Next Draw [HGB] EVERY 12 HOURS For 3 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Studies [14147]
Esophagogastroduodenoscopy (EGD) [GI0003] ONCE, Routine
Reason for Exam: Upper GI Bleed
Colonoscopy [243342]
Colonoscopy [GI0002] ONCE, Routine
Reason for Exam: Upper GI Bleed
G.I. lavage (GOLYTELY) 236 G soln [103976] 4 L, Oral, 1 X DAILY PRN, constipation
Administer until stool runs clear. If stool is not clear after 4L
call MD or Provider
Consults [14148]
Consult Gastroenterology (Inpatient) [CON0027] ONCE
Intent:
Concern or Specific Question or Task to be Addressed
(Symptom, Sign, or Diagnosis):
Can this consult be done via video?
Call back number:
Inflammatory Bowel Disease Treatment
admissions without contraindications chemoprophylaxis is best practice for all Inflammatory Bowel Disease DVT
Steroids and Consults [138582]
methylprednisolone sodium succ. (SOLU-MEDROL)
intraVENOUS [800058]
20 mg, Intravenous, EVERY 8 HOURS
Consult Gastroenterology (Inpatient) [CON0027] ONCE
Intent:
Concern or Specific Question or Task to be Addressed
(Symptom, Sign, or Diagnosis):
Draw for patients with 3 or more unformed stools in 1 or more days [138458]
Page 13 of 17
Printed by WILLIAMS, HEATHER R [HRS0] at 12/29/2017 10:51:03 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2017CCKM@uwhealth.org

C DIFF TOXIN B PCR, NAP1 IF POSITIVE
[HCCDIFPCR]
CONDITIONAL, Routine, Reserve testing for patients with 3 or
more unformed stools in 1 or more days. Do not repeat a
negative test within 7 days. Do not perform for test of cure.
Samples positive for the C. difficile toxin B gene (tcdB) will also
be tested for the hypervirulent epidemic strain (O27/NAP1/BI).
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
CULTURE, STOOL [ST] CONDITIONAL, Routine, Because these agents do not cause
hospital acquired infection, specimens on patients who have
been hospitalized greater than 3 days will require approval of
the Director of Microbiology or Pathology Resident.
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Pneumonia, Community Acquired (CAP) - Treatment
Acquired Pneumonia"treating for CAP, select the order panel "Respiratory Care for Community If
Respiratory [153200]
Respiratory Care for Community Acquired Pneumonia
[151742]
Respiratory Therapy per Protocol [RT0035] Routine
Protocol Type:
Incentive Spirometry [NURTRT0018] EVERY 2 HOURS, Routine, While awake.
Cough And Deep Breathe [NURTRT0019] EVERY 2 HOURS, Routine, While awake.
Anti-infectives [150144]
patients with a history of C.difficile data suggests a lower incidence of Clostridium difficile infection in Preliminary
based regimenusing a doxycycline -infection
Infectious Diseases
Society of
America/American
Thoracic Society
Guidelines
URL: http://workspaces.uconnect.wisc.edu/download/attachments/10327345/CAP+Guidelines+-+IDSA%
2C+2007.pdf?version=1&modificationDate=1297119316363
Ceftriaxone and Doxycycline - 1st Line [228345]
ceftriaxone (ROCEPHIN) intraVENOUS [800027] 1 g, Intravenous, EVERY 24 HOURS
doxycycline hyclate tab [67296] 100 mg, Oral, EVERY 12 HOURS
Ceftriaxone and Azithromycin - 2nd Line [228343]
ceftriaxone (ROCEPHIN) intraVENOUS [800027] 1 g, Intravenous, EVERY 24 HOURS
azithromycin (ZITHROMAX) tab [57023] 500 mg, Oral, EVERY 24 HOURS For 5 Days
azithromycin (ZITHROMAX) intraVENOUS [800011] 500 mg, Intravenous, EVERY 24 HOURS
Fluoroquinolone - 3rd Line (Single Response) [234230]
administration and therefore preferred. moxifloxacin achieves similar serum levels as the intravenous Oral
moxifloxacin (AVELOX) tab [63314] 400 mg, Oral, EVERY 24 HOURS
moxifloxacin (AVELOX) 400 mg in sodium chloride 0.8%
250 mL bag [168649]
400 mg, Intravenous, EVERY 24 HOURS, for 60 Minutes
Probiotic [200227]
spectrum -therapeutic broadconsider the use of probiotics in immunocompetent patients receiving Please
lactamase -lactam/beta-4th generation cephalosporins, betaantibiotics, such as fluoroquinolones, 3rd and
diarrhea clindamycin to prevent antibiotic associated inhibitors, and
lactobacillus rhamnosus GG (CULTURELLE) cap
[152674]
1 cap, Oral, 1 X DAILY
Draw STAT (If Not Done in ER) [34163]
CULTURE, BLOOD, BACTERIA AND YEAST [GM4045] STAT, Starting today For 1 Occurrences, Routine, For optimum
diagnosis of sepsis, sample 3-4 sites only on the first day of a
septic episode. Cultures on subsequent days are of minimal
diagnostic value. Culture detects bacteria, Candida and
Cryptococcus. If filamentous fungi are suspected see Culture,
Blood, Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition? if patient febrile and
temperature >38.2C
Draw before antibiotics are administered.
Page 14 of 17
Printed by WILLIAMS, HEATHER R [HRS0] at 12/29/2017 10:51:03 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2017CCKM@uwhealth.org

CULTURE, BLOOD, BACTERIA AND YEAST [GM4045] STAT, Starting today For 1 Occurrences, Routine, For optimum
diagnosis of sepsis, sample 3-4 sites only on the first day of a
septic episode. Cultures on subsequent days are of minimal
diagnostic value. Culture detects bacteria, Candida and
Cryptococcus. If filamentous fungi are suspected see Culture,
Blood, Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition? if patient febrile and
temperature >38.2C
Draw before antibiotics are administered.
Draw Now (If not Done in ER) [152341]
PROCALCITONIN [HCPRCTON] NEXT AM For 1 Occurrences, Routine, Accepted uses:
1. Diagnosis of community acquired pneumonia
2. Antibiotic de-escalation/discontinuation in patients improving
from bacterial pneumonia or culture-negative sepsis
It should NOT be ordered in the following conditions:
1. Evaluation of aspiration as it cannot differentiate chemical
from bacterial pneumonitis
2. Immunosuppressed patients
3. Culture-positive septicemia
4. Decompensated heart failure
5. Infectious disease syndromes other than pneumonia or
sepsis
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Next draw
CULTURE, SPUTUM WITH GRAM STAIN [HCSPUCS] ONCE, Starting today For 1 Occurrences, Routine, For patients
with an ET tube or tracheostomy, quantitative mini-BAL by RT
or bronchoscopic BAL are the preferred methods of specimen
collection.
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Collect before antibiotics are administered. Do not delay
antibiotics to obtain specimen. If unable to obtain expectorated
sample within 4 hours, RN or Pharmacist should place order for
RT to Induce Sputum.
LEGIONELLA URINARY AG [GM4910] ONCE For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
STREP PNEUMONIAE AG, URINE [GM4545] ONCE For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Pneumonia, Healthcare-Associated (HAP/HCAP) Treatment
American
Thoracic
Society
Guidelines:
Am J Respir
Crit Care Med
2005;171:858-
873
URL: http://workspaces.uconnect.wisc.edu/download/attachments/10327345/HAP+Guidelines+-+IDSA+and+ATS%
2C+2005.pdf?version=1&modificationDate=1297119505697
UWHC
Nosocomial
Pneumonia
Algorithm
URL: http://workspaces.uconnect.wisc.edu/download/attachments/10327345/Nosocomial+Pneumonia+Algorithm.pdf?
version=1&modificationDate=1297275105217
UWHC Health Care Acquired
Pneumonia In Non-Intubated
Patients
URL: http://workspaces.uconnect.wisc.edu/download/attachments/10327345/HCAP+In+Non-
Inbated+Patient+Algorithm.pdf?version=1&modificationDate=1297275046357
Page 15 of 17
Printed by WILLIAMS, HEATHER R [HRS0] at 12/29/2017 10:51:03 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2017CCKM@uwhealth.org

Best Practices for Blood Culturing URL: https://uconnect.wisc.edu/clinical/references/laboratory-
services/blood/
Respiratory [151741]
Respiratory Care for Healthcare Associated Pneumonia
[151742]
Respiratory Therapy per Protocol [RT0035] Routine
Protocol Type:
Incentive Spirometry [NURTRT0018] EVERY 2 HOURS, Routine, While awake.
Cough And Deep Breathe [NURTRT0019] EVERY 2 HOURS, Routine, While awake.
Anti-Infectives for Patients with suspected MRSA (Single Response) [152423]
Treatment of Patients with Reported Allergies to Beta-
Lactam Antibiotics - Adult - Inpatient - Clinical Practice
Guidelin
URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/infection-and-isolation/name-97535-
en.cckm
Cefepime - Vancomycin Note (Maximum Dose 2000 mg)
[238672]
cefepime (MAXIPIME) intraVENOUS [800016] 2 g, Intravenous, EVERY 8 HOURS
Do NOT delay administration of 1st dose pending sputum
collection. Give first dose NOW if not done in ED.
Note: Vancomycin Dosing Per Pharmacy [950027] CONTINUOUS
Maximum Dose of Vancomycin is 2 grams
Probiotic [200227]
spectrum -therapeutic broadconsider the use of probiotics in immunocompetent patients receiving Please
lactamase -lactam/beta-4th generation cephalosporins, betaantibiotics, such as fluoroquinolones, 3rd and
diarrhea clindamycin to prevent antibiotic associated inhibitors, and
lactobacillus rhamnosus GG (CULTURELLE) cap
[152674]
1 cap, Oral, 1 X DAILY
For Severely Ill Patients (ADD ON) (Single Response) [152439]
ciprofloxacin (CIPRO) intraVENOUS [800031] 600 mg, Intravenous, EVERY 12 HOURS
Do NOT delay administration of 1st dose pending sputum
collection. Give first dose NOW if not done in ED.
tobramycin (NEBCIN) intraVENOUS [800081] 5 mg/kg, Intravenous, EVERY 24 HOURS
Do NOT delay administration of 1st dose pending sputum
collection. Give first dose NOW if not done in ED. NOTE: After
first dose, Pharmacy to adjust subsequent doses.
Draw STAT (If Not Done in ER - Both Must be Ordered Together) [34163]
CULTURE, BLOOD, BACTERIA AND YEAST [GM4045] STAT, Starting today For 1 Occurrences, Routine, For optimum
diagnosis of sepsis, sample 3-4 sites only on the first day of a
septic episode. Cultures on subsequent days are of minimal
diagnostic value. Culture detects bacteria, Candida and
Cryptococcus. If filamentous fungi are suspected see Culture,
Blood, Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition? if patient febrile and
temperature >38.2C
Draw before antibiotics are administered.
CULTURE, BLOOD, BACTERIA AND YEAST [GM4045] STAT, Starting today For 1 Occurrences, Routine, For optimum
diagnosis of sepsis, sample 3-4 sites only on the first day of a
septic episode. Cultures on subsequent days are of minimal
diagnostic value. Culture detects bacteria, Candida and
Cryptococcus. If filamentous fungi are suspected see Culture,
Blood, Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition? if patient febrile and
temperature >38.2C
Draw before antibiotics are administered.
Draw Now (If not done in ER) [153069]
C REACTIVE PROTEIN [CRPN] 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 16 of 17
Printed by WILLIAMS, HEATHER R [HRS0] at 12/29/2017 10:51:03 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2017CCKM@uwhealth.org

CULTURE, SPUTUM WITH GRAM STAIN [HCSPUCS] ONCE For 1 Occurrences, Routine, For patients with an ET
tube or tracheostomy, quantitative mini-BAL by RT or
bronchoscopic BAL are the preferred methods of specimen
collection.
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
LEGIONELLA URINARY AG [GM4910] 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?
STREP PNEUMONIAE AG, URINE [GM4545] 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?
Obtain STAT (if NOT done in ER - Both must be ordered together) [188623]
MRSA BY PCR - Nose [HCMRSA] ONCE For 1 Occurrences, Routine, There is no need to obtain
repeated surveillance tests to clear patients from MRSA
isolation. Once a patient is flagged as MRSA positive it will
remain in the HealthLink header indefinitely.
For NICU patients: left and right nares only.
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
MRSA BY PCR - Throat [HCMRSA] ONCE For 1 Occurrences, Routine, There is no need to obtain
repeated surveillance tests to clear patients from MRSA
isolation. Once a patient is flagged as MRSA positive it will
remain in the HealthLink header indefinitely.
For NICU patients: left and right nares only.
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
BestPractice
No Hospital Problems have yet been identified. [107035]
Specify Hospital Problem(s) [COR0018] You will be prompted to specify a hospital problem on signing.
Page 17 of 17
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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2017CCKM@uwhealth.org