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/clinical/cckm-tools/content/order-sets/inpatient/hospital-wide/name-98244-en.cckm

201706156

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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 – Tobacco Abstinence – Adult – Supplemental [682]

IP – Tobacco Abstinence – Adult – Supplemental [682] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Hospital-wide


IP - Tobacco Abstinence - Adult - Supplemental [682]
Patient Care Orders
Non-Categorized Patient Care Orders [7371]
Tobacco Cessation Counseling [NURCOM0022] ONCE, Starting today For 1 Occurrences, For
patients motivated to make a quit attempt.
Education based on patient's stage of readiness
("Tobacco Use Assessment") [NURCOM0022]
ONCE, Starting today For 1 Occurrences
Medication - Tobacco Abstinence
therapy (i.e. patch -For patients that smoke greater than or equal to 10 cigarettes per day; dual
AND gum OR lozenge is recommended. For patiens that smoke less than 10 cigarettes per day
monotherapy (i.e. gum OR lozenge) is recommended.
Regimen #1 - Nicotine Gum/Lozenges - NOTE: Order alone or in addition to any other regmen (Single
Response) [12334]
nicotine polacrilex (NICORETTE) gum NOTE:
For patients whose first cigarette is > 30 minutes
after waking. [45872]
2 mg, Oral, EVERY 1 HOUR PRN, Nicotine
Replacement
Use the "Chew and Park" method: Chew gum slowly
until you can taste the nicotine or feel a tingling
sensation in your mouth. Stop chewing and park the
piece of gum between your cheek and gums. After
about one minute, when the tingling is almost gone,
start chewing again. Repeat this process until the
tingle is gone (about 30 minutes). Make sure to avoid
eating or drinking anything for 15 minutes before
using gum, and while you're using it.
nicotine polacrilex (NICORETTE) gum - NOTE:
For patients whose first cigarette is < 30 minutes
after waking [45872]
4 mg, Oral, EVERY 1 HOUR PRN, Nicotine
replacement
Use the "Chew and Park" method: Chew gum slowly
until you can taste the nicotine or feel a tingling
sensation in your mouth. Stop chewing and park the
piece of gum between your cheek and gums. After
about one minute, when the tingling is almost gone,
start chewing again. Repeat this process until the
tingle is gone (about 30 minutes). Make sure to avoid
eating or drinking anything for 15 minutes before
using gum, and while you're using it.
nicotine polacrilex (COMMIT) 2 MG Lozenge -
NOTE: For patients whose first cigarette is > 30
minutes after waking [71694]
1 lozenge, Oral, EVERY 1 HOUR PRN, Nicotine
Craving
Maximum 20 lozenges/day. Do not eat or drink 15
minutes before or during use. Place lozenge in mouth
and allow to slowly dissolve. Do not chew or swallow.
nicotine polacrilex (COMMIT) 2 MG Lozenge -
NOTE: For patients whose first cigarette is < 30
minutes after waking [71694]
2 lozenge, EVERY 1 HOUR PRN, Nicotine Craving
Maximum 40 lozenges/day. Do not eat or dink 15
minutes before or during use. Place lozenge in mouth
and allow to slowly dissolve. Do not chew or swallow.
Regimen #2 - Nicotine Patch for Patients Smoking Less Than 10 Cigarettes/Day [12332]
Nicotine [224380] "Followed by" Linked Panel
nicotine (NICOTROL) 24hr patch [64389] 14 mg, Transdermal, 1 X DAILY For 28 Days
Place patch on clean, dry, healthy, hairless skin on
the chest, back, belly, or upper arm. Move the site
with each new patch.
nicotine (NICOTROL) 24hr patch [64389] 7 mg, Transdermal, 1 X DAILY For 28 Days
Place patch on clean, dry, healthy, hairless skin on
the chest, back, belly, or upper arm. Move the site
with each new patch.
Page 1 of 2
Printed by STRAKA, KEVIN F [KFS1] at 5/31/2017 4:23:04 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 05/2017CCKM@uwhealth.org

Regimen #3 - Nicotine Patch for Patients Smoking 10 or More Cigarettes/Day [12333]
Nicotine Patch [222656] "Followed by" Linked Panel
nicotine (NICOTROL) 24hr patch [64389] 21 mg, Transdermal, 1 X DAILY For 28 Days
Place patch on clean, dry, healthy, hairless skin on
the chest, back, belly, or upper arm. Move the site
with each new patch.
nicotine (NICOTROL) 24hr patch [64389] 14 mg, Transdermal, 1 X DAILY For 28 Days
Place patch on clean, dry, healthy, hairless skin on
the chest, back, belly, or upper arm. Move the site
with each new patch.
nicotine (NICOTROL) 24hr patch [64389] 7 mg, Transdermal, 1 X DAILY For 28 Days
Place patch on clean, dry, healthy, hairless skin on
the chest, back, belly, or upper arm. Move the site
with each new patch.
Regimen #4 - Non-Nicotine Agent - Varenicline [12339]
Varenicline [222657] "Followed by" Linked Panel
varenicline (CHANTIX) tab [113262] 0.5 mg, Oral, 1 X DAILY For 3 Days
varenicline (CHANTIX) tab [113262] 0.5 mg, Oral, 2 X DAILY (AT MEALTIME) For 4
Days
varenicline (CHANTIX) tab [113262] 1 mg, Oral, 2 X DAILY (AT MEALTIME) For 77
Days
Regimen #5 - Non-Nicotine Agent - Bupropion [12340]
Bupropion [222658] "Followed by" Linked Panel
bupropion SR (WELLBUTRIN SR) 12hr ER tab
[74469]
150 mg, Oral, 1 X DAILY For 3 Days
bupropion SR (WELLBUTRIN SR) 12hr ER tab
[74469]
150 mg, Oral, 2 X DAILY (AT MEALTIME) For 81
Days
Page 2 of 2
Printed by STRAKA, KEVIN F [KFS1] at 5/31/2017 4:23:04 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 05/2017CCKM@uwhealth.org