/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-98246-en.cckm

20180111

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100

UWHC,UWMF,

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

IP – Parenteral Nutrition – Pediatric/Neonatal – Supplemental [1530]

IP – Parenteral Nutrition – Pediatric/Neonatal – Supplemental [1530] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Hospital-wide


IP - Parenteral Nutrition - Pediatric/Neonatal - Supplemental [1530]
Non-Categorized Patient Care Orders
Non-Categorized Patient Care Orders [20839]
Measure Weight [NURMON0015] 1X DAILY, Starting today, Routine
Weigh With?
Weigh when?
Measure Weight [NURMON0015] SEE COMMENTS, Starting today with First
Occurrence As Scheduled, Routine
Weigh With?
Weigh when?
Daily for 5 days, then 2 times per week.
Glucose, POC [IPGLUCOSE] EVERY 4 HOURS, Starting today For 4 Days,
Routine, Glucose, POC should always be ordered in
conjunction with orders for hypoglycemia management
and monitoring as indicated in the Hypoglycemia
Management (Adult) panel.
If Conditional, What Condition?
Every 4 hours until patient is at goal.
Glucose, POC [IPGLUCOSE] AS NEEDED FOR SIGNS AND SYMPTOMS OF
HYPOGLYCEMIA, Starting today For 1 Occurrences,
Routine, Glucose, POC should always be ordered in
conjunction with orders for hypoglycemia management
and monitoring as indicated in the Hypoglycemia
Management (Adult) panel.
If Conditional, What Condition?
Medications
Fat Emulsion - Infused Seperately [20854]
fat emulsion 20% (INTRALIPID 20%) infusion
[45137]
Intravenous, 1 X DAILY (PM)
fat emulsion 20% (SMOFLIPID 20%) infusion
[172247]
Intravenous, 1 X DAILY (PM)
Parenteral Nutrition (Single Response) [20855]
900 solutions may NOT exceed 100 g dextrose/1000 mL or 25 g protein/1000 mL or Peripheral
mOsm/1000 mL for the entire solution
When Selecting Amino Acid SolutionConsiderations
restrictedClinisol for patients older than 18 month or if fluid Use
Use Trophamine WITH cysteine in patients 18 months or younger who have 2 dedicated lines. Use
Trophamine WITHOUT cysteine f the patient does not have 2 lines or line time issues are anticipated
parenteral nutrition (PEDS < 30 kg) CENTRAL
[700328]
Intravenous, DAILY PEDS PN Starting today at 6:00
PM For 1 Days
parenteral nutrition (PEDS < 30 kg)
PERIPHERAL [700330]
Intravenous, DAILY PEDS PN Starting today at 6:00
PM For 1 Days
parenteral nutrition (PEDS > 30 Kg) CENTRAL
[700402]
Intravenous, DAILY PEDS PN Starting today at 6:00
PM For 1 Days
parenteral nutrition (PEDS > 30 Kg)
PERIPHERAL [700401]
Intravenous, DAILY PEDS PN Starting today at 6:00
PM For 1 Days
Other [80450]
Note: PN Rate Instructions [950020] 4 X DAILY
Laboratory
Baseline - Start of the Parenteral Nutrition [20841]
Page 1 of 6
Printed by STRAKA, KEVIN F [KFS1] at 1/11/2018 9:36:53 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

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?
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?
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?
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?
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?
Page 2 of 6
Printed by STRAKA, KEVIN F [KFS1] at 1/11/2018 9:36:53 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

GGT [GGT] 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?
TRIGLYCERIDE [TRIG] NEXT DRAW, Starting today For 1 Occurrences,
Routine, Fasting specimen is preferred.
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
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?
For Chronic Hemodialysis Patients [20842]
ZINC [HCZN] 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?
COPPER [XCOP] 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?
MISCELLANEOUS TEST - Chromium [RMISC] NEXT DRAW, Starting today For 1 Occurrences,
Routine
What lab test would you like to have performed?
For questions I can be reached at:
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?
After Initiation of Lipid [20843]
TRIGLYCERIDE [TRIG] NEXT AM For 1 Days, Routine, Fasting specimen is
preferred.
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Draw Daily for 4 Days [20844]
ELECTROLYTES [LYTE] NEXT AM For 4 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 4 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 AM For 4 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 4 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Page 3 of 6
Printed by STRAKA, KEVIN F [KFS1] at 1/11/2018 9:36:53 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

CALCIUM [CA] NEXT AM For 4 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 For 4 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 For 4 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Draw Every Monday and Thursday (Starting After Week 1) [20845]
ELECTROLYTES [LYTE] EVERY MONDAY AND THURSDAY, Starting 1/18/18
with First Occurrence As Scheduled For 4 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
BUN [BUN] EVERY MONDAY AND THURSDAY, Starting 1/18/18
with First Occurrence As Scheduled For 4 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
CREATININE [CRET] EVERY MONDAY AND THURSDAY, Starting 1/18/18
with First Occurrence As Scheduled For 4 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
GLUCOSE [GLU] EVERY MONDAY AND THURSDAY, Starting 1/18/18
with First Occurrence As Scheduled For 4 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
CALCIUM [CA] EVERY MONDAY AND THURSDAY, Starting 1/18/18
with First Occurrence As Scheduled For 4 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 MONDAY AND THURSDAY, Starting 1/18/18
with First Occurrence As Scheduled For 4 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 MONDAY AND THURSDAY, Starting 1/18/18
with First Occurrence As Scheduled For 4 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Page 4 of 6
Printed by STRAKA, KEVIN F [KFS1] at 1/11/2018 9:36:53 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

BILIRUBIN, TOTAL [TBIL] EVERY MONDAY AND THURSDAY, Starting 1/18/18
with First Occurrence As Scheduled For 4 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
AST/SGOT [AST] EVERY MONDAY AND THURSDAY, Starting 1/18/18
with First Occurrence As Scheduled For 4 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
GGT [GGT] EVERY MONDAY AND THURSDAY, Starting 1/18/18
with First Occurrence As Scheduled For 4 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
ALT/SGPT [ALT] EVERY MONDAY AND THURSDAY, Starting 1/18/18
with First Occurrence As Scheduled For 4 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
ALKALINE PHOSPHATASE [ALKP] EVERY MONDAY AND THURSDAY, Starting 1/18/18
with First Occurrence As Scheduled For 4 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Draw Every Monday (Starting After Week 1) [20846]
ALBUMIN [ALB] EVERY MONDAY, Starting 1/18/18 with First
Occurrence As Scheduled For 4 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
PREALBUMIN [XPRALB] EVERY MONDAY, Starting 1/18/18 with First
Occurrence As Scheduled For 4 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
C REACTIVE PROTEIN [CRPN] EVERY MONDAY, Starting 1/18/18 with First
Occurrence As Scheduled For 4 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
TRIGLYCERIDE [TRIG] EVERY MONDAY, Starting 1/18/18 with First
Occurrence As Scheduled For 4 Days, Routine,
Fasting specimen is preferred.
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Conditional Labs [20847]
Page 5 of 6
Printed by STRAKA, KEVIN F [KFS1] at 1/11/2018 9:36:53 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

GLUCOSE [GLU] CONDITIONAL For 4 Days, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw STAT if blood
glucose is less than 40 or greater than 400 mg/dL
Consults
Consults [20848]
Consult Nutrition (Inpatient) [CON0043] ONCE, Starting today For 1 Occurrences, Routine
Reason for Consult: Nutrition Assessment w/
Recommendations
Delegate to Initiate and Manage Tube Feeding:
Delegate to Initiate Feeding Tube Placement Order
Set:
Delegate to Manage Diet Order/Supplement Order:
Delegate to Dysphagia Diet Order Progression:
Page 6 of 6
Printed by STRAKA, KEVIN F [KFS1] at 1/11/2018 9:36:53 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org