/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/neurosciences/,

/clinical/cckm-tools/content/order-sets/inpatient/neurosciences/name-98144-en.cckm

20180129

page

100

UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,Neurosciences

IP - Neuroendovascular - Angiogram - Adult - Preprocedure [1622]

IP - Neuroendovascular - Angiogram - Adult - Preprocedure [1622] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Neurosciences


IP - Neuroendovascular - Angiogram - Adult - Preprocedure [1622]
for Adult Patients OnlyIntended
Carotid Stent or Carotid Endarterectomy Preprocedure orders use one of the For
following order sets:
[5292]Preprocedure -Adult -Carotid Endarterectomy -FDS
[5295] Preprocedure -Adult -Carotid Stent Placement (Neuro Suite/OR) -FDS
[5322]Preprocedure -Adult -Carotid Stent Placement (Cath Lab) -FDS
Patient Care Orders
Vital Signs [22620]
Vital Signs [NURMON0013] ONCE, Starting tomorrow For 1 Occurrences, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Check Pulse [NURMON0008] ONCE, Starting tomorrow For 1 Occurrences, Routine
Method:
Pulse Side: Bilateral
Pulse Location: Pedal,Posterial Tibial
Assess and mark pedal and posterior tibial pulses.
Patient Monitoring [22621]
Assess Neurologic Status [NURMON0006] ONCE, Starting tomorrow For 1 Occurrences, Routine
Nutrition [22623]
NPO Except Medications [NUT9999] EFFECTIVE MIDNIGHT, Starting tomorrow, Routine
Patient Type: Adult
Diet Type: NPO
NPO: NPO except Medications
Bedside Meal Instructions:
Room Service Class:
Non-Categorized Patient Care Orders [22625]
Measure Weight For Dose Calculations
[NURMON0054]
ONCE, Starting tomorrow For 1 Occurrences, Routine,
Standing weight preferred.
Insert and Maintain Urinary Catheter
[NURELM0013]
CONTINUOUS, Starting tomorrow For Until specified,
Routine, To discontinue this order, enter a new order
for "Discontinue Urinary Catheter".
To modify this order, enter a new order for "Maintain
Urinary Catheter" and make the necessary changes in
the new order.
Type: Indwelling Single Lumen
Indication for Placement:
Details: To Dependent Drainage
Does this need to be inserted/placed?
Page 1 of 8
Printed by O'BRIEN, RYLEY P [RPO249] at 1/29/2018 9:11:31 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Insert and Maintain Urinary Catheter - Condom
Catheter [NURELM0013]
CONTINUOUS, Starting tomorrow For Until specified,
Routine, To discontinue this order, enter a new order
for "Discontinue Urinary Catheter".
To modify this order, enter a new order for "Maintain
Urinary Catheter" and make the necessary changes in
the new order.
Type: Condom
Indication for Placement:
Details:
Does this need to be inserted/placed?
Apply and Maintain Anti-Embolism Stocking
[NURTRT0039]
CONTINUOUS, Starting tomorrow, Routine
Does this need to be inserted/placed? Yes
Left/Right/Bilateral? Bilateral
Type: Knee high
Hypoglycemia Management [22627]
BOTH orders when ordering. Select
Glucose, POC [IPGLUCOSE] ONCE, Starting tomorrow 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?
On arrival to Angio Suite.
Hypoglycemia Management (Adult) [191576]
Glucose, POC [IPGLUCOSE] AS NEEDED FOR SIGNS AND SYMPTOMS OF
HYPOGLYCEMIA, Starting tomorrow For Until
specified, 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?
Glucose, POC [IPGLUCOSE] AFTER PROVIDING HYPOGLYCEMIA
TREATMENT, Starting tomorrow For Until specified,
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?
Per hypoglycemia treatment algorithm Recheck
glucose 15 minutes after providing treatment until
glucose is greater than or equal to 70 mg/dL. If
patient has been critically low (i.e., glucose less than
40 mg/dL), recheck glucose after 1 hour to ensure
glucose remains greater than or equal to 70mg/dL.
After resolution of mild hypoglycemia (i.e., glucose
40-69 mg/dL), consider rechecking after 1 hour if
patient has signs/symptoms of hypoglycemia or is at
risk for a subsequent hypoglycemic event (e.g.,
previously administered insulin still active, altered
renal status, altered mental status, NPO or
interrupted nutrition, or any other condition that
increases hypoglycemia risk)
Page 2 of 8
Printed by O'BRIEN, RYLEY P [RPO249] at 1/29/2018 9:11:31 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

Notify Provider [NURCOM0001] Provider to Notify: Provider
Notify based on: Blood Glucose,Other
If blood glucose > (mg/dL): 400
If blood glucose < (mg/dL): 40
Other: Nutritional status changes
Hypoglycemia Treatment for blood glucose less
than 40 mg/dL and patient able to eat/swallow
safely [NURCOM0022]
CONDITIONAL, Starting tomorrow For Until
specified
If Conditional, What Condition? If blood glucose less
than 40mg/dL and patient able to eat/swallow safely.
Give 30 grams of carbohydrate (8 oz. of fruit juice).
Repeat treatment until glucose is 70 mg/dL or
greater.
Hypoglycemia Treatment for blood glucose
between 40 to 69 mg/dL and patient able to
eat/swallow safely [NURCOM0022]
CONDITIONAL, Starting tomorrow For Until
specified
If Conditional, What Condition? If glucose is 40-69
mg/dL and patient able to eat/swallow safely
Give 15 grams of carbohydrate (4 oz of fruit juice).
Repeat treatment until glucose is 70 mg/dL or
greater.
glucose-vitamin C chew tab [50690] 16 g, Oral, EVERY 15 MINUTES PRN Starting
tomorrow, hypoglycemia, Hypoglycemia, For blood
glucose 40-69 mg/dL
Use in patients able to safely eat/swallow but unable
to tolerate volume of fruit juice or per patient
preference. Repeat every 15 minutes until blood
glucose is 70 mg/dL or greater.
glucose-vitamin C chew tab [50690] 32 g, Oral, EVERY 15 MINUTES PRN Starting
tomorrow, hypoglycemia, Hypoglycemia, For blood
glucose less than 40 mg/dL
Use in patients able to safely eat/swallow but unable
to tolerate volume of fruit juice or per patient
preference. Repeat every 15 minutes until blood
glucose is 70 mg/dL or greater.
glucagon injection kit [107799] 1 mg, Subcutaneous, PRN Starting tomorrow, For
blood glucose less than 69 mg/dL and patient unable
to eat/swallow safely AND has NO IV access
Repeat every 15 minutes until blood glucose is 70
mg/dL or greater. See Adult Hypoglycemia Algorithm
dextrose injection [800233] 12.5 g, Intravenous, PRN Starting tomorrow, For
blood glucose 40-69 mg/dL and patient unable to
eat/swallow safely AND has IV access
Repeat every 15 minutes until blood glucose is 70
mg/dL or greater. See Adult Hypoglycemia Algorithm
dextrose injection [800233] 25 g, Intravenous, PRN Starting tomorrow, For blood
glucose less than 40 mg/dL and patient unable to
eat/swallow safely AND has IV access.
Repeat every 15 minutes until blood glucose is 70
mg/dL or greater. See Adult Hypoglycemia Algorithm
GLUCOSE, WHOLE BLOOD [HCWBGLU] CONDITIONAL, Starting tomorrow For 7 Days,
STAT
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition? Draw if blood
glucose is less than 40 mg/dL or greater than 400
mg/dL.
Page 3 of 8
Printed by O'BRIEN, RYLEY P [RPO249] at 1/29/2018 9:11:31 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

GLUCOSE, WHOLE BLOOD [HCWBGLU] CONDITIONAL, Starting tomorrow For 7 Days,
STAT
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition? Draw if blood
glucose is less than 40 mg/dL or greater than 400
mg/dL.
Intravenous Therapy
IV Fluids [22813]
dextrose 5%-NaCl 0.9% infusion [51641] at 125 mL/hr, Intravenous, CONTINUOUS Starting
tomorrow
dextrose 5%-NaCl 0.45% infusion [51613] at 125 mL/hr, Intravenous, CONTINUOUS Starting
tomorrow
sodium chloride 0.9 % infusion [64367] at 125 mL/hr, Intravenous, CONTINUOUS Starting
tomorrow
Medications - Pre-Procedure
Refer to "Contrast Induced Nephropathy Prophylaxis - Adult Supplemental Order Set"
For Patients On Oral Diabetics Agents [22871]
Note: Hold oral diabetic agents on morning of
procedure [950018]
ONCE Starting tomorrow For 1 Doses
Hold oral diabetic agents on morning of procedure
For Patients With Contrast Allergy [22816]
methylprednisolone (MEDROL) tab [720092] 32 mg, Oral, ONCE Starting tomorrow For 1 Doses
Give 12 hours prior to procedure for contrast allergy
methylprednisolone (MEDROL) tab [720092] 32 mg, Oral, ONCE Starting tomorrow For 1 Doses
Give 2 hours prior to procedure for contrast allergy
diphenhydramine (BENADRYL) cap [36791] 50 mg, Oral, ONCE Starting tomorrow For 1 Doses
Give 1 hour prior to procedure for contrast allergy
Medications - Intra-Procedure
Non-Categorized [22821]
lidocaine (STERILE UROJECT) 2 % gel [785049] Urethral, ONCE Starting tomorrow For 1 Doses,
IntraOp
Surgical Prophylaxis
First Line (Single Response) [221634]
cefuroxime (ZINACEF) intraVENOUS - NOTE:
Patients who are 40 - 120 kg [800030]
1.5 g, Intravenous, ON CALL Starting tomorrow For 1
Doses
cefuroxime (ZINACEF) intraVENOUS - NOTE:
Patients who are 121 kg and greater [800030]
3 g, Intravenous, ON CALL Starting tomorrow For 1
Doses
MRSA / Documented MRSA History (Single Response) [221635]
Patients who are 40 - 120 kg [228666]
cefuroxime (ZINACEF) intraVENOUS [800030] 1.5 g, Intravenous, ON CALL Starting tomorrow For
1 Doses
vancomycin (VANCOCIN) intraVENOUS
[800084]
20 mg/kg, Intravenous, ON CALL Starting tomorrow
For 1 Doses
Patients who are 121 kg and greater [228667]
cefuroxime (ZINACEF) intraVENOUS [800030] 3 g, Intravenous, ON CALL Starting tomorrow For 1
Doses
vancomycin (VANCOCIN) intraVENOUS
[800084]
20 mg/kg, Intravenous, ON CALL Starting tomorrow
For 1 Doses
Immediate/Severe Reactions to Penicillin or Known Cephalosporin Allergies (Single Response) [181813]
Patients who are 40-120 kg [228718]
ciprofloxacin (CIPRO) intraVENOUS [800031] 400 mg, Intravenous, ON CALL For 1 Doses, Pre-Op
Day Of Procedure
vancomycin (VANCOCIN) intraVENOUS
[800084]
20 mg/kg, Intravenous, ON CALL For 1 Doses, Pre-
Op Day Of Procedure
Page 4 of 8
Printed by O'BRIEN, RYLEY P [RPO249] at 1/29/2018 9:11:31 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

Patients who are 121-160 kg [228720]
ciprofloxacin (CIPRO) intraVENOUS [800031] 600 mg, Intravenous, ON CALL For 1 Doses, Pre-Op
Day Of Procedure
vancomycin (VANCOCIN) intraVENOUS
[800084]
20 mg/kg, Intravenous, ON CALL For 1 Doses, Pre-
Op Day Of Procedure
Patients who are greater than 160 kg [228719]
ciprofloxacin (CIPRO) intraVENOUS [800031] 800 mg, Intravenous, ON CALL For 1 Doses, Pre-Op
Day Of Procedure
vancomycin (VANCOCIN) intraVENOUS
[800084]
20 mg/kg, Intravenous, ON CALL For 1 Doses, Pre-
Op Day Of Procedure
Laboratory
Labs [233414]
BUN [BUN] STAT, 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?
CBC WITHOUT DIFFERENTIAL [HEMO] STAT, 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?
CREATININE [CRET] STAT, 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?
ELECTROLYTES [LYTE] STAT, 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?
Platelet Reactivity (PRU) Test and ADP
Aggregation (w/ Platelet and Hematocrit)
[183724]
Test measures the ability of platelets to aggregate in whole blood in response to ADP. This test
can be used to assess the affect of clopidogrel, prasugrel or any drug specific for the inhibition of
the ADP receptor.
valid.count must be greater that 75 K/uL for test results to be Platelet
PLATELET REACTIVITY (PRU) TEST
[HCVNPRU]
NEXT AM For 1 Occurrences, Routine, Patients who
have been treated with Glycoprotein IIb/IIIa inhibitors
should not be tested until platelet function has
recovered. This time period is approximately 14 days
after discontinuation of abciximab (ReoPro) and up
to 48 hours after discontinuation of eptifibatide
(Intergrilin) and tirofiban (Aggrastat).
Dose and name of antiplatelet medication:
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition?
HEMATOCRIT [HCT] 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?
PLATELET COUNT [PLT] 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 5 of 8
Printed by O'BRIEN, RYLEY P [RPO249] at 1/29/2018 9:11:31 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

PLATELET AGGREGATION, ADP [HCADPAGG] NEXT AM For 1 Occurrences, Routine, Test
measures the ability of platelets to aggregate in
whole blood in response to ADP. This test can be
used to assess the affect of clopidogrel, prasugrel or
any drug specific for the inhibition of the ADP
receptor. Platelet count must be greater that 75 K/uL
for test results to be valid.
Dose of Clopidogrel?
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition?
IP - LAB - ARACHIDONIC ACID
AGGREGATION (W/ PLATELET AND
HEMATOCRIT) [181407]
to arachidonic measures the ability of platelets to aggregate in whole blood in response Test
like drug. -or any aspirinacid. This test can be used to assess the affect of aspirin
valid.count must be greater that 75 K/uL for test results to be Platelet
HEMATOCRIT [HCT] 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?
PLATELET COUNT [PLT] 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?
PLATELET AGGREGATION, ARACHIDONIC
ACID [HCAAAGG]
NEXT AM For 1 Occurrences, Routine, Test
measures the ability of platelets to aggregate in
whole blood in response to arachidonic acid. This
test can be used to assess the affect of aspirin or
any aspirin-like drug. Platelet count must be greater
that 75 K/uL for test results to be valid.
Dose of Aspirin:
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition?
PROTHROMBIN TIME/INR [PT] STAT, 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?
PTT [PTT] STAT, 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?
URINALYSIS, NO MICROSCOPY [UACHEM] 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?
ACTIVATED CLOTTING TIME, POC
[HCACTPOC]
CONDITIONAL, Starting today, Routine
If Conditional, What Condition? Baseline ACT at
beginning of neurovascular procedure; then every 5
minutes after each heparin bolus is given until
ACT>200; then every 20 minutes.
Laboratory - Pregnancy Test [112034]
Page 6 of 8
Printed by O'BRIEN, RYLEY P [RPO249] at 1/29/2018 9:11:31 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

surgery is pelvic, renal, pregnancy test if female between menarche & menopause and any of: (1) Obtain
intercourse, (3) patient missed menses, (4) patient says abdominal, (2) patient had unprotected -or intra
pregnant. she "could" be
Urine, Pregnancy Test [UPREG] STAT, 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?
Diagnostic Tests and Imaging
Studies [22632]
ECG - 12 Lead Without Rhythm [EKG0008] ONCE, Starting tomorrow 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 [22634]
Consult Cardiology (Inpatient) [CON0012] 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:
Diabetes Consult Order Panel (Adult) [188497]
Diabetes Management Service : Will provide management or treatment recommendations for
patients with hyperglycemia and/or those who report outpatient use of insulin or other diabetes
medications. Patients should be expected to remain inpatient > 24 hrs from time of consult.
Consult is required for patients with insulin pumps or who use U-500 insulin. Consult Endocrine
for any non-diabetes-related endocrine questions.
Learning Center - Diabetes Education (Adult): Diabetes Education (Adult): Diabetes education
(meter/insulin skills/other diabetes survival skills) for patients/families with knowledge deficits
and/or need for diabetes knowledge assessment. Recommended for all new diagnoses or
patients with A1C > 9.
Diabetes Education – Nutrition : Diabetes nutrition therapy including nutrition assessment,
carbohydrate education (consistent carbohydrate meals, use of insulin-to-carbohydrate ratio),
and/or individualized, nutritious meal planning for carbohydrates, portions, or considering other
comorbidities. Recommended for all new diagnoses or patients with A1C > 9
Consult Diabetes Management Service (DMS)
(Inpatient) [CON0022]
ONCE
Can this consult be done via video?
Call back number:
Intent: Consult and Recommend (Write Orders)
Concern or Specific Question or Task to be
Addressed (Symptom, Sign, or Diagnosis):
Page 7 of 8
Printed by O'BRIEN, RYLEY P [RPO249] at 1/29/2018 9:11:31 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

Consult Learning Center - Diabetes Education
(Adult) [CON0021]
ONCE, Routine, - If patient is newly diagnosed or is
new to insulin, provide 24 hours notice to allow
adequate time for education,
- Indicate diabetes medication/treatment plan if
known.
- Consults requested after 1600 on Fridays may not
be seen until following Monday. Learning Center
available Mon-Sat 0800-1630 (only 1 RN available
on Saturday for CSC and AFCH).
- Staff may be contacted by Pager 7927 on
weekdays and Pager 3276 on weekends.
- Learning Center staff are not available on holidays.
Type of Education: Diabetes Self-Management
Education
Reason For Consult:
Expected Discharge Date:
Diabetes management / treatment plan:
Can this consult be done via video?
Consult Diabetes Education - Nutrition (Inpatient)
[CON0126]
ONCE, Routine, · If your patient is newly diagnosed
and/or is new to insulin therapy, provide 24 hours
notice to allow adequate time for nutrition education.
· Indicate diabetes medication/treatment plan if
known.
· Consults requested after 1300 on Friday may not
be completed until the following Monday.
· If you are placing a consult on a weekend day for a
patient who will be discharging that weekend, please
have the Paging Center contact the on-call dietitian
to help you facilitate the diabetes nutrition education
session prior to the patient's discharge.
Type of Education: Diabetes Self-Management
Education
Reason For Consult:
Expected Discharge Date:
Diabetes management / treatment plan:
Can this consult be done via video?
Consult Hematology (Inpatient) [CON0034] 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:
Consult Renal (Inpatient) [CON0070] 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:
Page 8 of 8
Printed by O'BRIEN, RYLEY P [RPO249] at 1/29/2018 9:11:31 AM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org