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/clinical/cckm-tools/content/order-sets/inpatient/neurosciences/name-98148-en.cckm

201606176

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100

UWHC,UWMF,

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

IP - Neurosurgery - Alcohol Withdrawal - Adult Supplemental [4945]

IP - Neurosurgery - Alcohol Withdrawal - Adult Supplemental [4945] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Neurosciences


IP - Neurosurgery - Alcohol Withdrawal - Adult Supplemental [4945]
UW Health Guidelines for Alcohol Withdrawal
Management
URL: https://uconnect.wisc.edu/clinical/cckm-
tools/cpg/guidelines/npg/guidelines/alcohol-use-
disorders/iv-references/resources/name-28819-en.file
Patient Care Orders
Patient Monitoring [145182]
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
Respiratory [205708]
Pulse Oximetry [NURMON0009] CONTINUOUS, Routine
Call MD with any sign of airway obstruction or snoring
[NURCOM0022]
CONTINUOUS
Non-Categorized Patient Care Orders [145184]
Complete CIWA-Ar and RASS Nursing Assessments
[NURCOM0022]
SEE COMMENTS, For CIWA < 10: document CIWA and
RASS score every 2 hours. If CIWA is < 10 x 4 consecutive
measurements, CIWA and RASS score every 4 hours x 48
hours, if still < 10 notify provider to consider discontinuation.
For CIWA 10-15: document CIWA and RASS score every 2
hours.
For CIWA 16-20: document CIWA and RASS score every
hour.
For CIWA > 20: document CIWA and RASS score every
hour.
** Notify provider if CIWA socre is greater than 15 for 3
consecutive measurements **
Contingency Parameters [145185]
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Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 05/2016CCKM@uwhealth.org

Notify [NURCOM0001] Provider to Notify: Provider
If systolic blood pressure > (mmHg):
If systolic blood pressure < (mmHg):
If diastolic blood pressure > (mmHg):
If diastolic blood pressure < (mmHg):
If temperature > (C):
If temperature < (C):
If heart rate > (bpm):
If heart rate < (bpm):
If respiratory rate >:
If respiratory rate <:
If blood glucose > (mg/dL):
If blood glucose < (mg/dL):
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL):
Other:
Refer to current Notify Provider order.
The patient has seizure activity
You suspect the CIWA score is not related to alcohol
withdrawal
The CIWA score is greater than 15 for 3 consecutive
measurements
The RASS score is -4 or -5.
The patient becomes disoriented to person, place, and time
and this is a change from baseline
The patient presents with severe agitation or loss of control
3 doses of gabapentin are given without response
Intravenous Therapy
IV Fluids [145191]
sodium chloride 0.9% BOLUS [730003] 1,000 mL, Intravenous, EVERY 1 HOUR PRN, For MAP < 70
mmHg
Call MD if greater than 3 boluses.
Medications
Medications [142607]
gabapentin (NEURONTIN) soln [65814] 600 mg, Dobhoff Tube, EVERY 4 HOURS
Administer for alcohol withdrawal symptoms
gabapentin (NEURONTIN) soln [65814] 300 mg, Dobhoff Tube, EVERY 2 HOURS PRN, other, For
CIWA score > 10
Administer for alcohol withdrawal symptoms
quetiapine (SEROQUEL) tab [720129] 25 mg, Dobhoff Tube, EVERY 3 HOURS PRN, delirium,
hallucinations/agitation
thiamine (VITAMIN B-1) intraVENOUS [800261] 100 mg, Intravenous, ONCE For 1 Doses
Administer prior to providing dextrose containing solutions
thiamine (VITAMIN B-1) tab [43659] 100 mg, Dobhoff Tube, 1 X DAILY Starting tomorrow For 2
Days
folic acid (FOLVITE) tab [37644] 1 mg, Dobhoff Tube, 1 X DAILY
multivitamin with mineral tab [800240] 1 tab, Dobhoff Tube, 1 X DAILY
ondansetron (ZOFRAN) tab [45939] 4 mg, Dobhoff Tube, EVERY 12 HOURS PRN For 96 Hours,
nausea/vomiting
Electrolyte Supplementation
Potassium Chloride (Single Response) [145193]
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Printed by O'BRIEN, RYLEY P [RPO249] at 5/13/2016 9:11:17 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
05/2016CCKM@uwhealth.org

potassium chloride 10 mEq/100 mL bag [46253] 10 mEq, Intravenous, PRN, potassium supplementation - See
Admin Instruction
For serum K between 3.6 - 3.9 mmol/L give 10 mEq x2;
For serum K between 3.1 - 3.5 mmol/L give 10 mEq x4;
For serum K less than or equal to 3.0 mmol/L give 10 mEq x6
Use only if patient is unable to tolerate enteral administration
for 60 Minutes
Reminder: Pharmacist to adjust per UWHC Renal Dosing
Protocol if applicable
potassium chloride 20 mEq/ 100 mL bag CENTRAL
LINE ONLY [46255]
20 mEq, Intravenous, PRN, potassium supplementation - See
Admin Instruction
For central line use ONLY
For serum K between 3.6 - 3.9 mmol/L give 20 mEq x1;
For serum K between 3.1 - 3.5 mmol/L give 20 mEq x2;
For serum K less than or equal to 3.0 mmol/L give 20 mEq x3
for 60 Minutes
Use only if patient is unable to tolerate enteral administration
for 60 Minutes
Reminder: Pharmacist to adjust per UWHC Renal Dosing
Protocol if applicable
potassium chloride 20 mEq oral packet [41217] 20 mEq, Dobhoff Tube, PRN, potassium supplementation -
See Admin Instructions
For serum K between 3.6 - 3.9 mmol/L give 20 mEq x1;
For serum K between 3.1 - 3.5 mmol/L give 20 mEq x2;
For serum K less than or equal to 3.0 mmol/L give 20 mEq x3
Reminder: Pharmacist to adjust per UWHC Renal Dosing
Protocol if applicable
Magnesium Sulfate [144693]
Magnesium Supplemental Scale [950039] PRN - NOTIFY PHARMACY WHEN NEEDED, magnesium
supplementation - see Admin Instructions
For serum magnesium 1.6-1.8 mg/dL give 0.05 g/kg IV x1
over 12 hours.
For serum magnesium 1-1.5 mg/dL give 0.1 g/kg IV x1 over
24 hours.
For serum magnesium less than 1 mg/dL give 0.15 g/kg IV x1
over 24 hours
Reminder: Pharmacist to adjust per UWHC Renal Dosing
Protocol if applicable
Phosphate Sodium (Single Response) [145194]
phosphate-potassium & sodium (PHOS-NAK) oral
packet - For normal renal function [112317]
2 packet, Dobhoff Tube, PRN, phosphate supplementation -
See Admin Instructions
For serum phosphate 1.6 - 2.4 mg/dL, give 2 packets every 4
hours while awake x 3 doses;
For serum phosphate 1.0 - 1.5 mg/dL, give 2 packets every 4
hours while awake x 4 doses
For serum phosphate less than 1.0 mg/dL, call provider for IV
dosing.
phosphorus (K-PHOS NEUTRAL) tab - For renal
dysfunction [45503]
1 tab, Dobhoff Tube, PRN, phosphate supplementation - See
Admin Instructions
For serum phosphate 1.6 - 2.3 mg/dL give 1 tablet every 4 h
while awake x 3 dose
For serum phosphate 1.0 - 1.5 mg/dL give 1 tablet every 4 h
while awake x 4 doses
For serum phosphate less than 1.0 mg/dL, call provider
Post Supplementation [142609]
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Printed by O'BRIEN, RYLEY P [RPO249] at 5/13/2016 9:11:17 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
05/2016CCKM@uwhealth.org

POTASSIUM [K] CONDITIONAL - RN COLLECT For 7 Days, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition? Draw 1 hour after IV
replacement or 4 hours after oral replacement.
MAGNESIUM [MAG] CONDITIONAL - RN COLLECT For 7 Days, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition? Draw AM following
completion of infusion
PHOSPHATE [PHOS] CONDITIONAL - RN COLLECT For 7 Days, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition? Draw 4 hours after enteral
replacement.
Laboratory
Labs [143280]
VITAMIN B12 [B12] NEXT DRAW 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 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) [146838]
Health Psychology - adjustment, protocol (eg. burn, trauma, rehab, pre-amp, transplant), noncompliance, grief, pain
Addictive Disorders - alcohol or drug related problems (eg. treatment recommendations, withdrawal mgmt)
Psychiatry - safety, agitation, capacity, med mgmt, psychotropic SE
ACE - 65 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?
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:
Tim Miller's Test question:
Page 4 of 5
Printed by O'BRIEN, RYLEY P [RPO249] at 5/13/2016 9:11:17 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
05/2016CCKM@uwhealth.org

Consult Ace/Geriatric (Inpatient) [CON0001] ONCE, Routine
Reason for Consult:
Can this consult be done via video?
Page 5 of 5
Printed by O'BRIEN, RYLEY P [RPO249] at 5/13/2016 9:11:17 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
05/2016CCKM@uwhealth.org