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/clinical/cckm-tools/content/order-sets/inpatient/orthopedicsrehab/name-105413-en.cckm

201711324

page

100

UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,Orthopedics/Rehab

IP - Orthopedics - Hip Fracture - Adult - Admission [6183]

IP - Orthopedics - Hip Fracture - Adult - Admission [6183] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Orthopedics/Rehab


IP - Orthopedics - Hip Fracture - Adult - Admission [6183]
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 [187462]
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:
Admission Status [187463]
Page 1 of 10
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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

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:
Venous Thromboembolism (VTE) Prophylaxis
VTE Prophylaxis (Single Response) [136416]
Caprini VTE Risk Assessment URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/hematology-and-
coagulation/related/name-97521-en.cckm
Moderate VTE Risk with Low Bleed Risk
[209996]
enoxaparin (LOVENOX) injection [800040] 30 mg, Subcutaneous, EVERY 12 HOURS
enoxaparin (LOVENOX) subcutaneous injection
[800040]
40 mg, Subcutaneous, EVERY 24 HOURS
heparin PF 5000 UNIT/0.5ML injection [156571] 5,000 units, Subcutaneous, EVERY 12 HOURS
Sequential Compression Device (SCD)
[EQP0023]
CONTINUOUS, Routine
Left/Right/Bilateral? 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
High VTE Risk with Low Bleed Risk [237203]
enoxaparin (LOVENOX) injection [800040] 30 mg, Subcutaneous, EVERY 12 HOURS
enoxaparin (LOVENOX) subcutaneous injection
[800040]
40 mg, Subcutaneous, EVERY 24 HOURS
heparin PF 5000 UNIT/0.5ML injection [156571] 5,000 units, Subcutaneous, EVERY 12 HOURS
heparin PF 5000 UNIT/0.5ML injection [156571] 5,000 units, Subcutaneous, EVERY 8 HOURS
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
High Bleed Risk [237204]
Sequential Compression Device (SCD)
(TREATMENT) [NURTRT0028]
CONTINUOUS, Routine
Left/Right/Bilateral? Bilateral
Page 2 of 10
Printed by O'BRIEN, RYLEY P [RPO249] at 11/17/2017 2:08:26 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

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:
VTE Prophylaxis (Single Response) [150230]
Caprini VTE Risk Assessment URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/hematology-and-
coagulation/related/name-97521-en.cckm
Moderate VTE Risk with Low Bleed Risk
[209996]
enoxaparin (LOVENOX) injection [800040] 30 mg, Subcutaneous, EVERY 12 HOURS
enoxaparin (LOVENOX) subcutaneous injection
[800040]
40 mg, Subcutaneous, EVERY 24 HOURS
heparin PF 5000 UNIT/0.5ML injection [156571] 5,000 units, Subcutaneous, EVERY 12 HOURS
Sequential Compression Device (SCD)
[EQP0023]
CONTINUOUS, Routine
Left/Right/Bilateral? 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
High VTE Risk with Low Bleed Risk [237205]
enoxaparin (LOVENOX) injection [800040] 30 mg, Subcutaneous, EVERY 12 HOURS
enoxaparin (LOVENOX) subcutaneous injection
[800040]
40 mg, Subcutaneous, EVERY 24 HOURS
heparin PF 5000 UNIT/0.5ML injection [156571] 5,000 units, Subcutaneous, EVERY 12 HOURS
heparin PF 5000 UNIT/0.5ML injection [156571] 5,000 units, Subcutaneous, EVERY 8 HOURS
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
High Bleed Risk [237206]
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 3 of 10
Printed by O'BRIEN, RYLEY P [RPO249] at 11/17/2017 2:08:26 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

Patient Care Orders
Vital Signs [18015]
Vital Signs [NURMON0013] EVERY 4 HOURS, Starting today For Until specified,
Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Neurovascular Checks [NURMON0045] EVERY 4 HOURS, Routine
Location:
Activity [211581]
Strict Bedrest [NURACT0008] CONTINUOUS, Routine
AD LIB:
AMBULATE:
CHAIR:
DANGLE:
BEDREST: strict bedrest
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Nutrition (Single Response) [211582]
NPO After Midnight [NUT9999] EFFECTIVE MIDNIGHT, Starting today, Routine
Patient Type: Adult
Diet Type: NPO
NPO: NPO except Medications
Bedside Meal Instructions:
Room Service Class:
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:
General Diet [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: General (no Modifications)
Bedside Meal Instructions:
Room Service Class:
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:
Nourishments & Supplements [NUT0005] EFFECTIVE NOW, Starting today, Routine
Medical Food / Oral Supplement(s): ENSURE HIGH
PROTEIN, VANILLA (CANS)
Nourishment / Snack Item(s):
Schedule: BREAKFAST, LUNCH, DINNER
Respiratory [20751]
Page 4 of 10
Printed by O'BRIEN, RYLEY P [RPO249] at 11/17/2017 2:08:26 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

Oxygen Therapy [RT0032] CONTINUOUS, Starting today For Until specified,
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?
Pulse Oximetry [NURMON0009] EVERY 4 HOURS, Starting today For Until specified,
Routine
Incentive Spirometry [NURTRT0018] EVERY 1 HOUR, Starting today For Until specified,
Routine
Cough And Deep Breathe [NURTRT0019] EVERY 1 HOUR, Starting today For Until specified,
Routine
Respiratory Therapy per Protocol [RT0035] Routine
Protocol Type:
Intake and Output [18101]
Measure Intake And Output [NURMON0005] EVERY 4 HOURS, Starting today For Until specified,
Routine
Non-Categorized Patient Care Orders [228417]
Measure Weight [NURMON0015] 1X DAILY, Routine
Weigh With?
Weigh when?
Initiate Bladder Management Protocol
[NURELM0014]
CONTINUOUS, Routine
Insert and Maintain Urinary Catheter
[NURELM0013]
CONTINUOUS 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:
Indication for Placement:
Details: To Dependent Drainage
Does this need to be inserted/placed?
Apply Brace, Spine [NURTRT0014] CONTINUOUS, Routine
Type:
Wearing schedule:
Apply Brace/Splint, Lower Body [NURTRT0009] CONTINUOUS, Routine, If ordering a Bledsoe Boot or
Hip Abduction Brace, please contact the cast room
technician at 265-0746.
Type:
Left/Right/Bilateral?
Wearing schedule:
Apply Brace/Splint, Upper Body [NURTRT0015] CONTINUOUS, Routine, If ordering a Sarmiento
Humeral Fracture Orthosis, please contact the cast
room technician at 265-0746.
Type:
Left/Right/Bilateral?
Wearing schedule:
Trapeze (Patient Helper) Patient Weight < 250
LBS [117142]
Trapeze (Patient Helper) Patient Weight < 250
Lbs - Treatment [NURTRT0056]
CONTINUOUS, Routine
Trapeze (Patient Helper) Patient Weight < 250
Lbs [EQP0029]
CONTINUOUS, Routine
What bed type needs the trapeze?
Trapeze (Patient Helper) Patient Weight > 250
LBS, Max 350 LBS [117144]
Page 5 of 10
Printed by O'BRIEN, RYLEY P [RPO249] at 11/17/2017 2:08:26 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

Trapeze (Patient Helper) Patient Weight > 250
Lbs, MAX 350 Lbs - Treatment [NURTRT0055]
CONTINUOUS, Routine
Trapeze (Patient Helper) Patient Weight > 250
Lbs, MAX 350 Lbs [EQP0062]
CONTINUOUS, Routine
What bed type needs the trapeze?
Pulsate Sizewise (Low Air Loss) weight <500
pounds (Specialty Bed) [EQP0037]
CONTINUOUS, Starting today, Routine, Pressure
relief low air loss surface.
Contingency Parameters [18107]
Notify Provider [NURCOM0001] Provider to Notify: Provider
If systolic blood pressure > (mmHg): 180
If systolic blood pressure < (mmHg): 90
If diastolic blood pressure > (mmHg):
If diastolic blood pressure < (mmHg):
If temperature > (C): 38.5
If temperature < (C):
If heart rate > (bpm): 120
If heart rate < (bpm): 60
If respiratory rate >:
If respiratory rate <: 8
If blood glucose > (mg/dL):
If blood glucose < (mg/dL):
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL):
Other: Sedation score greater than 5,Naloxone
administered,Pain not controlled with ordered
analgesics or ordered interventions
Intravenous Therapy
IV Fluids [13105]
sodium chloride 0.9% with KCl 20 mEq/L infusion
[46261]
at 100 mL/hr, Intravenous, CONTINUOUS
sodium chloride 0.9 % infusion [64367] at 100 mL/hr, Intravenous, CONTINUOUS
dextrose 5%-NaCl 0.45% with KCl 20 mEq/L
infusion [44910]
at 100 mL/hr, Intravenous, CONTINUOUS
dextrose 5%- NaCl 0.9% with KCl 20 mEq/L
infusion [44904]
at 100 mL/hr, Intravenous, CONTINUOUS
Flushes [227989]
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
sodium chloride flush 0.9% 10 mL injection
[785055]
Flush, PRN, flush/line care
Medications
Nursing Communication Orders [233646]
On day of surgery, do not administer ACE
inhibitors (angiotensin-converting-enzyme
inhibitors which include benzepril, captopril,
enalapril, fosinopril, lisinopril, moexipril,
perindopril, quinapril, ramipril, trandolapril)
[NURCOM0022]
ONCE
On day of surgery, do not administer ARB
(antiotensin II receptor blockers which include
losartan, candesartan, valsartan, irbesartan,
telmisartan, eprosartan, olmesartan)
[NURCOM0022]
ONCE
On day of surgery, do not administer oral diabetic
medications or fast acting insulin [NURCOM0022]
ONCE
Page 6 of 10
Printed by O'BRIEN, RYLEY P [RPO249] at 11/17/2017 2:08:26 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

On day of surgery, do not administer aspirin
UNLESS stents are in place then continue
[NURCOM0022]
ONCE
If patient is on any of the following: ACE; ARB;
oral diabetic medications or fast acting insulin; or
aspirin - please contact house officer.
[NURCOM0022]
ONCE
Patient should have discontinued use of any
herbal medications and NSAIDs now
[NURCOM0022]
ONCE
Analgesics - Acetaminophen - Scheduled [227990]
acetaMINOPHEN (TYLENOL) tab [34150] 1,000 mg, Oral, 3 X DAILY
Analgesics - Acetaminophen - PRN [227991]
acetaMINOPHEN (TYLENOL) tab [34149] 650 mg, Oral, EVERY 4 HOURS PRN, pain,
Administer for mild to moderate pain or multimodal
therapy.
Analgesics - Opioid - Oral - PRN (Single Response) [212916]
hydrocodone-acetaMINOPHEN (NORCO) 5-325
MG per tab [750021]
1-2 tab, Oral, EVERY 4 HOURS PRN, pain,
Administer for severe pain.
No more than 4 grams acetaminophen per 24 hours
for adults or 15mg/kg per dose for peds <40kg.
oxycodone tab [750032] 5-10 mg, Oral, EVERY 4 HOURS PRN, pain,
Administer for severe pain
Analgesics - Opioids - Intravenous - PRN (Single Response) [13106]
HYDROmorphone PF (DILAUDID) injection
[750050]
0.2-0.5 mg, Intravenous, EVERY 2 HOURS PRN,
Administer as needed for severe pain if unable to
tolerate oral medications, for 3 Minutes
MORPHine PF injection [750057] 1-2 mg, Intravenous, EVERY 2 HOURS PRN, pain,
Administer as needed for severe pain if unable to
tolerate oral medications, for 4 Minutes
Anti-emetics [13107]
ondansetron (ZOFRAN ODT) disintegrating tab
[64224]
4 mg, Oral, EVERY 12 HOURS PRN, nausea/vomiting
Administer as first line agent
ondansetron (ZOFRAN) injection [800202] 4 mg, Intravenous, EVERY 12 HOURS PRN,
nausea/vomiting
Administer as first line agent when unable to take
orally.
prochlorperazine (COMPAZINE) tab [41372] 10 mg, Oral, EVERY 6 HOURS PRN, nausea/vomiting
Administer as second line agent if able to take orally.
prochlorperazine (COMPAZINE) injection [41369] 10 mg, Intravenous, EVERY 6 HOURS PRN,
nausea/vomiting
Administer as second line agent in unable to take oral
prochlorperazine.
If ordered IV: push slowly, max rate 5 mg/minute.
Bowel Management [13108]
senna-docusate (SENOKOT-S) 8.6-50 mg per tab
[60530]
2 tab, Oral, 2 X DAILY
Hold for loose stools
magnesium hydroxide (MILK OF MAGNESIA)
susp [65443]
30 mL, Oral, 1 X DAILY PRN, constipation
Administer as first line agent.
polyethylene glycol (MIRALAX) oral packet
[61829]
17 g, Oral, 2 X DAILY PRN, constipation
Administer as second line agent if unresponsive to first
line agent.
Dissolve in 240 mL of liquid.
Page 7 of 10
Printed by O'BRIEN, RYLEY P [RPO249] at 11/17/2017 2:08:26 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

bisacodyl (DULCOLAX) rectal suppository
[35231]
10 mg, Rectal, 1 X DAILY PRN, constipation
Administer as third line agent if there is no response to
first and second line laxatives, or when there is need
for immediate laxation.
Administer as first line agent if patient is NPO.
Gastric [13109]
calcium carbonate (TUMS) chew tab [44477] 500-1,000 mg, Oral, EVERY 4 HOURS PRN,
dyspepsia
Administer as first line agent.
mag-al-simeth (MYLANTA ES) 400-400-40
MG/5ML susp [44073]
15 mL, Oral, EVERY 4 HOURS PRN, dyspepsia
Administer as second line agent.
pantoprazole (PROTONIX) delayed release tab
[62661]
40 mg, Oral, 1 X DAILY
Hypnotics (Single Response) [228331]
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)
Pruritus [211599]
loratadine (CLARITIN) tab [45611] 10 mg, Oral, 1 X DAILY PRN, allergies, For allergies,
itching
Non-Categorized [211600]
naloxone (NARCAN) injection [800199] 0.1 mg, Intravenous, PRN, opioid overdose
cholecalciferol (VITAMIN D-3) tab [720036] 2,000 units, Oral, 1 X DAILY
Note: This patient may be a candidate for spinal
anesthesia; if an order for Enoxaparin is active,
page provider for clarification prior to
administering the Enoxaparin. [950018]
ONCE For 1 Doses
Delete this order if the patient is not a candidate for
spinal anesthesia.
Laboratory
Page 8 of 10
Printed by O'BRIEN, RYLEY P [RPO249] at 11/17/2017 2:08:26 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

Laboratory [206346]
HEMATOCRIT [HCT] 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?
PROTHROMBIN TIME/INR [PT] 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?
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?
CALCIUM [CA] 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?
PHOSPHATE [PHOS] 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?
BUN [BUN] 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?
CREATININE [CRET] 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 [211626]
Consult Physical Therapy (Inpatient) Eval and
Treat [CON0061]
ONCE, Starting today For 1 Occurrences, Routine
Reason for Physical Therapy Consult: Mobility
Training
for durable medical equipment needs
Consult Occupational Therapy (Inpatient) Eval
and Treat [CON0046]
ONCE, Starting today For 1 Occurrences, Routine
Reason for Occupational Therapy Consult: ADL
Training
Consult Nutrition (Inpatient) [CON0043] ONCE For 1 Occurrences, Routine
Reason for Consult: Patient Education (Enter
Comment) (Nutrition education for protein, vitamin D,
and calcium.)
Delegate to Initiate and Manage Tube Feeding:
Delegate to Manage Diet Order/Supplement Order:
Delegate to Dysphagia Diet Order Progression:
Can this consult be done via video?
Consult to Fracture Liaison Service [CON0194] ONCE For 1 Occurrences, Routine
Reason for Consult:
Can this consult be done via video?
Consult Social Work (Inpatient) [CON0076] ONCE For 1 Occurrences, Routine
Reason for Consult:
Is this a STAT consult?
Can this consult be done via video?
Page 9 of 10
Printed by O'BRIEN, RYLEY P [RPO249] at 11/17/2017 2:08:26 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

Consult Case Management (Inpatient) [CON0013] ONCE For 1 Occurrences, Routine
Location?
Can this consult be done via video?
Consult Hospitalist (Inpatient) [CON0134] 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:
BestPractice
No Hospital Problems Have Yet Been Identified. [107035]
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