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/clinical/cckm-tools/content/order-sets/inpatient/orthopedicsrehab/name-98100-en.cckm

201712342

page

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UWHC,UWMF,

Tools,

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

IP - Orthopedics - General - Adult - Postoperative [2775]

IP - Orthopedics - General - Adult - Postoperative [2775] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Orthopedics/Rehab


IP - Orthopedics - General - Adult - Postoperative [2775]
for Adult Patients OnlyIntended
Admission Status
Level of Care (Single Response) [187485]
*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:
Post-Op/Phase II
Admit to Observation (Single Response)
[188297]
Admit To Observation [ADT0002] Attending:
Admitting Resident:
Requested Floor:
Service:
Post-Op/Phase II
Admit to Outpatient Short Stay (Single
Response) [188298]
Admit To Outpatient Short Stay [ADT0003] Attending:
Admitting Resident:
Requested Floor:
Service:
Post-Op/Phase II
Admission Status [95528]
Page 1 of 15
Printed by BENNETT, SARA J [SJB008] at 12/8/2017 9:10:13 AM
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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:
Post-Op/Phase II
Admit To Outpatient Short Stay [ADT0003] Attending:
Admitting Resident:
Requested Floor:
Service:
Post-Op/Phase II
Admission Status [84059]
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:
Post-Op/Phase II
Admit To Observation [ADT0002] Attending:
Admitting Resident:
Requested Floor:
Service:
Post-Op/Phase II
Admit To Outpatient Short Stay [ADT0003] Attending:
Admitting Resident:
Requested Floor:
Service:
Post-Op/Phase II
Venous Thromboembolism (VTE) Prophylaxis
VTE Prophylaxis (Single Response) [131964]
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 (Single
Response) [241183]
enoxaparin (LOVENOX) subcutaneous injection
[800040]
40 mg, Subcutaneous, EVERY 24 HOURS, Post-
Op/Phase II
heparin subcutaneous injection [800290] 5,000 units, Subcutaneous, EVERY 12 HOURS,
Post-Op/Phase II
Page 2 of 15
Printed by BENNETT, SARA J [SJB008] at 12/8/2017 9:10:13 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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12/2017CCKM@uwhealth.org

Sequential Compression Device (SCD) / Foot
Pump [EQP0023]
CONTINUOUS, Routine
Left/Right/Bilateral? Bilateral
Type: Knee High
Post-Op/Phase II
Apply and Maintain Anti-Embolism Stocking
[NURTRT0039]
CONTINUOUS, Routine
Does this need to be inserted/placed?
Left/Right/Bilateral? Bilateral
Type: Knee high
Post-Op/Phase II
High VTE Risk with Low Bleed Risk [241153]
enoxaparin (LOVENOX) subcutaneous injection
[800040]
40 mg, Subcutaneous, EVERY 24 HOURS, Post-
Op/Phase II
heparin subcutaneous injection [800290] 5,000 units, Subcutaneous, EVERY 12 HOURS,
Post-Op/Phase II
heparin subcutaneous injection [800290] 5,000 units, Subcutaneous, EVERY 8 HOURS, Post-
Op/Phase II
Sequential Compression Device (SCD)
(TREATMENT) [NURTRT0028]
CONTINUOUS, Routine
Left/Right/Bilateral? Bilateral
Post-Op/Phase II
Sequential Compression Device (SCD) / Foot
Pump (SUPPLY) [EQP0023]
CONTINUOUS, Routine
Left/Right/Bilateral?
Type: Knee High
Post-Op/Phase II
Apply and Maintain Anti-Embolism Stocking
[NURTRT0039]
CONTINUOUS, Routine
Does this need to be inserted/placed?
Left/Right/Bilateral? Bilateral
Type: Knee high
Post-Op/Phase II
High Bleed Risk with Any VTE Risk [228009]
Sequential Compression Device (SCD)
(TREATMENT) [NURTRT0028]
CONTINUOUS, Routine
Left/Right/Bilateral? Bilateral
Post-Op/Phase II
Sequential Compression Device (SCD) / Foot
Pump (SUPPLY) [EQP0023]
CONTINUOUS, Routine
Left/Right/Bilateral?
Type: Knee High
Post-Op/Phase II
Apply and Maintain Anti-Embolism Stocking
[NURTRT0039]
CONTINUOUS, Routine
Does this need to be inserted/placed?
Left/Right/Bilateral? Bilateral
Type: Knee high
Post-Op/Phase II
No VTE Prophylaxis [228010]
VTE Prophylaxis - Reason Not Ordered
[COR0008]
ONCE, Routine
Reason Not Ordered:
Post-Op/Phase II
VTE Prophylaxis (Single Response) [150166]
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 (Single
Response) [241186]
enoxaparin (LOVENOX) subcutaneous injection
[800040]
40 mg, Subcutaneous, EVERY 24 HOURS, Post-
Op/Phase II
heparin subcutaneous injection [800290] 5,000 units, Subcutaneous, EVERY 12 HOURS,
Post-Op/Phase II
Page 3 of 15
Printed by BENNETT, SARA J [SJB008] at 12/8/2017 9:10:13 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

Sequential Compression Device (SCD) / Foot
Pump [EQP0023]
CONTINUOUS, Routine
Left/Right/Bilateral? Bilateral
Type: Knee High
Post-Op/Phase II
Apply and Maintain Anti-Embolism Stocking
[NURTRT0039]
CONTINUOUS, Routine
Does this need to be inserted/placed?
Left/Right/Bilateral? Bilateral
Type: Knee high
Post-Op/Phase II
High VTE Risk with Low Bleed Risk [241165]
enoxaparin (LOVENOX) subcutaneous injection
[800040]
40 mg, Subcutaneous, EVERY 24 HOURS, Post-
Op/Phase II
heparin subcutaneous injection [800290] 5,000 units, Subcutaneous, EVERY 12 HOURS,
Post-Op/Phase II
heparin subcutaneous injection [800290] 5,000 units, Subcutaneous, EVERY 8 HOURS, Post-
Op/Phase II
Sequential Compression Device (SCD)
(TREATMENT) [NURTRT0028]
CONTINUOUS, Routine
Left/Right/Bilateral? Bilateral
Post-Op/Phase II
Sequential Compression Device (SCD) / Foot
Pump (SUPPLY) [EQP0023]
CONTINUOUS, Routine
Left/Right/Bilateral?
Type: Knee High
Post-Op/Phase II
Apply and Maintain Anti-Embolism Stocking
[NURTRT0039]
CONTINUOUS, Routine
Does this need to be inserted/placed?
Left/Right/Bilateral? Bilateral
Type: Knee high
Post-Op/Phase II
High Bleed Risk with Any VTE Risk [228013]
Sequential Compression Device (SCD)
(TREATMENT) [NURTRT0028]
CONTINUOUS, Routine
Left/Right/Bilateral? Bilateral
Post-Op/Phase II
Sequential Compression Device (SCD) / Foot
Pump (SUPPLY) [EQP0023]
CONTINUOUS, Routine
Left/Right/Bilateral?
Type: Knee High
Post-Op/Phase II
Apply and Maintain Anti-Embolism Stocking
[NURTRT0039]
CONTINUOUS, Routine
Does this need to be inserted/placed?
Left/Right/Bilateral? Bilateral
Type: Knee high
Post-Op/Phase II
No VTE Prophylaxis [228014]
VTE Prophylaxis - Reason Not Ordered
[COR0008]
ONCE, Routine
Reason Not Ordered:
Post-Op/Phase II
Patient Care Orders
Vitals [86581]
Vital Signs [NURMON0013] SEE COMMENTS, Starting today, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Every 2 hours times 4, then every 4 hours, Post-
Op/Phase II
Page 4 of 15
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12/2017CCKM@uwhealth.org

Neurovascular Checks [NURMON0045] SEE COMMENTS, Routine
Location:
Every 2 hours and 4, then every 4 hours., Post-
Op/Phase II
Activity [228000]
Activity [NURACT0008] CONTINUOUS, Routine
AMBULATE:
CHAIR:
BEDREST:
RESTRICTIONS:
Post-Op/Phase II
Activity - Weight Bearing (Single Response) [228001]
Weight Bearing Status [NURACT0008] CONTINUOUS, Routine
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Post-Op/Phase II
No Weight Bearing Restrictions [NURACT0011] ONCE, Post-Op/Phase II
Activity - Communication [228002]
Slide Transfer Only (To Chair, Commode,
Wheelchair) [NURACT0011]
SEE COMMENTS, Slide transfer only to chair,
commode, and/or wheelchair, Post-Op/Phase II
Pivot Only (To Chair, Commode, Wheelchair)
[NURACT0011]
SEE COMMENTS, Pivot only on {RIGHT/LEFT
LOWERCASE:18777} lower extremity to chair,
commode, and/or wheelchair., Post-Op/Phase II
Out of Bed with Nursing or Therapy
[NURACT0011]
SEE COMMENTS, Right Lower Extremity:
{LOWER EXTREMITY:30001041}
Left Lower Extremity:
{LOWER EXTREMITY:30001041}, Post-Op/Phase II
Gait Train [NURACT0011] SEE COMMENTS, Right Lower Extremity:
{LOWER EXTREMITY:30001041}
Left Lower Extremity:
{LOWER EXTREMITY:30001041}, Post-Op/Phase II
Elevate Head Of Bed As Tolerated
[NURACT0011]
SEE COMMENTS, Elevate head of bed as tolerated,
Post-Op/Phase II
Elevate Extremity [NURACT0010] Extremity:
Equal to (degrees):
Greater than (degrees):
Less than (degrees):
Other options:
Routine, CONTINUOUS, Post-Op/Phase II
Total Hip Precautions [PRECAU0006] CONTINUOUS, Routine, Post-Op/Phase II
Nutrition [86583]
Diet - NPO except Meds [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: NPO
NPO: NPO except Medications
Bedside Meal Instructions:
Room Service Class:
Post-Op/Phase II
Page 5 of 15
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Strict NPO [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: NPO
NPO: Strict NPO
Bedside Meal Instructions:
Room Service Class:
Post-Op/Phase II
Clear Liquid Diet [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: Diet Modifications
Diet Modifications: Liquid
Liquid: Clear Liquid
No Red or Purple Dye:
Liquid Thickness: Thin
Bedside Meal Instructions:
Room Service Class:
Post-Op/Phase II
General Diet [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: General (no Modifications)
Bedside Meal Instructions:
Room Service Class:
Post-Op/Phase II
Nourishments & Supplements [NUT0005] EFFECTIVE NOW, Starting today, Routine
Medical Food / Oral Supplement(s):
Nourishment / Snack Item(s):
Schedule:
Post-Op/Phase II
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:
Post-Op/Phase II
Respiratory [86584]
Oxygen Therapy [RT0032] CONTINUOUS, Starting today, Routine
FiO2 (%) Titrate to Keep Sats >/= to ___%:
Liter Flow:
Titrate oxygen to maintain O2 sat at (%): 92
O2 Delivery Device:
Attempt to Wean Off Oxygen?
Post-Op/Phase II
Pulse Oximetry [NURMON0009] SEE COMMENTS, Starting today, Routine, Every 2
hours and 4, then every 4 hours., Post-Op/Phase II
Incentive Spirometry [NURTRT0018] EVERY 1 HOUR, Starting today, Routine, Post-
Op/Phase II
Cough And Deep Breathe [NURTRT0019] EVERY 1 HOUR, Starting today, Routine, Post-
Op/Phase II
Respiratory Therapy per Protocol [RT0035] Routine
Protocol Type:
Post-Op/Phase II
Wound Care [140952]
Page 6 of 15
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12/2017CCKM@uwhealth.org

Wound Care - Closed Incision with
Sutures/Staples [NURWND0055]
CONTINUOUS, Routine
Wound Site:
Wound Location:
Assess Frequency: EVERY 8 HOURS
Incision Closed With: Other (Comment)
(Sutures/Staples)
Maintain OR Dressing: Minimum of 48 hours
Remove OR Dressing after 48 hours: No
Removal of OR Dressing performed by: Provider
Cleansing with Removal of OR Dressing:
Primary Dressing (after 48 hours):
Incision Care (after 48 hours):
If dressing becomes saturated in 48 hours, sterile
dressing change? No - Notify provider
Post-Op/Phase II
Wound Care - Closed Incision with
Dermabond/Other [NURWND0055]
CONTINUOUS, Routine
Wound Site:
Wound Location:
Assess Frequency: EVERY 8 HOURS
Incision Closed With:
Post-Op/Phase II
Intake and Output [86585]
Measure Intake And Output [NURMON0005] SEE COMMENTS, Starting today, Routine, Every 2
hours and 4, then every 4 hours, Post-Op/Phase II
Non-Categorized Patient Care Orders [86586]
Initiate Bladder Management Protocol
[NURELM0014]
CONTINUOUS, Routine, Post-Op/Phase II
Insert and Maintain Urinary Catheter
[NURELM0013]
CONTINUOUS, Starting today, 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?
Post-Op/Phase II
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:
Wound Vacuum [136891]
Page 7 of 15
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12/2017CCKM@uwhealth.org

Wound Vacuum [NURWND0013] CONTINUOUS, Routine
Wound Vacuum Site:
Type of Suction:
DPC (Intermittent Suction) Frequency:
If VAC is leaking or alarming, and troubleshooting is
not effective, notify the service that is managing the
VAC. Per manufacturer recommendations, a VAC
dressing without active therapy for more than 2
hours should be removed. If managing service
verifies removal of VAC dressing, the dressing
should be removed, wound should be cleansed and
irrigated with NS, and a wet to dry dressing should
be applied. If active bleeding develops suddenly or
in large amounts during V.A.C. therapy or if frank
(bright red) blood is seen in the tubing or in the
canister immediately stop V.A.C therapy(clamp
tubing and turn therapy off), leave dressing in place
and notify managing service or covering physician,
as dressing will need to be removed and source of
bleeding must be controlled.
Vacuum Assisted Closure - KCI [EQP0030] CONTINUOUS, Routine
Measure Drain Output [NURTAD0005] EVERY 8 HOURS, Routine
Pulsate Sizewise (Low Air Loss) weight <500
pounds (Specialty Bed) [EQP0037]
CONTINUOUS, Routine
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]
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?
Drain Orders [227568]
Maintain Drain [NURTAD0003] CONTINUOUS, Routine
Type:
Site:
Location:
Drainage Options:
Irrigate Frequency:
Irrigate With:
Irrigant Volume (mL):
Strip:
Strip For:
Dressing Change Frequency:
Dressing Type:
Post-Op/Phase II
Measure Drain Output [NURTAD0005] EVERY 4 HOURS, Routine, Post-Op/Phase II
Contingency Parameters [86587]
Page 8 of 15
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Notify [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 breaths/minute
If blood glucose > (mg/dL):
If blood glucose < (mg/dL):
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL):
Other: Sedation level greater than 5,Pain not
controlled with ordered analgesics or ordered
interventions
Post-Op/Phase II
Intravenous Therapy
Premedications for Needle Insertion [106327]
Use lidocaine topical dressing kit for stable patient, no lidocaine allergies, have at least 30
minutes time prior to needing to use IV
Sodium chloride (bacteriostatic) 0.9% intradermal: Useful for patients requiring urgent IV
access; onset is immediate.
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
Post-Op/Phase II
lidocaine (LMX) 4% topical dressing kit [66882] Topical, EVERY 1 HOUR PRN, peripheral line
insertion - see Admin Instructions
Do NOT apply to area greater than 200 square
centimeters (maximum 2.5 g/site; maximum 4 sites
per hour, 6 times per day). Do NOT leave on longer
than 2 hours. Use for stable patient, no allergies to
lidocaine, with at least 30 minutes time prior to IV use
Post-Op/Phase II
sodium chloride (bacteriostatic) 0.9 % injection
[50585]
0.05-0.1 mL, Intradermal, PRN, peripheral line
insertion - see Admin Instructions
Use an insulin or TB syringe with a 25-30 gauge
needle to inject solution and create a wheal. Wait 30
seconds to 1 minute then insert IV catheter into center
of wheal. Use if IV is needed within 30 minutes.
Post-Op/Phase II
IV Fluids [86589]
sodium chloride 0.9% with KCl 20 mEq/L infusion
[46261]
at 100 mL/hr, Intravenous, CONTINUOUS, Post-
Op/Phase II
sodium chloride 0.9 % infusion [64367] at 100 mL/hr, Intravenous, CONTINUOUS, Post-
Op/Phase II
dextrose 5%-NaCl 0.45% with KCl 20 mEq/L
infusion [44910]
at 100 mL/hr, Intravenous, CONTINUOUS, Post-
Op/Phase II
dextrose 5%- NaCl 0.9% with KCl 20 mEq/L
infusion [44904]
at 100 mL/hr, Intravenous, CONTINUOUS, Post-
Op/Phase II
Page 9 of 15
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12/2017CCKM@uwhealth.org

Flushes [228398]
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
Post-Op/Phase II
sodium chloride flush 0.9% 10 mL injection
[785055]
Flush, PRN, flush/line care
Per VAD Guidelines
Post-Op/Phase II
Surgical Prophylaxis
First Line with Implanted Device or on Antibiotic Greater Than 5 Days (Single Response) [153336]
cefuroxime (ZINACEF) intraVENOUS - NOTE:
Patients who are 40 - 120 kg [800030]
1.5 g, Intravenous, EVERY 8 HOURS For 2 Doses,
Post-Op/Phase II
cefuroxime (ZINACEF) intraVENOUS - NOTE:
Patients who are 121 kg and greater [800030]
3 g, Intravenous, EVERY 8 HOURS For 2 Doses,
Post-Op/Phase II
First Line (Single Response) [153335]
cefazolin (ANCEF) intraVENOUS - NOTE:
Patients who are 40-120 kg [800000]
2 g, Intravenous, EVERY 8 HOURS For 2 Doses,
Post-Op/Phase II
cefazolin (ANCEF) intraVENOUS - NOTE:
Patients who are 121 kg or greater [800000]
3 g, Intravenous, EVERY 8 HOURS For 2 Doses,
Post-Op/Phase II
MRSA / Documented MRSA History or High Risk for MRSA/MRSE (Implanted Device) (Single Response)
[153337]
Patients who are 40 - 120 kg - Cefazolin and
Vancomycin [228806]
cefazolin (ANCEF) intraVENOUS [800000] 2 g, Intravenous, EVERY 8 HOURS For 2 Doses,
Post-Op/Phase II
vancomycin (VANCOCIN) intraVENOUS -
(Maximum Dose = 2000 mg) [800084]
20 mg/kg, Intravenous, EVERY 12 HOURS For 1
Doses, Post-Op/Phase II
Patients who are 121 kg and greater - Cefazolin
and Vancomycin [228808]
cefazolin (ANCEF) intraVENOUS [800000] 3 g, Intravenous, EVERY 8 HOURS For 2 Doses,
Post-Op/Phase II
vancomycin (VANCOCIN) intraVENOUS -
(Maximum Dose = 2000 mg) [800084]
20 mg/kg, Intravenous, EVERY 12 HOURS For 1
Doses, Post-Op/Phase II
Patients who are 40-120kg - Cefuroxime and
Vancomycin [228807]
cefuroxime (ZINACEF) intraVENOUS [800030] 1.5 g, Intravenous, EVERY 8 HOURS For 2 Doses,
Post-Op/Phase II
vancomycin (VANCOCIN) intraVENOUS -
(Maximum Dose = 2000 mg) [800084]
20 mg/kg, Intravenous, EVERY 12 HOURS For 1
Doses, Post-Op/Phase II
Patients who are 121 kg or greater - Cefuroxime
and Vancomycin [228810]
cefuroxime (ZINACEF) intraVENOUS [800030] 3 g, Intravenous, EVERY 8 HOURS For 2 Doses,
Post-Op/Phase II
vancomycin (VANCOCIN) intraVENOUS -
Patients who are 40-120kg - Cefuroxime and
Vancomycin [800084]
20 mg/kg, Intravenous, EVERY 12 HOURS For 1
Doses, Post-Op/Phase II
Immediate/Severe Reactions to Penicillin or Known Cephalosporin Allergies [153354]
vancomycin (VANCOCIN) intraVENOUS [800084] 20 mg/kg, Intravenous, EVERY 12 HOURS For 1
Doses
Maximum Dose = 2000 mg
Post-Op/Phase II
Medications
Analgesics - Acetaminophen - Scheduled [227997]
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acetaMINOPHEN (TYLENOL) tab [34150] 1,000 mg, Oral, 3 X DAILY
No more than 4 grams acetaminophen per 24 hours
for adults or 15mg/kg per dose for peds <40kg.
Post-Op/Phase II
Analgesics - Acetaminophen - PRN [227998]
acetaMINOPHEN (TYLENOL) tab [750000] 325-650 mg, Oral, EVERY 4 HOURS PRN, pain
See Pain Management Algorithm for the Selection of
As-needed Analgesics
No more than 4 grams acetaminophen per 24 hours
for adults or 15mg/kg per dose for peds <40kg.
Post-Op/Phase II
Analgesics - Opioids - Oral - PRN (Single Response) [227999]
oxycodone-acetaminophen (PERCOCET) 5-325
MG per tab [750033]
1-2 tab, Oral, EVERY 4 HOURS PRN, pain
See Pain Management Algorithm for the Selection of
As-Needed Analgesics
No more than 4 grams acetaminophen per 24 hours
for adults or 15mg/kg per dose for peds <40kg.
Post-Op/Phase II
hydrocodone-acetaMINOPHEN (NORCO) 5-325
MG per tab RANGE [750021]
1-2 tab, Oral, EVERY 4 HOURS PRN, pain
See Pain Management Algorithm for the Selection of
As-Needed Analgesics
No more than 4 grams acetaminophen per 24 hours
for adults or 15mg/kg per dose for peds <40kg.
Post-Op/Phase II
hydrocodone-acetaMINOPHEN (NORCO) 10-325
MG per tab RANGE [750020]
1-2 tab, Oral, EVERY 4 HOURS PRN, pain
See Pain Management Algorithm for the Selection of
As-Needed Analgesics
No more than 4 grams acetaminophen per 24 hours
for adults or 15mg/kg per dose for peds <40kg.
Post-Op/Phase II
oxycodone tab [750032] 5-10 mg, Oral, EVERY 4 HOURS PRN, pain
See Pain Management Algorithm for the Selection of
As-Needed Analgesics
Post-Op/Phase II
oxycodone tab - NOTE: For patients > 75 years
old [45976]
2.5-5 mg, Oral, EVERY 4 HOURS PRN, pain
See Pain Management Algorithm for the Selection of
As-Needed Analgesics
Post-Op/Phase II
Analgesics - Opioids - Intravenous - PRN (Single Response) [86591]
MORPHine PF injection [750057] 1-2 mg, Intravenous, EVERY 2 HOURS PRN, pain
See Pain Management Algorithm for the Selection of
As-Needed Analgesics
for 4 Minutes, Post-Op/Phase II
HYDROmorphone PF (DILAUDID) injection
[750050]
0.2-0.5 mg, Intravenous, EVERY 2 HOURS PRN, pain
See Pain Management Algorithm for the Selection of
As-Needed Analgesics
for 3 Minutes, Post-Op/Phase II
Analgesics - Opioids - Oral - Scheduled (Single Response) [119054]
MORPHine (MS CONTIN, ORAMORPH) ER tab
[156572]
15 mg, Oral, 2 X DAILY, Post-Op/Phase II
MORPHine (MS CONTIN, ORAMORPH) ER tab
[156572]
30 mg, Oral, 2 X DAILY, Post-Op/Phase II
Anti-emetics [86592]
Adult - Standard - Anti-emetics [242247]
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ondansetron (ZOFRAN ODT) disintegrating tab
[64224]
4 mg, Oral, EVERY 6 HOURS PRN,
nausea/vomiting
Use first line
Post-Op/Phase II
ondansetron (ZOFRAN) injection [800202] 4 mg, Intravenous, EVERY 6 HOURS PRN,
nausea/vomiting
Use first line if unable to take medications by mouth
or enteral tube OR if immediate effect is needed.
Post-Op/Phase II
prochlorperazine (COMPAZINE) tab [41372] 10 mg, Oral, EVERY 6 HOURS PRN,
nausea/vomiting
Use second line if there is inadequate response to
first line anti-emetic within 30 minutes. If there is no
response to second line therapy within 30 minutes,
notify provider
Post-Op/Phase II
prochlorperazine (COMPAZINE) injection [41369] 10 mg, Intravenous, EVERY 6 HOURS PRN,
nausea/vomiting
Use second line. Use if there is inadequate
response to first line anti-emetic within 30 minutes
and if unable to take medications by mouth or
enteral tube OR if immediate effect is needed. If
there is no response to second line therapy within 30
minutes, notify provider
Post-Op/Phase II
Bowel Management [86594]
Adult - Bowel Management - Scheduled
[242250]
senna-docusate (SENOKOT S) 8.6-50 MG per
tab [60530]
2 tab, Oral, 2 X DAILY, Post-Op/Phase II
Adult - Bowel Management - As Needed
[242251]
polyethylene glycol (MIRALAX) oral packet
[61829]
17 g, Oral, 1 X DAILY PRN, constipation
First Line Therapy
Post-Op/Phase II
magnesium hydroxide (MILK OF MAGNESIA)
susp [65443]
30 mL, Oral, 1 X DAILY PRN, constipation
Administer as second line agent if no response to
first line agent after two hours.
Post-Op/Phase II
bisacodyl (DULCOLAX) rectal suppository
[35231]
10 mg, Rectal, 1 X DAILY PRN, constipation
If unable to take medications by mouth or enteral
tube OR if need immediate laxation OR if failure of
second line agent after 6 hours
Post-Op/Phase II
Gastric [86596]
calcium carbonate (TUMS) chew tab [44477] 500-1,000 mg, Oral, EVERY 4 HOURS PRN,
dyspepsia
Administer as first line agent.
Post-Op/Phase II
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 if no response to first
line agent after two hours.
Post-Op/Phase II
pantoprazole (PROTONIX) delayed release tab
[62661]
40 mg, Oral, 1 X DAILY, Post-Op/Phase II
Hypnotics (Single Response) [229303]
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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)
Post-Op/Phase II
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)
Post-Op/Phase II
Trazodone - Melatonin [227765] "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)
Post-Op/Phase II
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)
Post-Op/Phase II
Hypnotics (Single Response) [229306]
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.
Post-Op/Phase II
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)
Post-Op/Phase II
Pruritus [153195]
loratadine (CLARITIN) tab [45611] 10 mg, Oral, 1 X DAILY PRN, allergies, itching
Administer as first line agent.
Post-Op/Phase II
diphenhydramine (BENADRYL) cap - NOTE: Do
NOT order for patients older than 65 years
[36791]
25 mg, Oral, EVERY 6 HOURS PRN, itching
Administer as a second line agent if no response to
first-line agent after two hours.
NOTE: Do NOT order for patients older than 65 years
Post-Op/Phase II
diphenhydramine (BENADRYL) injection - NOTE:
Do NOT order for patients older than 65 years
[800106]
25 mg, Intravenous, EVERY 6 HOURS PRN, itching
Administer as a second line agent if no response to
first-line agent after two hours any unable to take
orally.
NOTE: Do NOT order for patients older than 65 years
Post-Op/Phase II
Non-categorized [85364]
naloxone (NARCAN) injection [800199] 0.1 mg, Intravenous, PRN, opioid overdose, Post-
Op/Phase II
Laboratory
Page 13 of 15
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Laboratory [86599]
HEMATOCRIT [HCT] 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?
Post-Op/Phase II
PROTHROMBIN TIME/INR [PT] 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?
Post-Op/Phase II
Next AM [105070]
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?
PROTHROMBIN TIME/INR [PT] 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?
MAGNESIUM [MAG] 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?
PHOSPHATE [PHOS] 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?
ELECTROLYTES [LYTE] 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?
GLUCOSE [GLU] 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?
BUN [BUN] 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?
CREATININE [CRET] 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?
CALCIUM [CA] 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?
Consults
Consults [86601]
Consult Physical Therapy (Inpatient) Eval and
Treat [CON0061]
ONCE, Starting today For 1 Occurrences, Routine
Reason for Physical Therapy Consult:
Post-Op/Phase II
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Consult Occupational Therapy (Inpatient) Eval
and Treat [CON0046]
ONCE, Starting today For 1 Occurrences, Routine
Reason for Occupational Therapy Consult:
Post-Op/Phase II
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:
Post-Op/Phase II
Consult Infectious Disease (Inpatient) [CON0037] ONCE
Intent: Consult and Recommend (Write Orders)
Concern or Specific Question or Task to be Addressed
(Symptom, Sign, or Diagnosis):
Post-Op/Phase II
Consult Nutrition (Inpatient) [CON0043] ONCE, Routine
Reason for Consult: Nutrition Assessment w/
Recommendations
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?
Post-Op/Phase II
Consult to Fracture Liaison Service [CON0194] ONCE, Routine
Reason for Consult:
Can this consult be done via video?
Post-Op/Phase II
Consult Case Management (Inpatient) [CON0013] ONCE, Routine
Location?
Can this consult be done via video?
Post-Op/Phase II
Consult Social Work (Inpatient) [CON0076] ONCE, Routine
Reason for Consult:
Is this a STAT consult?
Can this consult be done via video?
Post-Op/Phase II
BestPractice
No Hospital Problems have yet been identified [107363]
Specify Hospital Problem(s) [COR0018] You will be prompted to specify a hospital problem on
signing., Post-Op/Phase II
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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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12/2017CCKM@uwhealth.org