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/clinical/cckm-tools/content/order-sets/inpatient/orthopedicsrehab/name-98102-en.cckm

201711326

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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,Orthopedics/Rehab

IP - Orthopedics - Pediatric - Discharge [4773]

IP - Orthopedics - Pediatric - Discharge [4773] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Orthopedics/Rehab


IP - Orthopedics - Pediatric - Discharge [4773]
Patient Care Orders
Confirmed Discharge Date/Time [151653]
Confirmed Discharge Date/Time [ADT0013] Confirmed Discharge Date:
Confirmed Discharge Time:
Conditions for Discharge:
Provider to be Present at Discharge?
Reason For Hospitalization [129829]
Why You Were Hospitalized [NURCOM0073] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care
Plan., Routine
Activity [143319]
Activity - Up As Tolerated [NURACT0008] Routine
Discharge Activity: Up As Tolerated
Activity - Bed Rest [NURACT0008] Routine
Discharge Activity: Bed Rest
Activity - Partial Weight Bearing - Affected
Extremity [NURACT0008]
Routine
Discharge Activity: Partial Weight Bearing - Affected
Extremity
Activity - Touchdown Weight Bearing - Affected
Extremity [NURACT0008]
Routine
Discharge Activity: Touchdown Weight Bearing -
Affected Extremity
Activity - Non-Weight Bearing - Affected Extremity
[NURACT0008]
Routine
Discharge Activity: Non-Weight Bearing - Affected
Extremity
Activity - Weight Bearing as Tolerated
[NURACT0008]
Routine
Discharge Activity: Weight Bearing as Tolerated
Activity - Hip Flexion [NURACT0008] Routine
Discharge Activity: See Instructions
Hip Flexion to *** degrees.
Activity - Elevate Extremity [NURACT0008] Routine
Discharge Activity: See Instructions
Elevate extremity.
Activity - Other [NURACT0008] Routine
Discharge Activity:
Nutrition [143320]
Diet - General (No Modifications) [NUT8888] Routine
General: General (No Modifications)
Diet Modifications:
Other Diet Modifications:
Wound Care [142914]
Wound Care - Dressing Change [NURWND0015] Routine, ***
Wound Care - Bathing Instructions
[NURWND0015]
Routine, ***
Bowel Care [142617]
Bowel Care - GI [NURELM0068] Routine, Narcotic pain medications can cause severe
constipation. It is important to maintain a high fiber
diet, drink plenty of fluids, and take medications as
directed by providers.. You may be prescribed
medications that make stools easier to pass and
should be used if constipation occurs.
Bladder Care [121031]
Bladder Care [NURELM0067] Routine
Other Patient Care Instructions [144005]
Page 1 of 5
Printed by O'BRIEN, RYLEY P [RPO249] at 11/22/2017 9:15:39 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

Give Patient HFFY:Pain Medicine Safety
[NURCOM0025]
ONCE, Routine, Give patient HFFY #7971: Pain
Medicine Safety
Other Discharge Patient Care Instructions
[NURCOM0071]
Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care
Plan., Routine
Give Patient HFFY: Cast Care [NURCOM0025] ONCE For 1 Occurrences, Routine, Give patient
HFFY #4332 - Cast Care
Give Patient HFFY: Hip Spica Cast Care
[NURCOM0025]
ONCE For 1 Occurrences, Routine, Give patient
HFFY #6622 - Hip Spica Cast Care
Give Patient HFFY: Preparation guide for a
successful pin removal appointment
[NURCOM0025]
ONCE For 1 Occurrences, Routine, Give patient
HFFY #7313 - Preparation guide for a successful pin
removal appointment
Give Patient HFFY: Home Care after Scoliosis
Surgery [NURCOM0025]
ONCE For 1 Occurrences, Routine, Give patient
HFFY #6091 - Home Care after Scoliosis Surgery
When to Call Your Doctor [136392]
When to Call Your Doctor [NURCOM0079] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care
Plan.
You should include specific instructions on when and
who to call.
You should include actual provider names (i.e. not
'PCP').
You should NOT include the discharging unit as a
contact., Routine, Call orthopedic doctor if your child
has not had a bowel movement for 3 days or
temperature above 100.4 degrees F by mouth for 2
readings 4 hours apart; increased redness, warmth,
and/or pus-like drainage from incision site; swelling
not relieved by elevation, cast tightness or irritation,
numbness, tingling, coolness, paleness, or blue color;
pain not relieved by pain medications; loss of
movement.
Any other questions or concerns, please contact the
clinic at 608-263-6420. After hours, nights, weekends,
or holidays call 608-262-0486.
Follow-Up Care
Follow-Up Appointments [142618]
Schedule Appointment [NURCOM0026] Reason for Hospital Follow Up Appointment:
Which Provider: Other Provider or Specialist
When do you want appointment:
Which Clinic or Specialty: Pediatric Orthopedic Clinic
Please indicate what X-Rays are needed ***
X-Ray: {UWIP xray picks:31768}
Follow Up Appointments - Diabetes (Single Response) [148552]
*** RESPONSE REQUIRED *** This order facilitates documentation (only) about follow-up
appointments for patients with diabetes. Scheduling an appointment before discharge with a
provider who will manage a patient’s diabetes care (e.g., primary care physician, endocrinologist,
etc.) is a Joint Commission requirement. Exclusions are allowed based upon patient situation
(e.g., discharge to a skilled nursing facility, patient refusal, etc.). Only select “Appointment
Scheduled” if an appointment has already been scheduled, and use the Schedule Appointment
order as needed to request assistance in scheduling
Page 2 of 5
Printed by O'BRIEN, RYLEY P [RPO249] at 11/22/2017 9:15:39 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

No appointment: Patient does not have diabetes
[COR0064]
ONCE, Starting today For 1 Occurrences, Routine
Documentation (required): No appointment: Patient
does not have diabetes
1. This order facilitates documentation (only) about
follow-up appointments for patients with diabetes.
2. Scheduling an appointment before discharge with a
provider who will manage a patient's diabetes care
(e.g., primary care physician, endocrinologist, etc.) is a
Joint Commission requirement. Exclusions are
allowed based upon patient situation (e.g., patient
discharging to a skilled nursing facility, patient refusal,
etc.)
3. Only select "Appointment Scheduled" if an
appointment has already been scheduled with a
provider who can manage patient's diabetes.
4. Use the Schedule Appointment order as needed to
request assistance in scheduling an appointment.
Appointment scheduled (with provider who can
manage diabetes) [COR0064]
ONCE, Starting today For 1 Occurrences, Routine
Documentation (required): Appointment scheduled
(with provider who can manage diabetes)
1. This order facilitates documentation (only) about
follow-up appointments for patients with diabetes.
2. Scheduling an appointment before discharge with a
provider who will manage a patient's diabetes care
(e.g., primary care physician, endocrinologist, etc.) is a
Joint Commission requirement. Exclusions are
allowed based upon patient situation (e.g., patient
discharging to a skilled nursing facility, patient refusal,
etc.)
3. Only select "Appointment Scheduled" if an
appointment has already been scheduled with a
provider who can manage patient's diabetes.
4. Use the Schedule Appointment order as needed to
request assistance in scheduling an appointment.
Appointment scheduled per patient report
(ENTER DATE IN COMMENTS) [COR0064]
ONCE, Starting today For 1 Occurrences, Routine
Documentation (required): Appointment scheduled per
patient report (ENTER DATE IN COMMENTS)
1. This order facilitates documentation (only) about
follow-up appointments for patients with diabetes.
2. Scheduling an appointment before discharge with a
provider who will manage a patient's diabetes care
(e.g., primary care physician, endocrinologist, etc.) is a
Joint Commission requirement. Exclusions are
allowed based upon patient situation (e.g., patient
discharging to a skilled nursing facility, patient refusal,
etc.)
3. Only select "Appointment Scheduled" if an
appointment has already been scheduled with a
provider who can manage patient's diabetes.
4. Use the Schedule Appointment order as needed to
request assistance in scheduling an appointment.
Page 3 of 5
Printed by O'BRIEN, RYLEY P [RPO249] at 11/22/2017 9:15:39 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

Appointment pending: patient discharged on
weekend; follow-up information provided
[COR0064]
ONCE, Starting today For 1 Occurrences, Routine
Documentation (required): Appointment pending:
patient discharged on weekend; follow-up information
provided
1. This order facilitates documentation (only) about
follow-up appointments for patients with diabetes.
2. Scheduling an appointment before discharge with a
provider who will manage a patient's diabetes care
(e.g., primary care physician, endocrinologist, etc.) is a
Joint Commission requirement. Exclusions are
allowed based upon patient situation (e.g., patient
discharging to a skilled nursing facility, patient refusal,
etc.)
3. Only select "Appointment Scheduled" if an
appointment has already been scheduled with a
provider who can manage patient's diabetes.
4. Use the Schedule Appointment order as needed to
request assistance in scheduling an appointment.
Free clinic information provided [COR0064] ONCE, Starting today For 1 Occurrences, Routine
Documentation (required): Free clinic information
provided
1. This order facilitates documentation (only) about
follow-up appointments for patients with diabetes.
2. Scheduling an appointment before discharge with a
provider who will manage a patient's diabetes care
(e.g., primary care physician, endocrinologist, etc.) is a
Joint Commission requirement. Exclusions are
allowed based upon patient situation (e.g., patient
discharging to a skilled nursing facility, patient refusal,
etc.)
3. Only select "Appointment Scheduled" if an
appointment has already been scheduled with a
provider who can manage patient's diabetes.
4. Use the Schedule Appointment order as needed to
request assistance in scheduling an appointment.
No appointment: Patient discharging to a facility
(e.g., skilled nursing facility, correctional facility,
etc.) [COR0064]
ONCE, Starting today For 1 Occurrences, Routine
Documentation (required): No appointment: Patient
discharging to a facility (e.g., skilled nursing facility,
correctional facility, etc.)
1. This order facilitates documentation (only) about
follow-up appointments for patients with diabetes.
2. Scheduling an appointment before discharge with a
provider who will manage a patient's diabetes care
(e.g., primary care physician, endocrinologist, etc.) is a
Joint Commission requirement. Exclusions are
allowed based upon patient situation (e.g., patient
discharging to a skilled nursing facility, patient refusal,
etc.)
3. Only select "Appointment Scheduled" if an
appointment has already been scheduled with a
provider who can manage patient's diabetes.
4. Use the Schedule Appointment order as needed to
request assistance in scheduling an appointment.
Page 4 of 5
Printed by O'BRIEN, RYLEY P [RPO249] at 11/22/2017 9:15:39 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

No appointment: Patient refusal [COR0064] ONCE, Starting today For 1 Occurrences, Routine
Documentation (required): No appointment: Patient
refusal
1. This order facilitates documentation (only) about
follow-up appointments for patients with diabetes.
2. Scheduling an appointment before discharge with a
provider who will manage a patient's diabetes care
(e.g., primary care physician, endocrinologist, etc.) is a
Joint Commission requirement. Exclusions are
allowed based upon patient situation (e.g., patient
discharging to a skilled nursing facility, patient refusal,
etc.)
3. Only select "Appointment Scheduled" if an
appointment has already been scheduled with a
provider who can manage patient's diabetes.
4. Use the Schedule Appointment order as needed to
request assistance in scheduling an appointment.
Facility Therapy Needs [143317]
Continue Physical Therapy at Next Facility
[NURCOM0022]
Routine
Discharge Scripts [142620]
Discharge - Outpatient Therapy [DC0002] Routine
Type(Each Agency Requires a Separate Order): PT -
Evaluate and Treat
Diagnosis:
Facility:
Facility City:
Facility Phone:
Facility Fax:
Discharge - Outpatient Therapy [DC0002] Routine
Type(Each Agency Requires a Separate Order): OT -
Evaluate and Treat
Diagnosis:
Facility:
Facility City:
Facility Phone:
Facility Fax:
Page 5 of 5
Printed by O'BRIEN, RYLEY P [RPO249] at 11/22/2017 9:15:39 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org