/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/orthopedicsrehab/,

/clinical/cckm-tools/content/order-sets/inpatient/orthopedicsrehab/name-98104-en.cckm

201712341

page

100

UWHC,UWMF,

Tools,

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

IP - Orthopedics - Adult - Admission [1041]

IP - Orthopedics - Adult - Admission [1041] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Orthopedics/Rehab


IP - Orthopedics - Adult - Admission [1041]
for Adult Patients OnlyIntended
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 [123311]
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:
Page 1 of 11
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12/2017CCKM@uwhealth.org

Admit To Outpatient Short Stay [ADT0003] Attending:
Admitting Resident:
Requested Floor:
Service:
Admission Status (Single Response) [123309]
Admit To Inpatient Status [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 Outpatient Short Stay [ADT0003] 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 subcutaneous injection [800290] 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 [241260]
enoxaparin (LOVENOX) injection [800040] 30 mg, Subcutaneous, EVERY 12 HOURS
enoxaparin (LOVENOX) subcutaneous injection
[800040]
40 mg, Subcutaneous, EVERY 24 HOURS
heparin subcutaneous injection [800290] 5,000 units, Subcutaneous, EVERY 12 HOURS
heparin subcutaneous injection [800290] 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
Page 2 of 11
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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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12/2017CCKM@uwhealth.org

High Bleed Risk [237204]
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:
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 subcutaneous injection [800290] 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 [241263]
enoxaparin (LOVENOX) injection [800040] 30 mg, Subcutaneous, EVERY 12 HOURS
enoxaparin (LOVENOX) subcutaneous injection
[800040]
40 mg, Subcutaneous, EVERY 24 HOURS
heparin subcutaneous injection [800290] 5,000 units, Subcutaneous, EVERY 12 HOURS
heparin subcutaneous injection [800290] 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
Page 3 of 11
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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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12/2017CCKM@uwhealth.org

No VTE Prophylaxis [130084]
VTE Prophylaxis - Reason Not Ordered
[COR0008]
ONCE, Routine
Reason Not Ordered:
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 [20749]
Activity [NURACT0008] CONTINUOUS, Routine
AMBULATE:
CHAIR:
BEDREST:
RESTRICTIONS:
Activity - Weight Bearing (Single Response) [227563]
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:
No Weight Bearing Restrictions [NURACT0011] ONCE
Activity - Communication [227562]
Slide Transfer Only (To Chair, Commode,
Wheelchair) [NURACT0011]
SEE COMMENTS, Slide transfer only to chair,
commode, and/or wheelchair
Pivot Only (To Chair, Commode, Wheelchair)
[NURACT0011]
SEE COMMENTS, Pivot only on {RIGHT/LEFT
LOWERCASE:18777} lower extremity to chair,
commode, and/or wheelchair.
Out of Bed with Nursing or Therapy
[NURACT0011]
SEE COMMENTS, Right Lower Extremity:
{LOWER EXTREMITY:30001041}
Left Lower Extremity:
{LOWER EXTREMITY:30001041}
Gait Train [NURACT0011] SEE COMMENTS, Right Lower Extremity:
{LOWER EXTREMITY:30001041}
Left Lower Extremity:
{LOWER EXTREMITY:30001041}
Elevate Head Of Bed As Tolerated
[NURACT0011]
SEE COMMENTS, Elevate head of bed as tolerated
Elevate Extremity [NURACT0010] Extremity:
Equal to (degrees):
Greater than (degrees):
Less than (degrees):
Other options:
Routine, CONTINUOUS
Total Hip Precautions [PRECAU0006] CONTINUOUS, Routine
Nutrition [18099]
Page 4 of 11
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12/2017CCKM@uwhealth.org

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:
Respiratory [20751]
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:
Wound Care [142985]
Wound Care - Closed Incision (Adult)
[NURWND0055]
CONTINUOUS, Routine
Wound Site:
Wound Location:
Assess Frequency: EVERY 8 HOURS
Incision Closed With:
Intake and Output [18101]
Measure Intake And Output [NURMON0005] EVERY 4 HOURS, Starting today For Until specified,
Routine
Non-Categorized Patient Care Orders [18103]
Measure Weight [NURMON0015] ONCE For 1 Occurrences, Routine
Weigh With?
Weigh when?
Initiate Bladder Management Protocol
[NURELM0014]
CONTINUOUS, Routine
Page 5 of 11
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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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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]
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]
Page 6 of 11
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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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12/2017CCKM@uwhealth.org

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
Premedications for Needle Insertion [106310]
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.
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
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.
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
Refer to VAD Guidelines
Medications
Nursing Communication Orders [233646]
Page 7 of 11
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 12:15:27 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

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
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
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.
Analgesics - Opioids - Oral - PRN (Single Response) [228021]
hydrocodone-acetaMINOPHEN (NORCO) 5-325
MG per tab [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.
oxycodone tab [750032] 5-10 mg, Oral, EVERY 4 HOURS PRN, pain
See Pain Management Algorithm for the Selection of
As-Needed Analgesics
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.
Analgesics - Opioids - Intravenous - PRN (Single Response) [13106]
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
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
Anti-emetics [13107]
Adult - Standard - Anti-emetics [240445]
Page 8 of 11
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12/2017CCKM@uwhealth.org

ondansetron (ZOFRAN ODT) disintegrating tab
[64224]
4 mg, Oral, EVERY 6 HOURS PRN,
nausea/vomiting
Use first line
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.
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
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
Bowel Management [13108]
Adult - Bowel Management - Scheduled
[242092]
senna-docusate (SENOKOT S) 8.6-50 MG per
tab [60530]
2 tab, Oral, 2 X DAILY
Adult - Bowel Management - As Needed
[242093]
polyethylene glycol (MIRALAX) oral packet
[61829]
17 g, Oral, 1 X DAILY PRN, constipation
First Line Therapy
magnesium hydroxide (MILK OF MAGNESIA)
susp [65443]
30 mL, Oral, 1 X DAILY PRN, constipation
Second line therapy, if no response to first line
therapy within 12 hours
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
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 if no response to first
line agent after two hours.
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
Page 9 of 11
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12/2017CCKM@uwhealth.org

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 [123308]
loratadine (CLARITIN) tab [45611] 10 mg, Oral, 1 X DAILY PRN, allergies, itching
Administer as first line agent.
diphenhydramine (BENADRYL) cap - NOTE: Do
NOT order for patients older than 65 years
[36791]
25 mg, Oral, EVERY 6 HOURS PRN, itching
Administer as second line agent if no response to first
line agent after two hours.
NOTE: Do NOT order for patients older than 65 years
diphenhydramine (BENADRYL) injection - NOTE:
Do NOT order for patients older than 65 years
[36790]
25 mg, Intravenous, EVERY 6 HOURS PRN, itching
Administer as second line agent if no response to first
line agent after two hours and unable to take orally.
for 1 Minutes
NOTE: Do NOT order for patients older than 65 years
Non-categorized [13110]
naloxone (NARCAN) injection [800199] 0.1 mg, Intravenous, PRN, opioid overdose
Laboratory
Laboratory [28222]
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?
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?
ELECTROLYTES [LYTE] 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?
Page 10 of 11
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 12:15:27 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

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 [18111]
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:
Consult Physical Therapy (Inpatient) Eval and
Treat [CON0061]
ONCE, Starting today For 1 Occurrences, Routine
Reason for Physical Therapy Consult:
Consult Occupational Therapy (Inpatient) Eval
and Treat [CON0046]
ONCE For 1 Occurrences, Routine
Reason for Occupational Therapy Consult:
Consult to Fracture Liaison Service [CON0194] ONCE, Routine
Reason for Consult:
Can this consult be done via video?
Consult Case Management (Inpatient) [CON0013] ONCE, Routine
Location?
Can this consult be done via video?
Consult Social Work (Inpatient) [CON0076] ONCE, Routine
Reason for Consult:
Is this a STAT consult?
Can this consult be done via video?
BestPractice
No Hospital Problems have yet been identified. [107035]
Specify Hospital Problem(s) [COR0018] You will be prompted to specify a hospital problem on
signing.
Page 11 of 11
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 12:15:27 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org