/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/pain-management/,

/clinical/cckm-tools/content/order-sets/inpatient/pain-management/name-98077-en.cckm

20170106

page

100

UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,Pain Management

IP – Celiac Plexus Nerve Therapy – Adult – Preprocedure [2365]

IP – Celiac Plexus Nerve Therapy – Adult – Preprocedure [2365] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Pain Management


SmartSet: IP - CELIAC PLEXUS NERVE BLOCK - ADULT - PREPROCEDURE
(ID:2365)
General Information
Display name: IP - Celiac Plexus Nerve Block - Adult - Preprocedure
Type: General
Merge priority: 0
Version comment:
Content source:
Synonyms: 1. .PAIN
SmartSet notes:
Description: Intended for Adult Patients Only
Web information: Title URL
1.
Questionnaire:
Configuration
Patient Care Orders
Vital Signs
Vital Signs ONCE, Starting S For 1 Occurrences, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
On arrival.
Nutrition
NPO for Procedure - Hold Diet (Except
Medications)
CONTINUOUS NPO, Starting S, Routine
NPO For Which Procedure? Celiac Plexus Nerve
Block
Modifiers: NPO EXCEPT MEDICATIONS
Starting 6 hours prior to procedure.
Non-Categorized Patient Care Orders
Page 1 of 4
Printed by STRAKA, KEVIN F [KFS1] at 1/4/2017 2:08:01 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2017CCKM@uwhealth.org

Void Prior to Transport ONCE, Starting S For 1 Occurrences
Nursing Communication ONCE, Starting S For 1 Occurrences, Call patient for
appointment reminder on ***.
For Diabetic Patients
Glucose, POC ONCE, Starting S For 1 Occurrences, Routine,
Glucose, POC should always be ordered in
conjunction with orders for hypoglycemia
management and monitoring as indicated in the
Hypoglycemia Management (Adult) panel.
If Conditional, What Condition?
On arrival.
Contingency Parameters
Notify Pain Management Physician Provider to Notify: Other (Comment)
If systolic blood pressure > (mmHg):
If systolic blood pressure < (mmHg):
If diastolic blood pressure > (mmHg):
If diastolic blood pressure < (mmHg):
If temperature > (C):
If temperature < (C):
If heart rate > (bpm):
If heart rate < (bpm):
If respiratory rate >:
If respiratory rate <:
If blood glucose > (mg/dL): 200 (bedside)
If blood glucose < (mg/dL): 90 (bedside)
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL):
Other: aspirin in the last 3 days,clopidogrel (PLAVIX)
in the last 7 days,low molecular weight heparin
(dalteparin or enoxaparin) in the last 12
hours,unfractionated heparin for the last 8
hours,warfarin (COUMADIN) in the last 5 days,INR
greater than 1.5,platelet count less than
50,000/microliter
Intravenous Therapy
IV Fluids
dextrose 5%-NaCl 0.45% infusion Intravenous, CONTINUOUS
Medications - General
Medications
Page 2 of 4
Printed by STRAKA, KEVIN F [KFS1] at 1/4/2017 2:08:01 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2017CCKM@uwhealth.org

Note: NO anticoagulants unless approved by
Interventional Pain Medicine Service or
physician
EVERY 6 HOURS
No anticoagulants unless approved by Interventional
Pain Medicine Service or physician. Approved:
Subcutaneous heparin up to 5000 units/dose 3 times
a day, heparin lock flushes and aspirin up to 325 mg
2 times a day. NOT approved: warfarin, dabigatran,
IV heparin, low molecular weight heparin,
fondaparinux, clopidogrel, ticlopidine, cilostazol,
lepirudin, bivalirudin, argatroban, abciximab,
eptifibatide, rivaroxaban, apixaban, prasurgel, and
ticagrelor.
Laboratory
Preprocedure Labs
HEMATOCRIT CONDITIONAL - RN COLLECT For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw preprocedure
PLATELET COUNT CONDITIONAL - RN COLLECT For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw preprocedure
PROTHROMBIN TIME/INR CONDITIONAL - RN COLLECT For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw preprocedure
GLUCOSE CONDITIONAL - RN COLLECT For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw preprocedure
Criteria
Suggestions:
Filter: UWIP ORDER SET RESTRICTION - HOSPITAL ENCOUNTERS EXCEPT ED -
NOT IP DC[3000400]
Restrict SmartSet:
Settings
Discontinue action:
Deselect sections for
Pended/Held orders:
Pended/Held orders
display:
Release date: Use System Definitions Setting
Page 3 of 4
Printed by STRAKA, KEVIN F [KFS1] at 1/4/2017 2:08:01 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2017CCKM@uwhealth.org

Disallow user override:
Page 4 of 4
Printed by STRAKA, KEVIN F [KFS1] at 1/4/2017 2:08:01 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2017CCKM@uwhealth.org