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/clinical/cckm-tools/content/order-sets/inpatient/pain-management/name-98080-en.cckm

20170117

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UWHC,UWMF,

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

IP – Intrathecal Analgesia Therapy – Adult – Preprocedure [2122]

IP – Intrathecal Analgesia Therapy – Adult – Preprocedure [2122] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Pain Management


IP - Intrathecal Analgesia Therapy - Adult - Preprocedure [2122]
for Adult Patients OnlyIntended
Patient Care Orders
Vital Signs [29555]
Vital Signs [NURMON0013] ONCE, Starting today For 1 Occurrences, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
On arrival.
Nutrition [29556]
NPO for Procedure - Hold Diet [DIE0007] CONTINUOUS NPO, Starting today, Routine
NPO For Which Procedure? Intrathecal trial
Modifiers: STRICT NPO
Starting at least 6 hours prior to intrathecal procedure.
For Diabetic Patients [29573]
Glucose, POC [IPGLUCOSE] ONCE, Starting today 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.
Non-Categorized Patient Care Orders [31653]
Epidural/Intrathecal Infusion Pump (HOSPIRA
GEMSTAR) [EQP0013]
CONTINUOUS, Starting today with First Occurrence
As Scheduled, Routine
Nursing Communication [NURCOM0022] ONCE, Starting today For 1 Occurrences, Order
intrathecal catheter, epidural tubing #1204660 (yellow
- 2 piece set), and connector epidural catheter
#4009154 (PERIFIX) from central supply catalog.
Contingency Parameters [29587]
Notify Provider [NURCOM0001] Provider to Notify: Provider
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): 300
If blood glucose < (mg/dL):
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL):
Other: Aspirin in the last 5 days,Clopidogrel (PLAVIX)
in the last 7 days,Low molecular weight heparin
(LMWH) in the last 12 hours,Unfractioned heparin for
the last 8 hours,Warfarin (COUMADIN) for the last 5
days,INR greater than 1.5,Platelets less than 50K/uL
Page 1 of 2
Printed by STRAKA, KEVIN F [KFS1] at 1/13/2017 1:49:22 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2017CCKM@uwhealth.org

Intravenous Therapy
IV Fluids [29961]
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Starting today For Until specified,
Routine
Peripheral IV Size: 20 Gauge
Does this need to be inserted/placed?
sodium chloride 0.9% infusion [64367] Intravenous, CONTINUOUS
dextrose 5% infusion [36633] Intravenous, CONTINUOUS
Medications - General
Flushes - Adult [29962]
sodium chloride 0.9% flush 10 mL injection
[785055]
Flush, PRN, flush/line care
Flush per VAD guidelines
Medications - Preprocedure
Anti-anxiety (Single Response) [30191]
diazepam (VALIUM) tab [36679] 5 mg, Oral, ON CALL For 1 Doses
Give 60 minutes prior to procedure
diazepam (VALIUM) tab [36679] 10 mg, Oral, ON CALL For 1 Doses
Give 60 minutes prior to procedure
Anti-infectives (Single Response) [30192]
cefuroxime (ZINACEF) intraVENOUS - Patients
who are 40 - 120 kg [800030]
1.5 g, Intravenous, ON CALL For 1 Doses
Administer over 60 minutes prior to procedure.
cefuroxime (ZINACEF) intraVENOUS - Patients
who are greater than 120 kg [800030]
3 g, Intravenous, ON CALL For 1 Doses
Administer over 60 minutes prior to procedure.
vancomycin (VANCOCIN) intraVENOUS - NOTE:
Order for patients allergic to
penicillin/cephalosporins Maximum Dose = 2000
mg [800084]
20 mg/kg, Intravenous, ON CALL For 1 Doses
NOTE: Order for patients allergic to
penicillin/cephalosporins
Page 2 of 2
Printed by STRAKA, KEVIN F [KFS1] at 1/13/2017 1:49:22 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2017CCKM@uwhealth.org