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/clinical/cckm-tools/content/order-sets/inpatient/pain-management/name-98087-en.cckm

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IP – Spinal Cord Stimulator Therapy – Adult – Preprocedure [2367]

IP – Spinal Cord Stimulator Therapy – Adult – Preprocedure [2367] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Pain Management


SmartSet: IP - SPINAL CORD STIMULATOR THERAPY - ADULT -
PREPROCEDURE (ID:2367)
General Information
Display name: IP - Spinal Cord Stimulator Therapy - 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? Spinal Cord Stimulator
Modifiers: NPO EXCEPT MEDICATIONS
Starting 6 hours prior to procedure.
For Diabetic Patients
Page 1 of 4
Printed by STRAKA, KEVIN F [KFS1] at 1/31/2017 2:42:11 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2017CCKM@uwhealth.org

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.
Site Care
Order Abdominal Binder from Central Supply.
Measure Patient for Appropriate Size
ONCE, Starting S For 1 Occurrences
Contingency Parameters
Notify Pain Management Physician 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
(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
Insert and Maintain Peripheral IV CONTINUOUS, Starting S For Until specified,
Routine
Peripheral IV Size: 20 Gauge
Does this need to be inserted/placed?
sodium chloride 0.9% infusion Intravenous, CONTINUOUS
dextrose 5%-NaCl 0.45% with KCl 20 mEq/L
infusion
Intravenous, CONTINUOUS
dextrose 5% infusion Intravenous, CONTINUOUS
Flushes
Note: Initiate Vascular Access Device Flushing
Protocol
ONCE For 1 Doses
Note: Initiate Flushing Protocol
sodium chloride 0.9% flush 10 mL injection Flush, PRN, flush/line care
Flush per VAD guidelines
Page 2 of 4
Printed by STRAKA, KEVIN F [KFS1] at 1/31/2017 2:42:11 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2017CCKM@uwhealth.org

Medications - Preprocedure
Anti-anxiety
diazepam (VALIUM) tab 5 mg, Oral, ON CALL For 1 Doses
Give 60 minutes before procedure
diazepam (VALIUM) tab 10 mg, Oral, ON CALL For 1 Doses
Give 60 minutes before procedure
First Line
cefuroxime (ZINACEF) intraVENOUS - Patients
who are 40-160 kg
1.5 g, Intravenous, ON CALL For 1 Doses
Administer 60 minutes prior to procedure
cefuroxime (ZINACEF) intraVENOUS - Patients
who are greather than 160 kg
3 g, Intravenous, ON CALL For 1 Doses
Administer 60 minutes prior to procedure
MRSA/Documented MRSA History
Patients who are 40 - 120 kg - Cefuroxime and
Vancomycin (Maximum Dose = 2000 mg)
cefuroxime (ZINACEF) intraVENOUS 1.5 g, Intravenous, ON CALL For 1 Doses
Administer 60 minutes prior to procedure
vancomycin (VANCOCIN) intraVENOUS 20 mg/kg, Intravenous, ON CALL For 1 Doses
Administer 60 minutes prior to procedure
Patients who are greather than 120 kg -
Cefuroxime and Vancomycin (Maximum Dose =
2000 mg)
cefuroxime (ZINACEF) intraVENOUS 3 g, Intravenous, ON CALL For 1 Doses
Administer 60 minutes prior to procedure
vancomycin (VANCOCIN) intraVENOUS 20 mg/kg, Intravenous, ON CALL For 1 Doses
Administer 60 minutes prior to procedure
Immediate/Severe Reactions to Penicillin or Known Cephalosporin Allergies
vancomycin (VANCOCIN) intraVENOUS 20 mg/kg, Intravenous, ON CALL For 1 Doses
Administer 60 minutes prior to procedure
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:
Page 3 of 4
Printed by STRAKA, KEVIN F [KFS1] at 1/31/2017 2:42:11 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2017CCKM@uwhealth.org

Release date: Use System Definitions Setting
Disallow user override:
Page 4 of 4
Printed by STRAKA, KEVIN F [KFS1] at 1/31/2017 2:42:11 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2017CCKM@uwhealth.org