/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/plastics/,

/clinical/cckm-tools/content/order-sets/inpatient/plastics/name-98054-en.cckm

201710289

page

100

UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,Plastics

IP - Plastic Surgery - Adult - Discharge [4619]

IP - Plastic Surgery - Adult - Discharge [4619] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Plastics


IP - Plastic Surgery - Adult - Discharge [4619]
Skilled Nursing Facility Orders
This Patient is going to a skilled nursing facilty, directly below is a group of orders
commonly associated with this patient population. Please review the orders below and
select the appropriate ones for this patient. If this patient is not going to a SNF, contact
Case Management to update the discharge plan. Updating the discharge plan will remove
this set of SNF orders from the order set.
Skilled Nursing Facility Certification Statement [114940]
Facility Certification Statement [NURCOM0069] Routine
Skilled Nursing Facility Certification Statement [118260]
Facility Certification Statement [NURCOM0069] Routine
Skilled Nursing Facility Admit Order [114941]
Admit to Skilled Nursing Facility [ADT0015] Routine
Skilled Nursing Facility Admit Order [118261]
Admit to Skilled Nursing Facility [ADT0015] Routine
Skilled Nursing Facility Non-Categorized Orders [111713]
For dyspnea, Oxygen at 2 L/minute per nasal
canula; If this is an acute change for the patient
call PCP with assessment ASAP after oxygen is
started. Suction PRN to clear airways.
[NURCOM0022]
Routine
DME - Home Oxygen [1009468] Patient's O2 Requirements Assessed and Meets
Criteria for Home O2:
Delivery Device:
Equipment Needed:
Continuous (liters/min):
Continuous (FiO2):
With Activity (liters/min):
With Activity (FiO2):
With Sleep (liters/min):
With Sleep (FiO2):
Length of Need:
Vendor:
DME - CPAP [1009443] Formal Sleep Study Completed:
Diagnosis:
CPAP Pressure (cmH2O):
Oxygen Bleed-In (Liters/min):
Oxygen Bleed-In (FiO2):
If New Prescription for Oxygen Bleed-In, Patient's O2
Requirements Assessd and Meets Criteria for Home
O2:
Vendor:
Vendor City:
Vendor Phone:
Vendor Fax:
Page 1 of 21
Printed by WILLIAMS, HEATHER R [HRS0] at 10/16/2017 2:18:44 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2017CCKM@uwhealth.org

DME - BiPAP (S) [1009441] Patient Has Been Assessed and Meets Criteria for
Home BiPAP (S):
Diagnosis:
BiPAP Pressure - IPAP - Inspiratory Pressure
(cmH2O):
BiPAP Pressure - EPAP - Expiratory Pressure
(cmH2O):
Oxygen Bleed-In (Liters/min):
Oxygen Bleed-In (FiO2):
If New Prescription for Oxygen Bleed-In, Patient's O2
Requirements Assessd and Meets Criteria for Home
O2:
Vendor:
Vendor City:
Vendor Phone:
Vendor Fax:
DME - BiPAP (S/T) [1009442] Patient Has Been Assessed and Meets Criteria for
Home BiPAP (S/T):
Diagnosis:
Respiratory Rate:
BiPAP Pressure - IPAP - Inspiratory Pressure
(cmH2O):
BiPAP Pressure - EPAP - Expiratory Pressure
(cmH2O):
Oxygen Bleed-In (Liters/min):
Oxygen Bleed-In (FiO2):
If New Prescription for Oxygen Bleed-In, Patient's O2
Requirements Assessd and Meets Criteria for Home
O2:
Vendor:
Vendor City:
Vendor Phone:
Vendor Fax:
Patient may self administer medication per RN
assessment [NURCOM0022]
Routine
Patient medications (per Skilled Nursing Facility
policy) may be left at bedside [NURCOM0022]
Routine
Facility Therapy Needs [113391]
Physical Therapy to Evaluate and Treat at Next
Facility [NURCOM0022]
Routine
Occupational Therapy to Evaluate and Treat at
Next Facility [NURCOM0022]
Routine
Speech Therapy to Evaluate and Treat at Next
Facility [NURCOM0022]
Routine
Communicable Diseases [111717]
State Law requires at least one of the following statements be checked for your patient. May check both if
applicable
DHS 132.52 URL: http://docs.legis.wisconsin.gov/code/admin_code/dhs/110/132/V/52
Patient has been screened for TB within the last
90 days prior to admission and does not have any
other clinically apparent communicable diseases.
[NURCOM0022]
Routine
Patient has been found to have a communicable
disease, procedures to treat and limit the spread
of the disease have been ordered.
[NURCOM0022]
Routine
Page 2 of 21
Printed by WILLIAMS, HEATHER R [HRS0] at 10/16/2017 2:18:44 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2017CCKM@uwhealth.org

Communicable Diseases [118262]
State Law requires at least one of the following statements be checked for your patient. May check both if
applicable
DHS 132.52 URL: http://docs.legis.wisconsin.gov/code/admin_code/dhs/110/132/V/52
Patient has been screened for TB within the last
90 days prior to admission and does not have any
other clinically apparent communicable diseases.
[NURCOM0022]
Routine
Patient has been found to have a communicable
disease, procedures to treat and limit the spread
of the disease have been ordered.
[NURCOM0022]
Routine
Analgesics [111708]
acetaMINOPHEN (TYLENOL) tab [34149] 650 mg, 1 tab, 1, starting 10/16/17, No Print
acetaMINOPHEN (TYLENOL) suppository
[34153]
650 mg, 1 suppository, 1, starting 10/16/17, No Print
Blood Glucose Management [111710]
glucagon 1 mg injection kit [107799] 1 mg, 1 each, 1, starting 10/16/17, No Print
Glucose 40 % oral gel [118089] 10 g, 1 Tube, 1, starting 10/16/17, No Print
Nursing Communication [NURCOM0022] Routine, Notify {Notify for Blood Glucose:3004146} if
blood glucose is greater than 400 mg/dL or less than
40 mg/dL
Diabetes Care Instructions [NURCOM0112] Routine, - Patient's blood glucose goal range before
meals is *** mg/dL.
- Monitor patient's blood glucose {Glucose Monitoring
Frequency:25242}.
- If your patient's blood glucoses are uncontrolled
contact provider.
- "Uncontrolled" blood glucoses mean:
* Blood glucose above 150 mg/dL more than half the
time during a week.
* Blood glucose over *** mg/dL.
* Blood glucose less than 70 mg/dL two or more times
per week (or if having signs/symptoms of low blood
glucose such as shaking, sweating, or light-
headedness).
Bowel Management [111709]
bisacodyl (DULCOLAX) rectal suppository
[35231]
10 mg, 1 suppository, 1, starting 10/16/17, No Print
Senna-Docusate Sodium 8.6-50 MG per tab
[70181]
1-2 tab, 1 tab, 1, starting 10/16/17, No Print
magnesium hydroxide (MILK OF MAGNESIA)
susp [65443]
30 mL, 1 Bottle, 1, starting 10/16/17, No Print
polyethylene glycol (MIRALAX) oral powder
[61353]
17 g, 1 Bottle, 1, starting 10/16/17, No Print
ZZNon-categorized Medications [111711]
guaifenesin-dextroMETHORPHAN (ROBITUSSIN
DM) syrup [51568]
10 mL, 1 Bottle, 1, starting 10/16/17, No Print
carbamide peroxide (DEBROX) 6.5% otic soln
[35545]
3 drop, 1 Bottle, 1, starting 10/16/17 until 10/21/17, No
Print
alum-mag-simeth (MYLANTA ES) susp [44073] 30 mL, 1 Bottle, 1, starting 10/16/17, No Print
Patient Care Orders
Confirmed Discharge Date/Time [151653]
Page 3 of 21
Printed by WILLIAMS, HEATHER R [HRS0] at 10/16/2017 2:18:44 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2017CCKM@uwhealth.org

Confirmed Discharge Date/Time [ADT0013] Confirmed Discharge Date:
Confirmed Discharge Time:
Conditions for Discharge:
Provider to be Present at Discharge?
Reason for Hospitalization [130332]
Why You Were Hospitalized [NURCOM0073] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care
Plan., Routine
Discharge Instructions - Procedure Specific [234766]
Liposuction - Discharge Instructions [134705]
What to Expect [NURCOM0071] Please complete in PATIENT FRIENDLY terms.
This order will appear on the patient's After Hospital
Care Plan., Routine, • You may feel weak, tired and
sore for 2-3 weeks after surgery.
• Plan to be off work for about 1 week after surgery.
• You will have bruising and swelling that may last for
1-2 months.
• It is not uncommon to see a large amount of
pinkish watery drainage from your incisions. If it
becomes a more concentrated red drainage, you
should call the doctor.
• The suctioned areas will be swollen and bruised,
and you may feel some burning. The bruises may
get worse for 1-2 days and last for several weeks.
The swelling may last for 3 months. This is
NORMAL. Please be patient as it may take 3 months
to see your final results.
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
•No tub baths, swimming or whirlpools for 7 days.
• Plan rest periods throughout the day for the first
couple of weeks.
• Do not do strenuous activities/exercise for 2-3
weeks or until approved by your doctor (usually
about 3 weeks).
• Do not cross your legs or sit for more than 1 hour in
the same position.
• Do not fly for 10 days.
PRESSURE GARMENT (GIRDLE, BINDER):
• You must wear your pressure garment for two
weeks after surgery.
• You may remove the garment to shower. Wear the
garment again after your shower.
• The garment has special openings for elimination.
• You may feel dizzy the first time you take your
garment off. Have someone with you. Take the
pressure garment off slowly while sitting. After
removal, wear loose comfortable clothing., Phase II
Discharge
Breast Implants / Mammoplasty - Discharge
Instructions [134669]
Page 4 of 21
Printed by WILLIAMS, HEATHER R [HRS0] at 10/16/2017 2:18:44 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2017CCKM@uwhealth.org

What to Expect [NURCOM0071] Please complete in PATIENT FRIENDLY terms.
This order will appear on the patient's After Hospital
Care Plan., Routine, • Do not become overly
concerned if you notice a decrease sensation in your
nipples. The sensation usually returns in a few
weeks to a month.
• You may hear a sloshing sound in the breasts if
you had saline implants. This is caused by the fluid
and air in the implants. This will stop within a week.
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• Continue wearing the surgical bra for 24 hours
(overnight). Wear loose comfortable clothing. DO
NOT wear an under wire bra for 2 weeks. Instead,
wear a sports bra or the surgical bra given at
discharge.
• Keep your head elevated as much as possible for
the first 48 hours to help reduce swelling and
discomfort. A lounger is a good place to sleep and
rest. Use extra pillows while you lie in bed to elevate
your head and chest.
• Stay quiet, resting the first 24 hours. Excessive
activity may cause you to bleed. You may gradually
increase your activities as tolerated. Do not do any
activities that cause strenuous use of your arms
such as pushing, pulling, vacuuming and limit
reaching above your head for the first 2 weeks.
• Avoid any strenuous exercise, swimming, or
running for first two weeks.
• DO NOT massage your breasts. These implants do
not require massage., Phase II Discharge
Wound Care [NURWND0015] Routine, • Remove dressings prior to showering.
After showering, pat incisions dry and apply clean
dressings.
• If you have a dressing, you may see some bloody
drainage up to the size of a quarter. There may also
be a small amount of swelling. If there is excessive
bleeding or swelling, call your surgeon
• Check your incisions twice daily for any signs of
infection. Redness at the incision site is normal, but
redness extending beyond the incision (greater than
1 cm) or over the breast may indicate an infection. If
your sutures are not dissolvable they will be
removed at your one week post op appointment.
Facelift / Migraine Surgery / Facial Fractures -
Discharge Instructions [234805]
What to Expect [NURCOM0071] Please complete in PATIENT FRIENDLY terms.
This order will appear on the patient's After Hospital
Care Plan., Routine, • Do not be alarmed by the
swelling and bruising of the face. This will increase
for the first 36 hours and then very slowly decrease
in the next two weeks.
• It is normal for your face, neck or ears to feel weak
or numb after surgery. This will resolve over the
next few weeks.
Page 5 of 21
Printed by WILLIAMS, HEATHER R [HRS0] at 10/16/2017 2:18:44 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2017CCKM@uwhealth.org

Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• Keep your head elevated for at least the first week.
This requires using pillows, etc., or actual elevation
of the head of the bed or mattress. (Sleeping in a
recliner also works well.) Do not engage in activities
where you bend over, making you head lower than
your heart. Bend at the knees and squat down
instead of bending over at the waist.
• Generally, there should be no heavy exercise for
one month following surgery.
• Engage in only sedate activity for the first few days.
It is not necessary to stay in bed during this time. To
get out of bed, roll on your side first and push up with
your arms.
• When we see you after surgery, we will tell you
when you can take a shower and shampoo your hair
with any mild shampoo, such as Johnson’s Baby
Shampoo. There may be clotted blood in your hair,
most of which will come out with the first shower and
shampoo, but may require 2 or more shampoos. The
entire head can be shampooed, but it should be
done very gently in the area of the stitches and
staples. It is best to face away from the showerhead.
Use only the COOL setting on a hairdryer.
• You must not go into the sun for 2 weeks following
surgery.
• Do not apply any makeup or lotions to your face
during the first week., Phase II Discharge
Wound Care [NURWND0015] Routine, • You will be seen at the office for removal
of dressings, and possibly for drain removal.
• You may wish to bring a scarf to cover your hair the
day the dressing is removed.
• Cold compresses should be applied to your face
and neck for the first 48 hours after surgery to help
minimize the bruising and swelling.
• You will be provided with a Velcro removable
dressing that I would like you to wear for 1 week
(day and night). After that it can worn if comfortable
but is not required.
• When the drain is removed you should apply the
anti-biotic ointment to the incision lines around your
ears and under your chin. This should be done for 7
days.
• You may wish to bring a scarf to cover your hair the
day the dressing is removed.
• Avoid direct sun exposure for 2 weeks following
surgery.
• Do not apply any makeup or lotions to your face
during the first week.
• If you have a drain you will be instructed on how to
care for it by the nursing staff.
• If the drain stops functioning please call the OR
and they will instruct you on how to milk the drain.
Otoplasty - Discharge Instructions [134728]
Page 6 of 21
Printed by WILLIAMS, HEATHER R [HRS0] at 10/16/2017 2:18:44 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2017CCKM@uwhealth.org

Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• Do not pull on your ears.
• Sleep with your head elevated for 2-3 weeks.
• Be careful when pulling clothing over your head.
You may prefer to wear shirts and blouses that
button up the front.
• Do not wear earrings for 3 weeks after surgery.
• Glasses should be placed with care. Do not let your
glasses rest on the suture line. Try to place them so
they rest in the hairline.
• You may return to work within 2-3 days if you feel
strong enough.
• After your sutures are removed, you may shampoo
your hair as usual. If you normally use a hair dryer,
be sure it is on the cool setting., Phase II Discharge
Wound Care [NURWND0015] Routine, • For 4-6 weeks, wear a stocking cap or
headband to protect your ears.
• A bulky bandage will be wrapped around your head
to cover your ears. Leave the bandage on until your
clinic visit. Do not shower or get this bandage wet. If
the bandage is very loose or very tight, call the
doctor.
• When the bandage is first removed, the ears may
seem to be overcorrected or too close to the head.
This is normal. The ears will begin to take their new
position within a few days to weeks.
• There may be some drainage from the suture lines
for 2-3 days. Nondissolvable sutures will be removed
10-12 days following surgery.
Reconstructive Facial Flaps and Grafts -
Discharge Instructions [134729]
What to Expect [NURCOM0071] Please complete in PATIENT FRIENDLY terms.
This order will appear on the patient's After Hospital
Care Plan., Routine, • It is normal for your flap or
graft to feel weak or numb after surgery. This will
resolve over the next few weeks.
• Your flap or graft may appear pink, purplish or
dusky. There may be some exposed tissue covered
by Vaseline or other moist dressing.
Page 7 of 21
Printed by WILLIAMS, HEATHER R [HRS0] at 10/16/2017 2:18:44 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2017CCKM@uwhealth.org

Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• Keep your head elevated for at least the first week.
This requires using pillows, etc., or actual elevation
of the head of the bed or mattress. (Sleeping in a
recliner also works well.) Do not engage in activities
where you bend over, making you head lower than
your heart. Bend at the knees and squat down
instead of bending over at the waist.
• Generally, there should be no exercise for one
month following surgery.
• Engage in only sedate activity for the first few days.
It is not necessary to stay in bed during this time. To
get out of bed, roll on your side first and push up with
your arms.
• Please refrain from tobacco and nicotine
replacement for at least 2 weeks before and after
surgery.
• When we see you after surgery, we will tell you
when you can take a shower and shampoo your hair
with any mild shampoo, such as Johnson's Baby
Shampoo. There may be clotted blood in your hair,
most of which will come out with the first shower and
shampoo, but may require 2 or more shampoos. The
entire head can be shampooed, but it should be
done very gently in the area of the stitches and
staples. It is best to face away from the showerhead.
Use only the COOL setting on a hairdryer if your flap
or graft is near the hairline.
• Do not apply any makeup or lotions to your face
during the first week.
• Avoid sun exposure to your flap/ graft site for at
least 3 months., Phase II Discharge
Diet [NUT8888] Routine
General:
Diet Modifications:
Other Diet Modifications: -
Solid Consistency:
Liquid Consistency:
Liquid:
Esophagectomy:
Fat Controlled:
Fiber:
Fluid Restriction:
Heart Healthy:
Metabolic:
Renal:
Sodium Controlled:
NPO:
Tube Feeding:
It is best to eat a soft diet for the first week, such as
things that don't require much chewing. Avoid spicy
or thermal hot foods which can cause flushing.
Wound Care [NURWND0015] Routine, • You will be seen at the office for removal
of dressings, and possibly for drain removal.
• Keep area clean and dry. Change dressing as
directed by your surgeon.
Page 8 of 21
Printed by WILLIAMS, HEATHER R [HRS0] at 10/16/2017 2:18:44 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2017CCKM@uwhealth.org

Rhinoplasty - Discharge Instructions [134730]
What to Expect [NURCOM0071] Please complete in PATIENT FRIENDLY terms.
This order will appear on the patient's After Hospital
Care Plan., Routine, • You will be breathing through
your mouth until the swelling is resolved. This may
cause some dryness and irritation in your mouth and
throat. Use a humidifier or vaporizer along with
brushing your teeth may make you feel more
comfortable.
• Expect nasal drainage for the first 2-3 days.
• Directly after surgery, you may feel sick to your
stomach due to the drainage that you have
swallowed during the surgery. If you vomit, it is not
unusual for it to be bloody.
LONG TERM CARE:
• Swelling and Bruising of your nose and the
surrounding area is a normal result of nasal surgery.
The swelling will gradually resolve over time.
• You may have swelling under your upper lip and at
the bottom of your nose. This mild tenderness and
swelling should be gone within two weeks.
• Numbness over your nose is also very common
and will resolve in about 3 months.
• Breathing through your nose will gradually improve
after we clean your nose several days after surgery.
By the week after surgery your breathing should be
much improved.
• No sun exposure to the nose/ face for 3 months
following surgery. Sun exposure can cause swelling
and slow the healing process. You should wear a
sunscreen with at least SPF 15 and a brimmed hat
when outdoors.
Page 9 of 21
Printed by WILLIAMS, HEATHER R [HRS0] at 10/16/2017 2:18:44 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2017CCKM@uwhealth.org

Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• Do NOT hit or move any portions of your nose or
packing.
• Do NOT use a straw. This can create suction in
the back of your throat, which could cause a higher
risk of bleeding or swelling.
• DO NOT BLOW YOUR NOSE.
• Do not hold back a sneeze. Sneeze with your
mouth open.
• Keep your head elevated at least 30 degrees (Use
2 pillows or sleep in a recliner) for the next few
weeks. This helps to keep swelling to a minimum.
• Only light activity after your surgery for one week.
• You may wear your lightest weight glasses lightly
resting on your nasal cast, or taped to your forehead.
You may insert your contact lenses two days after
surgery. After removal of your nasal splint, you
should limit the time that glasses are worn. If your
glasses have small “feet”, you may wish to ask your
optician to install larger or softer “feet”. You may
have tenderness on the sides of your nose after
wearing glasses for a prolonged period of time.
Remove your glasses for an hour or two for relief.
This is normal, and should resolve in 3-4 months.
• No aerobics, jogging or swimming for 2-3 weeks, or
until ok with your Surgeon.
• No tub baths, swimming or whirlpools for 1-2
weeks., Phase II Discharge
Wound Care [NURWND0015] Routine, • You will need to change the small gauze
dressing under your nose when it becomes soiled.
The first day the drainage will be bloody. It will
change to pink-yellow color after the first day or so.
• Cold packs should be used for the first 48 hours to
decrease nasal drainage, to reduce swelling and
relieve discomfort. To make your own ice packs;
place frozen peas or corn in a Ziploc bag. Place this
pack diagonally across the eyes and the nasal
bridge.
• For the first week after surgery, cleanse the nose
and ear incisions with a Q-tip saturated with
hydrogen peroxide. Use a rolling motion along the
length of the incision and allow drying. Roll a thin
layer of antibiotic ointment over the incision. Do this
3 times a day.
Medications at Home [NURCOM0071] Please complete in PATIENT FRIENDLY terms.
This order will appear on the patient's After Hospital
Care Plan., Routine, • Do not use decongestants or
antihistamines unless your Surgeon has
recommended them.
• Start using the Deep Sea Nasal Spray that is in
your take home supplies 4 times a day starting the
day after surgery.
Septoplasty - Discharge Instructions [134731]
Page 10 of 21
Printed by WILLIAMS, HEATHER R [HRS0] at 10/16/2017 2:18:44 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2017CCKM@uwhealth.org

What to Expect [NURCOM0071] Please complete in PATIENT FRIENDLY terms.
This order will appear on the patient's After Hospital
Care Plan., Routine, • Expect nasal stuffiness. This
is caused by post-operative swelling that will
decrease over the next few weeks.
• Expect crusting in the nose for 3 to 6 weeks while
the incision is healing.
• Expect to have some nasal bleeding after your
surgery.
• Directly after surgery, you may feel sick to your
stomach. This is due to the drainage that you
swallow during surgery. This drainage is irritating to
the stomach and may cause you to vomit. If you
vomit, it may be bloody.
Activity [NURACT0008] Routine
Discharge Activity: See Instructions
• Do not hit or move any portions of your nose or
packing.
• Do not use a straw to drink fluids. This can create
suction in the back of your throat, which could cause
a higher risk of bleeding or swelling.
• You will be breathing through your mouth until the
swelling is resolved. This may cause some dryness
and irritation in your mouth and throat. Use a
humidifier or vaporizer along with brushing your
teeth may make you feel more comfortable.
• Do not hold back a sneeze. Sneeze with your
mouth open.
• Keep your head thirty degrees above your heart for
the next few weeks. Do not lie flat in bed. Sleep with
extra pillows under your head.
• Do not pick the inside of your nose.
• For one week after surgery, you may engage in
light activity only, and then you may resume normal
activity as tolerated.
• You may wear your lightest weight glasses and
lightly rest them on your nasal cast, or taped to your
forehead. You may insert your contact lenses two
days after surgery. After removal of your nasal
splint, you should limit the time that glasses are
worn.
• No aerobics, jogging or swimming for 2-3 weeks.
• Avoid stressful activities and situations., Phase II
Discharge
Page 11 of 21
Printed by WILLIAMS, HEATHER R [HRS0] at 10/16/2017 2:18:44 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2017CCKM@uwhealth.org

Wound Care [NURWND0015] Routine, • You will need to change the small gauze
dressing under your nose when it becomes soiled.
Your nurse will show you how to do this before you
go home. Heavy bleeding (soaking more that one
pad per hour) should be reported to your physician.
• Change the dressings as needed. You may stop
using the dressings when the drainage has stopped.
• At first, nasal drainage will be bloody. It will
gradually change to a pink-yellow color by the
following day.
• Cold packs can be used to decrease nasal
drainage, reduce swelling, and relieve discomfort.
Please use the ice packs for the first 48 hours.
• For the first week after surgery, cleanse the nasal
and ear incisions with a Q-tip saturated with
hydrogen peroxide. Use a rolling motion along the
length of the incision and allow drying. Roll a thin
layer of antibiotic ointment over the incision. Start
this the day after surgery and cleanse 3 times a day.
Medications at Home [NURCOM0071] Please complete in PATIENT FRIENDLY terms.
This order will appear on the patient's After Hospital
Care Plan., Routine, • Your doctor may prescribe a
nasal saline spray to loosen crusting and make you
more comfortable.
• Do not use decongestants or antihistamines unless
your doctor recommends them.
Hand Discharge Instructions [NURCOM0071] Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care
Plan., Routine, You may have a bulky dressing and
ace bandage.
• Pain and swelling can be relieved by taking your
medication and by elevating your arm above the level
of your heart. Ice packs may be used to decrease
swelling and pain for 1-2 days following surgery.
• Keep the dressing and/or elastic wrapping dry. The
elastic bandage may be rewrapped as necessary if it
becomes too loose or too tight.
• Check for circulation to the hand and fingers 3-4
times tomorrow. Do this by looking at the skin color
and feeling the temperature. The skin color should be
the same as your other hand and should feel warm to
the touch.
• Watch for excess swelling; some swelling is to be
expected. This should decrease with rest and
elevation.
• Watch for loss of motion or increased pain.
• Do not move fingers that are in a splint.
• Make sure there is feeling in the fingers. Be alert to
any numbness, tingling or "pins and needles"
sensation.
Activity [128292]
Activity - Up as Tolerated [NURACT0008] Routine
Discharge Activity: Up As Tolerated
Ambulate Three times a day [NURACT0011] Routine
Elevate Affected Extremity [NURACT0011] Routine, Elevate {RIGHT/LEFT/UPPER/LOWER 4
OPTIONS:30021751} extremity.
Page 12 of 21
Printed by WILLIAMS, HEATHER R [HRS0] at 10/16/2017 2:18:44 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2017CCKM@uwhealth.org

Non-Weight Bearing [NURACT0008] Routine
Discharge Activity:
Non weight bearing {UWIP LOCATION
SURGERY:30021977}.
No Lifting [NURACT0011] Routine, No lifting {10/20 LIFTING
RESTRICTIONS:30021752}.
No Straining or Bending [NURACT0011] Routine, {UWIP ACTIVITY/FOLLOW UP:30021810}
Keep Head Elevated when Sleeping
[NURACT0011]
Routine, Keep head elevated at least 30 degrees.
Use 2 pillows or sleep in a recliner for *** days.
No Strenuous Activity [NURACT0011] Routine, No aerobics or jogging {UWIP
ACTIVITY/FOLLOW UP:30021810}.
No Driving while Taking Opioids [NURACT0011] Routine
Sitting [NURACT0008] Routine
Discharge Activity:
{UWIP SITTING:30022080}
Nutrition [128295]
Diet - General (No Modifications) [NUT8888] Routine
General: General (No Modifications)
Diet Modifications:
Other Diet Modifications:
Surgical Soft Diet [NUT8888] Routine
General:
Diet Modifications: Surgical Soft
Other Diet Modifications:
Cleft Palate Soft Diet [NUT8888] Routine
General:
Diet Modifications: Palate Soft
Other Diet Modifications:
Jaw Wire Diet/Mechanical Soft Dental Diet
[NUT8888]
Routine
General:
Diet Modifications:
Other Diet Modifications: -
Solid Consistency:
Liquid Consistency:
Liquid:
Esophagectomy:
Fat Controlled:
Fiber:
Fluid Restriction:
Heart Healthy:
Metabolic:
Renal:
Sodium Controlled:
NPO:
Wired Jaw Puree - See Health Facts for You #279
Wound Care [128296]
Leave Original Surgical Dressing On
[NURWND0015]
Routine, {UWIP DRESSING/FOLLOW UP:30021811}
Monitor Wound for Signs of Infection
[NURWND0015]
Routine, Monitor wound(s) for signs of infection:
redness, swelling, drainage, odor.
Page 13 of 21
Printed by WILLIAMS, HEATHER R [HRS0] at 10/16/2017 2:18:44 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2017CCKM@uwhealth.org

Incision Care [NURWND0015] Routine, Remove dressings in ***. If you notice a large
steri-strip over the incision, leave this in place until it
falls off on its own. You may need to use gauze
bandages over the incisions for a few days until the
incisions stop weeping.
• You may apply {bacitracin/vaseline:3004787} to
incisions *** times a day for *** days.
• Applying ice to the incisions is {recommended/not
recommended:31296}
Patient May Shower [NURWND0015] Routine, Patient may shower *** days after surgery.
Pat dry incision. Do not rub incision.
No Tub Baths, Whirlpools or Swimming
[NURWND0018]
Routine, For {UWIP WEEKS:30021814}.
Keep Splint Clean, Dry and Intact
[NURWND0018]
Routine, Do not get wet.
No Sun Exposure to the Surgical Site
[NURWND0018]
Routine, For 8 weeks. Wear a sunscreen with at least
SPF 30.
Wear Abdominal Binder [NURWND0015] Routine, Wear abdominal binder until follow up clinic
visit. Remove only for showering.
Wear Surgical Bra [NURWND0015] Routine, Wear surgical bra until follow up clinic visit.
Remove only for showering.
Rinse mouth with chlorhexidine mouth wash at
least four times daily and after eating/snacking
[NURWND0015]
Routine
Rinse mouth with warm salt water at least four
times daily and after eating/snacking
[NURWND0015]
Routine
Brush teeth with soft toothbrush at least twice
daily [NURWND0015]
Routine
No Sticks or Straws in Mouth [NURWND0015] Routine, {UWIP ACTIVITY/FOLLOW UP:30021810}
Wound Care [NURWND0015] Routine, ***
IV Site [NURWND0015] Routine, Sometimes redness, warmth, or soreness
occurs at the IV (intravenous) site. This is to be
expected and can be relieved by putting a warm, wet
washcloth on the site 4 times a day. Call your
Doctor/Nurse if this does not get better in 2-3 days or
if gets worse.
Apply Cool Compresses to Affected Area as
Needed [NURWND0015]
Routine
Cut Wires or Rubber Bands for Airway
Emergencies Only [NURWND0015]
Routine
No nose blowing. Cough and Sneeze with mouth
open [NURWND0018]
Routine
Pressure Ulcer/Injury [NURWND0015] Routine, {UWIP WOUND CARE :30022081}
Bowel Care [128652]
Bowel Care [NURELM0068] Routine, Take docusate senna {UWIP DOCUSATE
OPTIONS:30021813} two times a day while taking
narcotic medication. Hold for loose stools.
Review Health Fact for You (HFFY) #4843
"Constipation from Opioids (Narcotics)"
Bladder Care [128653]
Bladder Care [NURELM0067] Routine
Drain Management [128297]
Page 14 of 21
Printed by WILLIAMS, HEATHER R [HRS0] at 10/16/2017 2:18:44 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2017CCKM@uwhealth.org

Maintain Jackson Pratt Drain [NURTAD0046] Routine, A closed-wound drain is a length of small
tubing with holes on the side of the tube and attached
to a bulb-type collector. It is placed under the incision
line at the time of surgery to collect blood and body
fluids and prevent them from accumulating under the
incision.
TO "MILK" THE DRAINAGE TUBE
1. Wash your hands.
2. Grasp the tubing firmly at a point near the incision
or dressing. This will stabilize
the tube and prevent it from being accidentally pulled
out.
3. With your other hand, grasp the tubing firmly
between your finger and thumb,
squeeze and pull downward on the tubing at the same
time, moving towards the bulb. You may need to
repeat this several times before the fluid moves down
the tube. If your finger and thumb won't glide
smoothly down the tubing, you may use a small
amount of hand lotion to help.
TO EMPTY THE DRAIN (BULB)
1. Wash your hands.
2. With bulb in an upright position, open the "plug" at
the top.
3. Empty the contents into the measuring container,
being careful not to touch
the tip of the plug. Measure each bulb separately.
4. Return the bulb to an upright position, squeeze it
firmly, and insert the plug
into the top while you are still squeezing the bulb.
This will create suction
on the drain so fluids will continue to be drawn out of
the wound.
5. Record the amount of drainage in the chart
provided; if the surgeon has
ordered it. Empty the drain *** times a day and/or
when it gets ½ full or heavy enough to pull on the
tube.
6. Discard the old drainage. (You may empty it into
the toilet.) Rinse the
measuring container thoroughly, and wash your hands
again.
NOTIFY YOUR SURGEON IF:
o There is a large increase in the amount of drainage.
o There is increased drainage noted on the dressing
accompanied by a decreased amount of drainage in
the bulb.
o There is no drainage in the bulb, even after "milking"
the drain tube.
o The drain tube falls out.
o There are signs of infection at the incision site
(redness, warmth, swelling, increase tenderness).
o You develop a fever above 100.5 degrees for 2
consecutive readings taken 4 hours apart.
Page 15 of 21
Printed by WILLIAMS, HEATHER R [HRS0] at 10/16/2017 2:18:44 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2017CCKM@uwhealth.org

o There is a significant change in the color or type of
drainage.
PLEASE NOTE: If your surgeon has given you
different or additional instructions, please follow those.
Nursing Communication - Tubes and Drains
[NURTAD0046]
Routine
Other Patient Care Instructions [128298]
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
Medication Instructions [128299]
Medication Instructions [NURCOM0022] Routine
When to Call Your Doctor [130334]
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 for
-Excessive bleeding.
-Persistent nausea and vomiting.
-Pain not relieved with pain medication.
-Fever over 100° F (by mouth) for two readings taken
four hours apart.
-Problems urinating or emptying your bladder.
-Incision or drain sites become more painful, swollen,
red and/or feel warmer than usual.
-Severe Chest Pain or Shortness of Breath - Call 911.
- Call Plastic Surgery Clinic for questions or problems,
Monday-Friday, 8:00 am - 4:30 pm at 608-263-7502.
If after hours, call 608-263-6400 and ask for the
plastic surgery resident on call.
Heart Failure Recommended Care
These order groups are showing because either your patient has an EF < 40% documented or
has Heart Failure on their problem list.
UW Health HF guideline URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/cardiovascular/name-97485-
en.cckm
Heart Failure Discharge Instructions [190359]
Weigh yourself daily or as directed
[NURCOM0071]
Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care
Plan., Routine
Page 16 of 21
Printed by WILLIAMS, HEATHER R [HRS0] at 10/16/2017 2:18:44 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2017CCKM@uwhealth.org

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 your doctor if you have any of
these symptoms as they may indicate worsening
Heart Failure:
- Increased shortness of breath
- Cough or chest congestion
- Swelling in your abdomen or legs
- Any increase or decrease in weight of more than 3
pounds in a day or 5 pounds total
If you do not have a scheduled return
appointment, please schedule an appointment
with your primary physician [NURCOM0071]
Please complete in PATIENT FRIENDLY terms. This
order will appear on the patient's After Hospital Care
Plan., Routine
Core Measure Documentation - ACE Inhibitor/ARB (Single Response) [150651]
Core Measures - This Does NOT Generate A Medication Order (Use Med Reconciliation To
Prescribe Medications)
ACE Inhibitor/ARB Reason Not Ordered
[COR0001]
ONCE, Starting today For 1 Occurrences, Routine
Reason Not Ordered:
ACE Inhibitor/ARB Already Ordered [COR0001] ONCE, Starting today For 1 Occurrences, Routine
Reason Not Ordered: Other (Comments required for
not ordering BOTH an ACEI and an ARB)
Follow-Up Care
Follow-Up Appointments - Ambulatory [128300]
Schedule Appointment [NURCOM0026] Reason for Hospital Follow Up Appointment: Post
operative visit
Which Provider:
Schedule Appointment [NURCOM0026] Reason for Hospital Follow Up Appointment:
Which Provider:
Schedule Appointment [NURCOM0026] Reason for Hospital Follow Up Appointment:
Which Provider:
Patient to Schedule Appointment [NURCOM0026] Reason for Hospital Follow Up Appointment:
Which Provider:
Follow up Appointment Already Scheduled
[NURCOM0019]
Details
Schedule Appointment With Physical Therapy
[NURCOM0026]
Reason for Hospital Follow Up Appointment:
Which Provider: Patient's Specific PCP/Care Team
When do you want appointment:
Which Clinic or Specialty: Physical Therapy
Schedule Appointment With Occupational
Therapy [NURCOM0026]
Reason for Hospital Follow Up Appointment:
Which Provider: Patient's Specific PCP/Care Team
When do you want appointment:
Which Clinic or Specialty: Occupational Therapy
Schedule Appointment With Speech Therapy
[NURCOM0026]
Reason for Hospital Follow Up Appointment:
Which Provider: Patient's Specific PCP/Care Team
When do you want appointment:
Which Clinic or Specialty: Speech Therapy
Schedule Appointment with Swallow Therapy
[NURCOM0026]
Reason for Hospital Follow Up Appointment:
Which Provider:
Follow Up Appointments - Diabetes (Single Response) [148552]
Page 17 of 21
Printed by WILLIAMS, HEATHER R [HRS0] at 10/16/2017 2:18:44 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2017CCKM@uwhealth.org

*** 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
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.
Page 18 of 21
Printed by WILLIAMS, HEATHER R [HRS0] at 10/16/2017 2:18:44 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2017CCKM@uwhealth.org

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.
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.
Page 19 of 21
Printed by WILLIAMS, HEATHER R [HRS0] at 10/16/2017 2:18:44 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2017CCKM@uwhealth.org

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.
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.
Discharge Labs [134929]
Page 20 of 21
Printed by WILLIAMS, HEATHER R [HRS0] at 10/16/2017 2:18:44 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2017CCKM@uwhealth.org

Please use the table below to determine what type of order to use to place discharge lab
orders.
Discharge Labs Workflow URL: https://uconnect.wisc.edu/growth/training--
education/health-link/10-minutes/inpatient-
discharge-consult/resources/name-82993-en.file
Recommended Discharge Labs [NURCOM0075] Details
Who is Responsible for the
Result?
Where Will Labs be
Completed?
What Order Should You
Use?
Current Attending Provider UW Health Lab Specific lab orders (A)
Non-UW Health Lab
Specific lab orders with order
class changed to OUTSIDE
(B)
Current Consulting Provider
UW Health Lab
Specific lab orders with
AUTHORIZING PROVIDER
CHANGED TO
CONSULTANT (A)
Non-UW Health Lab
Specific lab orders with order
class changed to OUTSIDE
and AUTHORIZING
PROVIDER CHANGED TO
CONSULTANT (B)
Another Provider
UW Health Lab
Recommended Discharge
Labs (C)
Non-UW Health Lab
Recommended Discharge
Labs (C)
(A) SPECIFIC LAB ORDERS:
These orders should be used if the CURRENT ATTENDING OR CONSULTING PROVIDER
will be responsible for the result of the lab AND the patient will have the labs completed at a
UW HEALTH LAB.
If a CONSULTING PROVIDER currently involved in the patient's care will be responsible for the
result, you must change the AUTHORIZING PROVIDER on the order to the CONSULTING
PROVIDER before signing the order. To do this, click the Providers button near the top of the
Review, Sign & Hold tab of the discharge navigator. Update the authorizing provider to the
consulting provider.
(B) SPECIFIC LAB ORDER WITH ORDER CLASS CHANGED TO OUTSIDE:
These orders should be used if the CURRENT ATTENDING OR CONSULTING PROVIDER
will be responsible for the result of the lab AND the patient will have labs completed at a NON-
UW HEALTH LAB.
If a CONSULTING PROVIDER currently involved in the patient’s care will be responsible for the
result, you must change the AUTHORIZING PROVIDER on the order to the CONSULTING
PROVIDER before signing the order. To do this, click the Providers button near the top of the
Review, Sign & Hold tab of the discharge navigator. Update the authorizing provider to the
consulting provider.
The patient will receive a paper order to take to the lab.
(C) RECOMMENDED DISCHARGE LABS:
This order should be used to recommend to another provider labs that a patient should have
completed after discharge. The provider designated in the 'Send Recommendations To' field is
responsible for PLACING the lab orders AND will be responsible for the RESULTS of any
ordered labs.
Page 21 of 21
Printed by WILLIAMS, HEATHER R [HRS0] at 10/16/2017 2:18:44 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2017CCKM@uwhealth.org