/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/pulmonary/,

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201606175

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UWHC,UWMF,

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

IP – Advanced Pulmonary – Adult – Discharge [4847]

IP – Advanced Pulmonary – Adult – Discharge [4847] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Pulmonary


IP - Advanced Pulmonary - Adult - Discharge [4847]
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]
SNF Certification Statement [NURCOM0069] Routine
Skilled Nursing Facility Certification Statement [118260]
SNF 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 Patient Care 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
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
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] 1 tab, 1, starting 3/5/15, No Print
acetaMINOPHEN (TYLENOL) suppository [34153] 1 suppository, 1, starting 3/5/15, No Print
Blood Glucose Management [111710]
glucagon 1 mg injection kit [107799] 1 each, 1, starting 3/5/15, No Print
Glucose 40 % oral gel [118089] 1 Tube, 1, starting 3/5/15, 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
Bowel Management [111709]
magnesium hydroxide (MILK OF MAGNESIA) susp
[65443]
1 Bottle, 1, starting 3/5/15, No Print
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bisacodyl (DULCOLAX) rectal suppository [35231] 1 suppository, 1, starting 3/5/15, No Print
Senna-Docusate Sodium 8.6-50 MG per tab [70181] 1 tab, 1, starting 3/5/15, No Print
polyethylene glycol (MIRALAX) oral powder [61353] 1 Bottle, 1, starting 3/5/15, No Print
phosphate (FLEET) enema [37517] 1 enema, 1, starting 3/5/15, No Print
Non-categorized Medications [111711]
guaifenesin-dextroMETHORPHAN (ROBITUSSIN DM)
syrup [51568]
1 Bottle, 1, starting 3/5/15, No Print
carbamide peroxide (DEBROX) 6.5% otic soln [35545] 1 Bottle, 1, starting 3/5/15 until 3/10/15, No Print
alum-mag-simeth (MYLANTA ES) susp [44073] 1 Bottle, 1, starting 3/5/15, No Print
Patient Care Orders
Reason For Hospitalization [130256]
Why You Were Hospitalized [NURCOM0073] Please complete in PATIENT FRIENDLY terms. This order
will appear on the patient's After Hospital Care Plan., Routine
Activity [130257]
Activity [NURACT0008] Routine
Discharge Activity:
Nutrition [130258]
Diet [NUT0006] Routine
Diet:
General:
Liquids and Modified Consistency:
Fluid Restriction:
Sodium:
Dysphagia:
Fat:
Renal:
Potassium:
Micronutrients:
Infant Formula Product:
Infant Formula Concentration:
Respiratory [130259]
DME - Home Oxygen [142943]
Both of the following orders MUST be completed in order for this DME to be delivered to the patient.
New reimbursement requirements in 2013 require that a physician, PA, NP, or CNS has a face-to-face encounter with a
patient prior to ordering certain durable medical equipment (DME). It also requires that the DME supplier be provided with
the documentation of the face-to-face encounter and a signed order prior to delivery of the DME.
National Coverage Determination for Home Use of
Oxygen (See section D for qualifying diagnoses)
URL: http://www.cms.gov/medicare-coverage-
database/details/ncd-details.aspx?
NCDId=169&ncdver=1&bc=AgAAQAAAAAAAAA%3d%
3d&
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 Only (liters/min):
With Sleep Only (FiO2):
Length of Need:
Vendor:
Vendor City:
Vendor Phone:
Vendor Fax:
DME - Home Oxygen Justification [1009463] Details
Schedule Appointment With Sleep Lab [NURCOM0026] Reason for Appointment: To determine if patient has sleep
apnea that needs to be treated with night CPAP
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When do you want appointment:
Which Clinic or Specialty: Sleep Lab
Which Provider (Optional):
Wound Care [130260]
Wound Care [NURWND0015] Routine
Bladder Care [130261]
Bladder Care [NURELM0067] Routine
Bowel Care [130262]
Bowel Care [NURELM0068] Routine
Other Patient Care Instructions [130263]
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,
- Plan to follow up in pulmonary clinic on ***. Should have
PFTs prior to visit.
When to Call Your Doctor [130264]
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 the pulmonary clinic with any signs of infection
including: fever, chills, sweats, increased shortness of breath,
increased pain, increased cough, or increased sputum
production
- Call the pulmonary clinic with questions or concerns at (608)
263-7203
- Call 608-262-0486 for emergencies
Follow-Up Referrals
Follow-Up Appointments - Cardiac Rehab (Single Response) [130265]
Outpatient Cardiac Rehab is recommended. Please select one of the following.
Referral Cardiac Rehab (Outpatient) [CON0174] All patients being discharged from UWHC IP CVM with the
following diagnoses should receive a referral to cardiac
rehab: Acute Myocardial Infarction (410.) (i.e. all STEMI or
NSTEMI patients), Stable Angina (413.9), Coronary Artery
Bypass Surgery (V45.81), Valve Surgery (repair or
replacement) (V42.2 or V42.3), Percutaneous Coronary
Angioplasty or Stenting (V45.82), or Heart Transplant (V42.1).
Typically, outpatient cardiac rehab follow-up appointments
occur 2-4 weeks post-hospitalization. Inpatient Preventive
Cardiology staff, Megan Renneberg or Lisa Wedekind, will
refer and make arrangements for the patient. If you have
further questions, you may call them at 263-6630.
Routine
Has this patient been seen by inpatient Cardiac
Rehab/Preventive Cardiology during this encounter?
Reason Cardiac Rehab Not Ordered [COR0027] Routine
Reason Not Ordered:
Follow-Up Appointments - Cardiac Rehab [130266]
Referral Cardiac Rehab (Outpatient) [CON0174] All patients being discharged from UWHC IP CVM with the
following diagnoses should receive a referral to cardiac
rehab: Acute Myocardial Infarction (410.) (i.e. all STEMI or
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NSTEMI patients), Stable Angina (413.9), Coronary Artery
Bypass Surgery (V45.81), Valve Surgery (repair or
replacement) (V42.2 or V42.3), Percutaneous Coronary
Angioplasty or Stenting (V45.82), or Heart Transplant (V42.1).
Typically, outpatient cardiac rehab follow-up appointments
occur 2-4 weeks post-hospitalization. Inpatient Preventive
Cardiology staff, Megan Renneberg or Lisa Wedekind, will
refer and make arrangements for the patient. If you have
further questions, you may call them at 263-6630.
Routine
Has this patient been seen by inpatient Cardiac
Rehab/Preventive Cardiology during this encounter?
Follow Up Appointments - Diabetes (Single Response) [148552]
*** 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.
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
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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.
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
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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.
Follow-Up Care
Follow-Up Apoointments [130267]
Schedule Appointment With Physical Therapy
[NURCOM0026]
Reason for Appointment:
When do you want appointment:
Which Clinic or Specialty: Physical Therapy
Which Provider (Optional):
Schedule Appointment With Occupational Therapy
[NURCOM0026]
Reason for Appointment:
When do you want appointment:
Which Clinic or Specialty: Occupational Therapy
Which Provider (Optional):
Schedule Appointment With Speech Therapy
[NURCOM0026]
Reason for Appointment:
When do you want appointment:
Which Clinic or Specialty: Speech Therapy
Which Provider (Optional):
Schedule Appointment [NURCOM0026] Reason for Appointment:
When do you want appointment:
Which Clinic or Specialty:
Which Provider (Optional):
Schedule Appointment [NURCOM0026] Reason for Appointment:
When do you want appointment:
Which Clinic or Specialty:
Which Provider (Optional):
Schedule Appointment [NURCOM0026] Reason for Appointment:
When do you want appointment:
Which Clinic or Specialty:
Which Provider (Optional):
Patient to Schedule Appointment [NURCOM0026] Routine
Reason for Appointment:
When do you want appointment:
Which Clinic or Specialty:
Which Provider (Optional):
Facility Therapy Needs [130268]
Continue Physical Therapy at Next Facility
[NURCOM0022]
Routine
Continue Occupational Therapy at Next Facility
[NURCOM0022]
Routine
Continue Speech Therapy at Next Facility
[NURCOM0022]
Routine
Discharge Labs [134929]
Please use the table below to determine what type of order to use to place discharge lab orders.
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
Current Attending Provider Non-UW Health Lab Outside Lab Order
Current Consulting Provider UW Health Lab Specific lab orders with authorizing provider changed to consultant
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Current Consulting Provider Non-UW Health Lab Outside Lab Order with authorizing provider changed to consultant
Another Provider UW Health Lab Recommended Discharge Labs
Another Provider Non-UW Health Lab Recommended Discharge Labs
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.
OUTSIDE LAB ORDER:
This order 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. The patient will receive a paper order to
take with them to the lab.
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.
Recommended Discharge Labs [NURCOM0075] Details
Outside Discharge Lab Order [LABDCOUT] Status: Future, Expires: 7/5/15, Normal, Routine, Qty-1
Labs [130269]
These lab orders should only be used if the current Attending Provider or Consulting Provider will be responsible for the
result of the lab.
CBC WITH DIFFERENTIAL [CBC] Status: Standing, Expires:7/5/15 MANUAL,Count:1, Normal,
Routine
BASIC METABOLIC PANEL [BMET] Status: Standing, Expires:7/5/15 MANUAL,Count:1, Normal,
Routine
PROTHROMBIN TIME/INR [PT] Status: Standing, Expires:4/5/16 MANUAL,Count:1, Normal,
Routine
ELECTROLYTES [LYTE] Status: Standing, Expires:7/5/15 MANUAL,Count:1, Normal,
Routine
BUN [BUN] Status: Standing, Expires:7/5/15 MANUAL,Count:1, Normal,
Routine
CREATININE [CRET] Status: Standing, Expires:4/5/16 MANUAL,Count:1, Normal,
Routine
GLUCOSE [GLU] Status: Standing, Expires:7/5/15 MANUAL,Count:1, Normal,
Routine
CALCIUM [CA] Status: Standing, Expires:7/5/15 MANUAL,Count:1, Normal,
Routine
BILIRUBIN, TOTAL [TBIL] Status: Standing, Expires:7/5/15 MANUAL,Count:1, Normal,
Routine
PROTEIN, TOTAL [TP] Status: Standing, Expires:7/5/15 MANUAL,Count:1, Normal,
Routine
ALBUMIN [ALB] Status: Standing, Expires:7/5/15 MANUAL,Count:1, Normal,
Routine
ALKALINE PHOSPHATASE [ALKP] Status: Standing, Expires:7/5/15 MANUAL,Count:1, Normal,
Routine
AST/SGOT [AST] Status: Standing, Expires:7/5/15 MANUAL,Count:1, Normal,
Routine
ALT/SGPT [ALT] Status: Standing, Expires:4/5/16 MANUAL,Count:1, Normal,
Routine
Imaging [130270]
X-RAY CHEST AP VIEW [R71010] Status: Future, Expires: 5/5/16, Normal, Routine
CT HEAD W & W/ O IV CONTRAST [R70470] Status: Future, Expires: 5/5/16, Normal, Routine
CT ABDOMEN PELVIS W & W/ O IV CONTRAST
[R07033]
Status: Future, Expires: 5/5/16, Normal, Routine
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