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IP - Bronchoscopy - Adult - Preprocedure [1337]

IP - Bronchoscopy - Adult - Preprocedure [1337] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Pulmonary


IP - Bronchoscopy - Adult - Preprocedure [1337]
for Adult Patients OnlyIntended
Patient Care Orders
Procedure Order [20652]
Bronchoscopy [PUL0001] ONCE, Starting today For 1 Occurrences, Routine
Reason for Exam:
Nutrition For Morning Procedure [17738]
NPO [NUT9999] EFFECTIVE MIDNIGHT, Starting today, Routine
Patient Type: Adult
Diet Type: NPO
NPO: Strict NPO
Bedside Meal Instructions:
Room Service Class:
NPO Except Medications [NUT9999] EFFECTIVE MIDNIGHT, Starting today, Routine
Patient Type: Adult
Diet Type: NPO
NPO: NPO except Medications
Bedside Meal Instructions:
Room Service Class:
Nutrition For Afternoon Procedure [20780]
Clear Liquid Det [NUT9999] EFFECTIVE 0500, Routine
Patient Type: Adult
Diet Type: Diet Modifications
Diet Modifications: Liquid
Liquid: Clear Liquid
No Red or Purple Dye:
Liquid Thickness: Thin
Bedside Meal Instructions:
Room Service Class:
For breakfast on day of procedure.
NPO for Procedure - Hold Diet - Except
Medications for Procedure [DIE0007]
CONTINUOUS NPO, Starting tomorrow, Routine
NPO For Which Procedure?
Modifiers: NPO EXCEPT MEDICATIONS
Starting at 0800 day of procedure.
Respiratory [17740]
Oxygen On Call to Procedure (Include
CPAP/BIPAP if Applicable) [RT0073]
ONCE, Starting today For 1 Occurrences, Routine
Non-Categorized Patient Care Orders [135838]
RN to Complete Preprocedure Checklist
[NURCOM0022]
ONCE, Starting today For 1 Occurrences
Intravenous Therapy
Intravenous Therapy [20710]
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Starting today, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
IntraOp
Sedation Medications [148628]
Page 1 of 4
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 11:33:39 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

FENTanyl PF injection RANGE [750047] 12.5-50 mcg, Intravenous, PRN For 24 Hours,
Sedation for endoscopy procedure
Initial dose of 50 mcg (consider lower doses for
patients older than 70 years old or less than 50 kg);
subsequent doses of 12.5-50 mcg every 2 minutes as
needed for moderate sedation. Titrate to maintain an
Adult Sedation Score between 3-4.
Doses to be directed by provider.
for 1 Minutes, APC/GI Sedation
midazolam (VERSED) injection RANGE [750056] 0.5-2 mg, Intravenous, PRN For 24 Hours, sedation,
Sedation for endoscopy procedure.
Initial dose of 2 mg (consider lower doses for patients
older than 70 years old or less than 50 kg).
Subsequent doses of 0.5-2 mg every 2 minutes as
needed for moderate sedation. Titrate to maintain an
Adult Sedation Score between 3-4.
If ordered IV: push rate 1 mg/minute.
Doses to be directed by provider.
APC/GI Sedation
diphenhydramine (BENADRYL) injection RANGE
[750044]
12.5-50 mg, Intravenous, PRN For 24 Hours, Sedation
for endoscopy procedure
Once prn for moderate sedation. Do not repeat
administration.
Doses to be directed by provider.
for 1 Minutes, APC/GI Sedation
promethazine (PHENERGAN) injection RANGE
[750060]
12.5-25 mg, Intravenous, PRN For 24 Hours,
nausea/vomiting
Second line or adjunct agent if diphenhydramine is not
patient preferred or if diphenhydramine is not
completely effective. Once prn for moderate sedation.
Do not repeat administration.
Extravasation Risk: CENTRAL or LARGE VEIN
required. No hand, foot, wrist, or antecubital veins or
areas of flexion
Requires further dilution in 10 to 20 mL NS or
preparation in a minibag. Administer over 10 to 15
minutes through a running IV line at a port furthest
from the patient's vein.
Discontinue immediately if burning or pain occurs with
administration.
Doses to be directed by provider.
IntraOp
Sedative Reversal [148629]
naloxone (NARCAN) injection [800199] 0.2-0.8 mg, Intravenous, PRN For 24 Hours, opioid
overdose, Sedation reversal
Administer over 2 minutes
Doses to be directed by provider.
IntraOp
flumazenil (ROMAZICON) injection [104460] 0.1-1 mg, Intravenous, PRN For 24 Hours, Sedation
reversal
Give 0.1-0.2 mg IV over 15 seconds; repeat dose after
45 seconds (1 minute intervals) as needed for
sedation reversal up to a maximum dose of 1 mg.
Doses to be directed by provider.
IntraOp
Page 2 of 4
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 11:33:39 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

Laboratory
Draw Day of Procedure [17741]
CBC WITHOUT DIFFERENTIAL [HEMO] CONDITIONAL For 4 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw Day of
Procedure
PROTHROMBIN TIME/INR [PT] CONDITIONAL For 4 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw Day of
Procedure
Consults
Consults [17742]
Diabetes Consult Order Panel (Adult) [188497]
Diabetes Management Service : Will provide management or treatment recommendations for
patients with hyperglycemia and/or those who report outpatient use of insulin or other diabetes
medications. Patients should be expected to remain inpatient > 24 hrs from time of consult.
Consult is required for patients with insulin pumps or who use U-500 insulin. Consult Endocrine
for any non-diabetes-related endocrine questions.
Learning Center - Diabetes Education (Adult): Diabetes Education (Adult): Diabetes education
(meter/insulin skills/other diabetes survival skills) for patients/families with knowledge deficits
and/or need for diabetes knowledge assessment. Recommended for all new diagnoses or
patients with A1C > 9.
Diabetes Education – Nutrition : Diabetes nutrition therapy including nutrition assessment,
carbohydrate education (consistent carbohydrate meals, use of insulin-to-carbohydrate ratio),
and/or individualized, nutritious meal planning for carbohydrates, portions, or considering other
comorbidities. Recommended for all new diagnoses or patients with A1C > 9
Consult Diabetes Management Service (DMS)
(Inpatient) [CON0022]
ONCE
Can this consult be done via video?
Call back number:
Intent: Consult and Recommend (Write Orders)
Concern or Specific Question or Task to be
Addressed (Symptom, Sign, or Diagnosis):
Consult Learning Center - Diabetes Education
(Adult) [CON0021]
ONCE, Routine, - If patient is newly diagnosed or is
new to insulin, provide 24 hours notice to allow
adequate time for education,
- Indicate diabetes medication/treatment plan if
known.
- Consults requested after 1600 on Fridays may not
be seen until following Monday. Learning Center
available Mon-Sat 0800-1630 (only 1 RN available
on Saturday for CSC and AFCH).
- Staff may be contacted by Pager 7927 on
weekdays and Pager 3276 on weekends.
- Learning Center staff are not available on holidays.
Type of Education: Diabetes Self-Management
Education
Reason For Consult:
Expected Discharge Date:
Diabetes management / treatment plan:
Can this consult be done via video?
Page 3 of 4
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 11:33:39 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

Consult Diabetes Education - Nutrition (Inpatient)
[CON0126]
ONCE, Routine, · If your patient is newly diagnosed
and/or is new to insulin therapy, provide 24 hours
notice to allow adequate time for nutrition education.
· Indicate diabetes medication/treatment plan if
known.
· Consults requested after 1300 on Friday may not
be completed until the following Monday.
· If you are placing a consult on a weekend day for a
patient who will be discharging that weekend, please
have the Paging Center contact the on-call dietitian
to help you facilitate the diabetes nutrition education
session prior to the patient's discharge.
Type of Education: Diabetes Self-Management
Education
Reason For Consult:
Expected Discharge Date:
Diabetes management / treatment plan:
Can this consult be done via video?
Page 4 of 4
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 11:33:39 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org