/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/radiology/,

/clinical/cckm-tools/content/order-sets/inpatient/radiology/name-97949-en.cckm

201605142

page

100

UWHC,UWMF,

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

IP - Body - Percutaneous Ablation - Adult - Preprocedure [1609]

IP - Body - Percutaneous Ablation - Adult - Preprocedure [1609] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Radiology


IP - Body - Percutaneous Ablation - Adult - Preprocedure [1609]
Intended for Adult Patients Only
Deep Vein Thrombosis Prophylactic Measures
Deep Vein Thrombosis Prophylactic Measures [22266]
Apply and Maintain Anti-Embolism Stocking
[NURTRT0039]
CONTINUOUS, Starting today For Until specified, Routine
Does this need to be inserted/placed? Yes
Left/Right/Bilateral? Bilateral
Type: Thigh high
Patient Care Orders
Vital Signs [22269]
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 admission
Nutrition [22270]
NPO [NUT0001] EFFECTIVE NOW, Starting today, Routine
General Diet:
Diabetic Diet:
NPO (If patient receiving tube feeding see question 25):
Liquids & Modified Consistency (If Dysphagia Protocol see
questions 21-24):
Fiber:
Renal & Dialysis Multi-Nutrient Restriction:
Lactose Restricted:
Protein:
Fat:
Sodium:
Potassium:
Phosphorus:
Other Minerals:
Calories:
Fluid Restriction: Total mLs/24 hours (IV & PO):
Research:
Metabolic:
Other Modifiers:
Infant Nutrition (Select product and calories per ounce):
Infant Formula (Calories per Ounce):
Dysphagia Protocol:
Dysphagia Protocol-Modified Consistency (Also select
Dysphagia Protocol Liquid Consistency and Dysphagia
Protocol-Supervision):
Dysphagia Protocol-Liquid Consistency:
Dysphagia Protocol-Supervision:
Tube Feeding (Use Tube Feeding Order Set to indicate order
detail):
Room Service Class:
Non-Categorized Patient Care Orders [22273]
Void prior to procedure [NURELM0022] CONTINUOUS, Starting today, Routine
Page 1 of 4
Printed by O'BRIEN, RYLEY P [RPO249] at 12/28/2015 8:17:54 AM

Copyright © 2015 University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:



















 
12/2015Lee Vermeulen, CCKM@uwhealth.org

Insert and Maintain Urinary Catheter [NURELM0013] CONTINUOUS, Starting today For Until specified, Routine,
To discontinue this order, enter a new order for "Discontinue
Urinary Catheter".
To modify this order, enter a new order for "Maintain Urinary
Catheter" and make the necessary changes in the new order.
Type: Indwelling Single Lumen
Indication for Placement:
Details: To Dependent Drainage
Does this need to be inserted/placed? Yes
To be placed in procedure room.
Contingency Parameters [22274]
Notify - Radiologist On Call [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):
If blood glucose < (mg/dL):
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL):
Other: INR greater than 1.5,Platelet count less than 50K/uL
Intravenous Therapy
IV Fluids [22366]
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS For Until specified, Routine
Peripheral IV Size: 18 Gauge
Does this need to be inserted/placed?
sodium chloride 0.9% infusion [64367] at 125 mL/hr, Intravenous, CONTINUOUS
dextrose 5%-NaCl 0.45% infusion [51613] Intravenous, CONTINUOUS
lactated ringers infusion [38890] Intravenous, CONTINUOUS
Surgical Prophylaxis
First Line (Single Response) [147677]
cefazolin (ANCEF) intraVENOUS - NOTE: Patients who
are 40-120 kg [800000]
2 g, Intravenous, ON CALL For 1 Doses, IntraOp
cefazolin (ANCEF) intraVENOUS - NOTE: Patients who
are greater than 120 kg [800000]
3 g, Intravenous, ON CALL For 1 Doses, IntraOp
MRSA/Documented History of MRSA (Single Response) [147679]
Patients who are 40 - 120 kg [199220]
cefazolin (ANCEF) intraVENOUS [800000] 2 g, Intravenous, ON CALL For 1 Doses, IntraOp
vancomycin (VANCOCIN) intraVENOUS [800084] 20 mg/kg, Intravenous, ON CALL For 1 Doses, Pre-Op
Day Of Procedure
Patients who are greater than 120 kg [199223]
cefazolin (ANCEF) intraVENOUS [800000] 3 g, Intravenous, ON CALL For 1 Doses, IntraOp
vancomycin (VANCOCIN) intraVENOUS [800084] 20 mg/kg, Intravenous, ON CALL For 1 Doses, Pre-Op
Day Of Procedure
Immediate/Severe Reactions to Penicillin or Known Cephalosporin Allergies (Single Response) [147678]
vancomycin (VANCOCIN) intraVENOUS [800084] 15 mg/kg, Intravenous, ON CALL For 1 Doses, Pre-Op Day
Of Procedure
clindamycin (CLEOCIN) intraVENOUS - NOTE: Patients
who are 40-80 kg [800033]
600 mg, Intravenous, ON CALL For 1 Doses, IntraOp
Page 2 of 4
Printed by O'BRIEN, RYLEY P [RPO249] at 12/28/2015 8:17:54 AM

Copyright © 2015 University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:



















 
12/2015Lee Vermeulen, CCKM@uwhealth.org

clindamycin (CLEOCIN) intraVENOUS - NOTE: Patients
who are 81-160 kg [800033]
900 mg, Intravenous, ON CALL For 1 Doses, IntraOp
clindamycin (CLEOCIN) intraVENOUS - NOTE:
Patientes who are greater than 160 kg [800033]
1,200 mg, Intravenous, ON CALL For 1 Doses, Pre-Op Day
Of Procedure
Laboratory
Draw on Arrival [22275]
AFP, TUMOR MARKER, SERUM [XAFPTM] STAT - RN COLLECT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
PROTHROMBIN TIME/INR [PT] STAT - RN COLLECT, Starting today For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
BUN [BUN] STAT - RN COLLECT, Starting today For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
CREATININE [CRET] STAT - RN COLLECT, Starting today For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
CARCINOEMBRYONIC ANTIGEN [CEA] STAT - RN COLLECT, Starting today For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
HEMATOCRIT [HCT] STAT - RN COLLECT, Starting today For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Blood Bank (Adult)
For Blood Products Refer to "IP - Blood Transfusion - Adult - Supplemental (996)" Order Set
Tests [12023]
TYPE AND SCREEN [HCTS] STAT - RN COLLECT, Starting tomorrow For 1 Occurrences,
Routine, As good clinical practice and for patient safety, the
Transfusion Service will automatically crossmatch 2 packed
RBCs on all patients with antibodies to ensure blood would
be available in the event it is needed. If you would like to opt
out of this automatic order for this patient please contact the
UWHC Blood Bank at (608) 263-8367 or The American
Center Lab at (608) 234-6600 as appropriate.
Diagnostic Tests and Imaging
Diagnostic Tests and Imaging [22282]
ECG - 12 Lead [EKG0008] ONCE, Starting today For 1 Occurrences, Routine
Reason for exam:
Page 3 of 4
Printed by O'BRIEN, RYLEY P [RPO249] at 12/28/2015 8:17:54 AM

Copyright © 2015 University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:



















 
12/2015Lee Vermeulen, CCKM@uwhealth.org

X-RAY CHEST PA & LAT VIEWS [R71020] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, Routine
Radiology Specialty Area: GENERAL IMAGING
Current signs and symptoms?
What specific question(s) would you like answered by this
exam?
Relevant recent/past history?
Is patient pregnant?
If being performed remotely, where?
Last patient weight? (will auto pull in value and date in
comment):
Transport Method: Floor Determined/Entered
If not done in the last 30 days
Page 4 of 4
Printed by O'BRIEN, RYLEY P [RPO249] at 12/28/2015 8:17:54 AM

Copyright © 2015 University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:



















 
12/2015Lee Vermeulen, CCKM@uwhealth.org