/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-97956-en.cckm

201712341

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UWHC,UWMF,

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

IP - IR - Generic - Adult - Preprocedure [2133]

IP - IR - Generic - Adult - Preprocedure [2133] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Radiology


IP - IR - Generic - Adult - Preprocedure [2133]
Patient Care Orders
Vitals [142859]
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 arrival
Patient Monitoring [141862]
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Starting today, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
Nutrition [29712]
NPO Except Medications [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: NPO
NPO: NPO except Medications
Bedside Meal Instructions:
Room Service Class:
Patient may have solid food until 6 hours prior to
procedure. May continue to take clear liquids until 4
hours prior to procedure. Then NPO except
medications with sips of water.
Intake and Output [141863]
Void Prior to Transport [NURELM0061] ONCE, Starting today For 1 Occurrences
Non-Categorized Patient Care Orders [29713]
Nursing Communication [NURCOM0022] ONCE, Starting today For 1 Occurrences, Procedure
to be performed ***.
For Diabetic Patients [29714]
Glucose, POC [IPGLUCOSE] CONDITIONAL, Starting today For 5 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 and every
60 minutes for prior glucose less than 60 mg/dL or
greater than 300 mg/dL
GLUCOSE [GLU] CONDITIONAL, 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? Obtain if POC glucose
less than 40 mg/dL or greater than 400 mg/dL
Contingency Parameters [29715]
Page 1 of 4
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 12:36:33 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

Notify Interventional Radiology Provider
[NURCOM0001]
Provider to Notify: Provider
If systolic blood pressure > (mmHg): 180
If systolic blood pressure < (mmHg): 100
If diastolic blood pressure > (mmHg): 100
If diastolic blood pressure < (mmHg): 60
If temperature > (C):
If temperature < (C):
If heart rate > (bpm): 120
If heart rate < (bpm): 50
If respiratory rate >:
If respiratory rate <:
If blood glucose > (mg/dL): 300
If blood glucose < (mg/dL): 90
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL):
Other: International normalized ratio (INR) is greater
than 1.5,Platelet count is less than 50,000/microliter
Intravenous Therapy
Premedications for Needle Insertion [124125]
Use lidocaine topical dressing kit for stable patient, no lidocaine allergies, have at least 30
minutes time prior to needing to use IV
Sodium chloride (bacteriostatic) 0.9% intradermal: Useful for patients requiring urgent IV
access; onset is immediate.
lidocaine (LMX) 4% topical dressing kit [66882] Topical, EVERY 1 HOUR PRN, peripheral line
insertion - see Admin Instructions
Do NOT apply to area greater than 200 square
centimeters (maximum 2.5 g/site; maximum 4 sites
per hour, 6 times per day). Do NOT leave on longer
than 2 hours. Use for stable patient, no allergies to
lidocaine, with at least 30 minutes time prior to IV use
sodium chloride (bacteriostatic) 0.9 % injection
[50585]
0.05-0.1 mL, Intradermal, PRN, peripheral line
insertion - see Admin Instructions
Use an insulin or TB syringe with a 25-30 gauge
needle to inject solution and create a wheal. Wait 30
seconds to 1 minute then insert IV catheter into center
of wheal. Use if IV is needed within 30 minutes.
IV Fluids [141818]
dextrose 5%-NaCl 0.45% infusion [51613] at 150 mL/hr, Intravenous, CONTINUOUS
sodium chloride 0.9% infusion [64367] at 150 mL/hr, Intravenous, CONTINUOUS
Surgical Prophylaxis - Nephrostomy Tube Changes
resistant organisms Ceftriaxone does not cover Enterococcus. Patients with a history of Note:
microbiologic history.need prophylaxis tailored to their specific
First Line (Single Response) [227180]
ceftriaxone (ROCEPHIN) intraVENOUS - Patients
who are 40-120 kg [800027]
1 g, Intravenous, ON CALL For 1 Doses
ceftriaxone (ROCEPHIN) intraVENOUS - Patients
who are 121 kg and greater [800027]
2 g, Intravenous, ON CALL For 1 Doses
MRSA / Documented MRSA History (Single Response) [227173]
Patients who are 40-120 kg [228549]
ceftriaxone (ROCEPHIN) intraVENOUS [800027] 1 g, Intravenous, ON CALL For 1 Doses
vancomycin (VANCOCIN) intraVENOUS -
(Maximum Dose 2 grams) [800084]
20 mg/kg, Intravenous, ON CALL For 1 Doses
Page 2 of 4
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 12:36:33 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

Patients who are 121 kg and greater [228550]
ceftriaxone (ROCEPHIN) intraVENOUS [800027] 2 g, Intravenous, ON CALL For 1 Doses
vancomycin (VANCOCIN) intraVENOUS -
(Maximum Dose 2 grams) [800084]
20 mg/kg, Intravenous, ON CALL For 1 Doses
Immediate/Severe Reactions to Penicillin or Known Cephalosporin Allergies [227178]
Patients who are 40 kg and greater [228545]
gentamicin (GARAMYCIN) intraVENOUS
[800049]
5 mg/kg, Intravenous, ON CALL For 1 Doses
vancomycin (VANCOCIN) intraVENOUS -
(Maximum Dose = 2 grams) [800084]
20 mg/kg, Intravenous, ON CALL For 1 Doses
Surgical Prophylaxis - Biliary or Cholecystctomy Tube Changes
resistant organisms Ceftriaxone does not cover Enterococcus. Patients with a history of Note:
microbiologic historyneed prophylaxis tailored to their specific
First Line (Single Response) [227181]
ceftriaxone (ROCEPHIN) intraVENOUS - Patients
who are 40-120 kg [800027]
1 g, Intravenous, ON CALL For 1 Doses
ceftriaxone (ROCEPHIN) intraVENOUS - Patients
who are 121 kg and greater [800027]
2 g, Intravenous, ON CALL For 1 Doses
MRSA / Documented MRSA History (Single Response) [227177]
Patients who are 40-120 kg [228547]
ceftriaxone (ROCEPHIN) intraVENOUS [800027] 1 g, Intravenous, ON CALL For 1 Doses
vancomycin (VANCOCIN) intraVENOUS -
(Maximum Dose 2 grams) [800084]
20 mg/kg, Intravenous, ON CALL For 1 Doses
Patients who are 121 kg and greater [228548]
ceftriaxone (ROCEPHIN) intraVENOUS [800027] 2 g, Intravenous, ON CALL For 1 Doses
vancomycin (VANCOCIN) intraVENOUS -
(Maximum Dose 2 grams) [800084]
20 mg/kg, Intravenous, ON CALL For 1 Doses
Immediate / Severe Reactions to Penicillin or Known Cephalosporin Allergies [226969]
Patients who are 40 kg and greater [228543]
gentamicin (GARAMYCIN) intraVENOUS
[800049]
5 mg/kg, Intravenous, ON CALL For 1 Doses
vancomycin (VANCOCIN) intraVENOUS -
(Maximum Dose = 2 grams) [800084]
20 mg/kg, Intravenous, ON CALL For 1 Doses
Laboratory
Preprocedure Labs [29716]
WHITE CELL COUNT [WBC] STAT, 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?
HEMOGLOBIN [HGB] STAT, 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?
PLATELET COUNT [PLT] STAT, 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?
PROTHROMBIN TIME/INR [PT] STAT, 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?
Page 3 of 4
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 12:36:33 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

ELECTROLYTES [LYTE] STAT, 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?
GLUCOSE [GLU] STAT, 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, 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, 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?
CALCIUM [CA] STAT, 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?
AST/SGOT [AST] STAT, 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?
ALT/SGPT [ALT] STAT, 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?
BILIRUBIN, TOTAL [TBIL] STAT, 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?
ALKALINE PHOSPHATASE [ALKP] STAT, 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?
HCG, QUALITATIVE, URINE [UPREG] STAT, 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?
Page 4 of 4
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 12:36:33 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org