/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-98004-en.cckm

201710275

page

100

UWHC,UWMF,

Tools,

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

IP - Musculoskeletal - Radiofrequency Ablation - Adult - Preprocedure [1819]

IP - Musculoskeletal - Radiofrequency Ablation - Adult - Preprocedure [1819] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Radiology


IP - Musculoskeletal - Radiofrequency Ablation - Preprocedure [1819]
Patient Care Orders
Activity [27700]
Up Ad Lib [NURACT0008] CONTINUOUS, Starting today, Routine
AD LIB: ad lib
AMBULATE:
CHAIR:
DANGLE:
BEDREST:
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Nutrition [111367]
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 Education [27703]
Prior to Procedure [NURCOM0022] ONCE, Starting today For 1 Occurrences, Patient to
read HFFY #5821 - Moderate Sedation Prior to
Transport to Radiology.
Prior to Procedure [NURCOM0022] ONCE, Starting today For 1 Occurrences, Patient to
read HFFY #6691 - Radiofrequency Ablation and
Cryoablation Prior to Transport to Radiology.
Non-Categorized Patient Care Orders [26144]
Void Prior to Transport [NURELM0022] CONTINUOUS For Until specified, Routine, Void prior
to transport.
Nursing Communication - Treatment
[NURTRT0048]
SEE COMMENTS, Starting today, Patient should take
all regularly scheduled medications except blood
thinners: Warfarin, IV Heparin, Enoxaparin,
Fondaparinux, Clopidogrel, Ticlopidine, Cilostazol,
Bivalirudin, Argatroban, Abciximab, Eptifibatide or
Dipyridamole (may use heparin lock flushes).
For Diabetic Patients [27706]
For Insulin Orders, Refer to "Diabetes Management - Supplemental" Order Set
Glucose, POC [IPGLUCOSE] ONCE, Starting today For 1 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?
Once, on arrival.
Contingency Parameters [27707]
Page 1 of 3
Printed by O'BRIEN, RYLEY P [RPO249] at 9/29/2017 2:38:19 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2017CCKM@uwhealth.org

Notify Provider [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): 200
If blood glucose < (mg/dL): 90
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL):
Other: If patient has taken aspirin in the last 3 days,If
patient has taken clopiogrel (PLAVIX) in the last 7
days,If patient has taken delteparin (FRAGMIN) or
enoxaparin (LOVENOX) in the last 12 hours,If patient
has taken unfractioned heparin for the last 8 hours,If
patient has taken metFORMIN (GLUCOPHAGE) the
morning of procedure,If patient has taken warfarin
(COUMADIN) for the last 5 days,International
normalized ratio (INR) is greater than 1.5,Platelet
count is less than 50,000/uL
Intravenous Therapy
IV Fluids - Adults [26511]
sodium chloride 0.9% infusion [64367] at 50 mL/hr, Intravenous, CONTINUOUS
IV Fluids - Peds [233974]
sodium chloride 0.9% infusion [64367] Intravenous, CONTINUOUS
Surgical Prophylaxis
First Line (Single Response) [233975]
cefazolin (ANCEF) intraVENOUS - Patients who
are less than 40 kg [800000]
30 mg/kg, Intravenous, ONCE For 1 Doses
cefazolin (ANCEF) intraVENOUS - Patients who
are 40 - 120 kg [800000]
2 g, Intravenous, ONCE For 1 Doses
cefazolin (ANCEF) intraVENOUS - Patients who
are 121 kg or greater [800000]
3 g, Intravenous, ONCE For 1 Doses
Documented MRSA or history of MRSA or MRSE risk (Single Response) [233976]
Patients who are less than 40 kg [233984]
cefazolin (ANCEF) intraVENOUS [800000] 30 mg/kg, Intravenous, ONCE For 1 Doses
vancomycin (VANCOCIN) intraVENOUS -
Maximum Dose = 2000 mg/dose [800084]
15 mg/kg, Intravenous, ONCE For 1 Doses
Patients who are 40 - 120 kg [233979]
cefazolin (ANCEF) intraVENOUS [800000] 2 g, Intravenous, ONCE For 1 Doses
vancomycin (VANCOCIN) intraVENOUS -
Maximum Dose = 2000 mg/dose [800084]
20 mg/kg, Intravenous, ONCE For 1 Doses
Patients who are 121 kg or greater [233982]
cefazolin (ANCEF) intraVENOUS [800000] 3 g, Intravenous, ONCE For 1 Doses
vancomycin (VANCOCIN) intraVENOUS -
Maximum Dose = 2000 mg/dose [800084]
20 mg/kg, Intravenous, ONCE For 1 Doses
Patients with IgE-mediated or severe reaction to beta-lactam (Single Response) [234203]
Page 2 of 3
Printed by O'BRIEN, RYLEY P [RPO249] at 9/29/2017 2:38:19 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
09/2017CCKM@uwhealth.org

vancomycin (VANCOCIN) intraVENOUS -
Patients who are less than 40 kg [800084]
15 mg/kg, Intravenous, ONCE For 1 Doses
vancomycin (VANCOCIN) intraVENOUS -
Patients who are 40 kg and greater - Maximum
Dose = 2000 mg/dose [800084]
20 mg/kg, Intravenous, ONCE For 1 Doses
Patients with IgE-mediated or severe reaction to beta-lactam AND MRSA or history of MRSA or MRSE
risk (Single Response) [234204]
vancomycin (VANCOCIN) intraVENOUS -
Patients who are less than 40 kg [800084]
15 mg/kg, Intravenous, ONCE For 1 Doses
vancomycin (VANCOCIN) intraVENOUS -
Patients who are 40 kg and greater - Maximum
Dose = 2000 mg/dose [800084]
20 mg/kg, Intravenous, ONCE For 1 Doses
Laboratory
Collect Now STAT if not Done in the Last 30 Days [27708]
PLATELET COUNT [PLT] STAT, Starting today For 1 Occurrences, STAT
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, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Conditional Labs [27709]
GLUCOSE [GLU] CONDITIONAL For 7 Days, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Stat, if bedside
glucose monitoring less than 40 mg/dL or greater than
400 mg/dL
Page 3 of 3
Printed by O'BRIEN, RYLEY P [RPO249] at 9/29/2017 2:38:19 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
09/2017CCKM@uwhealth.org