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IP - Virtual Colonoscopy and Bowel Preparation - Preprocedural [1302]

IP - Virtual Colonoscopy and Bowel Preparation - Preprocedural [1302] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Radiology


IP - Virtual Colonoscopy and Bowel Preparation - Preprocedural [1302]
Diagnostic Tests and Imaging
Studies [17015]
CT VIRTUAL COLONOSCOPY DIAGNOSTIC
[R0067T]
ONCE-RAD NEXT AVAILABLE For 1 Occurrences,
Routine
Current signs and symptoms?
What specific question(s) would you like answered by
this exam? Please include relevant recent/past
history.
Last patient weight? (will auto pull in value and date in
comment):
Transport Method: Floor Determined/Entered
CT VIRTUAL COLONOSCOPY SCREENING
[R0066T]
ONCE-RAD NEXT AVAILABLE For 1 Occurrences,
Routine
Is patient on anticoagulation therapy? If yes, specify
coagulation disorder and current medications in
comments box at bottom.
Current signs and symptoms?
What specific question(s) would you like answered by
this exam? Please include relevant recent/past
history.
Last patient weight? (will auto pull in value and date in
comment):
Transport Method: Floor Determined/Entered
CT VIRTUAL COLONOSCOPY DIAGNOSTIC W
& W/O IV CONTRAST [R0067TA]
ONCE-RAD NEXT AVAILABLE For 1 Occurrences,
Routine
Allergies to IV contrast or iodine?
Last creatinine value? (will auto pull in date and value
in comment):
Current signs and symptoms?
What specific question(s) would you like answered by
this exam? Please include relevant recent/past
history.
Last patient weight? (will auto pull in value and date in
comment):
Transport Method: Floor Determined/Entered
Patient Care Orders
Nutrition [17016]
Clear Liquid Diet [NUT9999] EFFECTIVE NOW, Starting today, 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:
Day before procedure. Encourage adequate hydration
within the bounds of possible fluid restrictions.
NPO for Procedure - Hold Diet [DIE0007] EFFECTIVE MIDNIGHT, Starting tomorrow at 12:01
AM For 12 Hours, Routine
NPO For Which Procedure? Virtual Colonoscopy
Modifiers: NPO EXCEPT MEDICATIONS
Medications - Bowel Preparation (choose one of the following prep kits)
Page 1 of 4
Printed by O'BRIEN, RYLEY P [RPO249] at 1/16/2018 2:48:52 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Routine - NOTE: Order for healthy adults without significant renal impairment, cardiac disease, liver
disease with ascites, or significant electrolyte disturbances [19582]
Note: If any medication is not given based on
below timeframe, please adjust all of the
medications to assure appropriate amount of time
is left between subsequent doses [950018]
ONCE For 1 Doses
If any medication is not given based on below
timeframe, please adjust all of the medications to
assure appropriate amount of time is left between
subsequent doses
bisacodyl EC (DULCOLAX) delayed release tab
[49076]
10 mg, Oral, ONCE Starting today at 11:00 AM For 1
Doses
Take with 8 ounces of clear liquid at 1100 day prior to
procedure. Do not crush.
Swallow whole; do not break, chew, or open tablet. Do
not administer within 1 hr of dairy products. Most
effective if administered with a full glass of water on an
empty stomach.
magnesium citrate soln [39309] 296 mL, Oral, ONCE Starting today For 1 Doses
Take once at 1500 day prior to procedure. Follow this
with at least 4 to 6 glasses (8 ounces each) of clear
liquids within the next 2 to 3 hours.
barium sulfate 2.1 % susp [130053] 225 mL, Oral, ONCE For 1 Doses
At 1800 day prior to procedure
magnesium citrate soln [39309] 296 mL, Oral, ONCE Starting today at 6:00 PM For 1
Doses
Take once at 1800 day prior to procedure. There must
be at least two to three hours between first and
second dose of magnesium citrate. Follow this with at
least 4 to 6 glasses (8 ounces each) of clear liquids
within the next 2 to 3 hours.
iohexol (OMNIPAQUE) 350 mg/mL soln [785223] 50 mL, Oral, ONCE Starting today at 9:00 PM For 1
Doses
Take once at 2100 day prior to procedure. Drink
undiluted followed by 8 ounces clear liquid beverage
or dilute in 8 ounces clear liquid.
PEG Prep - NOTE: Order for severely compromised patients who cannot tolerate moderate fluid or
electrolyte shifts, examples include patients with chronic kidney disease, end-stage renal disease,
advanced CHF, end-stage liver disease, significant electrolyte disturbance, or multiple co-morbidities
placing the patient at increased risk [19585]
G.I. lavage (GOLYTELY) 236 GM soln [103976] 4 L, Oral, ONCE Starting today at 12:00 PM For 1
Doses
Take 4 liter orally once starting at 1200 day prior to
procedure. Suggested to drink one 8 ounce glass
every 10 minutes. If not able to tolerate, drink at
slower rate of one 8 ounce glass every 15 to 20
minutes.
barium sulfate 2.1 % susp [130053] 225 mL, Oral, ONCE For 1 Doses
Give one hour after completion of GI lavage
iohexol (OMNIPAQUE) 350 mg/mL soln [785223] 50 mL, Oral, ONCE Starting today For 1 Doses
Take two hours after barium sulfate solution. Drink
undiluted followed by 8 ounces clear liquid beverage
or dilute in 8 ounces clear liquid.
Non-cathartic - NOTE: Order for symptomatic, frail, debilitated patients, and/or patients of advanced age
that either cannot tolerate a cathartic prep or where small polyps (< 1 cm) are not a clinical concern.
Please note that patients receiving the non-cathartic virtual colonoscopy prep will also generally receive
IV contrast during the virtual colonoscopy exam, unless contraindicated or felt to be unnecessary.
[19592]
Page 2 of 4
Printed by O'BRIEN, RYLEY P [RPO249] at 1/16/2018 2:48:52 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

Note: If any medication is not given based on
below timeframe, please adjust all of the
medications to assure appropriate amount of time
is left between subsequent doses [950018]
ONCE For 1 Doses
If any medication is not given based on below
timeframe, please adjust all of the medications to
assure appropriate amount of time is left between
subsequent doses
bisacodyl EC (DULCOLAX) delayed release tab
[49076]
10 mg, Oral, ONCE Starting today at 11:00 AM For 1
Doses
Swallow whole; do not break, chew, or open tablet. Do
not administer within 1 hr of dairy products. Most
effective if administered with a full glass of water on an
empty stomach.
Take once with 8 ounces of clear liquid at 1100 day
prior to procedure. Do not crush.
iohexol (OMNIPAQUE) 350 mg/mL soln [785223] 50 mL, Oral, ONCE Starting today at 3:00 PM For 1
Doses
Take once at 1500 day prior to procedure. Drink
undiluted followed by 8 ounces clear liquid beverage
or dilute in 8 ounces of clear liquid.
barium sulfate 2.1 % susp [130053] 225 mL, Oral, ONCE Starting today at 6:00 PM For 1
Doses
At 1800 day prior to procedure
iohexol (OMNIPAQUE) 350 mg/mL soln [785223] 50 mL, Oral, ONCE Starting today at 9:00 PM For 1
Doses
Take once at 2100 prior to procedure. Drink undiluted
followed by 8 ounces clear liquid beverage or dilute in
8 ounces of clear liquid.
Consults
Consults for Diabetic Patients [17017]
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):
Page 3 of 4
Printed by O'BRIEN, RYLEY P [RPO249] at 1/16/2018 2:48:52 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

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?
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 O'BRIEN, RYLEY P [RPO249] at 1/16/2018 2:48:52 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org