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IP/OP - Musculoskeletal Radiology Medication Orders Delegation Protocol – Adult/Pediatric - Procedure [5739]

IP/OP - Musculoskeletal Radiology Medication Orders Delegation Protocol – Adult/Pediatric - Procedure [5739] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Radiology


IP/OP - Musculoskeletal Radiology Medication Orders Delegation Protocol - Adult/Pediatric -
Procedure [5739]
Medications
First Procedure and/or Site [191376]
Contrast [191353]
iohexol (OMNIPAQUE) 300 MG/ML injection [156029] Other, ONCE For 1 Doses
gadoterate meglumine (DOTAREM) 5 MMOL/10ML
injection [160100]
Other, ONCE For 1 Doses
Steriod [191355]
triamcinolone acetonide (KENALOG-40) 40 mg/mL 1mL
vial STOCK VIAL [790047]
40 mg, Intraarticular, ONCE For 1 Doses
dexamethasone (DECADRON) 10 MG/ML injection
[36595]
10 mg, Peripheral Nerve, ONCE For 1 Doses
Anesthesic [191356]
lidocaine 1 % vial [39034] 9 mL, Subcutaneous, ONCE For 1 Doses
lidocaine PF 1 % injection [140344] Peripheral Nerve, ONCE For 1 Doses
lidocaine 0.5 % injection [142798] Other, ONCE For 1 Doses
ropivacaine (NAROPIN) 5 mg/mL 30 mL STOCK vial
[54132]
Other, ONCE For 1 Doses
bupivacaine PF (MARCAINE) 0.25 % 50mL STOCK
VIAL [790002]
Other, ONCE For 1 Doses
lidocaine (XYLOCAINE) 2% (20 mg/mL) 50mL vial
STOCK VIAL [790028]
Intraarticular, ONCE For 1 Doses
Other/Miscellaneous [191357]
sodium bicarbonate 8.4 % injection [760224] 1 mEq, Other, ONCE For 1 Doses
alcohol dehydrated 98 % ampule [34323] Other, ONCE For 1 Doses
sodium chloride flush 0.9% 10 mL PF injection [785055] Other, ONCE For 1 Doses
water (sterile) injection [42368] Intravenous, ONCE For 1 Doses
Second Procedure and/or Site [191377]
Contrast [191353]
iohexol (OMNIPAQUE) 300 MG/ML injection [156029] Other, ONCE For 1 Doses
gadoterate meglumine (DOTAREM) 5 MMOL/10ML
injection [160100]
Other, ONCE For 1 Doses
Steriod [191355]
triamcinolone acetonide (KENALOG-40) 40 mg/mL 1mL
vial STOCK VIAL [790047]
40 mg, Intraarticular, ONCE For 1 Doses
dexamethasone (DECADRON) 10 MG/ML injection
[36595]
10 mg, Peripheral Nerve, ONCE For 1 Doses
Anesthesic [191356]
lidocaine 1 % vial [39034] 9 mL, ONCE For 1 Doses
lidocaine PF 1 % injection [140344] Peripheral Nerve, ONCE For 1 Doses
lidocaine 0.5 % injection [142798] Other, ONCE For 1 Doses
ropivacaine (NAROPIN) 5 mg/mL 30 mL STOCK vial
[54132]
Other, ONCE For 1 Doses
bupivacaine PF (MARCAINE) 0.25 % 50mL STOCK
VIAL [790002]
Other, ONCE For 1 Doses
lidocaine (XYLOCAINE) 2% (20 mg/mL) 50mL vial
STOCK VIAL [790028]
Intraarticular, ONCE For 1 Doses
Other/Miscellaneous [191357]
sodium bicarbonate 8.4 % injection [760224] 1 mEq, Other, ONCE For 1 Doses
alcohol dehydrated 98 % ampule [34323] Other, ONCE For 1 Doses
sodium chloride flush 0.9% 10 mL PF injection [785055] Other, ONCE For 1 Doses
Page 1 of 2
Pr i nted by O'BRIEN, RYLEY P [RPO249] at 8/17/2015 11:04:51 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
07/2017CCKM@uwhealth.org

water (sterile) injection [42368] Intravenous, ONCE For 1 Doses
Third Procedure and/or Site [191378]
Contrast [191353]
iohexol (OMNIPAQUE) 300 MG/ML injection [156029] Other, ONCE For 1 Doses
gadoterate meglumine (DOTAREM) 5 MMOL/10ML
injection [160100]
Other, ONCE For 1 Doses
Steriod [191355]
triamcinolone acetonide (KENALOG-40) 40 mg/mL 1mL
vial STOCK VIAL [790047]
40 mg, Intraarticular, ONCE For 1 Doses
dexamethasone (DECADRON) 10 MG/ML injection
[36595]
10 mg, Peripheral Nerve, ONCE For 1 Doses
Anesthesic [191356]
lidocaine 1 % vial [39034] 9 mL, Other, ONCE For 1 Doses
lidocaine PF 1 % injection [140344] Peripheral Nerve, ONCE For 1 Doses
lidocaine 0.5 % injection [142798] Other, ONCE For 1 Doses
ropivacaine (NAROPIN) 5 mg/mL 30 mL STOCK vial
[54132]
Other, ONCE For 1 Doses
bupivacaine PF (MARCAINE) 0.25 % 50mL STOCK
VIAL [790002]
Other, ONCE For 1 Doses
lidocaine (XYLOCAINE) 2% (20 mg/mL) 50mL vial
STOCK VIAL [790028]
Intraarticular, ONCE For 1 Doses
Other/Miscellaneous [191357]
sodium bicarbonate 8.4 % injection [760224] 1 mEq, Other, ONCE For 1 Doses
alcohol dehydrated 98 % ampule [34323] Other, ONCE For 1 Doses
sodium chloride flush 0.9% 10 mL PF injection [785055] Other, ONCE For 1 Doses
water (sterile) injection [42368] Intravenous, ONCE For 1 Doses
Fourth Procedure and/or Site [193197]
Contrast [191353]
iohexol (OMNIPAQUE) 300 MG/ML injection [156029] Other, ONCE For 1 Doses
gadoterate meglumine (DOTAREM) 5 MMOL/10ML
injection [160100]
Other, ONCE For 1 Doses
Steriod [191355]
triamcinolone acetonide (KENALOG-40) 40 mg/mL 1mL
vial STOCK VIAL [790047]
40 mg, Intraarticular, ONCE For 1 Doses
dexamethasone (DECADRON) 10 MG/ML injection
[36595]
10 mg, Peripheral Nerve, ONCE For 1 Doses
Anesthesic [191356]
lidocaine 1 % vial [39034] 9 mL, Other, ONCE For 1 Doses
lidocaine PF 1 % injection [140344] Peripheral Nerve, ONCE For 1 Doses
lidocaine 0.5 % injection [142798] Other, ONCE For 1 Doses
ropivacaine (NAROPIN) 5 mg/mL 30 mL STOCK vial
[54132]
Other, ONCE For 1 Doses
bupivacaine PF (MARCAINE) 0.25 % 50mL STOCK
VIAL [790002]
Other, ONCE For 1 Doses
lidocaine (XYLOCAINE) 2% (20 mg/mL) 50mL vial
STOCK VIAL [790028]
Intraarticular, ONCE For 1 Doses
Other/Miscellaneous [191357]
sodium bicarbonate 8.4 % injection [760224] 1 mEq, Other, ONCE For 1 Doses
alcohol dehydrated 98 % ampule [34323] Other, ONCE For 1 Doses
sodium chloride flush 0.9% 10 mL PF injection [785055] Other, ONCE For 1 Doses
water (sterile) injection [42368] Intravenous, ONCE For 1 Doses
Page 2 of 2
Pr i nted by O'BRIEN, RYLEY P [RPO249] at 8/17/2015 11:04:51 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
07/2017CCKM@uwhealth.org