/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/transplant/,

/clinical/cckm-tools/content/order-sets/inpatient/transplant/name-97901-en.cckm

201708219

page

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UWHC,UWMF,

Tools,

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

IP Auto Islet Transplant Adult Postoperative [4837]

IP Auto Islet Transplant Adult Postoperative [4837] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Transplant


IP - Auto Islet Transplant - Adult - Postoperative [4837]
Intended for Adult Patients Only
Admission Status
Level of Care (Single Response) [187522]
*An admit patient order has already been written, but the level of care at which the patient
should be placed still needs to be identified.
Place Patient on General Care [ADT0018] General Care, has already been signed. This order
will ensure that the patient is placed at the appropriate
level of care.
Place Patient on Intermediate Care (IMC)
[ADT0018]
Intermediate Care, has already been signed. This
order will ensure that the patient is placed at the
appropriate level of care.
Place Patient on Intensive Care (ICU) [ADT0018] Intensive Care, has already been signed. This order
will ensure that the patient is placed at the appropriate
level of care.
Admit to Inpatient (Single Response) [188296]
Admit To Inpatient [ADT0001] Attending:
Admitting Resident:
Requested Floor:
Service:
I certify that an inpatient stay is medically necessary
because of either an anticipated LOS >2 midnights,
complexity and/or severity of illness, an inpatient-
only surgery, or a previously-authorized inpatient
stay. Rationale listed below. Yes
C - CLEAR DIAGNOSIS:
E - EVALUATIONS PLANNED:
R - RESULTS EXPECTED:
T - TREATMENTS ORDERED:
Post-Op/Phase II
Admit to Observation (Single Response)
[188297]
Admit To Observation [ADT0002] Attending:
Admitting Resident:
Requested Floor:
Service:
Post-Op/Phase II
Admit to Outpatient Short Stay (Single
Response) [188298]
Admit To Outpatient Short Stay [ADT0003] Attending:
Admitting Resident:
Requested Floor:
Service:
Post-Op/Phase II
Admission Status [129861]
Admit To Inpatient [ADT0001] Attending:
Admitting Resident:
Requested Floor:
Service: PANCREAS TRANSPLANT
Rationale for LOS greater than 2 midnights:
Post-Op/Phase II
Page 1 of 18
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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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Admit To Observation [ADT0002] Attending:
Admitting Resident:
Requested Floor:
Service:
Post-Op/Phase II
Admit To Outpatient Short Stay [ADT0003] Attending:
Admitting Resident:
Requested Floor:
Service:
Post-Op/Phase II
Admission Status [129862]
Admit To Inpatient [ADT0001] Attending:
Admitting Resident:
Requested Floor:
Service: PANCREAS TRANSPLANT
Rationale for LOS greater than 2 midnights:
Post-Op/Phase II
Admit To Observation [ADT0002] Attending:
Admitting Resident:
Requested Floor:
Service:
Post-Op/Phase II
Admit To Outpatient Short Stay [ADT0003] Attending:
Admitting Resident:
Requested Floor:
Service:
Post-Op/Phase II
Venous Thromboembolism (VTE) Management
VTE Prophylaxis (Single Response) [131999]
Caprini VTE Risk Assessment URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/hematology-and-
coagulation/related/name-97521-en.cckm
Low VTE Risk [130084]
VTE Prophylaxis - Reason Not Ordered
[COR0008]
ONCE, Routine
Reason Not Ordered: Low Risk
Post-Op/Phase II
Moderate VTE Risk with Low Bleed Risk (Single
Response) [209954]
enoxaparin (LOVENOX) subcutaneous injection
[800040]
40 mg, Subcutaneous, EVERY 24 HOURS, Post-
Op/Phase II
heparin PF 5000 UNIT/0.5ML injection [156571] 5,000 units, Subcutaneous, EVERY 12 HOURS,
Post-Op/Phase II
High VTE with Low Bleed Risk [211018]
enoxaparin (LOVENOX) subcutaneous injection
[800040]
40 mg, Subcutaneous, EVERY 24 HOURS, Post-
Op/Phase II
heparin PF 5000 UNIT/0.5ML injection [156571] 5,000 units, Subcutaneous, EVERY 8 HOURS, Post-
Op/Phase II
Sequential Compression Device (SCD)
(TREATMENT) [NURTRT0028]
CONTINUOUS, Routine
Left/Right/Bilateral? Bilateral
Sequential Compression Device (SCD) / Foot
Pump (SUPPLY) [EQP0023]
CONTINUOUS, Routine
Left/Right/Bilateral?
Type: Knee High
High Bleed Risk [129757]
Sequential Compression Device (SCD)
(TREATMENT) [NURTRT0028]
CONTINUOUS, Routine
Left/Right/Bilateral? Bilateral
Page 2 of 18
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Sequential Compression Device (SCD) / Foot
Pump (SUPPLY) [EQP0023]
CONTINUOUS, Routine
Left/Right/Bilateral?
Type: Knee High
Apply and Maintain Anti-Embolism Stocking
[NURTRT0039]
CONTINUOUS, Routine
Does this need to be inserted/placed?
Left/Right/Bilateral? Bilateral
Type: Knee high
Post-Op/Phase II
No VTE Prophylaxis [130084]
VTE Prophylaxis - Reason Not Ordered
[COR0008]
ONCE, Routine
Reason Not Ordered:
Post-Op/Phase II
VTE Prophylaxis (Single Response) [150176]
Caprini VTE Risk Assessment URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/hematology-and-
coagulation/related/name-97521-en.cckm
Low VTE Risk [130084]
VTE Prophylaxis - Reason Not Ordered
[COR0008]
ONCE, Routine
Reason Not Ordered: Low Risk
Post-Op/Phase II
Moderate VTE Risk with Low Bleed Risk (Single
Response) [209954]
enoxaparin (LOVENOX) subcutaneous injection
[800040]
40 mg, Subcutaneous, EVERY 24 HOURS, Post-
Op/Phase II
heparin PF 5000 UNIT/0.5ML injection [156571] 5,000 units, Subcutaneous, EVERY 12 HOURS,
Post-Op/Phase II
High VTE with Low Bleed Risk [211018]
enoxaparin (LOVENOX) subcutaneous injection
[800040]
40 mg, Subcutaneous, EVERY 24 HOURS, Post-
Op/Phase II
heparin PF 5000 UNIT/0.5ML injection [156571] 5,000 units, Subcutaneous, EVERY 12 HOURS,
Post-Op/Phase II
Sequential Compression Device (SCD)
(TREATMENT) [NURTRT0028]
CONTINUOUS, Routine
Left/Right/Bilateral? Bilateral
Sequential Compression Device (SCD) / Foot
Pump (SUPPLY) [EQP0023]
CONTINUOUS, Routine
Left/Right/Bilateral?
Type: Knee High
High Bleed Risk [129757]
Sequential Compression Device (SCD)
(TREATMENT) [NURTRT0028]
CONTINUOUS, Routine
Left/Right/Bilateral? Bilateral
Sequential Compression Device (SCD) / Foot
Pump (SUPPLY) [EQP0023]
CONTINUOUS, Routine
Left/Right/Bilateral?
Type: Knee High
Apply and Maintain Anti-Embolism Stocking
[NURTRT0039]
CONTINUOUS, Routine
Does this need to be inserted/placed?
Left/Right/Bilateral? Bilateral
Type: Knee high
Post-Op/Phase II
No VTE Prophylaxis [130084]
VTE Prophylaxis - Reason Not Ordered
[COR0008]
ONCE, Routine
Reason Not Ordered:
Post-Op/Phase II
Patient Care Orders
Vital Signs [135048]
Page 3 of 18
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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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08/2017CCKM@uwhealth.org

Vital Signs [NURMON0013] SEE COMMENTS, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Every 15 minutes x 4, then every 2 hours x 2, then
every 4 hours, Post-Op/Phase II
Activity [129865]
Activity [NURACT0008] CONTINUOUS, Routine
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:
Ambulate on night of surgery and then three times a
day, Post-Op/Phase II
Nutrition [137293]
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:
Post-Op/Phase II
Respiratory [130489]
Pulse Oximetry [NURMON0009] SEE COMMENTS, Starting today, Routine, EVERY 4
HOURS, and as needed., Post-Op/Phase II
Incentive Spirometry [NURTRT0018] SEE COMMENTS, Starting today, Routine, EVERY 1
HOUR for 24 hours then PRN, while awake., Post-
Op/Phase II
Turn, Cough And Deep Breathe [NURTRT0022] SEE COMMENTS, Starting today, Routine, EVERY 2
HOURS for 24 hours then PRN, while awake., Post-
Op/Phase II
Oxygen Therapy [RT0032] CONTINUOUS, Starting today, Routine
FiO2 (%) Titrate to Keep Sats >/= to ___%:
Liter Flow:
Titrate oxygen to maintain O2 sat at (%): 94
O2 Delivery Device: Nasal Cannula
Attempt to Wean Off Oxygen? Yes
Post-Op/Phase II
Patient Monitoring [134650]
Measure Intake And Output [NURMON0005] EVERY 4 HOURS, Routine, Post-Op/Phase II
Measure Urine Output [NURMON0012] EVERY 4 HOURS, Starting today, Routine, While
urinary catheter is in place., Post-Op/Phase II
Measure Weight Upon Admission
[NURMON0015]
ONCE, Starting today For 1 Occurrences, Routine
Weigh With?
Weigh when?
Upon Admission., Post-Op/Phase II
Page 4 of 18
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Measure Weight Daily [NURMON0015] 1X DAILY, Starting today, Routine
Weigh With?
Weigh when?
Post-Op/Phase II
Insert and Maintain Urinary Catheter
[NURELM0013]
CONTINUOUS, Starting today, 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:
Indication for Placement:
Details: To Dependent Drainage
Does this need to be inserted/placed?
Post-Op/Phase II
Non-Categorized Patient Care Orders [130575]
Apply Brace, Spine - Abdominal Binder
[NURTRT0014]
CONTINUOUS, Starting today, Routine
Type: Abdominal Binder
Wearing schedule:
Post-Op/Phase II
Cardiac Rhythm Monitoring - Adult
[NURMON0010]
INTERMITTENT (MAY REMOVE WHEN OFF
UNIT/BATHING), Starting today, Routine
Indication:
Notify Provider:
Functional Cardiac Defibrillator Present:
Post-Op/Phase II
Insert and Maintain NG Tube [130856]
NG Tube Placement - Adult [120994]
Insert and Maintain Nasogastric Tube
[NURTAD0014]
CONTINUOUS, Routine
Options:
Flush with:
Flush Frequency: EVERY 8 HOURS
Clamp NG Tube:
Check Residual:
Does this need to be inserted/placed?
Device Status:
Refer to Policy 2.20 Enteral Tubes Used for
Instillation of Fluids, Medications, or Feeding
Recommendations for flush quantity:
For adult patients, 30 mLs of fluid should be
sufficient.
lidocaine-oxymetazoline 4%-0.05% (ADULT)
nasal spray [785081]
2 spray, Nasal, ONCE For 1 Doses
For numbing prior to feeding tube insertion.
Slowly spray the chosen nostril once, if required may
repeat x1 in opposite nostril. Angle toward back of
throat spraying the anterior nostril and wait 30-60
seconds before introducing more local
anesthetic into the nostril. Caution: Entire bottle
should not be used for insertion of tube. Discard
excess solution when procedure completed.
Page 5 of 18
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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org

X-RAY ABDOMEN AP VIEW (KUB) [R74000] CONDITIONAL For 3 Days, Routine
Radiology Specialty Area: GENERAL IMAGING
Current signs and symptoms?
What specific question(s) would you like answered
by this exam? Evaluate nasogastric tube placement
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 Conditional, What Condition? Evaluate nasogastric
tube placement. The location of nasogastric tube
should be confirmed prior to the instillation of fluids,
medications, or feedings. Refer to Policy 2.20
Enteral Tubes Used for Instillation of Fluids,
Medications, or Feeding
Irrigate Nasogastric Tube [NURTAD0014] CONTINUOUS, Starting today, Routine
Options:
Flush with:
Flush Frequency:
Clamp NG Tube:
Check Residual:
Does this need to be inserted/placed?
Device Status:
Irrigate nasogastric tube with Sodium Chloride 0.9%
as needed to keep patent., Post-Op/Phase II
Jejunostomy Tube Placement Adult Panel [134690]
Insert and Maintain Jejunostomy Tube
[NURTAD0055]
CONTINUOUS, Routine
Flush Frequency: EVERY 8 HOURS
Maintain to gravity, Post-Op/Phase II
Insert and Maintain Gastrostomy Jejunostomy
Tube [NURTAD0056]
CONTINUOUS, Routine
Gastrostomy Port Drainage:
Jejunostomy Port Drainage:
Flush Jejunostomy Port With:
Flush Volume (mL):
Flush Frequency:
Site Assessment Frequency:
Care Frequency:
Wash With:
Primary Dressing:
Secondary Dressing:
Post-Op/Phase II
Maintain Tube (Flush) [NURTAD0057] CONTINUOUS, Routine
Location:
Drainage Options:
Flush With(Must also enter seperate medication order
to obtain drug):
Site Assessment Frequency:
Care Frequency:
Wash With:
Primary Dressing:
Secondary Dressing:
Flush every *** with 10 mL sterile Water, Post-
Op/Phase II
Contingency Parameters [89811]
Page 6 of 18
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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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Notify Provider [NURCOM0001] Provider to Notify: Provider
If systolic blood pressure > (mmHg): 180
If systolic blood pressure < (mmHg): 90
If diastolic blood pressure > (mmHg): 110
If diastolic blood pressure < (mmHg): 60
If temperature > (C): 38.5
If temperature < (C):
If heart rate > (bpm): 120
If heart rate < (bpm): 60
If respiratory rate >: 20
If respiratory rate <: 8
If blood glucose > (mg/dL): 200
If blood glucose < (mg/dL): 40
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL): 120 mL in 4 hour shift
Other:
Post-Op/Phase II
Intravenous Therapy
Premedications for Needle Insertion [120019]
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 within 1 minute. Choice of medication should be based on patient’s previous
experience/preference, history of lidocaine allergy and ease of access.
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
Post-Op/Phase II
lidocaine (XYLOCAINE) 1% injection [39034] 0.1-0.4 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.
Choice of medication should be based on patient’s
previous experience/preference, history of lidocaine
allergy and ease of access
Post-Op/Phase II
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.
Choice of medication should be based on patient’s
previous experience/preference, history of lidocaine
allergy and ease of access
Post-Op/Phase II
Intravenous Fluids [129869]
Page 7 of 18
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Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
Post-Op/Phase II
sodium chloride 0.45 % infusion [42187] at 100 mL/hr, Intravenous, CONTINUOUS, Post-
Op/Phase II
Medications - General
Patient Controlled Intravenous -Patient Controlled Analgesia (PCA) orders refer to IP For
[1441]Supplemental Order Set -Adult -Analgesia (PCA)
Analgesics - Acetaminophen - PRN [227947]
acetaMINOPHEN (TYLENOL) tab [34149] 650 mg, Oral, EVERY 4 HOURS PRN, pain,
Administer for mild to moderate pain, multimodal
therapy, or fever greater than 38.2 degrees C, Post-
Op/Phase II
Analgesics - Opioids - Oral- PRN [227949]
oxycodone tab RANGE [750032] 5-10 mg, Oral, EVERY 3 HOURS PRN, pain, Severe
pain
Start when IV narcotics discontinued
Post-Op/Phase II
Analgesics - Opioids - Intravenous - PRN [134353]
HYDROmorphone PF (DILAUDID) injection
[750050]
0.4-1 mg, Intravenous, EVERY 1 HOUR PRN, Severe
pain when unable to tolerate orally, for 3 Minutes,
Post-Op/Phase II
HYDROmorphone PF (DILAUDID) injection
[750050]
0.4-1 mg, Intravenous, EVERY 2 HOURS PRN,
Severe pain when unable to tolerate orally, for 3
Minutes, Post-Op/Phase II
Anti-emetics [129871]
ondansetron (ZOFRAN ODT) disintegrating tab
[64224]
4 mg, Oral, EVERY 24 HOURS PRN, nausea/vomiting
For first line therapy
ondansetron (ZOFRAN) injection [800202] 4 mg, Intravenous, EVERY 24 HOURS PRN,
nausea/vomiting
First line therapy when patient unable to tolerate orally
Post-Op/Phase II
metoclopramide (REGLAN) tab [39630] 10 mg, Oral, EVERY 6 HOURS PRN, nausea,
Nausea/Vomiting
For second line therapy
metoclopramide (REGLAN) injection [800059] 10 mg, Intravenous, EVERY 6 HOURS PRN,
nausea/vomiting
For second line therapy when patient unable to
tolerate orally
Post-Op/Phase II
Bowel Management - Scheduled [227948]
senna-docusate (SENOKOT-S) 8.6-50 mg per tab
[60530]
2 tab, Oral, 2 X DAILY
Hold for loose stools
Post-Op/Phase II
Bowel Management - As Needed [129873]
polyethylene glycol (MIRALAX) oral packet
[61829]
17 g, Oral, 1 X DAILY PRN, constipation
For first line therapy
Post-Op/Phase II
bisacodyl EC (DULCOLAX) RANGE delayed
release tab [750009]
5-10 mg, Oral, 1 X DAILY PRN, constipation
For second line therapy. Administer when there is no
response to first line therapy within 24 hours.
Post-Op/Phase II
Page 8 of 18
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bisacodyl (DULCOLAX) rectal suppository
[35231]
10 mg, Rectal, 1 X DAILY PRN, constipation
For second line therapy. Administer when there is no
response to first line therapy and patient unable to
tolerate orally OR when immediate laxation is
required.
Post-Op/Phase II
Anti-infectives [137089]
ceftriaxone (ROCEPHIN) intraVENOUS - Patients
weighing 80 kg or less [800027]
1 g, Intravenous, ONCE Starting tomorrow For 1
Doses, Post-Op/Phase II
ceftriaxone (ROCEPHIN) intraVENOUS - Patients
weighing greater than 80 kg [800027]
2 g, Intravenous, ONCE Starting tomorrow For 1
Doses, Post-Op/Phase II
ciprofloxacin (CIPRO) intraVENOUS - NOTE:
Order for patients allergic to
penicillin/cephalosporins [800031]
400 mg, Intravenous, ONCE Starting tomorrow For 1
Doses, Post-Op/Phase II
clindamycin (CLEOCIN) intraVENOUS - NOTE:
Order for patients allergic to
penicillin/cephalosporins [800033]
900 mg, Intravenous, EVERY 6 HOURS For 2 Doses,
Post-Op/Phase II
Anti-hypertensives - As needed [89820]
cloNIDINE (CATAPRES) tab [720040] 0.1 mg, Oral, EVERY 1 HOUR PRN, PRN systolic
blood pressure (SBP) greater than 170 mmHg or
diastolic blood pressure greater than 100 mmHg. Max
of 4 doses in 24 hours.
For first line therapy
Post-Op/Phase II
labetalol (NORMODYNE;TRANDATE) injection
RANGE [750053]
10-20 mg, Intravenous, EVERY 1 HOUR PRN, SBP
greater than 170 mmHg or DBP greater than 100
mmHg. Maximum of 4 doses in 24 hours.
For 2nd line therapy. Administer if unable to tolerate
orally or no response to first line therapy and heart
rate is more than 85 beats per minute. Do not
administer if heart rate is less than 60 beats per
minute.
for 2 Minutes, Post-Op/Phase II
hydrALAZINE (APRESOLINE) injection [750049] 10-20 mg, Intravenous, EVERY 1 HOUR PRN,
hypertension, Systolic blood pressure (SBP) greater
than 170 mmHg or diastolic blood pressure greater
than 100 mmHg.
For 2nd line therapy. Administer if unable to tolerate
orally or no response to first line therapy and heart
rate is less than 85 beats per minute.
Post-Op/Phase II
Vitamins/Minerals [129877]
multivitamin with mineral tab [800240] 1 tab, Oral, 1 X DAILY, Post-Op/Phase II
niacinamide tab [40222] 500 mg, Oral, 2 X DAILY (AT MEALTIME), Post-
Op/Phase II
pyridoxine (VITAMIN B-6) tab [43679] 100 mg, Oral, 1 X DAILY, Post-Op/Phase II
ascorbic acid (VITAMIN C) tab [43693] 500 mg, Oral, 1 X DAILY, Post-Op/Phase II
tocopherol (VITAMIN E) cap [43715] 400 units, Oral, 1 X DAILY, Post-Op/Phase II
vitamin A tab [141915] 15,000 units, Oral, 1 X DAILY, Post-Op/Phase II
Non-categorized [129878]
aspirin EC delayed release tab [49098] 81 mg, Oral, 1 X DAILY Starting tomorrow, Post-
Op/Phase II
ranitidine (ZANTAC) tab [720131] 150 mg, Oral, 2 X DAILY, Post-Op/Phase II
Page 9 of 18
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pancrelipase (CREON) 24000 units delayed
release cap [136489]
3 cap, Oral, 3 X DAILY (AT MEALTIME) Starting
8/7/17
Administer if patient is tolerating at least a full diet
Post-Op/Phase II
pancrelipase (CREON) 24000 units delayed
release cap [136489]
1 cap, Oral, PRN Starting 8/7/17, snacks
Administer if patient is tolerating at least a full diet
Post-Op/Phase II
heparin 5000 units/0.5 mL injection [45304] 5,000 units, Subcutaneous, EVERY 8 HOURS, Post-
Op/Phase II
naloxone (NARCAN) injection [800199] 0.1 mg, Intravenous, PRN, opioid overdose
Administer every 3 minutes times 4 doses as needed
for respiratory rate less than 8 breaths/minute. Notify
physician if administered.
Diabetes Management
Adult Hyperglycemia Algorithm URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/diabetes-and-
endocrinology/related/name-97511-en.cckm
Diabetes Management (Single Response) [120963]
Insulin Infusion [227975]
Glucose, POC [IPGLUCOSE] SEE COMMENTS, 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?
Every hour until within target range of 110-150
mg/dL for 3 hours (3 readings in a row), then
decrease frequency to every 2 hours. Hourly
monitoring must be resumed if blood glucose
deviates from target range., Post-Op/Phase II
Glucose, POC [IPGLUCOSE] AS NEEDED FOR SIGNS AND SYMPTOMS OF
HYPOGLYCEMIA, 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?
Post-Op/Phase II
Glucose, POC [IPGLUCOSE] ONCE, 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?
Post-Op/Phase II
GLUCOSE [GLU] CONDITIONAL - RN COLLECT For 7 Days, Routine
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition?
Draw if blood glucose less than 40 or greater than
400 mg/dL, Post-Op/Phase II
After Priming IV Tubing with Insulin, Waste 20
mL Insulin Drip to Saturate All IV Tubing Binding
Sites [NURVAD0053]
CONTINUOUS, Post-Op/Phase II
Page 10 of 18
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Notify Provider [NURCOM0001] Provider to Notify: Provider
Notify based on: Blood Glucose,Other
Other: Hypoglycemia has not resolved within 30
minutes of Insulin Infusion Algorithm hypoglycemia
treatment orders,Infusion rate less than 1 unit/hour
with glucose values less than Target Range,ICUs
only: When patient intially meets critieria to move to
columns 7-9,If patient transferring from ICU to
general/IMC care and still requiring high dose
columns 7-9
If blood glucose > (mg/dL): 400
If blood glucose < (mg/dL): 40
Post-Op/Phase II
Note: Discontinue all previous insulin orders and
oral hypoglycemic agents [950018]
ONCE
Note: Discontinue all previous insulin orders and oral
hypoglycemic agents
Post-Op/Phase II
insulin regular (human) infusion [700217] 0.2-54 Units/hr, Intravenous, CONTINUOUS
Administer insulin drip in accordance with Insulin
Infusion Algorithm - Adult (General Care and IMC
units - use standard algorithm columns 1-6; ICU only
- use standard and HIGH DOSE columns 1-9)
Post-Op/Phase II
insulin lispro (human) (HUMALOG) 100 UNIT/ML
injection [53264]
2 units, Subcutaneous, 3 X DAILY PRN, less than
50% of meal consumed
Give within 15 minutes of meal.
Post-Op/Phase II
insulin lispro (human) (HUMALOG) 100 UNIT/ML
injection [53264]
4 units, Subcutaneous, 3 X DAILY PRN, 50% or
more of meal consumed
Give within 15 minutes of meal
Post-Op/Phase II
Note: Give insulin with meals. See PRN orders
[950018]
3 X DAILY (AT MEALTIME)
Note: Give insulin with meals. See PRN orders
Post-Op/Phase II
Initiate Insulin Infusion Algorithm Hypoglycemia
Treatment Orders [NURCOM0022]
CONTINUOUS, Post-Op/Phase II
glucose-vitamin C chew tab [50690] 16 g, Oral, EVERY 15 MINUTES PRN,
hypoglycemia, per hypoglycemia treatment algorithm
- see Admin Instructions
Use in patients able to safely eat/swallow but unable
to tolerate volume of fruit juice or per patient
preference
For blood glucose 40-69 mg/dL give 16 g (4 tablets)
Repeat every 15 minutes until blood glucose is 70
mg/dL or greater
Post-Op/Phase II
glucose-vitamin C chew tab [50690] 32 g, Oral, EVERY 15 MINUTES PRN,
hypoglycemia, per hypoglycemia treatment algorithm
- see Admin Instructions
Use in patients able to safely eat/swallow but unable
to tolerate volume of fruit juice or per patient
preference
For blood glucose less than 40 mg/dL give 32 g (8
tablets).
Repeat every 15 minutes until blood glucose is 70
mg/dL or greater
Page 11 of 18
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dextrose injection [800233] 12.5 g, Intravenous, PRN, per hypoglycemia
treatment algorithm - see Admin Instructions
Use for patients who are unable to eat or swallow
safely or are NPO
For blood glucose greater than 40 mg/dl and less
than 70 mg/dl give 12.5 g
Post-Op/Phase II
dextrose injection [800233] 25 g, Intravenous, PRN, per hypoglycemia treatment
algorithm - see Admin Instructions
Use for patients who are unable to eat or swallow
safely or are NPO. For blood glucose 40 mg/dL or
less administer 25 g
Post-Op/Phase II
glucagon injection kit [107799] 1 mg, Subcutaneous, PRN, per hypoglycemia
treatment algorithm - see Admin Instructions
For blood glucose less than 70 mg/dl for patients
who are unable to eat or swallow safely or are NPO
AND who have NO IV Access
Post-Op/Phase II
Consult Diabetes Management Service
(Inpatient) [CON0022]
ONCE
Can this consult be done via video?
Call back number:
Intent:
Concern or Specific Question or Task to be
Addressed (Symptom, Sign, or Diagnosis):
Post-Op/Phase II
Consult Diabetes Education - Learning Center
(Inpatient) [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:
Post-Op/Phase II
Laboratory
Draw 6 Hours Post-Transplant [129887]
HEMATOCRIT [HCT] CONDITIONAL - RN COLLECT For 1 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw 6 hours post-
transplant
Post-Op/Phase II
Draw 12 Hours Post-Transplant [129888]
Page 12 of 18
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HEMATOCRIT [HCT] CONDITIONAL - RN COLLECT For 1 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw 12 hours post-
transplant
Post-Op/Phase II
Draw Post-Op Day #1 - Post Transplant [134727]
ALT/SGPT [ALT] NEXT AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
ALKALINE PHOSPHATASE [ALKP] NEXT AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
AMMONIA [GM2200] NEXT AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
AST/SGOT [AST] NEXT AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
BILIRUBIN, TOTAL [TBIL] NEXT AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
GGT [GGT] NEXT AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
Draw Post-Op Day #4 Post-Transplant [130795]
HEMOGLOBIN [HGB] NEXT AM, Starting 8/8/17 For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op Day #4, Post-Op/Phase II
Labs - Draw Daily - Days 1-7 [129889]
BUN [BUN] NEXT AM, Starting today For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
Days 1-7, Post-Op/Phase II
CREATININE [CRET] NEXT AM For 7 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
Days 1-7, Post-Op/Phase II
Page 13 of 18
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08/2017CCKM@uwhealth.org

CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
CONDITIONAL - RN COLLECT, Starting today For 7
Days, Routine, For optimum diagnosis of sepsis,
sample 3-4 sites only on the first day of a septic
episode. Cultures on subsequent days are of minimal
diagnostic value. Culture detects bacteria, Candida
and Cryptococcus. If filamentous fungi are suspected
see Culture, Blood, Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition? Draw if temperature >
38.5 C, once in a 24 hour period.
Days 1-7, Post-Op/Phase II
CULTURE, BLOOD, BACTERIA AND YEAST -
Urinalysis with Microscopy [GM4045]
CONDITIONAL - RN COLLECT, Starting today For 7
Days, Routine, For optimum diagnosis of sepsis,
sample 3-4 sites only on the first day of a septic
episode. Cultures on subsequent days are of minimal
diagnostic value. Culture detects bacteria, Candida
and Cryptococcus. If filamentous fungi are suspected
see Culture, Blood, Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition? Draw if temperature >
38.5 C
Urine - CLEAN CATCH, Post-Op/Phase II
CULTURE, STOOL WITH E. COLI (SHIGA)
TOXIN [135594]
CULTURE, STOOL [ST] CONDITIONAL - RN COLLECT, Starting today For 7
Days, Routine, Because these agents do not cause
hospital acquired infection, specimens on patients
who have been hospitalized greater than 3 days will
require approval of the Director of Microbiology or
Pathology Resident.
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition? Collect if patient has
diarrhea, once each week.
Days 1-7, Post-Op/Phase II
E. COLI (SHIGA) TOXIN [HCSTEC] CONDITIONAL - RN COLLECT, Starting today For 7
Days, Routine, Because these agents do not cause
hospital acquired infection, specimens on patients
who have been hospitalized greater than 3 days will
require approval of the Director of Microbiology or
Pathology Resident.
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition? Collect if patient has
diarrhea, once each week.
Days 1-7, Post-Op/Phase II
Page 14 of 18
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08/2017CCKM@uwhealth.org

CULTURE, URINE [URC] CONDITIONAL - RN COLLECT, Starting today For 7
Days, Routine
Does patient have an indwelling urinary catheter?
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw if temperature >
38.5 C, once in a 24 hour period.
Days 1-7, Post-Op/Phase II
ELECTROLYTES [LYTE] NEXT AM, Starting today For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Days 1-7, Post-Op/Phase II
GLUCOSE, FASTING [HCFSGLU] NEXT AM, Starting today For 7 Days, Routine, Patient
should have nothing to eat or drink (except water) for
a minimum of 8 hours before test.
If add on test, what should lab do if unable to add test
to previous specimen?
Days 1-7, Post-Op/Phase II
HEMATOCRIT [HCT] NEXT AM, Starting today For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
Days 1-7, Post-Op/Phase II
PLATELET COUNT [PLT] NEXT AM, Starting today For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Days 1-7, Post-Op/Phase II
URINALYSIS WITH MICROSCOPY [UA] CONDITIONAL - RN COLLECT, Starting today For 7
Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw if temperature >
38.5 C, once in a 24 hour period.
Days 1-7, Post-Op/Phase II
WHITE CELL COUNT AND DIFFERENTIAL
[WBCD]
NEXT AM, Starting today For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Days 1-7, Post-Op/Phase II
C DIFF TOXIN B PCR, NAP1 IF POSITIVE,
CONDITIONAL [142816]
C DIFF TOXIN B PCR, NAP1 IF POSITIVE
[HCCDIFPCR]
CONDITIONAL - RN COLLECT, Routine, Reserve
testing for patients with 3 or more unformed stools in
1 or more days. Do not repeat a negative test within
7 days. Do not perform for test of cure. Samples
positive for the C. difficile toxin B gene (tcdB) will
also be tested for the hypervirulent epidemic strain
(O27/NAP1/BI).
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition? Draw if patient has
diahrrea ((Once each week))
Days 1-7, Post-Op/Phase II
Isolation - Enhanced Contact - Clostridium
Difficile [ISO0010]
CONDITIONAL
Page 15 of 18
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Isolation Cart [EQP0016] CONTINUOUS, Starting today For 7 Days, Routine,
Days 1-7, Post-Op/Phase II
Draw Every Monday, Wednesday, Friday - Days 1-7 [137280]
MAGNESIUM [MAG] EVERY MONDAY, WEDNESDAY, AND FRIDAY,
Starting today, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
CALCIUM [CA] EVERY MONDAY, WEDNESDAY, AND FRIDAY,
Starting today, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
PHOSPHATE [PHOS] EVERY MONDAY, WEDNESDAY, AND FRIDAY,
Starting today, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
Labs - Draw Daily - Days 8-14 [130797]
CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
CONDITIONAL - RN COLLECT, Starting today For 7
Days, Routine, For optimum diagnosis of sepsis,
sample 3-4 sites only on the first day of a septic
episode. Cultures on subsequent days are of minimal
diagnostic value. Culture detects bacteria, Candida
and Cryptococcus. If filamentous fungi are suspected
see Culture, Blood, Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition? As needed for temp >
38.5 C, once in a 24 hour period
Days 8-14, Post-Op/Phase II
CULTURE, BLOOD, BACTERIA AND YEAST -
Urinalysis with Microscopy [GM4045]
CONDITIONAL - RN COLLECT, Starting 8/11/17 For
7 Days, Routine, For optimum diagnosis of sepsis,
sample 3-4 sites only on the first day of a septic
episode. Cultures on subsequent days are of minimal
diagnostic value. Culture detects bacteria, Candida
and Cryptococcus. If filamentous fungi are suspected
see Culture, Blood, Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition? As needed for temp >
38.5 C
Urine - CLEAN CATCH, Days 8-14, Post-Op/Phase II
GLUCOSE, FASTING [HCFSGLU] NEXT AM, Starting 8/11/17 For 7 Days, Routine,
Patient should have nothing to eat or drink (except
water) for a minimum of 8 hours before test.
If add on test, what should lab do if unable to add test
to previous specimen?
Days 8-14, Post-Op/Phase II
Draw Every Monday, Wednesday, Friday - Days 8-14 [134744]
Page 16 of 18
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08/2017CCKM@uwhealth.org

BUN [BUN] EVERY MONDAY, WEDNESDAY, AND FRIDAY,
Starting today, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
CALCIUM [CA] EVERY MONDAY, WEDNESDAY, AND FRIDAY,
Starting today, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
CBC WITH DIFFERENTIAL [CBC] EVERY MONDAY, WEDNESDAY, AND FRIDAY,
Starting today, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
CREATININE [CRET] EVERY MONDAY, WEDNESDAY, AND FRIDAY,
Starting today, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
ELECTROLYTES [LYTE] EVERY MONDAY, WEDNESDAY, AND FRIDAY,
Starting today, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
HEMATOCRIT [HCT] EVERY MONDAY, WEDNESDAY, AND FRIDAY,
Starting today, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
MAGNESIUM [MAG] EVERY MONDAY, WEDNESDAY, AND FRIDAY,
Starting today, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
PHOSPHATE [PHOS] EVERY MONDAY, WEDNESDAY, AND FRIDAY,
Starting today, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
PLATELET COUNT [PLT] EVERY MONDAY, WEDNESDAY, AND FRIDAY,
Starting today, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw for patients
receiving antithymocyte globulin treatment.
Post-Op/Phase II
Page 17 of 18
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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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08/2017CCKM@uwhealth.org

CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
CONDITIONAL - RN COLLECT, Starting today,
Routine, For optimum diagnosis of sepsis, sample 3-4
sites only on the first day of a septic episode. Cultures
on subsequent days are of minimal diagnostic value.
Culture detects bacteria, Candida and Cryptococcus.
If filamentous fungi are suspected see Culture, Blood,
Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition? Draw if temperature >
38.5 C, once in a 24 hour period.
Post-Op/Phase II
CULTURE, BLOOD, BACTERIA AND YEAST -
URINALYSIS WITH MICROSCOPY [GM4045]
CONDITIONAL - RN COLLECT, Routine, For
optimum diagnosis of sepsis, sample 3-4 sites only on
the first day of a septic episode. Cultures on
subsequent days are of minimal diagnostic value.
Culture detects bacteria, Candida and Cryptococcus.
If filamentous fungi are suspected see Culture, Blood,
Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition? Conditional sentence
should read: Draw if temperature > 38.5 C
Post-Op/Phase II
Consults
Consults [129894]
Consult Social Work (Inpatient) [CON0076] ONCE, Starting today For 1 Occurrences, Routine
Reason for Consult: OTHER
Evaluate and treat., Post-Op/Phase II
BestPractice
No Hospital Problems have yet been identified [129895]
Specify Hospital Problem(s) [COR0018] You will be prompted to specify a hospital problem on
signing., Post-Op/Phase II
Page 18 of 18
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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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08/2017CCKM@uwhealth.org