/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-97902-en.cckm

20180105

page

100

UWHC,UWMF,

Tools,

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

IP - Cardiac Transplant - Adult - Postoperative [2849]

IP - Cardiac Transplant - Adult - Postoperative [2849] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Transplant


IP - Cardiac Transplant - Adult - Postoperative [2849]
for Adult Patients OnlyIntended
Admission Status
Level of Care (Single Response) [187519]
*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 [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 [95591]
Admit To Inpatient [ADT0001] Attending:
Admitting Resident:
Requested Floor: B4/5
Service:
Rationale for LOS greater than 2 midnights:
Post-Op/Phase II
Admission Status [144369]
Page 1 of 31
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Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

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
Venous Thromboembolism (VTE) Prophylaxis
VTE Prophylaxis (Single Response) [144143]
Caprini VTE Risk Assessment URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/hematology-and-
coagulation/related/name-97521-en.cckm
High VTE Risk with Low Bleed Risk [130117]
enoxaparin (LOVENOX) subcutaneous injection
[800040]
40 mg, Subcutaneous, EVERY 24 HOURS, Post-
Op/Phase II
heparin subcutaneous injection [800290] 5,000 units, Subcutaneous, EVERY 12 HOURS,
Post-Op/Phase II
heparin subcutaneous injection [800290] 5,000 units, Subcutaneous, EVERY 8 HOURS
Starting tomorrow at 6:00 AM
Begin Postoperative Day 1
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
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
High VTE Risk with 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
VTE Prophylaxis (Single Response) [150210]
Page 2 of 31
Printed by STRAKA, KEVIN F [KFS1] at 1/4/2018 2:31:19 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Caprini VTE Risk Assessment URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/hematology-and-
coagulation/related/name-97521-en.cckm
High VTE Risk with Low Bleed Risk [130117]
enoxaparin (LOVENOX) subcutaneous injection
[800040]
40 mg, Subcutaneous, EVERY 24 HOURS, Post-
Op/Phase II
heparin subcutaneous injection [800290] 5,000 units, Subcutaneous, EVERY 12 HOURS,
Post-Op/Phase II
heparin subcutaneous injection [800290] 5,000 units, Subcutaneous, EVERY 8 HOURS
Starting tomorrow at 6:00 AM
Begin Postoperative Day 1
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
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
High VTE Risk with 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 [88587]
Vital Signs [NURMON0013] SEE COMMENTS, Starting today, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Every 15 minutes times 4, then every 30 minutes
times 4, then every hour while on ICU status. Every 4
hours while on intermediate care (IMC) or general
care status., Post-Op/Phase II
Check Peripheral Pulse [NURMON0008] EVERY 4 HOURS, Starting today, Routine
Method:
Pulse Side:
Pulse Location:
Post-Op/Phase II
Patient Monitoring [88588]
Page 3 of 31
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Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Measure Arterial Line [NURMON0060] CONTINUOUS, Post-Op/Phase II
Measure Hemodynamic Parameters
[NURMON0023]
CONTINUOUS, Routine
Pulmonary Artery Systolic Pressure (mmHg): Other
(Comment)
Pulmonary Artery Diastolic Pressure (mmHg): Other
(Comment)
Pulmonary Artery Mean Pressure (mmHg):
Pulmonary Artery Wedge Pressure (mmHg):
Central Venous Pressure (mmHg): Other (Comment)
Central Venous Pressure (mmH2O):
Cardiac Output: Every 4 hours
Cardiac Output Method:
Cardiac Index: Every 4 hours
Systemic Vascular Resistance: Every 4 hours
Pulmonary Vascular Resistance: Every 4 hours
Pulmonary Vascular Resistance Index:
Stroke Volume (mL/beat):
Stroke Volume Index:
Systemic Vascular Resistance Index:
Left Cardiac Work Index:
Right Cardiac Work Index:
Left Ventricular Stroke Work Index:
Right Ventricular Stroke Work Index:
Pulmonary Capillary Wedge Pressure (mmHg):
Measure with FloTrac? No
Every 15 minutes times 4, then every 30 minutes
times 4, then every hour. If no Drip every 2 hours.,
Post-Op/Phase II
Assess Neurologic Status [NURMON0006] EVERY 2 HOURS, Starting today, Routine, Every 2
hours until fully awake starting on arrival to unit., Post-
Op/Phase II
Cardiac Rhythm Monitoring - Adult
[NURMON0010]
CONTINUOUS, Routine
Indication: Other (Comment Required)
Notify Provider: Symptomatic Change in
Rhythm,Serious Arrhythmia
Functional Cardiac Defibrillator Present:
Post-Op/Phase II
Activity [87683]
Activity Bedrest While Intubated [NURACT0008] SEE COMMENTS, Starting today For 1 Weeks,
Routine
AD LIB:
AMBULATE:
CHAIR:
DANGLE:
BEDREST: strict bedrest
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Increase activity to dangle once patient is extubated.,
Post-Op/Phase II
Page 4 of 31
Printed by STRAKA, KEVIN F [KFS1] at 1/4/2018 2:31:19 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Elevate Head Of Bed Unless Chest Is Open
[NURACT0002]
Equal to (degrees): 30
Greater than (degrees):
Less than (degrees):
Other options:
Routine, CONTINUOUS, Starting today, Post-
Op/Phase II
High Fowler's Position During Weaning
[NURACT0011]
CONTINUOUS, Starting today, Post-Op/Phase II
Dangle With Leg Extension Exercises After
Extubation [NURACT0008]
CONTINUOUS, Starting today, Routine
AD LIB:
AMBULATE:
CHAIR:
DANGLE: 3x daily
BEDREST:
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Once extubated, increase activity to dangle., Post-
Op/Phase II
Activity Chair [NURACT0008] CONTINUOUS, Routine
AD LIB:
AMBULATE:
CHAIR: 3x daily
DANGLE:
BEDREST:
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
To chair if tolerate dangling, Post-Op/Phase II
Activity Ambulate [NURACT0008] CONTINUOUS, Routine
AD LIB:
AMBULATE: 4x daily
CHAIR:
DANGLE:
BEDREST:
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Once pulmonary catheter is removed, Post-Op/Phase
II
Reposition Patient [NURACT0005] Type:
Routine, SEE COMMENTS, Starting today, Every 2
hours., Post-Op/Phase II
Sternal Precautions [PRECAU0010] CONTINUOUS, Starting today, Routine, Sternal
Precautions:
No lifting greater than 8 pounds.
No pushing/pulling with arms during transfers.
No shoulder elevation past 90 degrees., Post-
Op/Phase II
Nutrition [88590]
Page 5 of 31
Printed by STRAKA, KEVIN F [KFS1] at 1/4/2018 2:31:19 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

NPO [NUT9999] EFFECTIVE NOW, Starting tomorrow, Routine
Patient Type: Adult
Diet Type: NPO
NPO: Strict NPO
Bedside Meal Instructions:
Room Service Class:
Until extubated., Post-Op/Phase II
Respiratory [88591]
Pulse Oximetry [NURMON0009] CONTINUOUS, Starting today, Routine, Post-
Op/Phase II
Mechanical Ventilation - Adult [117146]
Provide Manual Resuscitator at Bedside
[RT0039]
CONTINUOUS, Routine, Post-Op/Phase II
Mechanical Ventilation [RT0028] Routine, For ADULT patients order chlorihexidene
gluconate (PERIDEX) 0.12% soln 15 mL to swab
oral cavity 2x daily while on ventilation.
Is this a modification to a current vent order?
Ventilator Management: Per MD
Wean: Per Cardiothoracic Surgery Algorithm
Set Rate/Min:
PEEP (cmH2O):
Mode:
Tidal Volume Multiplier: 6
FiO2 (%) Titrate to Keep Sats >/= to ___%:
Pressure Support:
Pressure Control:
P High (cmH20):
P Low (PEEP) (cmH20):
T High (sec):
T Low (T PEEP) (sec):
PS above P High (cmH2O):
PS above PEEP (cmH2O):
NAVA Level (µV):
Refer to Cardiac Surgery, Transplant, and VAD Early
Extubation Algorithm, Post-Op/Phase II
chlorhexidine (PERIDEX) 0.12 % soln
MULTIDOSE [792004]
15 mL, Mouth/Throat, 2 X DAILY Starting today
Use to swab oral cavity. Discontinue when patient no
longer on ventilation.
Post-Op/Phase II
Respiratory - Post Extubation [88592]
Respiratory Therapy per Protocol [RT0035] Routine
Protocol Type:
Post Extubation, 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 (%): 92
O2 Delivery Device: Nasal Cannula
Attempt to Wean Off Oxygen? Yes
Post Extubation, Post-Op/Phase II
Incentive Spirometry [NURTRT0018] EVERY 1 HOUR, Starting today, Routine, Every hour
while awake, every 4 hours while asleep post
extubation, Post-Op/Phase II
Wound/Procedure Site Care [88594]
Page 6 of 31
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Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Maintain Chest Tube [NURTAD0001] CONTINUOUS, Starting today, Routine
Location: Mediastinal
Position: Anterior
Drainage Options: -20 cm wall suction
Site Assessment Frequency: EVERY 8 HOURS
Care Frequency: 1X DAILY (With sterile technique)
Wash With: Chlorhexidine Sponge
Primary Dressing: Gauze
Secondary Dressing:
Location applies to all chest tubes., Post-Op/Phase II
Measure Chest Tube Output [NURTAD0013] SEE COMMENTS, Starting today, Routine, Every 15
minutes times 4, then every 30 minutes times 4, then
every hour while on ICU status. Every 4 hours while
on intermediate care (IMC) or general care status.,
Post-Op/Phase II
Wound Care - Closed Incision (Adult)
[NURWND0055]
CONTINUOUS, Routine
Wound Site:
Wound Location:
Assess Frequency: EVERY 8 HOURS
Incision Closed With: Other (Comment) (Dermabond)
Maintain OR Dressing: Minimum of 48 hours
Remove OR Dressing after 48 hours: Yes
Removal of OR Dressing performed by: RN
Cleansing with Removal of OR Dressing: CHG
Primary Dressing (after 48 hours): Dry Gauze
Incision Care (after 48 hours): Cleanse daily with CHG
If dressing becomes saturated in 48 hours, sterile
dressing change? Yes - Notify provider
Post-Op/Phase II
Wound Care [NURWND0015] CONTINUOUS, Starting today, Routine
Wound Type: Open
Wound Site: Chest
Wound Location:
Assess Frequency: EVERY 8 HOURS
Care Frequency:
Wash With:
Irrigate/Rinse With:
Apply (Must also enter separate medication order to
obtain drug):
Primary Dressing: Other (Comment) (Ioban)
Secondary Dressing:
Provider to perform dressing change if patient's chest
is still open., Post-Op/Phase II
Intake and Output [88595]
Measure Intake And Output [NURMON0005] SEE COMMENTS, Starting today, Routine, Every 15
minutes times 4, then every 30 minutes times 4, then
every hour while on ICU status. Every 4 hours while
on intermediate care (IMC) or general care status.,
Post-Op/Phase II
Temporary Pacemaker Epicardial Settings (Single Response) [88596]
Epicardial Pacemaker Settings (ADULT)
[NURTRT0077]
ON, Starting today, Routine,
Use .epicardialpacemaker in the comments field to
create the list of pacemaker setting fields., Post-
Op/Phase II
Non-Categorized Patient Care Orders [88597]
OG Tube Placement - Adult [120995]
Page 7 of 31
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Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Insert and Maintain Orogastric Tube
[NURTAD0015]
CONTINUOUS, Routine
Options:
Flush with:
Flush Frequency: EVERY 8 HOURS
Check Residual:
Does this need to be inserted/placed?
Device Status:
Refer to Policy 2.20AP Care & Maintenance of
Enteral Tubes (Adult & Pediatric)
Recommendations for flush quantity:
For adult patients, 30 mLs of fluid should be
sufficient.
X-RAY ABDOMEN SINGLE VIEW [R74018] CONDITIONAL For 3 Days, Routine
Radiology Specialty Area: GENERAL IMAGING
Current signs and symptoms? Orogastric tube
placement
What specific question(s) would you like answered
by this exam? Evaluate orogastric tube placement
Relevant recent/past history? Cardiac Surgery
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 orogastric
tube placement. The location of orogastric 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
Strict Handwashing per Precautions for
Immunocompromised Patients [NURCOM0022]
CONTINUOUS, Starting today, Precautions for
Immunocompromised Patients Policy 13.06., Post-
Op/Phase II
No Live Plants or Flowers [NURCOM0022] SEE COMMENTS, Starting today, No live plants or
flowers in patient's room or at nurses station., Post-
Op/Phase II
Must Wear Duckbill mask (PCM 2000)
[NURCOM0022]
CONTINUOUS, Starting today, Patients must wear
properly fitting duckbill mask (PCM 2000) when
leaving HEPA flitered unit., Post-Op/Phase II
Measure Weight [NURMON0015] 1X DAILY, Starting today, Routine
Weigh With?
Weigh when?
Post-Op/Phase II
Page 8 of 31
Printed by STRAKA, KEVIN F [KFS1] at 1/4/2018 2:31:19 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

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: Postoperative Requirements
of Specific Procedure
Initiate Urinary Catheter Removal Protocol? No
Details: To Dependent Drainage
Irrigate With:
Irrigation Frequency:
Does this need to be inserted/placed?
Post-Op/Phase II
Use Warm Air Blanket [NURTRT0027] CONDITIONAL For Until specified, Routine, Warming
blanket immediately postoperative for temperature
less than 36.0 degrees Celsius., Post-Op/Phase II
Apply Cool Compress to Affected Area
[NURTRT0003]
SEE COMMENTS For Until specified, Routine
Site: Affected Area
Cooling blanket for temperature greater than 38.6
degrees Celsius., Post-Op/Phase II
Notify Primary Service to Place Diabetes
Management Service Consult Order if Patient Has
A Single Blood Glucose Result Greater Than 180
milligrams per deciliter within 24 hours of
anesthesia end time. [NURCOM0022]
CONTINUOUS, Starting today, Post-Op/Phase II
Initiate B4/5 Insulin Infusion Protocol
[NURMON0062]
CONTINUOUS, Routine, Post-Op/Phase II
Maintain Active Type and Screen while on ICU
status. Contact Provider for order.
[NURCOM0022]
CONTINUOUS, Starting today For Until specified,
Post-Op/Phase II
Contingency Parameters [88598]
Page 9 of 31
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Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Notify Provider [NURCOM0001] Provider to Notify: Provider
If systolic blood pressure > (mmHg): 150
If systolic blood pressure < (mmHg): 80
If diastolic blood pressure > (mmHg):
If diastolic blood pressure < (mmHg):
If temperature > (C): 38.5
If temperature < (C):
If heart rate > (bpm): 125
If heart rate < (bpm): 80
If respiratory rate >:
If respiratory rate <:
If blood glucose > (mg/dL): 400
If blood glucose < (mg/dL): 40
If pain score >:
Pulse Oximetry < (%): 90
If urine output < (mL): 30 milliliters/hour
Other: Rhythm changes and/or arrhythmias,Cardiac
index less than 2.2 liters/minute/square meter,Serum
potassium less than 3.2 or greater than 5.0
mmol/L,More than 1 temperature spike,Ventricular
ectopy.,Systemic vascular resistance (SVR) less than
700 or greater than 1400,Chest tube output greater
than 150 milliliters/hour,Hematocrit less than
24%,PaO2 less than 60,PaCo2 greater than 50,pH
less than 7.3 or greater than 7.5,Serum magnesium
less than 1.0 mg/dL
Post-Op/Phase II
Notify Attending Transplant Cardiologist
[NURCOM0001]
Provider to Notify: Other (Comment)
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):
If blood glucose < (mg/dL):
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL):
Other: White blood cell count less than 3K/uL.
Post-Op/Phase II
Cardiac Arrest/Change In Rhythm
Resuscitation Orders [142071]
Cardiac Surgery/Heart Transplant Post
Resuscitation Algorithm
URL: https://uconnect.wisc.edu/policies/clinical/uwhc-
clinical/uwhc-wide/patient-care/resources/name-
67288-en.file
Resuscitation Progression - Ventricular
Fibrillation/Pulseless Ventricular Tachycardia
(Witnessed) [NURVENT0018]
CONTINUOUS, Starting today, Routine, Post-
Op/Phase II
Resuscitation Progression - Asystole/Severe
Bradycardia [NURVENT0019]
CONTINUOUS, Starting today, Routine, Post-
Op/Phase II
Page 10 of 31
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Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Resuscitation Progression - Pulseless Electrical
Activity [NURVENT0020]
CONTINUOUS, Starting today, Routine, Post-
Op/Phase II
Intravenous Therapy
IV Fluids [88600]
dextrose 5%-NaCl 0.2% infusion [51615] at 5 mL/hr, Intravenous, CONTINUOUS
Per central venous pressure port
Post-Op/Phase II
CMV Status
CMV Status - Donor (Single Response) [96089]
Note: Donor CMV Status Pending - Pharmacy to
confirm donor status [950018]
CONTINUOUS, Post-Op/Phase II
Note: Donor is CMV Positive [950018] ONCE For 1 Doses, Post-Op/Phase II
Note: Donor is CMV Negative [950018] ONCE For 1 Doses, Post-Op/Phase II
CMV Status - Recipient (Single Response) [96090]
Note: Recipient is CMV Positive [950018] ONCE For 1 Doses, Post-Op/Phase II
Note: Recipient is CMV Negative [950018] ONCE For 1 Doses, Post-Op/Phase II
Surgical Prophylaxis
First Line (Single Response) [233766]
Patients who are 40-120 kg [233780]
cefuroxime (ZINACEF) intraVENOUS [800030] 1.5 g, Intravenous, EVERY 12 HOURS For 3 Doses,
Post-Op/Phase II
vancomycin (VANCOCIN) intraVENOUS
[800084]
15 mg/kg, Intravenous, EVERY 12 HOURS For 3
Doses, Post-Op/Phase II
Patients who are 120 kg or greater [233781]
cefuroxime (ZINACEF) intraVENOUS [800030] 3 g, Intravenous, EVERY 12 HOURS For 3 Doses,
Post-Op/Phase II
vancomycin (VANCOCIN) intraVENOUS
[800084]
15 mg/kg, Intravenous, EVERY 12 HOURS For 3
Doses, Post-Op/Phase II
Documented MRSA or History of MRSA Risk (Single Response) [233767]
Patients who are 40-120 kg [233782]
cefuroxime (ZINACEF) intraVENOUS [800030] 1.5 g, Intravenous, EVERY 12 HOURS For 3 Doses,
Post-Op/Phase II
vancomycin (VANCOCIN) intraVENOUS
[800084]
15 mg/kg, Intravenous, EVERY 12 HOURS For 3
Doses, Post-Op/Phase II
Patients who are 120 kg or greater [233783]
cefuroxime (ZINACEF) intraVENOUS [800030] 3 g, Intravenous, EVERY 12 HOURS For 3 Doses,
Post-Op/Phase II
vancomycin (VANCOCIN) intraVENOUS
[800084]
15 mg/kg, Intravenous, EVERY 12 HOURS For 3
Doses, Post-Op/Phase II
Patients who are 40 - 120 kg [233784]
ciprofloxacin (CIPRO) intraVENOUS [800031] 400 mg, Intravenous, EVERY 12 HOURS For 3
Doses, Post-Op/Phase II
vancomycin (VANCOCIN) intraVENOUS
[800084]
15 mg/kg, Intravenous, EVERY 12 HOURS For 3
Doses, Post-Op/Phase II
Patients who are 121 - 160 kg [233785]
ciprofloxacin (CIPRO) intraVENOUS [800031] 600 mg, Intravenous, EVERY 12 HOURS For 3
Doses, Post-Op/Phase II
vancomycin (VANCOCIN) intraVENOUS
[800084]
15 mg/kg, Intravenous, EVERY 12 HOURS For 3
Doses, Post-Op/Phase II
Patients who are 161 kg and greater [233786]
ciprofloxacin (CIPRO) intraVENOUS [800031] 800 mg, Intravenous, EVERY 12 HOURS For 3
Doses, Post-Op/Phase II
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vancomycin (VANCOCIN) intraVENOUS
[800084]
15 mg/kg, Intravenous, EVERY 12 HOURS For 3
Doses, Post-Op/Phase II
Patients with IgE-mediated or Severe Reaction to Beta Lactams (Single Response) [237304]
Patients who are 40-120 kg [233789]
ciprofloxacin (CIPRO) intraVENOUS [800031] 400 mg, Intravenous, EVERY 12 HOURS For 1
Doses, Post-Op/Phase II
vancomycin (VANCOCIN) intraVENOUS
[800084]
15 mg/kg, Intravenous, EVERY 12 HOURS For 1
Doses, Post-Op/Phase II
patients who are 121 kg to 160 kg [233791]
ciprofloxacin (CIPRO) intraVENOUS [800031] 600 mg, Intravenous, EVERY 12 HOURS For 1
Doses, Post-Op/Phase II
vancomycin (VANCOCIN) intraVENOUS
[800084]
15 mg/kg, Intravenous, EVERY 12 HOURS For 1
Doses, Post-Op/Phase II
Patients who are 160 kg or greater [233790]
ciprofloxacin (CIPRO) intraVENOUS [800031] 800 mg, Intravenous, EVERY 12 HOURS For 1
Doses, Post-Op/Phase II
vancomycin (VANCOCIN) intraVENOUS
[800084]
15 mg/kg, Intravenous, EVERY 12 HOURS For 1
Doses, Post-Op/Phase II
Patients with IgE-mediated or severe reaction to Beta-lactam AND MRSA or history of MRSA or MRSE
Risk (Single Response) [237315]
Patients who are 40-120 kg [233792]
ciprofloxacin (CIPRO) intraVENOUS [800031] 400 mg, Intravenous, EVERY 12 HOURS For 1
Doses, Post-Op/Phase II
vancomycin (VANCOCIN) intraVENOUS
[800084]
15 mg/kg, Intravenous, EVERY 12 HOURS For 1
Doses, Post-Op/Phase II
patients who are 121 kg to 160 kg [233794]
ciprofloxacin (CIPRO) intraVENOUS [800031] 600 mg, Intravenous, EVERY 12 HOURS For 1
Doses, Post-Op/Phase II
vancomycin (VANCOCIN) intraVENOUS
[800084]
15 mg/kg, Intravenous, EVERY 12 HOURS For 1
Doses, Post-Op/Phase II
Patients who are 160 kg or greater [233793]
ciprofloxacin (CIPRO) intraVENOUS [800031] 800 mg, Intravenous, EVERY 12 HOURS For 1
Doses, Post-Op/Phase II
vancomycin (VANCOCIN) intraVENOUS
[800084]
15 mg/kg, Intravenous, EVERY 12 HOURS For 1
Doses, Post-Op/Phase II
Medications - Anti-infectives
Candida Prophylaxis [88613]
nystatin (MYCOSTATIN) susp [40456] 5 mL, Swish & Swallow, 4 X DAILY
Discontinue when tolerating oral medications
Post-Op/Phase II
clotrimazole (MYCELEX) troche [111248] 10 mg, Oral, 4 X DAILY
Suck and swallow. Begin when tolerating oral
medications
Post-Op/Phase II
PJP Prophylaxis [88614]
sulfamethoxazole-trimethoprim (BACTRIM DS)
800-160 MG per tab [46804]
1 tab, Oral, 1 X DAILY Starting 1/8/18, Post-Op/Phase
II
Donor OR Recipient CMV Positive [88615]
ganciclovir (CYTOVENE) intraVENOUS [800188] 5 mg/kg, Intravenous, EVERY 12 HOURS For 6 Days,
Post-Op/Phase II
valganciclovir (VALCYTE) tab [66847] 900 mg, Oral, 1 X DAILY Starting 1/11/18, Post-
Op/Phase II
Donor AND Recipient Both CMV Negative [88616]
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acyclovir (ZOVIRAX) tab [44027] 400 mg, Oral, 2 X DAILY
Begin when tolerating oral medications
Post-Op/Phase II
Medications - Immunosuppressants
Calcineurin Inhibitors/Purine Synthesis Inhibitors [88602]
tacrolimus susp [780140] 1 mg, Oral, 2 X DAILY
Pharmacy to order tacrolimus (GENERIC) cap 1 mg
orally every 12 hours when patient tolerating oral
intake
Post-Op/Phase II
mycophenolate mofetil (CELLCEPT) susp [61374] 1,500 mg, Oral, 2 X DAILY
Pharmacy to order mycophenolate sodium
(MYFORTIC) 1080 mg orally 2 X daily when patient
tolerating oral intake.
Post-Op/Phase II
Steroid Taper - Intravenous [88603]
methylprednisolone sodium succ. (SOLU-
MEDROL) intraVENOUS [800058]
250 mg, Intravenous, ONCE For 1 Doses
Give 8 hours after arrival in Cardiothoracic ICU
Post-Op/Phase II
methylprednisolone sodium succ. (SOLU-
MEDROL) intraVENOUS [800058]
125 mg, Intravenous, ONCE Starting tomorrow For 1
Doses, Post-Op/Phase II
methylprednisolone sodium succ. (SOLU-
MEDROL) intraVENOUS [800058]
72 mg, Intravenous, ONCE Starting 1/6/18 For 1
Doses, Post-Op/Phase II
methylprednisolone sodium succ. (SOLU-
MEDROL) intraVENOUS [800058]
56 mg, Intravenous, ONCE Starting 1/7/18 For 1
Doses, Post-Op/Phase II
methylprednisolone sodium succ. (SOLU-
MEDROL) intraVENOUS [800058]
48 mg, Intravenous, 1 X DAILY Starting 1/8/18, Post-
Op/Phase II
Note: Discontinue methylprednisolone and begin
prednisone at an equivalent dose when patient
tolerating oral medications. [950018]
1 X DAILY Starting 1/6/18
Discontinue methylprednisolone and begin prednisone
at an equivalent dose when patient tolerating oral
medications.
Post-Op/Phase II
Steroid Taper - Oral [88604]
prednisone (DELTASONE) tab [41277] 90 mg, Oral, ONCE Starting 1/6/18 For 1 Doses
Give in place of methylprednisolone when tolerating
oral medications.
Post-Op/Phase II
prednisone (DELTASONE) tab [41277] 70 mg, Oral, ONCE Starting 1/7/18 For 1 Doses
Give in place of methylprednisolone when tolerating
oral medications.
Post-Op/Phase II
prednisone (DELTASONE) tab [41277] 30 mg, Oral, 2 X DAILY (AT MEALTIME) Starting
1/8/18
Give in place of methylprednisolone when tolerating
oral medications.
Post-Op/Phase II
Note: Do NOT lower prednisone dose below 60
mg prior to obtaining first biopsy result [950018]
1 X DAILY
Do NOT lower prednisone dose below 60 mg prior to
obtaining first biopsy result
Post-Op/Phase II
Medications - General
Analgesics [87696]
Page 13 of 31
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HYDROmorphone PF (DILAUDID) injection
RANGE [750050]
0.2-0.8 mg, Intravenous, EVERY 1 HOUR PRN For 24
Hours, pain
See Pain Management Algorithm for the Selection of
As-Needed Analgesics
for 3 Minutes, Post-Op/Phase II
acetaMINOPHEN (TYLENOL) tab [34150] 1,000 mg, Oral, 4 X DAILY For 5 Days, Post-
Op/Phase II
acetaMINOPHEN (TYLENOL) suppository
[34153]
650 mg, Rectal, EVERY 4 HOURS PRN, pain
See Pain Management Algorithm for the Selection of
As-Needed Analgesics
No more than 4 grams acetaminophen per 24 hours
for adults or 15mg/kg per dose for peds <40kg.
If unable to tolerate oral medications
Post-Op/Phase II
oxycodone tab RANGE [750032] 5-15 mg, Oral, EVERY 3 HOURS PRN For 5 Days,
pain
See Pain Management Algorithm for the Selection of
As-Needed Analgesics
Post-Op/Phase II
Analgesics [181405]
HYDROmorphone PF (DILAUDID) injection
RANGE [750050]
0.2-0.5 mg, Intravenous, EVERY 1 HOUR PRN For 24
Hours, pain
See Pain Management Algorithm for the Selection of
As-Needed Analgesics
for 3 Minutes, Post-Op/Phase II
acetaMINOPHEN (TYLENOL) tab [34150] 1,000 mg, Oral, 4 X DAILY For 5 Days, Post-
Op/Phase II
oxycodone tab RANGE [750032] 5-10 mg, Oral, EVERY 3 HOURS PRN For 5 Days,
pain
See Pain Management Algorithm for the Selection of
As-Needed Analgesics
Post-Op/Phase II
Anti-emetics [88609]
ondansetron (ZOFRAN ODT) disintegrating tab
[64224]
4 mg, Oral, EVERY 24 HOURS PRN, nausea/vomiting
Use first line
Post-Op/Phase II
ondansetron (ZOFRAN) injection [800202] 4 mg, Intravenous, EVERY 24 HOURS PRN,
nausea/vomiting
Use first line if unable to take medications by mouth or
enteral tube OR if immediate effect is needed.
Post-Op/Phase II
Hypnotics (Single Response) [229303]
traZODONE (DESYREL) tab [720150] 50 mg, Oral, 1 X DAILY (HS) PRN, sleep
Offer only after failure of non-pharmacologic
interventions (see RN Care Problem Sleep/Rest
Disturbance Adult)
Post-Op/Phase II
melatonin tab [119466] 3 mg, Oral, 1 X DAILY (HS) PRN, sleep
Offer only after failure of non-pharmacologic
interventions (see RN Care Problem Sleep/Rest
Disturbance Adult)
Post-Op/Phase II
Trazodone - Melatonin [227765] "And" Linked Panel
Page 14 of 31
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traZODONE (DESYREL) tab [720150] 50 mg, Oral, 1 X DAILY (HS) PRN, sleep
Use first line.
Offer only after failure of non-pharmacologic
interventions (see RN Care Problem Sleep/Rest
Disturbance Adult)
Post-Op/Phase II
melatonin tab [119466] 3 mg, Oral, 1 X DAILY (HS) PRN, sleep
Use second line if failure to respond to trazodone
within 60 minutes
Offer only after failure of non-pharmacologic
interventions (see RN Care Problem Sleep/Rest
Disturbance Adult)
Post-Op/Phase II
Hypnotics (Single Response) [229306]
traZODONE (DESYREL) tab [720150] 25 mg, Oral, 1 X DAILY (HS) PRN, sleep
Offer only after failure of non-pharmacologic
interventions (see RN Care Problem Sleep/Rest
Disturbance Adult)
If needed, give prior to midnight if possible. May
contribute to sedation the following day.
Post-Op/Phase II
melatonin tab [119466] 1 mg, Oral, 1 X DAILY (HS) PRN, sleep
Offer only after failure of non-pharmacologic
interventions (see RN Care Problem Sleep/Rest
Disturbance Adult)
Post-Op/Phase II
Gastric [88617]
famotidine (PEPCID) intraVENOUS [800279] 20 mg, Intravenous, EVERY 12 HOURS
NOTE: May be switched to oral when tolerating
Post-Op/Phase II
Bowel Management [87698]
bisacodyl (DULCOLAX) rectal suppository -
NOTE: Give on POD#2 [35231]
10 mg, Rectal, ONCE Starting 1/6/18 at 8:00 AM For
1 Doses
Hold for loose stools, NOTE: Order on postoperative
day 2
Post-Op/Phase II
senna-docusate (SENOKOT S) 8.6-50 MG per
tab [60530]
2 tab, Oral, 2 X DAILY Starting tomorrow
Hold for loose stool or suspected obstruction. Use
rescue therapy after first 48hrs if inadequate response
to scheduled bowel management.
Post-Op/Phase II
magnesium hydroxide (MILK OF MAGNESIA)
susp [65443]
30 mL, Oral, ONCE Starting 1/6/18 at 8:00 AM For 1
Doses
Hold if patient
Adult - Bowel Management - As Needed
[242378]
polyethylene glycol (MIRALAX) oral packet
[61829]
17 g, Oral, 1 X DAILY PRN Starting 1/6/18 at 10:00
AM, constipation
First Line Therapy Hold for loose stool or suspected
obstruction. Use as first line rescue therapy if
inadequate response to scheduled bowel
management.
Post-Op/Phase II
magnesium hydroxide (MILK OF MAGNESIA)
susp [65443]
30 mL, Oral, 1 X DAILY PRN Starting 1/6/18 at
10:00 AM, constipation
Second line therapy, if no response to first line
therapy within 12 hours. Hold if patient is NPO
Page 15 of 31
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bisacodyl (DULCOLAX) rectal suppository
[35231]
10 mg, Rectal, 1 X DAILY PRN Starting 1/6/18 at
10:00 AM, constipation
If unable to take medications by mouth or enteral
tube OR if need immediate laxation OR if failure of
second line agent after 6 hours
Post-Op/Phase II
Potassium Supplementation (Single Response) [87702]
potassium chloride 20 mEq/ 50 mL bag
CENTRAL LINE ONLY [46256]
20 mEq, Intravenous, PRN, Potassium
Supplementation
For potassium level between 3.8 - 4.0 mmol/L give 20
mEq x1
For potassium level between 3.5 - 3.7 mmol/L give 20
mEq x2
For potassium level between 3.2 - 3.4 mmol/L give 20
mEq x3
for 60 Minutes, Post-Op/Phase II
potassium chloride 10 mEq/100 mL bag - NOTE:
Order for patients with renal impairment (CrCl
less than 30 mL/min) [46253]
10 mEq, Intravenous, PRN - NOTIFY PHARMACY
WHEN NEEDED, potassium supplementation - See
Administration Instructions
For potassium level between 3.5 - 3.7 mmol/L give 10
mEq x1
For potassium level between 3.2 - 3.4 mmol/L give 10
mEq x2
Order for patients with renal impairment (CrCl less
than 30 mL/min)
for 60 Minutes, Post-Op/Phase II
Magnesium Supplementation (Single Response) [87536]
Magnesium Supplemental Scale [950039] PRN - NOTIFY PHARMACY WHEN NEEDED,
magnesium supplementation - See Administation
Instructions
Non-cardiac patients: For serum magnesium 1.6-1.8
mg/dL - do not replace
Cardiac patients: For serum magnesium 1.6-1.8
mg/dL give 0.05 g/kg IV x1
For serum magnesium 1.0-1.5 mg/dL give 0.1 g/kg IV
x1
For serum magnesium less than 1 mg/dL give 0.15
g/kg IV x1
Administer each 2 gram bag over 3 hours at a
frequency of one bag every 4 hours.
Maximum 6 grams per replacement dose
Reminder: Pharmacist to adjust per UWHC Renal
Dosing Protocol if applicable
Post-Op/Phase II
Page 16 of 31
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Magnesium Supplemental Scale - NOTE: Order in
patients with RENAL impairment (CrCl<30
mL/min) [950039]
PRN - NOTIFY PHARMACY WHEN NEEDED,
magnesium supplementation - See Administation
Instructions
Non-cardiac patients: For serum magnesium 1.6-1.8
mg/dL - do not replace
Cardiac patients: For serum magnesium 1.6-1.8
mg/dL give 0.025 g/kg IV x1
For serum magnesium 1.0-1.5 mg/dL give 0.05 g/kg IV
x1
For serum magnesium less than 1 mg/dL give 0.075
g/kg IV x1
Administer each 2 gram bag over 3 hours at a
frequency of one bag every 4 hours.
Maximum 6 grams per replacement dose
Reminder: Pharmacist to adjust per UWHC Renal
Dosing Protocol if applicable
NOTE: Order in patients with RENAL impairment
(CrCl < 30 mL/min)
Post-Op/Phase II
Phosphate SODIUM (Single Response) [193032]
phosphate-potassium & sodium (PHOS-NAK) oral
packet - For normal renal function [112317]
2 packet, Oral, PRN, phosphate supplementation -
See Admin Instructions
For serum phosphate 1.6 - 2.4 mg/dL, give 2 packets
every 4 hours while awake x 3 doses;
For serum phosphate 1.0 - 1.5 mg/dL, give 2 packets
every 4 hours while awake x 4 doses
For serum phosphate less than 1.0 mg/dL, call
provider for IV dosing.
Post-Op/Phase II
phosphorus (K-PHOS NEUTRAL) tab - For renal
dysfunction [45503]
1 tab, Oral, PRN, phosphate supplementation - See
Admin Instructions
For serum phosphate 1.6 - 2.4 mg/dL give 1 tablet
every 4 h while awake x 3 doses
For serum phosphate 1.0 - 1.5 mg/dL give 1 tablet
every 4 h while awake x 4 doses
For serum phosphate less than 1.0 mg/dL, call
provider
Post-Op/Phase II
Flushes [88620]
sodium chloride 0.9% flush 10 mL injection
[785055]
10 mL, Intravenous, EVERY 8 HOURS PRN, flush/line
care
Flush every saline lock port with 10 mL/port for each
line. Refer to VAD guidelines
Post-Op/Phase II
sodium chloride 0.9% infusion [64367] at 4 mL/hr, Intravenous, CONTINUOUS
Give per intraflow for arterial line, central venous and
distal swan port
Post-Op/Phase II
Vasoactive Agents [88621]
DOPamine (INTROPIN) 800 mg in dextrose 5%
250 mL infusion [50506]
2 mcg/kg/min, Intravenous, CONTINUOUS, Post-
Op/Phase II
norepinephrine (LEVOPHED) infusion [700247] Intravenous, CONTINUOUS, Post-Op/Phase II
vasopressin (PITRESSIN) 20 units in dextrose 5
% 100 mL infusion [700977]
0.04-0.06 Units/min, Intravenous, CONTINUOUS,
Post-Op/Phase II
epINEPHrine infusion [700197] Intravenous, CONTINUOUS, Post-Op/Phase II
Page 17 of 31
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milrinone 20mg in dextrose 5% 100 mL
(PRIMACOR) infusion [175995]
Intravenous, CONTINUOUS
{Titrate Y/N?:2000174}
Do not wean unless approved by the attending
surgeon
Post-Op/Phase II
DOBUTamine (DOBUTREX) 1000mg in dextrose
5% 250 mL infusion [51747]
Intravenous, CONTINUOUS
Do NOT wean unless approved by attending surgeon
Post-Op/Phase II
isoproterenol (ISUPEL) infusion [700221] Intravenous, CONTINUOUS, Post-Op/Phase II
Non-categorized [194447]
albumin human 5% infusion [44038] 12.5 g, Intravenous, PRN For 48 Hours, For systolic
blood pressure less than 80 mmHg, Post-Op/Phase II
lidocaine (XYLOCAINE-CARDIAC) injection
[39041]
75 mg, Intravenous, PRN, Symptomatic ventricular
arrhythmias associated with hypotension, shortness of
breath, decreased level of consciousness, or chest
pain; or ventricular tachycardia lasting greater than 30
seconds
If ordered IV: push rate 25-50 mg/minute
hydrALAZINE (APRESOLINE) injection RANGE
[750049]
10-20 mg, Intravenous, EVERY 2 HOURS PRN,
hypertension
Administer for SBP > 140. If you give more than 3
doses of hydralazine in any 8 hour period notify
provider
Post-Op/Phase II
propofol (DIPRIVAN) 10 mg/mL infusion [800260] 5-50 mcg/kg/min, Intravenous, CONTINUOUS
Initiate at 10 mcg/kg/min or current rate. Titrate in 5-10
mcg/kg/min increments every 5 minutes to achieve
Richmond Agitation-Sedation Score (RASS) of 0.
Post-Op/Phase II
Glucose Management
Glucose Management [119808]
Subcutaneous Correction Insulin [193143]
Glucose, POC [IPGLUCOSE] EVERY 6 HRS IF NPO/ CONT. TUBE FEEDING/
OR TPN, Starting tomorrow For Until specified,
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] EVERY 2 HOURS, Starting today For 24 Hours,
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? Draw until patient
begins on clear liquids
Draw until patient begins on clear liquids, Post-
Op/Phase II
Page 18 of 31
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Glucose, POC [IPGLUCOSE] BEFORE MEALS AND BEDTIME, Starting
tomorrow, 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? If patient eating or
drinking
If patient eating or drinking, 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] AFTER PROVIDING HYPOGLYCEMIA
TREATMENT, 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?
Per hypoglycemia treatment algorithm: Recheck
glucose 15 minutes after providing treatment until
glucose is greater than or equal to 70 mg/dL. If
patient has been critically low (i.e., glucose less than
40 mg/dL), recheck glucose after 1 hour to ensure
glucose remains greater than or equal to 70mg/dL.
After resolution of mild hypoglycemia (i.e., glucose
40-69 mg/dL), consider rechecking after 1 hour if
patient has signs/symptoms of hypoglycemia or is at
risk for a subsequent hypoglycemic event (e.g.,
previously administered insulin still active, altered
renal status, altered mental status, NPO or
interrupted nutrition, or any other condition that
increases hypoglycemia risk)., Post-Op/Phase II
insulin lispro (human) 100 UNIT/ML injection -
NOTE: CORRECTION insulin POD#0-1 [53264]
2-10 units, Subcutaneous, EVERY 4 HOURS PRN
For 1 Days, POD#0-1 Hyperglycemia - See
Administration Instructions
For blood glucose 151-200 mg/dL give 2 units; For
blood glucose 201-250 mg/dL give 4 units; For blood
glucose 251-300 mg/dL give 6 units; For blood
glucose 301-350 mg/dL give 8 units; For blood
glucose 351-400 mg/dL give 10 units; Give even if
NPO or meals skipped. Do NOT give more often
than 4 hours when NPO
Post-Op/Phase II
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insulin lispro (human) 100 UNIT/ML injection -
CORRECTION Insulin POD#2 [53264]
2-10 units, Subcutaneous, 3 X DAILY PRN Starting
tomorrow, Starting POD#2 Hyperglycemia - See
Administration Instructions
Daytime hyperglycemia dosing
For blood glucose 151-200 mg/dL give 2 units;
For blood glucose 201-250 mg/dL give 4 units;
For blood glucose 251-300 mg/dL give 6 units;
For blood glucose 301-350 mg/dL give 8 units;
For blood glucose 351-400 mg/dL give 10 units;
Give even if NPO or meals skipped. Do NOT give
more often than 4 hours when NPO.
Post-Op/Phase II
insulin lispro (human) 100 UNIT/ML injection -
BEDTIME 1-4 UNITS [53264]
1-4 units, Subcutaneous, 1 X DAILY (HS) PRN
Starting tomorrow, Starting POD#2 Hyperglycemia -
See Administration Instructions
For blood glucose 201-250 mg/dL give 1 units;
For blood glucose 251-300 mg/dL give 2 units;
For blood glucose 301-350 mg/dL give 3 units;
For blood glucose 351-400 mg/dL give 4 units;
Give even if NPO
Post-Op/Phase II
Hypoglycemia Treatment for blood glucose less
than 40 mg/dL and patient able to eat/swallow
safely [NURCOM0022]
CONDITIONAL
If Conditional, What Condition? If blood glucose less
than 40mg/dL and patient able to eat/swallow safely.
Give 30 grams of carbohydrate (8 oz. of fruit juice).
Repeat treatment until glucose is 70 mg/dL or
greater., Post-Op/Phase II
Hypoglycemia Treatment for blood glucose
between 40 to 69 mg/dL and patient able to
eat/swallow safely [NURCOM0022]
CONDITIONAL
If Conditional, What Condition? If glucose is 40-69
mg/dL and patient able to eat/swallow safely
Give 15 grams of carbohydrate (4 oz of fruit juice).
Repeat treatment until glucose is 70 mg/dL or
greater., Post-Op/Phase II
glucose-vitamin C chew tab [50690] 16 g, Oral, EVERY 15 MINUTES PRN,
hypoglycemia, For blood glucose 40-69 mg/dL
Use in patients able to safely eat/swallow but unable
to tolerate volume of fruit juice or per patient
preference. 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, For blood glucose less than 40 mg/dL
Use in patients able to safely eat/swallow but unable
to tolerate volume of fruit juice or per patient
preference. Repeat every 15 minutes until blood
glucose is 70 mg/dL or greater
Post-Op/Phase II
dextrose injection [800233] 12.5 g, Intravenous, PRN, For blood glucose 40-69
mg/dL and patient unable to eat/swallow safely AND
has IV access
Repeat every 15 minutes until blood glucose is 70
mg/dL or greater. See Adult Hypoglycemia Algorithm
Post-Op/Phase II
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dextrose injection [800233] 25 g, Intravenous, PRN, For blood glucose less than
40 mg/dL and patient unable to eat/swallow safely
AND has IV access
Repeat every 15 minutes until blood glucose is 70
mg/dL or greater. See Adult Hypoglycemia Algorithm
Post-Op/Phase II
Laboratory
Immediately Postoperative [88624]
HEMATOCRIT [HCT] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Immediately postoperative, Post-Op/Phase II
PLATELET COUNT [PLT] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Immediately postoperative, Post-Op/Phase II
PROTHROMBIN TIME/INR [PT] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Immediately postoperative, Post-Op/Phase II
PTT [PTT] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Immediately postoperative, Post-Op/Phase II
ELECTROLYTES [LYTE] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Immediately postoperative, Post-Op/Phase II
GLUCOSE [GLU] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Immediately postoperative, Post-Op/Phase II
BUN [BUN] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Immediately postoperative, Post-Op/Phase II
CREATININE [CRET] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Immediately postoperative, Post-Op/Phase II
BLOOD GASES AND O2 SATURATION
[HCBGASOS]
STAT For 1 Occurrences, Routine
Indicate FIO2:
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Immediately postoperative, Post-Op/Phase II
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BLOOD GASES AND O2 SATURATION -
Venous [HCBGASOS]
STAT For 1 Occurrences, Routine
Indicate FIO2:
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Immediately postoperative, Post-Op/Phase II
4 Hours Postoperative [88625]
HEMATOCRIT [HCT] CONDITIONAL 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 4 hours
postoperative.
Post-Op/Phase II
POTASSIUM [K] CONDITIONAL For 1 Hours, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw 4 hours
postoperative.
Post-Op/Phase II
BLOOD GASES AND O2 SATURATION
[HCBGASOS]
CONDITIONAL For 1 Days, Routine
If source is OTHER, indicate here:
Indicate FIO2:
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw 4 hours
postoperative.
Post-Op/Phase II
Postoperative Day 1 [88626]
CBC WITHOUT DIFFERENTIAL [HEMO] SPECIFIC TIME, Starting tomorrow at 5:00 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
PROTHROMBIN TIME/INR [PT] SPECIFIC TIME, Starting tomorrow at 5:00 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
PTT [PTT] SPECIFIC TIME, Starting tomorrow at 5:00 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
ELECTROLYTES [LYTE] SPECIFIC TIME, Starting tomorrow at 5:00 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
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GLUCOSE [GLU] SPECIFIC TIME, Starting tomorrow at 5:00 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
BUN [BUN] SPECIFIC TIME, Starting tomorrow at 5:00 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
CREATININE [CRET] SPECIFIC TIME, Starting tomorrow at 5:00 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
MAGNESIUM [MAG] SPECIFIC TIME, Starting tomorrow at 5:00 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
CALCIUM [CA] SPECIFIC TIME, Starting tomorrow at 5:00 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
PHOSPHATE [PHOS] SPECIFIC TIME, Starting tomorrow at 5:00 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
LD, TOTAL [LDH] SPECIFIC TIME, Starting tomorrow at 5:00 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
PREALBUMIN [XPRALB] SPECIFIC TIME, Starting tomorrow at 5:00 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] SPECIFIC TIME, Starting tomorrow at 5:00 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
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ALT/SGPT [ALT] SPECIFIC TIME, Starting tomorrow at 5:00 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] SPECIFIC TIME, Starting tomorrow at 5:00 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] SPECIFIC TIME, Starting tomorrow at 5:00 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
ALBUMIN [ALB] SPECIFIC TIME, Starting tomorrow at 5:00 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
BLOOD GASES AND O2 SATURATION
[HCBGASOS]
SPECIFIC TIME, Starting tomorrow at 5:00 AM For 1
Occurrences, Routine
Indicate FIO2:
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
BLOOD GASES AND O2 SATURATION -
Venous [HCBGASOS]
SPECIFIC TIME, Starting tomorrow at 5:00 AM For 1
Occurrences, Routine
Indicate FIO2:
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
TACROLIMUS [HCTAC] SPECIFIC TIME, Starting tomorrow at 7:00 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
Daily - Beginning Postoperative Day 2 [95597]
TACROLIMUS [HCTAC] NEXT AM, Starting 1/6/18 at 7:00 AM For 6 Days,
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] NEXT AM, Starting 1/6/18 at 5:00 AM For 6 Days,
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
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CBC WITHOUT DIFFERENTIAL [HEMO] NEXT AM, Starting 1/6/18 at 5:00 AM For 6 Days,
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] NEXT AM, Starting 1/6/18 at 5:00 AM For 6 Days,
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
BUN [BUN] NEXT AM, Starting 1/6/18 at 5:00 AM For 6 Days,
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] NEXT AM, Starting 1/6/18 at 5:00 AM For 6 Days,
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
Conditional Labs [88627]
POTASSIUM [K] CONDITIONAL For 4 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Once, 1 hour after
intravenous supplementation (as needed if on
diuretics).
Post-Op/Phase II
MAGNESIUM [MAG] CONDITIONAL For 4 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Once, 1 hour after
intravenous supplementation (as needed if on
diuretics).
Post-Op/Phase II
PHOSPHATE [PHOS] CONDITIONAL For 4 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? 1 hour after IV
supplementation, 4 hours after oral supplementation
Post-Op/Phase II
LACTATE [GM2255] CONDITIONAL, Starting today For 48 Hours, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? For pH less than 7.3
HEMATOCRIT [HCT] CONDITIONAL For 4 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Once, 1 hour after
packed red blood cell infusion.
Post-Op/Phase II
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BLOOD GASES AND O2 SATURATION
[HCBGASOS]
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? Cardiac Index less
than 2.0
Post-Op/Phase II
PROTHROMBIN TIME/INR [PT] CONDITIONAL For 4 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Once, 1 hour after
plasma infusion.
Post-Op/Phase II
PTT [PTT] CONDITIONAL For 4 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Once, 1 hour after
plasma infusion.
Post-Op/Phase II
BLOOD GASES AND O2 SATURATION
[HCBGASOS]
CONDITIONAL, Starting today For 4 Days, STAT
If source is OTHER, indicate here:
Indicate FIO2:
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? After vent changes or
for changes in respiratory status
Post-Op/Phase II
CALCIUM [CA] CONDITIONAL, Starting today For 4 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Once, 1 hour after
intravenous supplement
Post-Op/Phase II
GLUCOSE [GLU] CONDITIONAL, 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 blood glucose
is <40 or >400 mg/dL
Draw if blood glucose is <40 or >400 mg/dL, Post-
Op/Phase II
Once, for Temperature Greater than 38.5 degrees Celsius After First 24 Hours [88628]
URINALYSIS WITH MICROSCOPY [UA] CONDITIONAL For 4 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Once, for temperature
greater than 38.5 degrees Celsius after first 24 hours.
Post-Op/Phase II
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CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
CONDITIONAL For 4 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 add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Once, for temperature
greater than 38.5 degrees Celsius after first 24 hours.
All Lines/Peripheral, Post-Op/Phase II
CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
CONDITIONAL For 4 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? Once, for temperature
greater than 38.5 degrees Celsius after first 24 hours.
All Lines/Peripheral, Post-Op/Phase II
CULTURE, SPUTUM WITH GRAM STAIN
[HCSPUCS]
CONDITIONAL For 4 Days, Routine, For patients with
an ET tube or tracheostomy, quantitative mini-BAL by
RT or bronchoscopic BAL are the preferred methods
of specimen collection.
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Once, for temperature
greater than 38.5 degrees Celsius after first 24 hours.
Expectorated/Endotracheal Tube, Post-Op/Phase II
CULTURE, URINE [URC] CONDITIONAL For 4 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? Once, for temperature
greater than 38.5 degrees Celsius after first 24 hours.
Indwelling Catheter, Post-Op/Phase II
Diagnostic Tests and Imaging
Chest X-Ray Orders [88636]
Page 27 of 31
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X-RAY CHEST SINGLE VIEW [R71045] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, Routine
Current signs and symptoms? Assess ETT placement
What specific question(s) would you like answered by
this exam? Assess ETT placement
Relevant recent/past history? Status Post Cardiac
Transplant
Is patient pregnant?
If being performed remotely, where? Bedside
Last patient weight? (will auto pull in value and date in
comment):
Transport Method: Floor Determined/Entered
On admission to Cardiothoracic ICU.
X-RAY CHEST SINGLE VIEW - Day 1 [R71045] ONCE-RAD NEXT AVAILABLE, Starting tomorrow For
1 Occurrences, Routine
Current signs and symptoms? Assess for pleural
effusion
What specific question(s) would you like answered by
this exam? Assess for pleural effusion
Relevant recent/past history? Status Post Cardiac
Transplant
Is patient pregnant?
If being performed remotely, where? Bedside
Last patient weight? (will auto pull in value and date in
comment):
Transport Method: Floor Determined/Entered
Post-Op/Phase II
X-RAY CHEST SINGLE VIEW - Day 2 [R71045] ONCE-RAD NEXT AVAILABLE, Starting 1/6/18 For 1
Occurrences, Routine
Current signs and symptoms? Assess for pleural
effusion
What specific question(s) would you like answered by
this exam? Assess for pleural effusion
Relevant recent/past history? Status Post Cardiac
Transplant
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
Post-Op/Phase II
X-RAY CHEST SINGLE VIEW - Day 3 [R71045] ONCE-RAD NEXT AVAILABLE, Starting 1/7/18 For 1
Occurrences, Routine
Current signs and symptoms? Assess for pleural
effusion
What specific question(s) would you like answered by
this exam? Assess for pleural effusion
Relevant recent/past history? Status Post Cardiac
Transplant
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
Post-Op/Phase II
ECG Orders [88637]
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ECG - 12 Lead Without Rhythm [EKG0008] ONCE, Starting today For 1 Occurrences, Routine
Reason for exam: Heart or Lung Transplant
Disclaimer for University Hospital Only: A Stat status
for an ECG is in reference to the timing of the ECG.
The goal is to perform a STAT ECG within 10 minutes
of the order being placed. It is the responsibility of the
ordering provider to review the STAT ECGs. All ECGs
(stat or routine) will be formally reviewed within one
business day.
On arrival to Cardiothoracic ICU (unless 100%
paced)., Post-Op/Phase II
ECG - 12 Lead Without Rhythm [EKG0008] ONCE, Starting 1/11/18 For 1 Occurrences, Routine
Reason for exam: Heart or Lung Transplant
Disclaimer for University Hospital Only: A Stat status
for an ECG is in reference to the timing of the ECG.
The goal is to perform a STAT ECG within 10 minutes
of the order being placed. It is the responsibility of the
ordering provider to review the STAT ECGs. All ECGs
(stat or routine) will be formally reviewed within one
business day.
On day of first biopsy post transplant., Post-Op/Phase
II
Echocardiogram [88638]
Transthoracic Resting Echocardiogram
[ECH0003]
ONCE, Starting 1/11/18 For 1 Occurrences, Routine
Reason for exam: HEART OR LUNG TRANSPLANT
Do you want Agitated Bubble Study?
Is patient mechanically ventilated? No
Is patient ICU status? No
Does patient need continuous monitoring? Yes
On day of first biopsy post transplant., Post-Op/Phase
II
Consults
Consults [88640]
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
Page 29 of 31
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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):
Post-Op/Phase II
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?
Post-Op/Phase II
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?
Post-Op/Phase II
Consult Nutrition (Inpatient) [CON0043] ONCE, Starting today For 1 Occurrences, Routine
Reason for Consult:
Delegate to Initiate and Manage Tube Feeding:
Delegate to Manage Diet Order/Supplement Order:
Delegate to Dysphagia Diet Order Progression:
Can this consult be done via video?
Post-Op/Phase II
Consult Occupational Therapy (Inpatient) Eval
and Treat [CON0046]
ONCE, Starting today For 1 Occurrences, Routine
Reason for Occupational Therapy Consult: ADL
Training
Post-Op/Phase II
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Consult Physical Therapy (Inpatient) Eval and
Treat [CON0061]
ONCE, Starting today For 1 Occurrences, Routine
Reason for Physical Therapy Consult: Mobility
Training
Post-Op/Phase II
Consult Cardiac Rehab/Preventive Cardiology
(Inpatient) [CON0010]
ONCE, Starting today For 1 Occurrences, Routine
Reason for consult: Other (Comment)
Initiate cardiac transplant activity protocol., Post-
Op/Phase II
Consult Social Work (Inpatient) [CON0076] ONCE, Starting today For 1 Occurrences, Routine
Reason for Consult: OTHER (Heart transplant)
Post-Op/Phase II
Consult Swallow Therapy (Inpatient) [CON0079] ONCE, Routine
Reason for Consult: Evaluate and Treat Patient
May the Speech Pathologist and Registered Dietician
place diet orders on your behalf?
Is this a potential new stroke patient?
Evaluation after intubation of *** days., Post-Op/Phase
II
BestPractice
No Hospital Problems have yet been identified [107363]
Specify Hospital Problem(s) [COR0018] You will be prompted to specify a hospital problem on
signing., Post-Op/Phase II
Page 31 of 31
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