/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-97910-en.cckm

20180119

page

100

UWHC,UWMF,

Tools,

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

IP - Liver Transplant - Adult - Intensive Care Unit - Postoperative [2885]

IP - Liver Transplant - Adult - Intensive Care Unit - Postoperative [2885] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Transplant


IP - Liver Transplant - Adult - Intensive Care Unit - Postoperative [2885]
for Adult Patients OnlyIntended
Admission Status
Level of Care (Single Response) [187485]
*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 [106022]
Page 1 of 32
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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 [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 [84059]
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 [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) Prophylaxis
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]
Page 2 of 32
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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

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 subcutaneous injection [800290] 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 subcutaneous injection [800290] 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
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 subcutaneous injection [800290] 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 subcutaneous injection [800290] 5,000 units, Subcutaneous, EVERY 12 HOURS,
Post-Op/Phase II
Sequential Compression Device (SCD)
(TREATMENT) [NURTRT0028]
CONTINUOUS, Routine
Left/Right/Bilateral? Bilateral
Page 3 of 32
Printed by STRAKA, KEVIN F [KFS1] at 1/18/2018 3:19:54 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

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
PACU Normoglycemia Management
Normoglycemia Management (Single Response) [217140]
Patients withOUT Diabetes and NOT on Insulin
Infusion [228192]
Glucose, POC [IPGLUCOSE] ONCE For 1 Occurrences, Routine, Glucose, POC
should always be ordered in conjunction with orders
for hypoglycemia management and monitoring as
indicated in the Hypoglycemia Management (Adult)
panel.
If Conditional, What Condition?
PACU
If Glucose POC 200 mg/dL or Greater Initiate
Perioperative Normoglycemia for Surgical
Patients Adult Delegation Protocol
[NURMON0167]
CONTINUOUS For 24 Hours, Routine, Use order set
Perioperative Normoglycemia for Surgical Patients
Delegation Protocol order set [6133] to place orders,
PACU
Patients WITH Diabetes and NOT on Insulin
Infusion [228194]
Glucose, POC [IPGLUCOSE] ONCE For 1 Occurrences, Routine, Glucose, POC
should always be ordered in conjunction with orders
for hypoglycemia management and monitoring as
indicated in the Hypoglycemia Management (Adult)
panel.
If Conditional, What Condition?
PACU
If Glucose POC is 180 mg/dL or Greater Initiate
Perioperative Normoglycemia for Surgical
Patients Adult Delegation Protocol
[NURMON0167]
ONCE For 1 Occurrences, Routine, Use order set
Perioperative Normoglycemia for Surgical Patients
Delegation Protocol order set [6133] to place orders,
PACU
Patient ON Insulin Infusion [217180]
insulin infusionSupplemental order set [1345] to order -Adult -Insulin Infusion -IP Use
Confirm Time and Value of Last Glucose POC
and Insulin Infusion Column [NURCOM0022]
ONCE, PACU
Hypoglycemia Management [216855]
URL:
Hypoglycemia Management (Adult) [191576]
Page 4 of 32
Printed by STRAKA, KEVIN F [KFS1] at 1/18/2018 3:19:54 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Glucose, POC [IPGLUCOSE] AS NEEDED FOR SIGNS AND SYMPTOMS OF
HYPOGLYCEMIA, Starting today 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?
PACU
Glucose, POC [IPGLUCOSE] AFTER PROVIDING HYPOGLYCEMIA
TREATMENT, Starting today 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?
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), PACU
Notify Provider [NURCOM0001] Provider to Notify: Provider
Notify based on: Blood Glucose,Other
If blood glucose > (mg/dL): 400
If blood glucose < (mg/dL): 40
Other: Nutritional status changes
PACU
Hypoglycemia Treatment for blood glucose less
than 40 mg/dL and patient able to eat/swallow
safely [NURCOM0022]
CONDITIONAL, Starting today For Until specified
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., PACU
Hypoglycemia Treatment for blood glucose
between 40 to 69 mg/dL and patient able to
eat/swallow safely [NURCOM0022]
CONDITIONAL, Starting today For Until specified
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., PACU
glucose-vitamin C chew tab [50690] 16 g, Oral, EVERY 15 MINUTES PRN,
hypoglycemia, 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.
PACU
Page 5 of 32
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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

glucose-vitamin C chew tab [50690] 32 g, Oral, EVERY 15 MINUTES PRN,
hypoglycemia, 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.
PACU
glucagon injection kit [107799] 1 mg, Subcutaneous, PRN, For blood glucose less
than 69 mg/dL and patient unable to eat/swallow
safely AND has NO IV access
Repeat every 15 minutes until blood glucose is 70
mg/dL or greater. See Adult Hypoglycemia Algorithm
PACU
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
PACU
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
PACU
GLUCOSE, WHOLE BLOOD [HCWBGLU] CONDITIONAL, Starting today For 7 Days, STAT
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 less than 40 mg/dL or greater than 400
mg/dL.
PACU
GLUCOSE, WHOLE BLOOD [HCWBGLU] CONDITIONAL, Starting 1/26/18 For 7 Days, STAT
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 less than 40 mg/dL or greater than 400
mg/dL.
PACU
Post-OP Normoglycemia Management
Normoglycemia Management (Single Response) [216839]
Patients withOUT Diabetes and NOT on Insulin
Infusion [228199]
Glucose, POC [IPGLUCOSE] CONDITIONAL For 8 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?
Check once on arrival if PACU Glucose POC is >/=
180 mg/dL
Recheck in 4 hours if initial floor Glucose POC is
180-199 mg/dL, Post-Op/Phase II
Page 6 of 32
Printed by STRAKA, KEVIN F [KFS1] at 1/18/2018 3:19:54 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Glucose Monitoring and Response
[NURCOM0022]
ONCE For 1 Occurrences, If Glucose POC obtained
on arrival is:
< 180 mg/dL - no further action needed.
180-199 mg/dL - recheck and contact provider to
order the following: if patient is NPO, provider to
order glucose POC every 6 hours; if eating glucose
POC before meals and at bedtime. Provider should
order an A1c if not performed in the last 90 days.
200 mg/dL or greater - initiate Perioperative
Normoglycemia Delegation Protocol, Post-Op/Phase
II
If Glucose POC is 200 mg/dL or Greater Initiate
Perioperative Normoglycemia for Surgical
Patients Adult Delegation Protocol
[NURMON0167]
CONTINUOUS For 24 Hours, Routine, Use order set
Perioperative Normoglycemia for Surgical Patients
Delegation Protocol order set [6133] to place orders,
Post-Op/Phase II
Patients WITH Diabetes and NOT on Insulin
Infusion [228200]
Glucose, POC [IPGLUCOSE] ONCE For 1 Occurrences, Routine, Glucose, POC
should always be ordered in conjunction with orders
for hypoglycemia management and monitoring as
indicated in the Hypoglycemia Management (Adult)
panel.
If Conditional, What Condition?
Post-Op/Phase II
Glucose Monitoring and Response
[NURCOM0022]
ONCE For 1 Occurrences, If Glucose POC obtained
on arrival is:
<180 mg/dL - contact provider to order the following:
if patient is NPO, provider to order glucose POC
every 6 hours; if eating glucose POC before meals
and at bedtime. Provider should order an A1c if not
performed in the last 90 days.
180 mg/dL or greater - initiate Perioperative
Normoglycemia Delegation Protocol, Post-Op/Phase
II
If Glucose POC 180 mg/dL or Greater Initiate
Perioperative Normoglycemia for Surgical
Patients Adult Delegation Protocol
[NURMON0167]
CONTINUOUS, Routine, Use order set Perioperative
Normoglycemia for Surgical Patients Delegation
Protocol order set [6133] to place orders, Post-
Op/Phase II
Patient ON Insulin Infusion [217180]
insulin infusionSupplemental order set [1345] to order -Adult -Insulin Infusion -IP Use
Confirm Time and Value of Last Glucose POC
and Insulin Infusion Column [NURCOM0022]
ONCE, Post-Op/Phase II
Hypoglycemia Management [217170]
Hypoglycemia Management (Adult) [191576]
Glucose, POC [IPGLUCOSE] AS NEEDED FOR SIGNS AND SYMPTOMS OF
HYPOGLYCEMIA, Starting today 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
Page 7 of 32
Printed by STRAKA, KEVIN F [KFS1] at 1/18/2018 3:19:54 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Glucose, POC [IPGLUCOSE] AFTER PROVIDING HYPOGLYCEMIA
TREATMENT, Starting today 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?
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
Notify Provider [NURCOM0001] Provider to Notify: Provider
Notify based on: Blood Glucose,Other
If blood glucose > (mg/dL): 400
If blood glucose < (mg/dL): 40
Other: Nutritional status changes
Post-Op/Phase II
Hypoglycemia Treatment for blood glucose less
than 40 mg/dL and patient able to eat/swallow
safely [NURCOM0022]
CONDITIONAL, Starting today For Until specified
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, Starting today For Until specified
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, 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, 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
Page 8 of 32
Printed by STRAKA, KEVIN F [KFS1] at 1/18/2018 3:19:54 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

glucagon injection kit [107799] 1 mg, Subcutaneous, PRN, For blood glucose less
than 69 mg/dL and patient unable to eat/swallow
safely AND has NO IV access
Repeat every 15 minutes until blood glucose is 70
mg/dL or greater. See Adult Hypoglycemia Algorithm
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
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
GLUCOSE, WHOLE BLOOD [HCWBGLU] CONDITIONAL, Starting today For 7 Days, STAT
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 less than 40 mg/dL or greater than 400
mg/dL.
Post-Op/Phase II
GLUCOSE, WHOLE BLOOD [HCWBGLU] CONDITIONAL, Starting 1/26/18 For 7 Days, STAT
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 less than 40 mg/dL or greater than 400
mg/dL.
Post-Op/Phase II
Patient Care Orders
Vital Signs [135048]
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 [89675]
Activity [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:
Post-Op/Phase II
Page 9 of 32
Printed by STRAKA, KEVIN F [KFS1] at 1/18/2018 3:19:54 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Nutrition [89676]
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
Clear Liquid Diet [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: Diet Modifications
Diet Modifications: Liquid
Liquid: Clear Liquid
No Red or Purple Dye:
Liquid Thickness: Thin
Bedside Meal Instructions:
Room Service Class:
Post-Op/Phase II
Respiratory [89677]
Pulse Oximetry [NURMON0009] SEE COMMENTS, Starting today, Routine, Every 15
minutes x 4, then every 2 hours x 2, then every 4
hours., Post-Op/Phase II
Incentive Spirometry [NURTRT0018] SEE COMMENTS, Starting today, Routine, Once
extubated. EVERY 1 HOUR for 24 hours then PRN,
while awake, Post-Op/Phase II
Turn, Cough And Deep Breathe [NURTRT0022] SEE COMMENTS, Starting today For Until specified,
Routine, EVERY 2 HOURS for 24 hours then PRN,
while awake, Post-Op/Phase II
Oxygen Therapy [RT0032] CONTINUOUS, Starting today For Until specified,
Routine
FiO2 (%) Titrate to Keep Sats >/= to ___%:
Liter Flow:
Titrate oxygen to maintain O2 sat at (%): 94
O2 Delivery Device:
Attempt to Wean Off Oxygen? Yes
Post-Op/Phase II
Mechanical Ventilation - Adult [117146]
Provide Manual Resuscitator at Bedside
[RT0039]
CONTINUOUS, Routine
Page 10 of 32
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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

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:
Wean:
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):
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.
Intake and Output [89679]
Measure Intake And Output [NURMON0005] EVERY 4 HOURS, Starting today For Until specified,
Routine, Post-Op/Phase II
Measure Urine Output [NURMON0012] SEE COMMENTS, Starting today For Until specified,
Routine, Every 1 hour for 24 hours, then every 4 hours
while urinary catheter is in place., Post-Op/Phase II
Patient Monitoring [138007]
Measure Weight [NURMON0015] 1X DAILY, Starting today, Routine
Weigh With?
Weigh when?
Post-Op/Phase II
Maintain Drain (T-Tube) [NURTAD0003] CONTINUOUS, Starting today For Until specified,
Routine
Type: T-Tube
Site:
Location:
Drainage Options: Dependent Drainage
Irrigate Frequency:
Irrigate With:
Irrigant Volume (mL):
Strip:
Strip For:
Dressing Change Frequency:
Dressing Type:
Measure T-tube output every 4 hours for 24 hours,
then every 8 hours., Post-Op/Phase II
Page 11 of 32
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Maintain Drain - Bulb [NURTAD0003] CONTINUOUS, Starting today For Until specified,
Routine
Type: Closed Suction (Jackson-Pratt)
Site: Abdomen
Location: Right,Left
Drainage Options: Bulb
Irrigate Frequency:
Irrigate With:
Irrigant Volume (mL):
Strip:
Strip For:
Dressing Change Frequency:
Dressing Type:
Post-Op/Phase II
Cardiac Rhythm Monitoring - Adult
[NURMON0010]
INTERMITTENT (MAY REMOVE WHEN OFF
UNIT/BATHING), Starting today, Routine
Notify Provider: Symptomatic Change in
Rhythm,Serious Arrhythmia
Functional Cardiac Defibrillator Present:
Post-Op/Phase II
Measure Central Venous Pressure
[NURMON0002]
EVERY 4 HOURS, Starting today For Until specified,
Routine, Post-Op/Phase II
Measure Pulmanary Artery Pressure
[NURCOM0022]
EVERY 1 HOUR, Starting today For Until specified,
Every hour post-operatively, Post-Op/Phase II
Wound Care [210698]
Wound Care - Closed Incision (Adult)
[NURWND0055]
CONTINUOUS, Routine
Wound Site:
Wound Location:
Assess Frequency: EVERY 8 HOURS
Incision Closed With: Staples
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
Non-Categorized Patient Care Orders [89680]
Glucose, POC [IPGLUCOSE] EVERY 4 HOURS, Starting today 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
Elevate Head Of Bed - 30 Degrees
[NURACT0002]
Equal to (degrees): 30
Greater than (degrees):
Less than (degrees):
Other options:
Routine, CONTINUOUS, Starting today, Post-
Op/Phase II
Page 12 of 32
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Apply Abdominal Binder [NURTRT0014] CONTINUOUS, Starting today For Until specified,
Routine
Type: Abdominal Binder
Wearing schedule: Continuous
Post-Op/Phase II
Heel Protector (Foot Pillow and Positioner)
[NURCOM0022]
CONDITIONAL, Starting today For Until specified
If Conditional, What Condition? For post surgical
comfort
Post-Op/Phase II
Insert and Maintain Urinary Catheter
[NURELM0013]
CONTINUOUS, Starting today For Until specified,
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
NG Tube Placement - Adult [120994]
Insert and Maintain Nasogastric Tube
[NURTAD0014]
CONTINUOUS, Starting today For Until specified,
Routine
Options: Low, Continuous Suction
Flush with: Normal saline
Flush Frequency: PRN (Flush as needed with 30
mL)
Clamp NG Tube:
Check Residual:
Does this need to be inserted/placed?
Device Status:
Flush as needed with 30 milliliters Sodium Chloride
0.9% to keep patent.
Refer to Policy 2.20 Enteral Tubes Used for
Instillation of Fluids, Medications, or Feeding, Post-
Op/Phase II
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 13 of 32
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Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
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X-RAY ABDOMEN SINGLE VIEW [R74018] 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
Contingency Parameters [89681]
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 >: 34
If respiratory rate <:
If blood glucose > (mg/dL): 400
If blood glucose < (mg/dL): 40
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL): 30mL/hour
Other: Central venous pressure less than 2 or greater
than 14 mmHg,Pulmonary capillary wedge pressure
less than 6 or greater than 16mmHg,Magnesium less
than 2.0 milligrams/deciliter,Potassium less than 4.0 or
greater than 6.0 milligrams/deciliter,Phosphate less
than 3.0 milligrams/deciliter,Ionized calcium less than
4.5 milligrams/deciliter,Hematocrit less than
27%,Platelet count less than 50,000,INR greater than
1.6,Sodium less than 125,Platelets less than 50,000
Post-Op/Phase II
Intravenous Therapy
Premedications for Needle Insertion [106327]
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 immediate.
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
Post-Op/Phase II
Page 14 of 32
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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
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.
Post-Op/Phase II
Intravenous Fluids (Single Response) [89683]
dextrose 5%-NaCl 0.45% with KCl 20 mEq/L
infusion [44910]
at 50 mL/hr, Intravenous, CONTINUOUS, Post-
Op/Phase II
dextrose 5%-NaCl 0.45% infusion [51613] at 50 mL/hr, Intravenous, CONTINUOUS, Post-
Op/Phase II
Supplemental Fluids [190377]
dextrose 10% 1000 mL with 40 mEq potassium
chloride [710000]
at 100 mL/hr, Intravenous, CONTINUOUS, Post-
Op/Phase II
magnesium sulfate intraVENOUS [800111] 2 g, Intravenous, EVERY 12 HOURS For 2 Doses,
Post-Op/Phase II
Surgical Prophylaxis
First Line [233656]
Patients who are 40-120 kg [233693]
ampicillin (OMNIPEN) intraVENOUS [800009] 2 g, Intravenous, EVERY 6 HOURS For 7 Doses,
Post-Op/Phase II
ceftriaxone (ROCEPHIN) intraVENOUS [800027] 1 g, Intravenous, EVERY 24 HOURS Starting
tomorrow For 1 Doses
To be given 24 hours after the pre-operative
ceftriaxone dose
Post-Op/Phase II
Patients who are 121 kg and greater [233699]
ampicillin (OMNIPEN) intraVENOUS [800009] 2 g, Intravenous, EVERY 6 HOURS For 7 Doses,
Post-Op/Phase II
ceftriaxone (ROCEPHIN) intraVENOUS [800027] 2 g, Intravenous, EVERY 24 HOURS Starting
tomorrow For 1 Doses
To be given 24 hours after the pre-operative
ceftriaxone dose
Post-Op/Phase II
Documented MRSA or History of MRSA or MRSE Risk [233657]
Patients who are 40 - 120 kg [233694]
ceftriaxone (ROCEPHIN) intraVENOUS [800027] 1 g, Intravenous, EVERY 24 HOURS Starting
tomorrow For 1 Doses
To be given 24 hours after the pre-operative
ceftriaxone dose
Post-Op/Phase II
vancomycin (VANCOCIN) intraVENOUS - NOTE:
Maximum Dose = 2000 mg [800084]
15 mg/kg, Intravenous, EVERY 12 HOURS For 3
Doses, Post-Op/Phase II
Patients who are 121 kg and greater [233698]
Page 15 of 32
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Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
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ceftriaxone (ROCEPHIN) intraVENOUS [800027] 2 g, Intravenous, EVERY 24 HOURS Starting
tomorrow For 1 Doses
To be given 24 hours after the pre-operative
ceftriaxone dose
Post-Op/Phase II
vancomycin (VANCOCIN) intraVENOUS - NOTE:
Maximum Dose = 2000 mg [800084]
15 mg/kg, Intravenous, EVERY 12 HOURS For 3
Doses, Post-Op/Phase II
Documented VRE or History of VRE Risk [233658]
Patients who are 40 - 120 kg [233700]
ceftriaxone (ROCEPHIN) intraVENOUS [800027] 1 g, Intravenous, EVERY 24 HOURS Starting
tomorrow For 1 Doses
To be given 24 hours after the pre-operative
ceftriaxone dose
Post-Op/Phase II
DAPTOmycin intraVENOUS [800182] 4 mg/kg, Intravenous, EVERY 24 HOURS Starting
tomorrow For 1 Doses
To be given 24 hours after the pre-operative
daptomycin dose
Post-Op/Phase II
Patients who are 121 kg and greater [233701]
ceftriaxone (ROCEPHIN) intraVENOUS [800027] 2 g, Intravenous, EVERY 24 HOURS Starting
tomorrow For 1 Doses
To be given 24 hours after the pre-operative
ceftriaxone dose
Post-Op/Phase II
DAPTOmycin intraVENOUS [800182] 4 mg/kg, Intravenous, EVERY 24 HOURS Starting
tomorrow For 1 Doses
To be given 24 hours after the pre-operative
daptomycin dose
Post-Op/Phase II
Patients with IgE-mediated or Severe Reaction to Beta Lactams [233660]
Patients who are 40 kg and greater [233702]
vancomycin (VANCOCIN) intraVENOUS - NOTE:
Maximum Dose = 2000 mg [800084]
15 mg/kg, Intravenous, EVERY 12 HOURS For 3
Doses, Post-Op/Phase II
aztreonam (AZACTAM) intraVENOUS [800013] 2 g, Intravenous, EVERY 8 HOURS For 5 Doses,
Post-Op/Phase II
Patients with IgE-mediated or severe reaction to Beta-lactam AND Documented VRE or History of VRE
[233662]
Patients who are 40 kg and greater [233703]
aztreonam (AZACTAM) intraVENOUS [800013] 2 g, Intravenous, EVERY 8 HOURS For 5 Doses,
Post-Op/Phase II
DAPTOmycin intraVENOUS [800182] 4 mg/kg, Intravenous, EVERY 24 HOURS Starting
tomorrow For 1 Doses
To be given 24 hours after the pre-operative
daptomycin dose
Post-Op/Phase II
Medications - General
Analgesics - Opioids - Oral - PRN [89685]
oxycodone tab RANGE [750032] 5-10 mg, Oral, EVERY 3 HOURS PRN, pain
See Pain Management Algorithm for the Selection of
As-Needed Analgesics
Post-Op/Phase II
Analgesics - Opioids - Intravenous - PRN (Single Response) [222192]
Page 16 of 32
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HYDROmorphone PF (DILAUDID) injection
RANGE [750050]
0.4-1 mg, Intravenous, EVERY 2 HOURS PRN, pain
See Pain Management Algorithm for the Selection of
As-Needed Analgesics
for 3 Minutes, Post-Op/Phase II
Anti-emetics [137692]
Adult - Standard - Anti-emetics [241794]
ondansetron (ZOFRAN ODT) disintegrating tab
[64224]
4 mg, Oral, EVERY 6 HOURS PRN,
nausea/vomiting
Use first line
Post-Op/Phase II
ondansetron (ZOFRAN) injection [800202] 4 mg, Intravenous, EVERY 6 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
prochlorperazine (COMPAZINE) tab [41372] 10 mg, Oral, EVERY 6 HOURS PRN,
nausea/vomiting
Use second line if there is inadequate response to
first line anti-emetic within 30 minutes. If there is no
response to second line therapy within 30 minutes,
notify provider
Post-Op/Phase II
prochlorperazine (COMPAZINE) injection [41369] 10 mg, Intravenous, EVERY 6 HOURS PRN,
nausea/vomiting
Use second line. Use if there is inadequate
response to first line anti-emetic within 30 minutes
and if unable to take medications by mouth or
enteral tube OR if immediate effect is needed. If
there is no response to second line therapy within 30
minutes, notify provider
Post-Op/Phase II
Antihypertensives [105901]
cloNIDINE (CATAPRES) tab [720040] 0.1 mg, Oral, EVERY 4 HOURS PRN, systolic blood
pressure (SBP) greater than 170 mmHg or diastolic
blood pressure (DBP) greater than 100 mmHg
For first line therapy - Max of 4 doses in 24 hours
Post-Op/Phase II
labetalol (NORMODYNE;TRANDATE) injection
RANGE [750053]
10-20 mg, Intravenous, EVERY 1 HOUR PRN,
systolic blood pressure (SBP) greater than 170 mmHg
or diastolic blood pressure (DBP) 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 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,
systolic blood pressure (SBP) greater than 170 mmHg
or diastolic blood pressure (DBP) 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
Bowel Management - Scheduled [222193]
Page 17 of 32
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senna-docusate (SENOKOT S) 8.6-50 MG per
tab [60530]
2 tab, Oral, 2 X DAILY, Post-Op/Phase II
Bowel Management - As Needed [24616]
Adult - Bowel Management - As Needed
[241579]
polyethylene glycol (MIRALAX) oral packet
[61829]
17 g, Oral, 1 X DAILY PRN, constipation
First Line Therapy
Post-Op/Phase II
magnesium hydroxide (MILK OF MAGNESIA)
susp [65443]
30 mL, Oral, 1 X DAILY PRN, constipation
Second line therapy, if no response to first line
therapy within 12 hours
Post-Op/Phase II
bisacodyl (DULCOLAX) rectal suppository
[35231]
10 mg, Rectal, 1 X DAILY PRN, 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
PJP Prophylaxis (Single Response) [90081]
sulfamethoxazole-trimethoprim (BACTRIM DS)
800-160 MG per tab [46804]
1 tab, Oral, 1 X DAILY Starting tomorrow For 365
Days, Post-Op/Phase II
Albuterol - Pentamidine - Order if patient is
allergic to sulfa [233692]
albuterol neb soln (3 mL) [800248] 2.5 mg, Nebulization, EVERY 30 DAYS Starting
1/21/18 at 12:00 PM For 180 Days
Give prior to pentamidine NOTE: Start post-
operative day #3; Order BOTH pentamidine and
albuterol for patients allergic to sulfa
Post-Op/Phase II
pentamidine (PENTAM) neb soln [780161] 300 mg, Nebulization, EVERY 30 DAYS Starting
1/21/18 at 12:00 PM For 180 Days
NOTE: Start post-operative day #3; Order BOTH
pentamidine and albuterol for patients allergic to
sulfa
Post-Op/Phase II
Anti-virals - NOTE: Order for CMV Donor (+) And/Or Recipient (+) [89695]
ganciclovir (CYTOVENE) intraVENOUS [800188] 5 mg/kg, Intravenous, EVERY 24 HOURS
If patient's BMI > 30, dose on adjusted body weight
Post-Op/Phase II
Anti-virals - NOTE: Order for CMV Donor (-)/Recipient (-) [89696]
ganciclovir (CYTOVENE) intraVENOUS [800188] 5 mg/kg, Intravenous, EVERY 24 HOURS For 3 Days
If patient's BMI > 30, dose on adjusted body weight
Post-Op/Phase II
acyclovir (ZOVIRAX) tab [44027] 400 mg, Oral, 2 X DAILY (AT MEALTIME) Starting
1/21/18 with First Dose As Scheduled
NOTE: Order for CMV Donor (-)/Recipient (-)
Post-Op/Phase II
Invasive Fungal Infection Prophlyaxis [204843]
nystatin (MYCOSTATIN) susp [40456] 5 mL, Swish & Swallow, 2 X DAILY Starting tomorrow
For 90 Days, Post-Op/Phase II
Note: Pharmacy to screen for invasive fungal
infection [950018]
ONCE For 1 Doses
Non-categorized [89691]
sodium chloride 0.9% flush 10 mL injection
[785055]
Flush, PRN, flush/line care
Flush per Venous Access Device guidelines
Post-Op/Phase II
Page 18 of 32
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aspirin chew tab [720014] 81 mg, Oral, 1 X DAILY Starting 1/23/18
Do not give if platelets less than 50,000
Post-Op/Phase II
calcium carbonate (OS-CAL) 1250 (500 CA)
MG/5ML susp [177336]
1,250 mg, Oral, 2 X DAILY (AT MEALTIME) Starting
tomorrow, Post-Op/Phase II
cholecalciferol (VITAMIN D-3) tab [114243] 1,000 units, Oral, 1 X DAILY Starting tomorrow, Post-
Op/Phase II
multivitamin with mineral tab [800240] 1 tab, Oral, 1 X DAILY Starting tomorrow, Post-
Op/Phase II
ursodiol (ACTIGALL) 50 MG/ML susp [780143] 300 mg, Nasogastric Tube, 2 X DAILY (AT
MEALTIME), 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
Post-Op/Phase II
famotidine (PEPCID) tab [45134] 20 mg, Oral, 2 X DAILY, Post-Op/Phase II
albumin human 5% infusion [44038] 12.5 g, Intravenous, EVERY 12 HOURS For 6 Doses,
Post-Op/Phase II
Medications - Immunosuppression
Purine Synthesis Inhibitors [89699]
mycophenolate (CELLCEPT) intraVENOUS
[800198]
1,000 mg, Intravenous, 2 X DAILY (AT MEALTIME)
For 4 Doses, Post-Op/Phase II
mycophenolate mofetil (CELLCEPT) susp [61374] 1,000 mg, Nasogastric Tube, 2 X DAILY (AT
MEALTIME) Starting 1/20/18, Post-Op/Phase II
Calcineurin Inhibitors (Single Response) [89701]
tacrolimus cap [61281] Oral, 2 X DAILY (AT MEALTIME), Post-Op/Phase II
Steroids [89702]
dexamethasone (DECADRON) intraVENOUS
[800037]
50 mg, Intravenous, 1 X DAILY Starting tomorrow For
1 Doses, Post-Op/Phase II
dexamethasone (DECADRON) intraVENOUS
[800037]
25 mg, Intravenous, 1 X DAILY Starting 1/20/18 For 1
Doses, Post-Op/Phase II
dexamethasone (DECADRON) intraVENOUS
[800037]
12 mg, Intravenous, 1 X DAILY Starting 1/21/18 For 1
Doses, Post-Op/Phase II
dexamethasone (DECADRON) intraVENOUS
[800037]
6 mg, Intravenous, 1 X DAILY Starting 1/22/18 For 1
Doses, Post-Op/Phase II
dexamethasone (DECADRON) intraVENOUS
[800037]
4 mg, Intravenous, 1 X DAILY Starting 1/23/18, Post-
Op/Phase II
Laboratory
Draw Upon Admission to TLC [89705]
ELECTROLYTES [LYTE] COLLECT UPON ADMISSION, Starting today 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] COLLECT UPON ADMISSION, Starting today 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
Page 19 of 32
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CREATININE [CRET] COLLECT UPON ADMISSION, Starting today 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
GLUCOSE [GLU] COLLECT UPON ADMISSION, Starting today 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] COLLECT UPON ADMISSION, Starting today 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] COLLECT UPON ADMISSION, Starting today 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] COLLECT UPON ADMISSION, Starting today 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] COLLECT UPON ADMISSION, Starting today 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] COLLECT UPON ADMISSION, Starting today 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
ALT/SGPT [ALT] COLLECT UPON ADMISSION, Starting today 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
HEMATOCRIT [HCT] COLLECT UPON ADMISSION, Starting today 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
Page 20 of 32
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PLATELET COUNT [PLT] COLLECT UPON ADMISSION, Starting today 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] COLLECT UPON ADMISSION, Starting today 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] COLLECT UPON ADMISSION, Starting today 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] COLLECT UPON ADMISSION, Starting today 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, IONIZED, WHOLE BLOOD
[HCWBICA]
COLLECT UPON ADMISSION, Starting today 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] COLLECT UPON ADMISSION, Starting today 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] COLLECT UPON ADMISSION, Starting today 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] COLLECT UPON ADMISSION, Starting today 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
FIBRINOGEN [GM1320] COLLECT UPON ADMISSION, Starting today 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
Page 21 of 32
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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

BLOOD GASES AND O2 SATURATION
[HCBGASOS]
COLLECT UPON ADMISSION, Starting today 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
PostOperative Labs (Single Response) [221702]
Draw 6 Hours Post-Operative [221700]
HEMATOCRIT [HCT] CONDITIONAL, Starting today For 1 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] CONDITIONAL, Starting today For 1 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
PLATELET COUNT [PLT] CONDITIONAL, Starting today For 1 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] CONDITIONAL, Starting today For 1 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
PHOSPHATE [PHOS] CONDITIONAL, Starting today For 1 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
PROTIME/INR [SACRPT] CONDITIONAL, Starting today For 1 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
PTT [PTT] CONDITIONAL, Starting today For 1 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
BLOOD GASES AND O2 SATURATION
[HCBGASOS]
CONDITIONAL, Starting today For 1 Days, 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
ALT/SGPT [ALT] CONDITIONAL, Starting today For 1 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
Page 22 of 32
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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

AST/SGOT [AST] CONDITIONAL, Starting today For 1 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
ALKALINE PHOSPHATASE [ALKP] CONDITIONAL, Starting today For 1 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
BILIRUBIN, TOTAL [TBIL] CONDITIONAL, Starting today For 1 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
BILIRUBIN, DIRECT [DBIL] CONDITIONAL, Starting today For 1 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
GGT [GGT] CONDITIONAL, Starting today For 1 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
LD, TOTAL [LDH] CONDITIONAL, Starting today For 1 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
LACTATE [GM2255] CONDITIONAL, Starting today For 1 Days, STAT
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] CONDITIONAL, Starting today For 1 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
FIBRINOGEN [GM1320] CONDITIONAL, Starting today For 1 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
Draw 12 Hours Post-Operative [89706]
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?
Post-Op/Phase II
ELECTROLYTES [LYTE] 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?
Post-Op/Phase II
Page 23 of 32
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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

PLATELET COUNT [PLT] 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?
Post-Op/Phase II
MAGNESIUM [MAG] 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?
Post-Op/Phase II
PHOSPHATE [PHOS] 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?
Post-Op/Phase II
PROTHROMBIN TIME/INR [PT] 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?
Post-Op/Phase II
PTT [PTT] 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?
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 12 hours
postoperative.
Post-Op/Phase II
ALT/SGPT [ALT] 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?
Post-Op/Phase II
AST/SGOT [AST] 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?
Post-Op/Phase II
ALKALINE PHOSPHATASE [ALKP] 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?
Post-Op/Phase II
BILIRUBIN, TOTAL [TBIL] 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?
Post-Op/Phase II
Page 24 of 32
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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

BILIRUBIN, DIRECT [DBIL] 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?
Post-Op/Phase II
GGT [GGT] 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?
Post-Op/Phase II
LD, TOTAL [LDH] 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?
Post-Op/Phase II
LACTATE [GM2255] 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?
Post-Op/Phase II
AMMONIA [GM2200] 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?
Post-Op/Phase II
FIBRINOGEN [GM1320] 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?
Post-Op/Phase II
Draw Daily [89707]
WHITE CELL COUNT [WBC] NEXT AM For 7 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] NEXT AM For 7 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] NEXT AM For 7 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] NEXT AM For 7 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
GLUCOSE [GLU] NEXT AM For 7 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
Page 25 of 32
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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

CALCIUM [CA] NEXT AM For 7 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 7 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 7 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 7 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
ALT/SGPT [ALT] NEXT AM For 7 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
HEMATOCRIT [HCT] NEXT AM For 7 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
PLATELET COUNT [PLT] NEXT AM For 7 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 7 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] NEXT AM For 7 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] NEXT AM For 7 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, IONIZED, WHOLE BLOOD
[HCWBICA]
NEXT AM For 7 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
Page 26 of 32
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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

PHOSPHATE [PHOS] NEXT AM For 7 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] NEXT AM For 7 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 7 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
FIBRINOGEN [GM1320] NEXT AM For 7 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]
NEXT AM For 7 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
URINALYSIS WITH MICROSCOPY [UA] NEXT AM For 7 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
CULTURE, BLOOD, BACTERIA/YEAST (2
SITES) [116728]
.Practices for Blood Culturing Best This order equals 2 sites (4 bottles). See link below for
CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
NEXT DRAW, 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?
CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
NEXT DRAW, 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?
Page 27 of 32
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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

CULTURE, SPUTUM WITH GRAM STAIN
[HCSPUCS]
CONDITIONAL For 7 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? Draw as needed for
temperature greater than 38.5 degrees Celsius.
Post-Op/Phase II
TACROLIMUS [HCTAC] CONDITIONAL For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Daily while on
tacrolimus
Post-Op/Phase II
GLUCOSE [GLU] CONDITIONAL For 7 Days, STAT
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? Draw if bedside blood
glucose monitoring is less than 40 or greater than 400
mg/dL
Post-Op/Phase II
Draw Monday, Wednesday and Friday [106045]
ALBUMIN [ALB] EVERY MONDAY, WEDNESDAY, AND FRIDAY For
Until specified, 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 Two Times Daily for Live Donor Recipients Only [193329]
Draw Two Times Daily for Live Donor Recipients
Only [193328]
CBC WITH DIFFERENTIAL [CBC] NEXT AM For 1 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
ALKALINE PHOSPHATASE [ALKP] NEXT AM For 1 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
GGT [GGT] NEXT AM For 1 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
AST/SGOT [AST] NEXT AM For 1 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
ALT/SGPT [ALT] NEXT AM For 1 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
Page 28 of 32
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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

BILIRUBIN, TOTAL [TBIL] NEXT AM For 1 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
AMMONIA [GM2200] NEXT AM For 1 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
PROTHROMBIN TIME/INR [PT] NEXT AM For 1 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
FIBRINOGEN [GM1320] NEXT AM For 1 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 For 1 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 For 1 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
CARBON DIOXIDE [CO2] NEXT AM For 1 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
GLUCOSE [GLU] NEXT AM For 1 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
CHLORIDE [CL] NEXT AM For 1 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
POTASSIUM [K] NEXT AM For 1 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
SODIUM [NA] NEXT AM For 1 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
Blood Bank
Page 29 of 32
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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

Tests [83989]
TYPE AND SCREEN [HCTS] STAT, Starting today For 1 Occurrences, Routine, As
good clinical practice and for patient safety, the
Transfusion Service will automatically crossmatch 2
packed RBCs on all patients with antibodies to ensure
blood would be available in the event it is needed. If
you would like to opt out of this automatic order for this
patient please contact the UWHC Blood Bank at (608)
263-8367 or The American Center Lab at (608) 234-
6600 as appropriate., Post-Op/Phase II
Diagnostic Tests and Imaging
Diagnostic Tests and Imaging [89715]
X-RAY CHEST 2 VIEWS [R71046] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, Routine
Radiology Specialty Area: GENERAL IMAGING
Current signs and symptoms?
What specific question(s) would you like answered by
this exam? To check placement of ETT and central
lines
Relevant recent/past history? Status post liver
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
US ABDOMEN LIMITED [R76705] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, Routine
Current signs and symptoms?
What specific question(s) would you like answered by
this exam? To check patency of vessels.
Relevant recent/past history? Status post liver
transplant
For scheduling purposes, does the patient require
general anesthesia, sedation or anxiolytics? Note:
ordering provider is responsible for prescribing oral
anxiolytics or arranging peds anesthesia / sedation
services. See reference link above.
If being performed remotely, where?
Transport Method: Floor Determined/Entered
Post-Op/Phase II
Page 30 of 32
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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

US DEEP DOPPLER [R93975] ONCE-RAD NEXT AVAILABLE, Starting today For 1
Occurrences, Routine
Current signs and symptoms?
What specific question(s) would you like answered by
this exam? To check patency of vessels.
Relevant recent/past history? Status post liver
transplant
For scheduling purposes, does the patient require
general anesthesia, sedation or anxiolytics? Note:
ordering provider is responsible for prescribing oral
anxiolytics or arranging peds anesthesia / sedation
services. See reference link above.
If being performed remotely, where?
Transport Method: Floor Determined/Entered
Post-Op/Phase II
Consults
Consults [89717]
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?
To maximize nutritional status of patient status post
liver transplant., Post-Op/Phase II
Consult Physical Therapy (Inpatient) Eval and
Treat [CON0061]
ONCE, Starting tomorrow For 1 Occurrences, Routine
Reason for Physical Therapy Consult: Mobility
Training
Liver transplant, Post-Op/Phase II
Consult Occupational Therapy (Inpatient) Eval
and Treat [CON0046]
ONCE, Starting tomorrow For 1 Occurrences, Routine
Reason for Occupational Therapy Consult: ADL
Training
Liver transplant, Post-Op/Phase II
Consult Social Work (Inpatient) [CON0076] ONCE, Starting today For 1 Occurrences, Routine
Reason for Consult: OTHER
Evaluate and treat., Post-Op/Phase II
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 31 of 32
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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

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
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
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Printed by STRAKA, KEVIN F [KFS1] at 1/18/2018 3:19:54 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org