/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-97921-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 - Pancreas Transplant - Adult - Postoperative [2889]

IP - Pancreas Transplant - Adult - Postoperative [2889] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Transplant


IP - Pancreas Transplant - Adult - Postoperative [2889]
for Adult Patients OnlyIntended
Admission Status
Level of Care (Single Response) [205592]
*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 [106047]
Admit To Inpatient [ADT0001] Attending:
Admitting Resident:
Requested Floor:
Service: PANCREAS TRANSPLANT
Rationale for LOS greater than 2 midnights:
Post-Op/Phase II
Page 1 of 18
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Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

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
Transfer Status
Transfer Status [114455]
Transfer Patient [ADT0005] PANCREAS TRANSPLANT, Intermediate Care, 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]
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
Page 2 of 18
Printed by STRAKA, KEVIN F [KFS1] at 1/4/2018 2:26:22 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

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
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
Page 3 of 18
Printed by STRAKA, KEVIN F [KFS1] at 1/4/2018 2:26:22 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Apply and Maintain Anti-Embolism Stocking
[NURTRT0039]
CONTINUOUS, Routine
Does this need to be inserted/placed?
Left/Right/Bilateral? Bilateral
Type: Knee high
Post-Op/Phase II
No VTE Prophylaxis [130084]
VTE Prophylaxis - Reason Not Ordered
[COR0008]
ONCE, Routine
Reason Not Ordered:
Post-Op/Phase II
Patient Care Orders
Vital Signs [135048]
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 [89806]
Ambulate on night of surgery and then three times
a day [NURACT0008]
CONTINUOUS, Routine
AD LIB:
AMBULATE: with assistance
CHAIR:
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
Nutrition [89807]
NPO Except Medications [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: NPO
NPO: NPO except Medications
Bedside Meal Instructions:
Room Service Class:
Post-Op/Phase II
Respiratory [90581]
Pulse Oximetry [NURMON0009] SEE COMMENTS, Starting today For 24 Hours,
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 For Until specified,
Routine, EVERY 1 HOUR for 24 hours then PRN,
while awake, Post-Op/Phase II
Turn, Cough And Deep Breathe [NURTRT0022] SEE COMMENTS, Starting today, Routine, EVERY 2
HOURS for 24 hours then PRN, while awake, Post-
Op/Phase II
Page 4 of 18
Printed by STRAKA, KEVIN F [KFS1] at 1/4/2018 2:26:22 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

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: Nasal Cannula
Attempt to Wean Off Oxygen? Yes
Post-Op/Phase II
Intake and Output [89809]
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 2 hours for 24 hours, then every 4
hours while urinary catheter is in place, then every 4
hours., Post-Op/Phase II
Patient Monitoring [138395]
Measure Weight [NURMON0015] 1X DAILY, Starting today, Routine
Weigh With?
Weigh when?
Post-Op/Phase II
Measure Central Venous Pressure
[NURMON0002]
SEE COMMENTS, Starting today For Until specified,
Routine, Check as needed for patients with central
line., Post-Op/Phase II
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: Indwelling Single Lumen
Indication for Placement:
Details: To Dependent Drainage
Irrigate With: Other (Comment)
Irrigation Frequency:
Does this need to be inserted/placed?
sodium chloride 0.9% 30 mL, 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
Wound Care [138394]
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
Page 5 of 18
Printed by STRAKA, KEVIN F [KFS1] at 1/4/2018 2:26:22 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Non-Categorized Patient Care Orders [89810]
Glucose, POC [IPGLUCOSE] SEE COMMENTS, Starting today For 7 Days,
Routine, Glucose, POC should always be ordered in
conjunction with orders for hypoglycemia management
and monitoring as indicated in the Hypoglycemia
Management (Adult) panel.
If Conditional, What Condition?
Every 2 hours for 24 hours postoperative, then 4 times
daily., Post-Op/Phase II
Apply Brace, Spine - Abdominal Binder
[NURTRT0014]
CONTINUOUS, Starting today, Routine
Type: Abdominal Binder
Wearing schedule:
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
Measure Abdominal Girth [NURMON0016] EVERY 8 HOURS, Starting today For 72 Hours,
Routine, Keep abdominal binder on., Post-Op/Phase II
NG Tube Placement - Adult [120994]
Insert and Maintain Nasogastric Tube
[NURTAD0014]
CONTINUOUS, Routine
Options: Low, Continuous Suction
Flush with: Normal saline
Flush Frequency: PRN
Clamp NG Tube:
Check Residual:
Does this need to be inserted/placed?
Device Status:
Irrigate nasogastric tube with Soduim Chloride 0.9%
as needed 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.
Post-Op/Phase II
Page 6 of 18
Printed by STRAKA, KEVIN F [KFS1] at 1/4/2018 2:26:22 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

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
CENTRAL VENOUS CATHETER PLACEMENT
[R77001F]
ONCE-RAD NEXT AVAILABLE, Routine
What type of Central Catheter would you like placed?
PICC
Current signs and symptoms?
What specific question(s) would you like answered by
this exam?
Relevant recent/past history?
Is patient pregnant?
Allergies to IV contrast or iodine?
Is patient on anticoagulation therapy? If yes, specify
coagulation disorder and current medications in
comments box at bottom.
Last creatinine value? (will auto pull in date and value
in comment):
Last patient weight? (will auto pull in value and date in
comment):
Last e-GFR value? (will auto pull in value and date in
comment):
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.
Transport Method: Floor Determined/Entered
Post-Op/Phase II
Contingency Parameters [89811]
Page 7 of 18
Printed by STRAKA, KEVIN F [KFS1] at 1/4/2018 2:26:22 PM
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): 180
If systolic blood pressure < (mmHg): 90
If diastolic blood pressure > (mmHg): 110
If diastolic blood pressure < (mmHg): 60
If temperature > (C): 38.5
If temperature < (C):
If heart rate > (bpm): 120
If heart rate < (bpm): 60
If respiratory rate >: 20
If respiratory rate <: 8
If blood glucose > (mg/dL): 200
If blood glucose < (mg/dL): 40
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL): 120 mL in 4 hour shift
Other:
Post-Op/Phase II
Intravenous Therapy
IV Fluids [89813]
sodium chloride 0.45 % infusion [42187] at 100 mL/hr, Intravenous, CONTINUOUS, Post-
Op/Phase II
dextrose 5%-NaCl 0.45% infusion [51613] at 100 mL/hr, Intravenous, CONTINUOUS
Use for blood glucose less than 80 mg/dL
Post-Op/Phase II
Surgical Prophylaxis
First Line (Single Response) [90592]
Patients who are 40 - 120 kg [233787]
ampicillin (OMNIPEN) intraVENOUS [800009] 2 g, Intravenous, EVERY 6 HOURS For 7 Doses,
Post-Op/Phase II
ceftriaxone (ROCEPHIN) intraVENOUS [800027] 1 g, Intravenous, ONCE Starting tomorrow For 1
Doses, Post-Op/Phase II
fluconazole (DIFLUCAN) intraVENOUS [800044] 400 mg, Intravenous, ONCE Starting tomorrow For 1
Doses, Post-Op/Phase II
Patients who are 121 kg and greater [233788]
ampicillin (OMNIPEN) intraVENOUS [800009] 2 g, Intravenous, EVERY 6 HOURS For 7 Doses,
Post-Op/Phase II
ceftriaxone (ROCEPHIN) intraVENOUS [800027] 2 g, Intravenous, ONCE Starting tomorrow For 1
Doses, Post-Op/Phase II
fluconazole (DIFLUCAN) intraVENOUS [800044] 400 mg, Intravenous, ONCE Starting tomorrow For 1
Doses, Post-Op/Phase II
Documented MRSA or History of MRSA Risk (Single Response) [233353]
Patients who are 40 - 120 kg [239959]
vancomycin (VANCOCIN) intraVENOUS
[800084]
15 mg/kg, Intravenous, EVERY 12 HOURS For 3
Doses, Post-Op/Phase II
ceftriaxone (ROCEPHIN) intraVENOUS [800027] 1 g, Intravenous, ONCE For 1 Doses, Post-
Op/Phase II
fluconazole (DIFLUCAN) intraVENOUS [800044] 400 mg, Intravenous, ONCE For 1 Doses, Post-
Op/Phase II
Patients who are 121 kg and greater [239962]
vancomycin (VANCOCIN) intraVENOUS
[800084]
15 mg/kg, Intravenous, EVERY 12 HOURS For 3
Doses
ceftriaxone (ROCEPHIN) intraVENOUS [800027] 2 g, Intravenous, ONCE For 1 Doses
fluconazole (DIFLUCAN) intraVENOUS [800044] 400 mg, Intravenous, ONCE For 1 Doses, Post-
Op/Phase II
Page 8 of 18
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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

Patients with IgE-mediated or Severe Reaction to Beta Lactams [233364]
Patients who are 40 kg and greater [239968]
vancomycin (VANCOCIN) intraVENOUS
[800084]
15 mg/kg, Intravenous, EVERY 12 HOURS For 3
Doses
aztreonam (AZACTAM) intraVENOUS [800013] 2 g, Intravenous, EVERY 8 HOURS For 5 Doses
fluconazole (DIFLUCAN) intraVENOUS [800044] 400 mg, Intravenous, ONCE For 1 Doses
Patients with IgE-mediated or severe reaction to Beta-lactam AND MRSA or history of MRSA or MRSE
Risk (Single Response) [233374]
Patients who are 40 kg and greater [239971]
vancomycin (VANCOCIN) intraVENOUS
[800084]
15 mg/kg, Intravenous, EVERY 12 HOURS For 3
Doses
aztreonam (AZACTAM) intraVENOUS [800013] 2 g, Intravenous, EVERY 8 HOURS For 5 Doses
fluconazole (DIFLUCAN) intraVENOUS [800044] 400 mg, Intravenous, ONCE For 1 Doses
Medications - General
Analgesics - Acetaminophen - Oral - PRN [220062]
acetaMINOPHEN (TYLENOL) tab [34149] 650 mg, Oral, EVERY 4 HOURS PRN, pain/fever
For mild to moderate pain, multimodal therapy, or
fever greater than 38.2 degrees Celsius. No more than
4 grams acetaminophen per 24 hours for adults or
15mg/kg per dose for peds <40kg.
Post-Op/Phase II
Analgesics - Opioids - Oral - PRN [220063]
oxycodone tab RANGE [750032] 5-10 mg, Oral, EVERY 3 HOURS PRN, pain
Start when IV narcotics discontinued For severe pain.
Post-Op/Phase II
Analgesics - Opioids - Intravenous- PRN [89815]
HYDROmorphone PF (DILAUDID) injection
[750050]
0.4-1 mg, Intravenous, EVERY 2 HOURS PRN, pain
For severe pain when patient unable to tolerate orally.
for 3 Minutes, Post-Op/Phase II
Anti-emetics [154187]
ondansetron (ZOFRAN ODT) disintegrating tab
[64224]
4 mg, Oral, EVERY 8 HOURS PRN, nausea/vomiting
For first line therapy
Post-Op/Phase II
ondansetron (ZOFRAN) injection [800202] 4 mg, Intravenous, EVERY 8 HOURS PRN,
nausea/vomiting
For first line therapy. Administer if patient unable to
tolerate orally.
Post-Op/Phase II
metoclopramide (REGLAN) tab [39630] 10 mg, Oral, EVERY 6 HOURS PRN, GI motility,
nausea/vomiting
For second line therapy. Administer if patient
unresponsive to first line therapy within 30 minutes of
administration.
metoclopramide (REGLAN) injection [800059] 10 mg, Intravenous, EVERY 6 HOURS PRN,
nausea/vomiting
If ordered IV: Administer over 2 minutes
For second line therapy. Administer if patient unable
to tolerate orally and unresponsive to first line therapy
within 30 minutes of administration.
Post-Op/Phase II
prochlorperazine (COMPAZINE) tab [41372] 10 mg, Oral, EVERY 6 HOURS PRN, nausea
For third line therapy
Page 9 of 18
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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

prochlorperazine (COMPAZINE) injection [41369] 10 mg, Intravenous, EVERY 6 HOURS PRN,
nausea/vomiting
If ordered IV: push slowly, max rate 5 mg/minute.
For third line therapy. Administer if patient is unable
to tolerate orally.
Bowel Management [89817]
senna-docusate (SENOKOT-S) 8.6-50 mg per tab
[60530]
2 tab, Oral, 2 X DAILY
Hold for loose stools
Post-Op/Phase II
polyethylene glycol (MIRALAX) oral packet
[61829]
17 g, Oral, 1 X DAILY PRN, constipation
For first line therapy.
Post-Op/Phase II
bisacodyl (DULCOLAX) rectal suppository
[35231]
10 mg, Rectal, 1 X DAILY PRN, constipation
For second line therapy. Administer when there is no
response to first line therapy or when immediate
laxation is required.
Post-Op/Phase II
Candida Prophylaxis [89818]
nystatin (MYCOSTATIN) susp [40456] 5 mL, Swish & Swallow, 2 X DAILY Starting 1/6/18 For
90 Days, Post-Op/Phase II
Anti-hypertensives [154220]
cloNIDINE (CATAPRES) tab [720040] 0.1 mg, Oral, EVERY 4 HOURS PRN, Systolic blood
pressure (SBP) greater than 170 mmHg or diastolic
blood pressure 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 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 greater than 100 mmHg.
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
Non-Categorized General Medications [89822]
calcium carbonate (TUMS) chew tab [44477] 1,000 mg, Oral, EVERY 4 HOURS PRN, dyspepsia,
Post-Op/Phase II
aspirin chew tab [720014] 81 mg, Oral, 1 X DAILY Starting today
Administer on PostOp Day 1
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
calcium elemental tab [40685] 500 mg, Oral, 2 X DAILY (AT MEALTIME) Starting
tomorrow
Administer on PostOp Day 1
Post-Op/Phase II
Page 10 of 18
Printed by STRAKA, KEVIN F [KFS1] at 1/4/2018 2:26:22 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

albumin human 25% infusion [44037] 25 g, Intravenous, EVERY 12 HOURS For 4 Doses,
Post-Op/Phase II
mannitol 25 % vial [39352] 6.25 g, Intravenous, ONCE For 1 Doses
**Examine for Crystals** Administer with 0.2 - 0.22
micron filter
NOTE: Administer after first dose of albumin is
administered.
Post-Op/Phase II
dextrose injection [800233] 12.5 g, Intravenous, PRN, blood glucose less than 80
mg/dL, 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.
Gastric (Single Response) [198937]
famotidine (PEPCID) tab [45134] 20 mg, Oral, 1 X DAILY, Post-Op/Phase II
pantoprazole (PROTONIX) delayed release tab
[62661]
40 mg, Oral, 1 X DAILY, Post-Op/Phase II
Medications - Pneumocystitis Jiroveci Pneumonia Prophylaxis - NOTE: Order
one regimen only
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
1/7/18 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
1/7/18 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
Medications - Anti-virals
NOTE: Order for CMV Donor (+) AND/OR Recipient (+) (Single Response) [90600]
valganciclovir (VALCYTE) tab [66847] 900 mg, Oral, 1 X DAILY
NOTE: Order for CMV Donor (+) AND/OR Recipient
(+)
Post-Op/Phase II
Anti-virals - NOTE: Order BOTH for CMV Donor (-)/Recipient (-) [89828]
acyclovir (ZOVIRAX) tab [44027] 400 mg, Oral, 2 X DAILY For 90 Days with First Dose
As Scheduled
NOTE: Order for CMV Donor (-)/Recipient (-)
Post-Op/Phase II
Medications - Immunosuppression
Purine Synthesis Inhibitors [89831]
mycophenolate (CELLCEPT) intraVENOUS
[800198]
1,000 mg, Intravenous, 2 X DAILY (AT MEALTIME)
For 4 Doses, Post-Op/Phase II
mycophenolate sodium (MYFORTIC) delayed
release tab [75184]
720 mg, Oral, 3 X DAILY (AT MEALTIME) Starting
1/6/18, Post-Op/Phase II
Steriods [154229]
Page 11 of 18
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dexamethasone (DECADRON) intraVENOUS
[800037]
50 mg, Intravenous, 1 X DAILY (NOON) Starting
tomorrow For 1 Doses, Post-Op/Phase II
dexamethasone (DECADRON) intraVENOUS
[800037]
18 mg, Intravenous, 1 X DAILY (NOON) Starting
1/6/18 For 1 Doses, Post-Op/Phase II
dexamethasone (DECADRON) intraVENOUS
[800037]
12 mg, Intravenous, 1 X DAILY (NOON) Starting
1/7/18 For 1 Doses, Post-Op/Phase II
prednisone (DELTASONE) tab [41277] 30 mg, Oral, 1 X DAILY Starting 1/8/18, Post-
Op/Phase II
Laboratory
Draw 6 Hours Post-Operation [89837]
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 6 hrs post-
operation
Post-Op/Phase II
POTASSIUM [K] 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 6 hrs post-op
Post-Op/Phase II
Draw 12 Hours Post-Operation [89838]
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 12 hrs post-
operation
Post-Op/Phase II
Draw Post-Op Day #7 [89840]
HLA CLASS I DONOR SPECIFIC AB BY
LUMINEX [HCDSA1B]
NEXT AM, Starting 1/11/18 at 5:00 AM For 1
Occurrences, Routine
Indicate organ for transplant:
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
HLA CLASS II DONOR SPECIFIC AB BY
LUMINEX [HCDSA2B]
NEXT AM, Starting 1/11/18 at 5:00 AM For 1
Occurrences, Routine
Indicate organ for transplant:
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
C-PEPTIDE [XCPEP] NEXT AM, Starting 1/11/18 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
Draw Daily - Days 1-7 [89841]
HEMATOCRIT [HCT] NEXT AM, Starting today at 5:00 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?
Days 1-7, Post-Op/Phase II
Page 12 of 18
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Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
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WHITE CELL COUNT [WBC] NEXT AM, Starting today at 5:00 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?
Days 1-7, Post-Op/Phase II
BUN [BUN] NEXT AM, Starting today at 5:00 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?
Days 1-7, Post-Op/Phase II
CREATININE [CRET] NEXT AM, Starting today at 5:00 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?
Days 1-7, Post-Op/Phase II
GLUCOSE, FASTING [HCFSGLU] NEXT AM, Starting today at 5:00 AM For 7
Occurrences, Routine, Patient should have nothing to
eat or drink (except water) for a minimum of 8 hours
before test.
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Days 1-7, Post-Op/Phase II
AMYLASE [AMYL] NEXT AM, Starting today at 5:00 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?
Days 1-7, Post-Op/Phase II
LIPASE [LIPS] NEXT AM, Starting today at 5:00 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?
Days 1-7, Post-Op/Phase II
BETA-2 MICROGLOBULIN [XB2MS] NEXT AM, Starting today at 5:00 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?
Days 1-7, Post-Op/Phase II
PLATELET COUNT [PLT] NEXT AM, Starting today at 5:00 AM 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 as needed for
patients receiving antithymocyte globulin treatment.
Days 1-7, Post-Op/Phase II
TACROLIMUS [HCTAC] NEXT AM, Starting today at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
Days 1-7, Post-Op/Phase II
Page 13 of 18
Printed by STRAKA, KEVIN F [KFS1] at 1/4/2018 2:26:22 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
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CYCLOSPORINE [XCYCA] NEXT AM, Starting today at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
Days 1-7, Post-Op/Phase II
CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
CONDITIONAL For 7 Days, Routine, For optimum
diagnosis of sepsis, sample 3-4 sites only on the first
day of a septic episode. Cultures on subsequent days
are of minimal diagnostic value. Culture detects
bacteria, Candida and Cryptococcus. If filamentous
fungi are suspected see Culture, Blood, Filamentous
Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition? Central line for
temperature > 38.5 C
Days 1-7, Post-Op/Phase II
CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
CONDITIONAL For 7 Days, Routine, For optimum
diagnosis of sepsis, sample 3-4 sites only on the first
day of a septic episode. Cultures on subsequent days
are of minimal diagnostic value. Culture detects
bacteria, Candida and Cryptococcus. If filamentous
fungi are suspected see Culture, Blood, Filamentous
Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition? Peripheral for
temperature > 38.5 C
Days 1-7, Post-Op/Phase II
CULTURE, URINE [URC] CONDITIONAL For 7 Days, Routine
Does patient have an indwelling urinary catheter?
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? For temperature >
38.5 C
Days 1-7, Post-Op/Phase II
URINALYSIS WITH MICROSCOPY [UA] 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? For temperature >
38.5 C
Days 1-7, Post-Op/Phase II
CULTURE, STOOL [ST] CONDITIONAL For 3 Days, Routine, Because these
agents do not cause hospital acquired infection,
specimens on patients who have been hospitalized
greater than 3 days will require approval of the
Director of Microbiology or Pathology Resident.
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? For diarrhea
Days 1-7. Maximum 1 draw every 24 hours, Post-
Op/Phase II
Page 14 of 18
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Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
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GLUCOSE [GLU] 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? Draw if bedside blood
glucose monitoring is less than 40 or greater than 400
mg/dL
Days 1-7, Post-Op/Phase II
Draw Daily - Days 8-14 [89842]
HEMATOCRIT [HCT] NEXT AM, Starting 1/11/18 at 5:00 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?
Days 8-14, Post-Op/Phase II
WHITE CELL COUNT [WBC] NEXT AM, Starting 1/11/18 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
Days 8-14, Post-Op/Phase II
BUN [BUN] NEXT AM, Starting 1/11/18 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
Days 8-14, Post-Op/Phase II
CREATININE [CRET] NEXT AM, Starting 1/11/18 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
Days 8-14, Post-Op/Phase II
GLUCOSE, FASTING [HCFSGLU] NEXT AM, Starting 1/11/18 at 5:00 AM For 7
Occurrences, Routine, Patient should have nothing to
eat or drink (except water) for a minimum of 8 hours
before test.
If add on test, what should lab do if unable to add test
to previous specimen?
Days 8-14, Post-Op/Phase II
AMYLASE [AMYL] NEXT AM, Starting 1/11/18 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
Days 8-14, Post-Op/Phase II
LIPASE [LIPS] NEXT AM, Starting 1/11/18 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
Days 8-14, Post-Op/Phase II
BETA-2 MICROGLOBULIN [XB2MS] NEXT AM, Starting 1/11/18 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
Days 8-14, Post-Op/Phase II
TACROLIMUS [HCTAC] NEXT AM, Starting 1/11/18 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
Days 8-14, Post-Op/Phase II
Page 15 of 18
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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

CYCLOSPORINE [XCYCA] NEXT AM, Starting 1/11/18 at 5:00 AM For 7
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
Days 8-14, Post-Op/Phase II
PLATELET COUNT [PLT] CONDITIONAL, Starting 1/11/18 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 for patients
receiving antithymocyte globulin treatment.
Days 8-14, Post-Op/Phase II
CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
CONDITIONAL, Starting 1/11/18 For 7 Days, Routine,
For optimum diagnosis of sepsis, sample 3-4 sites
only on the first day of a septic episode. Cultures on
subsequent days are of minimal diagnostic value.
Culture detects bacteria, Candida and Cryptococcus.
If filamentous fungi are suspected see Culture, Blood,
Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition? Central line for
temperature > 38.5 C
Days 8-14, Post-Op/Phase II
CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
CONDITIONAL, Starting 1/11/18 For 7 Days, Routine,
For optimum diagnosis of sepsis, sample 3-4 sites
only on the first day of a septic episode. Cultures on
subsequent days are of minimal diagnostic value.
Culture detects bacteria, Candida and Cryptococcus.
If filamentous fungi are suspected see Culture, Blood,
Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition? Peripheral for
temperature > 38.5 C
Days 8-14, Post-Op/Phase II
CULTURE, URINE [URC] CONDITIONAL, Starting 1/11/18 For 7 Days, Routine
Does patient have an indwelling urinary catheter?
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? For temperature >
38.5 C
Days 8-14, Post-Op/Phase II
URINALYSIS WITH MICROSCOPY [UA] CONDITIONAL, Starting 1/11/18 For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? As needed for temp >
38.5 C
Days 8-14, Post-Op/Phase II
GLUCOSE [GLU] CONDITIONAL, Starting 1/11/18 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 bedside blood
glucose monitoring is less than 40 or greater than 400
mg/dL
Days 8-14, Post-Op/Phase II
Page 16 of 18
Printed by STRAKA, KEVIN F [KFS1] at 1/4/2018 2:26:22 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Draw Every Monday and Friday - Days 1-7 [89845]
MAGNESIUM [MAG] EVERY MONDAY AND FRIDAY, Starting today For 7
Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Days 1-7, Post-Op/Phase II
PHOSPHATE [PHOS] EVERY MONDAY AND FRIDAY, Starting today with
First Occurrence As Scheduled For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Days 1-7, Post-Op/Phase II
ELECTROLYTES [LYTE] EVERY MONDAY AND FRIDAY, Starting today with
First Occurrence As Scheduled For 7 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Days 1-7, Post-Op/Phase II
Draw Every Tuesday, Wednesday, Thursday, Saturday, and Sunday - Days 1-7 [109178]
POTASSIUM [K] EVERY TUESDAY, WEDNESDAY, THURSDAY,
SATURDAY, AND SUNDAY, 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 days 1-7, Post-Op/Phase II
Draw Every Monday and Friday - Days 8-14 [89846]
MAGNESIUM [MAG] EVERY MONDAY AND FRIDAY, Starting 1/12/18 with
First Occurrence As Scheduled 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 days 8-14, Post-Op/Phase II
PHOSPHATE [PHOS] EVERY MONDAY AND FRIDAY, Starting 1/12/18 with
First Occurrence As Scheduled 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 days 8-14, Post-Op/Phase II
ELECTROLYTES [LYTE] EVERY MONDAY AND FRIDAY, Starting 1/12/18 with
First Occurrence As Scheduled 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 days 8-14, Post-Op/Phase II
Draw Every Tuesday, Wednesday, Thursday, Saturday, and Sunday - Days 8-14 [109179]
POTASSIUM [K] EVERY TUESDAY, WEDNESDAY, THURSDAY,
SATURDAY, AND SUNDAY, Starting 1/12/18 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 days 8-14, Post-Op/Phase II
Consults
Consults [89850]
Page 17 of 18
Printed by STRAKA, KEVIN F [KFS1] at 1/4/2018 2:26:22 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Consult Social Work (Inpatient) [CON0076] ONCE, Starting today For 1 Occurrences, Routine
Reason for Consult: OTHER
Evaluate and treat patient., 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 18 of 18
Printed by STRAKA, KEVIN F [KFS1] at 1/4/2018 2:26:22 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org