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/clinical/cckm-tools/content/order-sets/inpatient/transplant/name-97931-en.cckm

20170497

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UWHC,UWMF,

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

IP - Renal or Pancreas Transplant - Surgical Readmission - Adult - Postoperative [2926]

IP - Renal or Pancreas Transplant - Surgical Readmission - Adult - Postoperative [2926] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Transplant


IP - Renal or Pancreas Transplant - Adult - Surgical Readmission -
Postoperative [2926]
for First Day Surgery (FDS) and Inpatient postoperative status; post Use
surgical kidney or pancreas transplant patients.
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 [84057]
Page 1 of 15
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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 15
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VTE Prophylaxis - Reason Not Ordered
[COR0008]
ONCE, Routine
Reason Not Ordered: Low Risk
Post-Op/Phase II
Moderate VTE Risk with Low Bleed Risk (Single
Response) [209954]
enoxaparin (LOVENOX) subcutaneous injection
[800040]
40 mg, Subcutaneous, EVERY 24 HOURS, Post-
Op/Phase II
heparin PF 5000 UNIT/0.5ML injection [156571] 5,000 units, Subcutaneous, EVERY 12 HOURS,
Post-Op/Phase II
High VTE with Low Bleed Risk [211018]
enoxaparin (LOVENOX) subcutaneous injection
[800040]
40 mg, Subcutaneous, EVERY 24 HOURS, Post-
Op/Phase II
heparin PF 5000 UNIT/0.5ML injection [156571] 5,000 units, Subcutaneous, EVERY 8 HOURS,
Post-Op/Phase II
Sequential Compression Device (SCD)
(TREATMENT) [NURTRT0028]
CONTINUOUS, Routine
Left/Right/Bilateral? Bilateral
Sequential Compression Device (SCD) / Foot
Pump (SUPPLY) [EQP0023]
CONTINUOUS, Routine
Left/Right/Bilateral?
Type: Knee High
High Bleed Risk [129757]
Sequential Compression Device (SCD)
(TREATMENT) [NURTRT0028]
CONTINUOUS, Routine
Left/Right/Bilateral? Bilateral
Sequential Compression Device (SCD) / Foot
Pump (SUPPLY) [EQP0023]
CONTINUOUS, Routine
Left/Right/Bilateral?
Type: Knee High
Apply and Maintain Anti-Embolism Stocking
[NURTRT0039]
CONTINUOUS, Routine
Does this need to be inserted/placed?
Left/Right/Bilateral? Bilateral
Type: Knee high
Post-Op/Phase II
No VTE Prophylaxis [130084]
VTE Prophylaxis - Reason Not Ordered
[COR0008]
ONCE, Routine
Reason Not Ordered:
Post-Op/Phase II
VTE Prophylaxis (Single Response) [150176]
Caprini VTE Risk Assessment URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/hematology-and-
coagulation/related/name-97521-en.cckm
Low VTE Risk [130084]
VTE Prophylaxis - Reason Not Ordered
[COR0008]
ONCE, Routine
Reason Not Ordered: Low Risk
Post-Op/Phase II
Moderate VTE Risk with Low Bleed Risk (Single
Response) [209954]
enoxaparin (LOVENOX) subcutaneous injection
[800040]
40 mg, Subcutaneous, EVERY 24 HOURS, Post-
Op/Phase II
heparin PF 5000 UNIT/0.5ML injection [156571] 5,000 units, Subcutaneous, EVERY 12 HOURS,
Post-Op/Phase II
High VTE with Low Bleed Risk [211018]
enoxaparin (LOVENOX) subcutaneous injection
[800040]
40 mg, Subcutaneous, EVERY 24 HOURS, Post-
Op/Phase II
heparin PF 5000 UNIT/0.5ML injection [156571] 5,000 units, Subcutaneous, EVERY 12 HOURS,
Post-Op/Phase II
Sequential Compression Device (SCD)
(TREATMENT) [NURTRT0028]
CONTINUOUS, Routine
Left/Right/Bilateral? Bilateral
Page 3 of 15
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Sequential Compression Device (SCD) / Foot
Pump (SUPPLY) [EQP0023]
CONTINUOUS, Routine
Left/Right/Bilateral?
Type: Knee High
High Bleed Risk [129757]
Sequential Compression Device (SCD)
(TREATMENT) [NURTRT0028]
CONTINUOUS, Routine
Left/Right/Bilateral? Bilateral
Sequential Compression Device (SCD) / Foot
Pump (SUPPLY) [EQP0023]
CONTINUOUS, Routine
Left/Right/Bilateral?
Type: Knee High
Apply and Maintain Anti-Embolism Stocking
[NURTRT0039]
CONTINUOUS, Routine
Does this need to be inserted/placed?
Left/Right/Bilateral? Bilateral
Type: Knee high
Post-Op/Phase II
No VTE Prophylaxis [130084]
VTE Prophylaxis - Reason Not Ordered
[COR0008]
ONCE, Routine
Reason Not Ordered:
Post-Op/Phase II
Patient Care Orders
Vital Signs [135048]
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 [90579]
Ambulate on night of surgery and then three
times a day [NURACT0008]
CONTINUOUS, Routine
AD LIB:
AMBULATE:
CHAIR:
DANGLE:
BEDREST:
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Post-Op/Phase II
Nutrition [90545]
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
Page 4 of 15
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Diabetes Meal Plan [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: Diet Modifications
Diet Modifications: Diabetes
Bedside Meal Instructions:
Room Service Class:
Post-Op/Phase II
General Diet [NUT9999] EFFECTIVE NOW, Starting today, Routine
Patient Type: Adult
Diet Type: General (no Modifications)
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
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
Respiratory [90546]
Incentive Spirometry [NURTRT0018] EVERY 1 HOUR, Starting today For Until specified,
Routine, Every 1 hr for 24 hours, then PRN while
awake., Post-Op/Phase II
Turn, Cough And Deep Breathe [NURTRT0022] EVERY 2 HOURS, Starting today For Until specified,
Routine, Every 2 hrs for 24 hours, then PRN while
awake., Post-Op/Phase II
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
Page 5 of 15
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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 (%): 92
O2 Delivery Device: Nasal Cannula
Attempt to Wean Off Oxygen? Yes
As needed, Post-Op/Phase II
Intake and Output [90547]
Measure Intake And Output [NURMON0005] EVERY 4 HOURS, Starting today For Until specified,
Routine, Post-Op/Phase II
Patient Monitoring [136299]
Measure Height [NURMON0052] ONCE For 1 Occurrences, Routine, Measure upon
admission. Must measure using anthropometric
"measuring rod", Pre-Op Day Of Procedure
Measure Weight - Once Upon Admission
[NURMON0015]
ONCE For 1 Occurrences, Routine
Weigh With?
Weigh when?
Pre-Op Day Of Procedure
Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
Pre-Op Day Of Procedure
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
Maintain Drain [NURTAD0003] CONTINUOUS, Starting today, Routine
Type: Closed Suction (Jackson-Pratt)
Site:
Location:
Drainage Options: Bulb
Irrigate Frequency:
Irrigate With:
Irrigant Volume (mL):
Strip:
Strip For:
Dressing Change Frequency:
Dressing Type:
Post-Op/Phase II
Non-Categorized Patient Care Orders [90548]
Monitoring and Insulin Supplemental" Order Set for all Glucose -Adult -to "Diabetes Management Refer
Therapy
Heel Protector (foot pillow and positoner)
[NURCOM0022]
CONTINUOUS, Starting today For Until specified,
Post-Op/Phase II
Glucose, POC [IPGLUCOSE] 4X DAILY, Starting today For 4 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?
4 times a day for diabetic patients., Post-Op/Phase II
Contingency Parameters [90549]
Page 6 of 15
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Notify Provider [NURCOM0001] CONTINUOUS
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): 400
If blood glucose < (mg/dL): 40
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL): 240 mL/8 hours
Other:
Post-Op/Phase II
Intravenous Therapy
IV Fluids (Single Response) [90551]
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, Post-
Op/Phase II
Medications - General
Analgesics - Acetaminophen - PRN [222149]
acetaMINOPHEN (TYLENOL) tab [34149] 650 mg, Oral, EVERY 4 HOURS PRN, pain, mild to
moderate pain, multimodal therapy, or fever greater
than 38.2 degrees Celsius
Mild to moderate pain
No more than 4 grams of acetaminophen per 24
hours for adults or 15 mg/kg per dose for peds < 40
kg
Post-Op/Phase II
acetaMINOPHEN (TYLENOL) suppository
[43994]
650 mg, Rectal, EVERY 6 HOURS PRN, pain/fever,
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
Administer when patient unable to take orally
Post-Op/Phase II
Analgesics - Opioids - Intravenous- PRN (Single Response) [222194]
HYDROmorphone PF (DILAUDID) injection
RANGE [750050]
0.4-1 mg, Intravenous, EVERY 4 HOURS PRN, pain
Administer when patient unable to tolerate oral
for 3 Minutes, Post-Op/Phase II
Analgesics - Opioids - Oral - PRN [90553]
oxycodone tab RANGE [750032] 5-10 mg, Oral, EVERY 6 HOURS PRN, pain, Severe
pain
Begin when patient no longer taking IV narcotics.
Post-Op/Phase II
Anti-emetics [137088]
ondansetron (ZOFRAN ODT) dispersible tab
[64224]
4 mg, Oral, EVERY 8 HOURS PRN, nausea/vomiting
For 1st line therapy
Post-Op/Phase II
Page 7 of 15
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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
prochlorperazine (COMPAZINE) tab [41372] 10 mg, Oral, EVERY 6 HOURS PRN,
nausea/vomiting
For second line therapy if unresponsive to first line
therapy within 30 minutes
Post-Op/Phase II
prochlorperazine (COMPAZINE) injection [41369] 10 mg, Intravenous, EVERY 6 HOURS PRN,
nausea/vomiting
For second line therapy. Administer if patient is
unable to tolerate orally and unresponsive to first line
therapy within 30 minutes
If ordered IV: push slowly, max rate 5 mg/minute.
Post-Op/Phase II
Anti-hypertensives - As needed [90555]
cloNIDINE (CATAPRES) tab [720040] 0.1 mg, Oral, EVERY 4 HOURS PRN, 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, 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 more than 85 beats per minute
Post-Op/Phase II
Bowel Management [90556]
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, ONCE For 1 Doses
For 2nd line therapy. Administer when there is no
response to 1st line therapy or when immediate
laxation is needed
Post-Op/Phase II
Non-categorized [90557]
Page 8 of 15
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calcium carbonate (TUMS) chew tab [44477] 1,000 mg, Oral, EVERY 4 HOURS PRN, dyspepsia,
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
Laboratory
Draw 6 Hours Post-Op [90561]
HEMATOCRIT [HCT] CONDITIONAL - RN COLLECT For 1 Days, Routine
If Conditional, What Condition? 6 hours post-op
If add on test, what should lab do if unable to add test
to previous specimen?
Post-Op/Phase II
POTASSIUM [K] CONDITIONAL - RN COLLECT For 1 Days, Routine
If Conditional, What Condition? 6 hours post-op
If add on test, what should lab do if unable to add test
to previous specimen?
Post-Op/Phase II
Draw Daily - Days 1-7 [90562]
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?
Days 1-7, Post-Op/Phase II
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?
Days 1-7, Post-Op/Phase II
CREATININE [CRET] NEXT AM For 7 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Days 1-7, 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?
Days 1-7, Post-Op/Phase II
POTASSIUM [K] 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?
Days 1-7, 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?
Days 1-7, Post-Op/Phase II
BETA-2 MICROGLOBULIN [XB2MS] 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?
Days 1-7, Post-Op/Phase II
Page 9 of 15
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CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
CONDITIONAL - RN COLLECT 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 as
needed for temp > 38.5 C
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 - RN COLLECT 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 as needed
for temp > 38.5 C
If add on test, what should lab do if unable to add test
to previous specimen?
Days 1-7, Post-Op/Phase II
URINALYSIS WITH MICROSCOPY [UA] CONDITIONAL - RN COLLECT, Starting today For 7
Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? As needed for temp >
38.5 C
Days 1-7, Post-Op/Phase II
CULTURE, URINE [URC] CONDITIONAL - RN COLLECT 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? as needed for temp >
38.5 C
Days 1-7, Post-Op/Phase II
CULTURE, STOOL [ST] CONDITIONAL - RN COLLECT For 7 Days, Routine,
Because these agents do not cause hospital acquired
infection, specimens on patients who have been
hospitalized greater than 3 days will require approval
of the Director of Microbiology or Pathology Resident.
If Conditional, What Condition? As needed for
diarrhea
If add on test, what should lab do if unable to add test
to previous specimen?
Days 1-7, Post-Op/Phase II
Page 10 of 15
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GLUCOSE [GLU] CONDITIONAL - RN COLLECT 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
Days 1-7, Post-Op/Phase II
AMYLASE [AMYL] 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?
Days 1-7, Post-Op/Phase II
LIPASE [LIPS] 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?
Days 1-7, Post-Op/Phase II
TACROLIMUS [HCTAC] 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?
Days 1-7, Post-Op/Phase II
CYCLOSPORINE [XCYCA] 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?
Days 1-7, Post-Op/Phase II
Draw Daily - Days 8-14 [90563]
HEMATOCRIT [HCT] NEXT AM, Starting 4/12/17 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 4/12/17 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
CREATININE [CRET] NEXT AM, Starting 4/12/17 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
BUN [BUN] NEXT AM, Starting 4/12/17 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
Page 11 of 15
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POTASSIUM [K] NEXT AM, Starting 4/12/17 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
GLUCOSE [GLU] NEXT AM, Starting 4/12/17 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
BETA-2 MICROGLOBULIN [XB2MS] NEXT AM, Starting 4/12/17 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
CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
CONDITIONAL - RN COLLECT, Starting 4/12/17 For
7 Days, Routine, For optimum diagnosis of sepsis,
sample 3-4 sites only on the first day of a septic
episode. Cultures on subsequent days are of minimal
diagnostic value. Culture detects bacteria, Candida
and Cryptococcus. If filamentous fungi are suspected
see Culture, Blood, Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition? Central line as
needed for temp > 38.5 C
If add on test, what should lab do if unable to add test
to previous specimen?
Days 8-14, Post-Op/Phase II
CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
CONDITIONAL - RN COLLECT, Starting 4/12/17 For
7 Days, Routine, For optimum diagnosis of sepsis,
sample 3-4 sites only on the first day of a septic
episode. Cultures on subsequent days are of minimal
diagnostic value. Culture detects bacteria, Candida
and Cryptococcus. If filamentous fungi are suspected
see Culture, Blood, Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition? peripheral as needed
for temp > 38.5 C
If add on test, what should lab do if unable to add test
to previous specimen?
Days 8-14, Post-Op/Phase II
URINALYSIS WITH MICROSCOPY [UA] CONDITIONAL - RN COLLECT, Starting 4/12/17 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
Page 12 of 15
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04/2017CCKM@uwhealth.org

CULTURE, URINE [URC] CONDITIONAL - RN COLLECT, Starting 4/12/17 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? as needed for temp >
38.5 C
Days 8-14, Post-Op/Phase II
GLUCOSE [GLU] CONDITIONAL - RN COLLECT, Starting 4/12/17 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
Days 8-14, Post-Op/Phase II
AMYLASE [AMYL] NEXT AM, Starting 4/12/17 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
LIPASE [LIPS] NEXT AM, Starting 4/12/17 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
TACROLIMUS [HCTAC] NEXT AM, Starting 4/12/17 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
CYCLOSPORINE [XCYCA] NEXT AM, Starting 4/12/17 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
Draw Every Monday and Friday - Days 1-7 [90564]
MAGNESIUM [MAG] 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
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
Draw Every Monday and Friday - Days 8-14 [90565]
Page 13 of 15
Printed by STRAKA, KEVIN F [KFS1] at 4/5/2017 12:39:45 PM
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04/2017CCKM@uwhealth.org

MAGNESIUM [MAG] EVERY MONDAY AND FRIDAY, Starting 4/12/17
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 8-14, Post-Op/Phase II
PHOSPHATE [PHOS] EVERY MONDAY AND FRIDAY, Starting 4/12/17
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 8-14, Post-Op/Phase II
Consults
Consults [90567]
Consult Social Work (Inpatient) [CON0076] ONCE, Starting today For 1 Occurrences, Routine
Reason for Consult: OTHER
Evaluate and treat patient., 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
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):
Page 14 of 15
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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
Page 15 of 15
Printed by STRAKA, KEVIN F [KFS1] at 4/5/2017 12:39:45 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
04/2017CCKM@uwhealth.org