/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-97941-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 - Renal Transplant - Recipient - Postoperative [2895]

IP - Renal Transplant - Recipient - Postoperative [2895] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Transplant


IP - Renal Transplant - Recipient - Postoperative [2895]
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 [106265]
Page 1 of 22
Printed by STRAKA, KEVIN F [KFS1] at 1/18/2018 3:11:01 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Admit To Inpatient [ADT0001] Attending:
Admitting Resident:
Requested Floor:
Service:
I certify that an inpatient stay is medically necessary
because of either an anticipated LOS >2 midnights,
complexity and/or severity of illness, an inpatient-only
surgery, or a previously-authorized inpatient stay.
Rationale listed below. Yes
C - CLEAR DIAGNOSIS:
E - EVALUATIONS PLANNED:
R - RESULTS EXPECTED:
T - TREATMENTS ORDERED:
Post-Op/Phase II
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 [121589]
Admit To Inpatient [ADT0001] Attending:
Admitting Resident:
Requested Floor:
Service: RENAL TRANSPLANT
Rationale for LOS greater than 2 midnights:
Post-Op/Phase II
Admit To Observation [ADT0002] Attending:
Admitting Resident:
Requested Floor:
Service:
Post-Op/Phase II
Admit To Outpatient Short Stay [ADT0003] Attending:
Admitting Resident:
Requested Floor:
Service:
Post-Op/Phase II
Transfer Status
Transfer Status [114458]
Transfer Patient [ADT0005] RENAL 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
Page 2 of 22
Printed by STRAKA, KEVIN F [KFS1] at 1/18/2018 3:11:01 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

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
Sequential Compression Device (SCD) / Foot
Pump (SUPPLY) [EQP0023]
CONTINUOUS, Routine
Left/Right/Bilateral?
Type: Knee High
Page 3 of 22
Printed by STRAKA, KEVIN F [KFS1] at 1/18/2018 3:11:01 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

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 22
Printed by STRAKA, KEVIN F [KFS1] at 1/18/2018 3:11:01 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 22
Printed by STRAKA, KEVIN F [KFS1] at 1/18/2018 3:11:01 PM
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 22
Printed by STRAKA, KEVIN F [KFS1] at 1/18/2018 3:11:01 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 22
Printed by STRAKA, KEVIN F [KFS1] at 1/18/2018 3:11:01 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 22
Printed by STRAKA, KEVIN F [KFS1] at 1/18/2018 3:11:01 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 [90444]
Ambulate on night of surgery and then three times
a day [NURACT0008]
CONTINUOUS, Routine
Location:
Ambulate on night of surgery and then three times a
day, Post-Op/Phase II
Nutrition [90445]
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 9 of 22
Printed by STRAKA, KEVIN F [KFS1] at 1/18/2018 3:11:01 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Respiratory [90446]
Pulse Oximetry [NURMON0009] SEE COMMENTS, Starting today For 24 Hours,
Routine, Every 15 minutes x4, then every 2 hours x2,
then every 4 hours., Post-Op/Phase II
Incentive Spirometry [NURTRT0018] EVERY 1 HOUR, Starting today, 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, Routine, Every 2
hours for 24 hours, then PRN (while awake), Post-
Op/Phase II
Oxygen Therapy [RT0032] CONTINUOUS, Starting today, Routine
FiO2 (%) Titrate to Keep Sats >/= to ___%:
Liter Flow:
Titrate oxygen to maintain O2 sat at (%): 94
O2 Delivery Device:
Attempt to Wean Off Oxygen? Yes
Post-Op/Phase II
Intake and Output [90447]
Measure Intake And Output [NURMON0005] EVERY 4 HOURS, Starting today, Routine, Post-
Op/Phase II
Measure Urine Output [NURMON0012] SEE COMMENTS, Starting today, Routine, Every 1
hour for 24 hours, then every 4 hours while urinary
catheter is in place., Post-Op/Phase II
Patient Monitoring [136012]
Measure Weight [NURMON0015] 1X DAILY, Starting today, Routine
Weigh With?
Weigh when?
Post-Op/Phase II
Maintain Drain [NURTAD0003] CONTINUOUS, Starting today, Routine
Type: Closed Suction (Jackson-Pratt)
Site:
Location:
Drainage Options:
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
Glucose, POC [IPGLUCOSE] 4X DAILY, 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?
For diabetic patients., Post-Op/Phase II
Page 10 of 22
Printed by STRAKA, KEVIN F [KFS1] at 1/18/2018 3:11:01 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

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
Does this need to be inserted/placed?
Post-Op/Phase II
Intermittent Manual Urinary Catheter Irrigation
[NURELM0070]
PRN For Until specified, Routine, Low urine output is
not an indication for irrigation.
Irrigation through the catheter sampling port is NOT
recommended practice.
Does not apply to Pediatric patients.
Indication for Irrigation:
Irrigate With: Normal Saline
Amount to irrigate with: Up to 60 mL
Method of Irrigation:
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
Non-Categorized Patient Care Orders [90064]
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
Glucose, POC [IPGLUCOSE] AS NEEDED FOR SIGNS AND SYMPTOMS OF
HYPOGLYCEMIA, Routine, Glucose, POC should
always be ordered in conjunction with orders for
hypoglycemia management and monitoring as
indicated in the Hypoglycemia Management (Adult)
panel.
If Conditional, What Condition?
Post-Op/Phase II
Contingency Parameters [90065]
Page 11 of 22
Printed by STRAKA, KEVIN F [KFS1] at 1/18/2018 3:11:01 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): 400
If blood glucose < (mg/dL): 40
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL): 30 mL/hr for first 48 hours
Other:
Post-Op/Phase II
Intravenous Therapy
IV Fluids [90067]
dextrose 5%-NaCl 0.45% infusion [51613] at 30-200 mL/hr, Intravenous, CONTINUOUS For 24
Hours
Infuse 30 mL/hr + urine output volume (max of 200
mL/hr) for 24 hours post-op
Post-Op/Phase II
dextrose 5%-NaCl 0.45% infusion [51613] at 50-100 mL/hr, Intravenous, CONTINUOUS Starting
tomorrow
Infuse at 50 mL/hr for urinary output less than or equal
to 30 mL/hr starting 24 hours post-operatively. Infuse
at 100 mL/hr for urinary output greater than 30 mL/hr
starting 24 hours post-operatively
Post-Op/Phase II
Medications - General
Analgeics - Acetaminopen - Oral - PRN [241916]
acetaMINOPHEN (TYLENOL) tab [34149] 650 mg, Oral, EVERY 4 HOURS PRN, pain
See Pain Management Algorithm for Selection of As-
Needed Analgesics
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 alcohol free (TYLENOL) oral
suspension [800005]
650 mg, Oral, EVERY 4 HOURS PRN, pain
See Pain Management Algorithm for Selection of As-
Needed Analgesics
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
Analgesics - Opioids - Intravenous - PRN [241917]
HYDROmorphone PF (DILAUDID) injection
[750050]
0.4-1 mg, Intravenous, EVERY 4 HOURS PRN
See Pain Management Algorithm for the Selection of
As-Needed Analgesics
for 3 Minutes, Post-Op/Phase II
Analgesics - Opioids - Oral - PRN [241918]
oxycodone tab RANGE [750032] 5-10 mg, Oral, EVERY 6 HOURS PRN, pain
See Pain Management Algorithm for the Selection of
As-needed Analgesics
Anti-emetics [241919]
Page 12 of 22
Printed by STRAKA, KEVIN F [KFS1] at 1/18/2018 3:11:01 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Adult - Standard - Anti-emetics [241921]
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
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
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 [241922]
Adult - Bowel Management - Scheduled
[241925]
senna-docusate (SENOKOT S) 8.6-50 MG per
tab [60530]
2 tab, Oral, 2 X DAILY, Post-Op/Phase II
Page 13 of 22
Printed by STRAKA, KEVIN F [KFS1] at 1/18/2018 3:11:01 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Adult - Bowel Management - As Needed
[241926]
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
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
Candida Prophylaxis [193330]
nystatin (MYCOSTATIN) susp [40456] 5 mL, Swish & Swallow, 2 X DAILY Starting tomorrow
For 30 Days, Post-Op/Phase II
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
Non-Categorized [135857]
sodium chloride flush 0.9% 10 mL injection
[785055]
Flush, PRN, flush/line care
Flush per VAD guidelines
Post-Op/Phase II
calcium carbonate (TUMS) chew tab [44477] 1,000 mg, Oral, EVERY 4 HOURS PRN, dyspepsia,
Post-Op/Phase II
heparin lock flush 10 UNIT/ML injection [75031] 1-150 units, Flush, PRN, flush/line care
Flush per VAD guidelines
Post-Op/Phase II
aspirin chew tab [720014] 81 mg, Oral, 1 X DAILY Starting tomorrow
Administer on Post Op Day 1
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 Post Op 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
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 per minute.
Notify physician if administered
Medications - Anti-virals
Anti-virals - NOTE: Order BOTH for CMV Donor (-)/Recipient (-) [90601]
acyclovir (ZOVIRAX) tab [44027] 400 mg, Oral, 2 X DAILY Starting today For 90 Days
with First Dose As Scheduled
NOTE: Order for CMV Donor (-)/Recipient (-)
Post-Op/Phase II
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
Medications - PJP Prophylaxis - NOTE: Order one regimen only
Page 14 of 22
Printed by STRAKA, KEVIN F [KFS1] at 1/18/2018 3:11:01 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

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
Medications - Immunosuppression
Purine Synthesis Inhibitors - Maintenance Doses (Single Response) [154905]
mycophenolate sodium (MYFORTIC) delayed
release tab [75184]
720 mg, Oral, 2 X DAILY (AT MEALTIME) Starting
today, Post-Op/Phase II
Steroid Taper (Single Response) [193011]
Corticosteroid Continuation Taper [193013]
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
1/20/18 For 1 Doses, Post-Op/Phase II
dexamethasone (DECADRON) intraVENOUS
[800037]
12 mg, Intravenous, 1 X DAILY (NOON) Starting
1/21/18 For 1 Doses, Post-Op/Phase II
prednisone (DELTASONE) tab [41277] 30 mg, Oral, 1 X DAILY Starting 1/22/18 For 7
Doses, Post-Op/Phase II
Note: Steroid taper [950018] 1 X DAILY Starting 1/29/18
prednisone 25mg oral 1x daily starting POD10,
20mg oral 1 x daily starting POD17, 15mg oral 1x
daily starting POD24, 10mg oral 1 x daily starting
POD30
Early Steroid Withdrawal Taper (NOTE: Use for
HLA Identical patients or for patients on an early
steroid withdrawal protocol) [193020]
dexamethasone (DECADRON) intraVENOUS
[800037]
50 mg, Intravenous, 1 X DAILY Starting tomorrow
For 1 Doses, Post-Op/Phase II
dexamethasone (DECADRON) intraVENOUS
[800037]
18 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
prednisone (DELTASONE) tab [41277] 30 mg, Oral, 1 X DAILY Starting 1/22/18 For 1
Doses, Post-Op/Phase II
Note: Early steriod withdrawal. Last dose of
steriods. [950018]
ONCE Starting 1/22/18 For 1 Doses, Post-Op/Phase
II
Laboratory
Draw 6 Hours Post-Operation [90089]
Page 15 of 22
Printed by STRAKA, KEVIN F [KFS1] at 1/18/2018 3:11:01 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

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 hours 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 hours post-
operation
Post-Op/Phase II
Draw 12 Hours Post-Operation [90090]
HEMATOCRIT [HCT] CONDITIONAL For 1 Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
Post-Op/Phase II
Draw Postoperative Day 2 [121596]
BILIRUBIN, TOTAL [TBIL] NEXT AM, Starting 1/21/18 For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
ALKALINE PHOSPHATASE [ALKP] NEXT AM, Starting 1/21/18 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] NEXT AM, Starting 1/21/18 For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
AST/SGOT [AST] NEXT AM, Starting 1/21/18 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
AMYLASE [AMYL] NEXT AM, Starting 1/21/18 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] NEXT AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
Page 16 of 22
Printed by STRAKA, KEVIN F [KFS1] at 1/18/2018 3:11:01 PM
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 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
ELECTROLYTES [LYTE] NEXT AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
CALCIUM [CA] NEXT AM For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Post-Op/Phase II
Draw Daily - Days 1-7 [90091]
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?
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?
Days 1-7, Post-Op/Phase II
CREATININE [CRET] NEXT AM For 7 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
Days 1-7, Post-Op/Phase II
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 as needed
for temp > 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 as needed
for temp > 38.5 C
Days 1-7, Post-Op/Phase II
Page 17 of 22
Printed by STRAKA, KEVIN F [KFS1] at 1/18/2018 3:11:01 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

CULTURE, STOOL [ST] CONDITIONAL For 7 Days, Routine, Because these
agents do not cause hospital acquired infection,
specimens on patients who have been hospitalized
greater than 3 days will require approval of the
Director of Microbiology or Pathology Resident.
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition? As needed for
diarrhea
Days 1-7. Maximum 1 draw every 24 hours, 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? As needed for temp >
38.5 C
Days 1-7, Post-Op/Phase II
GLUCOSE, FASTING [HCFSGLU] NEXT 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 1-7, Post-Op/Phase II
GLUCOSE [GLU] CONDITIONAL, 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
HEMATOCRIT [HCT] NEXT AM For 7 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
Days 1-7, Post-Op/Phase II
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?
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? As needed for temp >
38.5 C
Days 1-7, Post-Op/Phase II
WHITE CELL COUNT AND DIFFERENTIAL
[WBCD]
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
Draw Daily - Days 8-14 [90092]
Page 18 of 22
Printed by STRAKA, KEVIN F [KFS1] at 1/18/2018 3:11:01 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

BETA-2 MICROGLOBULIN [XB2MS] NEXT AM, Starting 1/26/18 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 1/26/18 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 1/26/18 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, Starting 1/26/18 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 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, Starting 1/26/18 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 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, URINE [URC] CONDITIONAL, Starting 1/26/18 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? As needed for temp >
38.5 C
Days 8-14, Post-Op/Phase II
Page 19 of 22
Printed by STRAKA, KEVIN F [KFS1] at 1/18/2018 3:11:01 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

GLUCOSE, FASTING [HCFSGLU] NEXT AM, Starting 1/26/18 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 8-14, Post-Op/Phase II
GLUCOSE [GLU] CONDITIONAL, Starting 1/26/18 For 7 Occurrences,
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
HEMATOCRIT [HCT] NEXT AM, Starting 1/26/18 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
PLATELET COUNT [PLT] NEXT AM, Starting 1/26/18 For 7 Occurrences,
Routine
If Conditional, What Condition?
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, Starting 1/26/18 For 7 Days, Routine
If Conditional, What Condition? 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
WHITE CELL COUNT AND DIFFERENTIAL
[WBCD]
NEXT AM, Starting 1/26/18 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
POTASSIUM [K] NEXT AM, Starting 1/26/18 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
Consults
Consults [90096]
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]
Page 20 of 22
Printed by STRAKA, KEVIN F [KFS1] at 1/18/2018 3:11:01 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

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):
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
Page 21 of 22
Printed by STRAKA, KEVIN F [KFS1] at 1/18/2018 3:11:01 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Consult Diabetes Education - Nutrition (Inpatient)
[CON0126]
ONCE, Routine, · If your patient is newly diagnosed
and/or is new to insulin therapy, provide 24 hours
notice to allow adequate time for nutrition education.
· Indicate diabetes medication/treatment plan if
known.
· Consults requested after 1300 on Friday may not
be completed until the following Monday.
· If you are placing a consult on a weekend day for a
patient who will be discharging that weekend, please
have the Paging Center contact the on-call dietitian
to help you facilitate the diabetes nutrition education
session prior to the patient's discharge.
Type of Education: Diabetes Self-Management
Education
Reason For Consult:
Expected Discharge Date:
Diabetes management / treatment plan:
Can this consult be done via video?
Post-Op/Phase II
Consult Learning Center (Inpatient) [CON0058] ONCE, Starting today For 1 Occurrences, Routine
Type of Education:
Reason for Consult:
Expected Discharge Date:
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 22 of 22
Printed by STRAKA, KEVIN F [KFS1] at 1/18/2018 3:11:01 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org