/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/vascular-surgery/,

/clinical/cckm-tools/content/order-sets/inpatient/vascular-surgery/name-97884-en.cckm

201712341

page

100

UWHC,UWMF,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,Vascular Surgery

IP - Vascular Surgery - Arteriogram - Femoral Approach without Sheath - Adult - Intermediate/General Care - Postprocedure [1017]

IP - Vascular Surgery - Arteriogram - Femoral Approach without Sheath - Adult - Intermediate/General Care - Postprocedure [1017] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Vascular Surgery


IP - Vascular Surgery - Arteriogram - Femoral Approach without Sheath - Adult -
Intermediate/General Care - Postprocedure [1017]
for Adult Patients OnlyIntended
Admission Status
Level of Care (Single Response) [187485]
*An admit patient order has already been written, but the level of care at which the patient
should be placed still needs to be identified.
Place Patient on General Care [ADT0018] General Care, has already been signed. This order
will ensure that the patient is placed at the appropriate
level of care.
Place Patient on Intermediate Care (IMC)
[ADT0018]
Intermediate Care, has already been signed. This
order will ensure that the patient is placed at the
appropriate level of care.
Place Patient on Intensive Care (ICU) [ADT0018] Intensive Care, has already been signed. This order
will ensure that the patient is placed at the appropriate
level of care.
Admit to Inpatient (Single Response) [188296]
Admit To Inpatient [ADT0001] Attending:
Admitting Resident:
Requested Floor:
Service:
I certify that an inpatient stay is medically necessary
because of either an anticipated LOS >2 midnights,
complexity and/or severity of illness, an inpatient-
only surgery, or a previously-authorized inpatient
stay. Rationale listed below. Yes
C - CLEAR DIAGNOSIS:
E - EVALUATIONS PLANNED:
R - RESULTS EXPECTED:
T - TREATMENTS ORDERED:
Post-Op/Phase II
Admit to Observation (Single Response)
[188297]
Admit To Observation [ADT0002] Attending:
Admitting Resident:
Requested Floor:
Service:
Post-Op/Phase II
Admit to Outpatient Short Stay (Single
Response) [188298]
Admit To Outpatient Short Stay [ADT0003] Attending:
Admitting Resident:
Requested Floor:
Service:
Post-Op/Phase II
Admission Status (Single Response) [198873]
Page 1 of 10
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 12:42:00 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@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 (Single Response) [107912]
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:
Admit To Observation [ADT0002] Attending:
Admitting Resident:
Requested Floor:
Service:
Admit To Outpatient Short Stay [ADT0003] Attending:
Admitting Resident:
Requested Floor:
Service:
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 10
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 12:42:00 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@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 10
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 12:42:00 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@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
Patient Care Orders
Vital Signs [13989]
Vital Signs [NURMON0013] SEE COMMENTS, Routine
Temperature Measurement Method:
Temperature Measurement Restrictions:
BP Source:
BP Location:
BP Position:
BP Restrictions:
Every 15 minutes times 4, then every 30 minutes
times 4, then every hour times 4, then every 4 hours
times 2, then every 8 hours.
Check Pulse [NURMON0008] SEE COMMENTS, Routine
Method:
Pulse Side: Bilateral
Pulse Location: Pedal,Posterial Tibial
Every 15 minutes times 4, then every 30 minutes
times 4, then every hour times 4, then every 4 hours
times 2, then every 8 hours.
Patient Monitoring [198964]
Monitor Entry Site [NURMON0060] SEE COMMENTS, Starting today, Site: Femoral
Artery
Location: {right, left, bilaterally:4001510}
Monitor entry site for hematoma or new bleeding every
15 minutes times 4, then every 30 minutes times 4,
then every hour times 4, then every 4 hours times 2,
then every 8 hours. Keep entry site clean and dry for
24 hours postprocedure. Apply direct pressure to
procedure site for hematoma or persistent bleeding.,
Post-Op/Phase II
High Risk Entry Site [NURCOM0022] CONTINUOUS, Pain in the flank, back, or abdomen
may indicate internal bleeding. Notify Vascular
Surgery resident on call., Post-Op/Phase II
For bleeding, oozing, swelling, or hematoma at
entry site [NURCOM0022]
CONTINUOUS, For bleeding, oozing, swelling, or
hematoma at entry site
-Apply direct manual pressure
-Notify Vascular Surgery resident on call
-Do not apply sandbag, Post-Op/Phase II
Page 4 of 10
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 12:42:00 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

Neurovascular Checks [NURMON0045] SEE COMMENTS, Starting today For Until specified,
Routine
Location:
Location: {right, left, bilateral:4001510} lower
extremity.
Every 15 minutes times 4, then every 30 minutes
times 4, then every hour times 4, then every 4 hours
times 2, then every 8 hours., Post-Op/Phase II
Activity [13990]
Bed Rest [NURACT0008] CONTINUOUS, Starting today, Routine
AD LIB:
AMBULATE:
CHAIR:
DANGLE:
BEDREST: other (comment)
RESTRICTIONS:
UPPER LEFT EXTREMITY WEIGHT BEARING:
UPPER RIGHT EXTREMITY WEIGHT BEARING:
LOWER LEFT EXTREMITY WEIGHT BEARING:
LOWER RIGHT EXTREMITY WEIGHT BEARING:
Ambulate [NURACT0008] CONTINUOUS, Starting today, 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:
Starting *** hours post sheath removal.
Elevate Head Of Bed [NURACT0002] Equal to (degrees): 0
Greater than (degrees):
Less than (degrees):
Other options:
Routine, CONTINUOUS, Starting today, For 1 hour
post sheath removal.
May Elevate Head Of Bed [NURACT0002] Equal to (degrees):
Greater than (degrees):
Less than (degrees): 45
Other options:
Routine, CONTINUOUS, Starting today, Starting 1
hour post sheath removal.
Nutrition [13991]
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
Page 5 of 10
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 12:42:00 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

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
Wound/Procedure Site Care [13992]
Wound Care - Closed Incision (Adult)
[NURWND0055]
CONTINUOUS, Routine
Wound Site:
Wound Location:
Assess Frequency: SEE COMMENTS (Q 15 min x4,
Q 30 min x4, Q 1 hr x4, Q 4 hr x2, then Q 8 h)
Incision Closed With: Pressure
Incision Care: Cleanse daily with CHG
Primary Dressing (after 48 hours): Other (Comment)
(dry gauze & tegaderm)
Monitor for hematoma or new bleeding, apply direct
pressure to procedure site for hematoma or persistent
bleeding, Post-Op/Phase II
Apply Direct Pressure [NURTRT0041] SEE COMMENTS, Starting today, Routine
Site: Affected Area
As needed for hematoma or persistent bleeding.,
Post-Op/Phase II
Non-Categorized Patient Care Orders [109440]
Measure Ankle/Brachial Index - Post Procedure
[NURMON0017]
ONCE For 1 Occurrences, Routine, To be done by
nursing upon return to inpatient unit.
Measure Ankle/Brachial Index - POD 1
[NURMON0017]
ONCE For 1 Occurrences, Routine, To be done by
nursing in the morning on postoperative day 1. No
need for formal studies unless this is abnormal.
Contingency Parameters [13993]
Notify [NURCOM0001] Provider to Notify: Provider
If systolic blood pressure > (mmHg):
If systolic blood pressure < (mmHg): ***
If diastolic blood pressure > (mmHg): ***
If diastolic blood pressure < (mmHg):
If temperature > (C):
If temperature < (C):
If heart rate > (bpm): 100
If heart rate < (bpm): 50
If respiratory rate >:
If respiratory rate <:
If blood glucose > (mg/dL): 400
If blood glucose < (mg/dL): 40
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL):
Other: Any signs of bleeding,Back pain,Absence of
lower extremity pulse,Change in pulse exam,If
Ankle/Brachial Index decreases by 0.15 or greater
Intravenous Therapy
Premedications for Needle Insertion [106327]
Page 6 of 10
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 12:42:00 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

Use lidocaine topical dressing kit for stable patient, no lidocaine allergies, have at least 30
minutes time prior to needing to use IV
Sodium chloride (bacteriostatic) 0.9% intradermal: Useful for patients requiring urgent IV
access; onset is immediate.
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Routine
Peripheral IV Size: RN Discretion
Does this need to be inserted/placed?
Post-Op/Phase II
lidocaine (LMX) 4% topical dressing kit [66882] Topical, EVERY 1 HOUR PRN, peripheral line
insertion - see Admin Instructions
Do NOT apply to area greater than 200 square
centimeters (maximum 2.5 g/site; maximum 4 sites
per hour, 6 times per day). Do NOT leave on longer
than 2 hours. Use for stable patient, no allergies to
lidocaine, with at least 30 minutes time prior to IV use
Post-Op/Phase II
sodium chloride (bacteriostatic) 0.9 % injection
[50585]
0.05-0.1 mL, Intradermal, PRN, peripheral line
insertion - see Admin Instructions
Use an insulin or TB syringe with a 25-30 gauge
needle to inject solution and create a wheal. Wait 30
seconds to 1 minute then insert IV catheter into center
of wheal. Use if IV is needed within 30 minutes.
Post-Op/Phase II
IV Fluids [12948]
sodium chloride 0.9 % infusion [64367] Intravenous, CONTINUOUS
Medications - General
Beta-Blockers [12869]
atenolol (TENORMIN) tab [720016] Oral
Hold for heart rate less than 50 beats per minute or
systolic blood pressure less than 100 mmHg.
Post-Op/Phase II
carvedilol (COREG) tab [54511] Oral, 2 X DAILY
Hold for heart rate less than 50 beats per minute or
systolic blood pressure less than *** mmHg.
Post-Op/Phase II
labetalol (NORMODYNE;TRANDATE) injection
[750053]
10-20 mg, Intravenous, EVERY 1 HOUR PRN, for
systolic blood pressure greater than 160 mmHg or
diastolic blood pressure greater than 100 mmHg
Hold for heart rate less than 50 beats per minute
for 2 Minutes, Post-Op/Phase II
metoprolol (LOPRESSOR) tab [720094] Oral
Hold for heart rate less than 50 beats per minute or
systolic blood pressure less than 100 mmHg
Post-Op/Phase II
Analgesics [18952]
acetaMINOPHEN (TYLENOL) tab [750000] 325-650 mg, Oral, EVERY 4 HOURS PRN, pain, See
Pain Management Algorithm for the Selection of As-
needed Analgesics
Bowel Management [122993]
Adult - Bowel Management - Scheduled
[241890]
senna-docusate (SENOKOT S) 8.6-50 MG per
tab [60530]
2 tab, Oral, 2 X DAILY Starting tomorrow, Post-
Op/Phase II
Page 7 of 10
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 12:42:00 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

Adult - Bowel Management - As Needed
[241564]
polyethylene glycol (MIRALAX) oral packet
[61829]
17 g, Oral, 1 X DAILY PRN Starting tomorrow,
constipation
First Line Therapy
Post-Op/Phase II
magnesium hydroxide (MILK OF MAGNESIA)
susp [65443]
30 mL, Oral, 1 X DAILY PRN Starting tomorrow,
constipation
Second line therapy, if no response to first line
therapy within 12 hours
Post-Op/Phase II
bisacodyl (DULCOLAX) rectal suppository
[35231]
10 mg, Rectal, 1 X DAILY PRN Starting tomorrow,
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
Non-categorized [12950]
aspirin chew tab [720014] 81 mg, Oral, 1 X DAILY
aspirin chew tab [720014] 162 mg, Oral, 1 X DAILY
aspirin EC delayed release tab [49098] 325 mg, Oral, 1 X DAILY
clopidogrel (PLAVIX) tab [58345] 75 mg, Oral, 1 X DAILY
Give for *** week (s)
Laboratory
Draw Postoperative Day 1 in AM [13979]
BUN [BUN] 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?
CREATININE [CRET] 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?
HEMATOCRIT [HCT] 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?
PLATELET COUNT [PLT] 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?
PROTHROMBIN TIME/INR [PT] 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?
Diagnostic Tests and Imaging
Vascular Lab [13980]
Ankle/Brachial Index [VASC0001] ONCE, Starting tomorrow For 1 Occurrences, Routine
Reason for exam:
Is patient mechanically ventilated?
Is patient ICU status?
Does patient need continuous monitoring?
Performed in Heart Vascular Care Echo/Vasc Lab
Page 8 of 10
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 12:42:00 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

Ultrasound Imaging of Peripheral Artery
[VASC0007]
ONCE, Starting tomorrow For 1 Occurrences, Routine
Reason for exam:
Which extremity?
Left, Right, or Bilateral?
Is patient mechanically ventilated?
Is patient ICU status?
Does patient need continuous monitoring?
Performed in Heart Vascular Care Echo/Vasc Lab
Transcutaneous O2 Test [VASC0006] ONCE, Starting tomorrow For 1 Occurrences, Routine
Reason for exam:
What area of the body?
Is patient mechanically ventilated?
Is patient ICU status?
Does patient need continuous monitoring?
Performed in Heart Vascular Care Echo/Vasc Lab
Consults [13981]
Consult Transplant Nephrology (Inpatient)
[CON0083]
ONCE
Purpose of Consult: EVALUATE AND TREAT
PATIENT
Consulting Provider:
Reason for Consult: End stage renal disease.
Can this consult be done via video?
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):
Post-Op/Phase II
Page 9 of 10
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 12:42:00 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

Consult Learning Center - Diabetes Education
(Adult) [CON0021]
ONCE, Routine, - If patient is newly diagnosed or is
new to insulin, provide 24 hours notice to allow
adequate time for education,
- Indicate diabetes medication/treatment plan if
known.
- Consults requested after 1600 on Fridays may not
be seen until following Monday. Learning Center
available Mon-Sat 0800-1630 (only 1 RN available
on Saturday for CSC and AFCH).
- Staff may be contacted by Pager 7927 on
weekdays and Pager 3276 on weekends.
- Learning Center staff are not available on holidays.
Type of Education: Diabetes Self-Management
Education
Reason For Consult:
Expected Discharge Date:
Diabetes management / treatment plan:
Can this consult be done via video?
Post-Op/Phase II
Consult Diabetes Education - Nutrition (Inpatient)
[CON0126]
ONCE, Routine, · If your patient is newly diagnosed
and/or is new to insulin therapy, provide 24 hours
notice to allow adequate time for nutrition education.
· Indicate diabetes medication/treatment plan if
known.
· Consults requested after 1300 on Friday may not
be completed until the following Monday.
· If you are placing a consult on a weekend day for a
patient who will be discharging that weekend, please
have the Paging Center contact the on-call dietitian
to help you facilitate the diabetes nutrition education
session prior to the patient's discharge.
Type of Education: Diabetes Self-Management
Education
Reason For Consult:
Expected Discharge Date:
Diabetes management / treatment plan:
Can this consult be done via video?
Post-Op/Phase II
Consult Cardiac Rehab/Preventive Cardiology
(Inpatient) [CON0010]
ONCE, Starting today For 1 Occurrences, Routine
Reason for consult: Other (Comment) (Risk factor
assessment and modification)
Can this consult be done via video?
Post-Op/Phase II
BestPractice
No hospital problems have yet been identified [198967]
Specify Hospital Problem(s) [COR0018] You will be prompted to specify a hospital problem on
signing., Post-Op/Phase II
Page 10 of 10
Printed by BENNETT, SARA J [SJB008] at 12/7/2017 12:42:00 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org