Cardiac Catheterization PreProcedure [980] - Houston Methodist Hospital

Cardiac Catheterization PreProcedure [980]

Pre Anesthesia Testing

Pre Anesthesia Testing Orders

The ambulatory orders in this section are specifically for Pre Anesthesia Testing. For additional PAT orders, please use

'Future Status' and 'Pre-Admission Testing Phase of Care'

[ ] Other Diagnostic Studies

[ ] ECG Pre/Post Op

[ ] Pv carotid duplex

[ ] Us vein mapping lower extremity

[ ] Us duplex venous lower extremity

[ ] Respiratory

[ ] Spirometry pre & post w/ bronchodilator

Routine, Ancillary Performed, Status: Future, Expires: S+365,

Pre-Admission Testing

Status: Future, Expires: S+365, Routine, Clinic Performed

Status: Future, Expires: S+365, Routine, Clinic Performed

Status: Future, Expires: S+365, Routine, Clinic Performed

Routine, Status: Future, Expires: S+365, Pre-Admission Testing

Encounter type?

[ ] Body Plethysmographic lung volumes

Routine, Status: Future, Expires: S+365, Pre-Admission Testing

Encounter type?

[ ] Dif fusion capacity

Routine, Status: Future, Expires: S+365, Pre-Admission Testing

Encounter type?

[ ] Spirometry

Routine, Status: Future, Expires: S+365, Pre-Admission Testing

Encounter type?

[ ] Laboratory: Preoperative Testing Labs - All Facilities

[ ] COVID-19 qualitative PCR - Nasal Swab

Routine, Status: Future, Expires: S+365, Clinic Collect

Specimen Source: Nasal Swab

Is this f or pre-procedure or non-PUI assessment? Yes

Pre-Admission Testing

[ ] CBC with platelet and differential

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

[ ] Comprehensive metabolic panel

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

[ ] Basic metabolic panel

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

[ ] Prothrombin time with INR

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

[ ] Partial thromboplastin time

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

[ ] Hepatic function panel

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

[ ] Platelet f unction analysis

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

[ ] Hemoglobin A1c

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

[ ] Type and screen

[ ] Type and screen

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

[ ] ABO and Rh confirmation

Once, Blood Bank Confirmation

[ ] hCG qualitative, serum screen

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

[ ] POC pregnancy, urine

Routine, Point Of Care, Pre-Admission Testing

[ ] Urinalysis, automated with microscopy

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

[ ] Laboratory: Additional Labs - HMWB, HMCL, HMTW

[ ] Urinalysis screen and microscopy, with

Routine, Status: Future, Expires: S+365, Clinic Collect

ref lex to culture

Specimen Source: Urine

Specimen Site:

Pre-Admission Testing

[ ] CBC hemogram

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

Printed on 6/15/2021 at 8:18 AM from SUP

Page 1 of 9

[ ] HIV 1, 2 antibody

[ ] Syphilis treponema screen with RPR

conf irmation (reverse algorithm)

[ ] Hepatitis acute panel

[ ] Thromboelastograph

[ ] Vitamin D 25 hydroxy level

[ ] MRSA PCR

[ ] T3

[ ] T4

[ ] Thyroid stimulating hormone

[ ] Prostate specific antigen

[ ] Laboratory: Additional Labs - HMSL, HMW

[ ] Urinalysis screen and microscopy, with

ref lex to culture

[ ] CBC hemogram

[ ] Rapid HIV 1 & 2

[ ] Syphilis treponema screen with RPR

conf irmation (reverse algorithm)

[ ] Hepatitis acute panel

[ ] Thromboelastograph

[ ] Vitamin D 25 hydroxy level

[ ] MRSA PCR

[ ] T3

[ ] T4

[ ] Thyroid stimulating hormone

[ ] Prostate specific antigen

[ ] Laboratory: Additional Labs - HMH, HMSJ

[ ] Urinalysis screen and microscopy, with

ref lex to culture

[ ] CBC hemogram

[ ] HIV Ag/Ab combination

[ ] Syphilis treponema screen with RPR

conf irmation (reverse algorithm)

[ ] Hepatitis acute panel

[ ] Thromboelastograph

Printed on 6/15/2021 at 8:18 AM from SUP

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

Routine, Status: Future, Expires: S+365, Clinic Collect

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

Routine, Status: Future, Expires: S+365, Clinic Collect, Nares,

Pre-Admission Testing

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

Routine, Status: Future, Expires: S+365, Clinic Collect

Specimen Source: Urine

Specimen Site:

Pre-Admission Testing

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

Routine, Status: Future, Expires: S+365, Clinic Collect

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

Routine, Status: Future, Expires: S+365, Clinic Collect, Nares,

Pre-Admission Testing

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

Routine, Status: Future, Expires: S+365, Clinic Collect

Specimen Source: Urine

Specimen Site:

Pre-Admission Testing

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

Routine, Status: Future, Expires: S+365, Clinic Collect

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

Page 2 of 9

[ ] Vitamin D 25 hydroxy level

[ ] MRSA PCR

[ ] T3

[ ] T4

[ ] Thyroid stimulating hormone

[ ] Prostate specific antigen

[ ] Laboratory: Additional for Bariatric patients

[ ] Lipid panel

[ ] hCG qualitative, serum screen

[ ] Total iron binding capacity

[ ] T4, f ree

[ ] Thyroid stimulating hormone

[ ] Hemoglobin A1c

[ ] Parathyroid hormone

[ ] CBC with platelet and differential

[ ] Prothrombin time with INR

[ ] Partial thromboplastin time, activated

[ ] Vitamin A level, plasma or serum

[ ] Vitamin B12 level

[ ] Vitamin D 25 hydroxy level

[ ] Copper level, serum

[ ] Folate level

[ ] Vitamin B1 level, whole blood

[ ] Zinc level, serum

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

Routine, Status: Future, Expires: S+365, Clinic Collect, Nares,

Pre-Admission Testing

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

Routine, Status: Future, Expires: S+365, Clinic Collect

Has the patient been fasting for 8 hours or more?

Pre-Admission Testing

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

Routine, Status: Future, Expires: S+365, Clinic Collect, Pre-Admission

Testing

Case Requests

Cardiac Catherization Case Requests (Single Response)

(X) Case request Cath Lab

Scheduling/ADT, Scheduling/ADT

Nursing

Informed Consent

Printed on 6/15/2021 at 8:18 AM from SUP

Page 3 of 9

[X] Complete Consent For Disclosure and consent for

anesthesia, sedation and pain management.

[ ] Complete Consent For Selective coronary arteriogram

[ ] Complete Consent For Left heart catheterization

[ ] Complete Consent For Percutaneous coronary

intervention

[ ] Complete Consent For Right and left heart

catheterization, Selective coronary angiogram, Left

ventriculogram

[ ] Complete Consent For Abdominal angiogram

Printed on 6/15/2021 at 8:18 AM from SUP

Routine, Once

Consent For:

Procedure:

Diagnosis/Condition:

Physician:

Risks, benefits, and alternatives (as outlined by the Texas

Medical Disclosure Panel, as appears on Houston Methodist

Medical/Surgical Consent forms) were discussed with

patient/surrogate?

Place on chart., Pre-op

Routine, Once

Consent For: Selective coronary arteriogram

Procedure:

Diagnosis/Condition:

Physician:

Risks, benefits, and alternatives (as outlined by the Texas

Medical Disclosure Panel, as appears on Houston Methodist

Medical/Surgical Consent forms) were discussed with

patient/surrogate?

Place on chart., Pre-op

Routine, Once

Consent For: Left heart catheterization

Procedure:

Diagnosis/Condition:

Physician:

Risks, benefits, and alternatives (as outlined by the Texas

Medical Disclosure Panel, as appears on Houston Methodist

Medical/Surgical Consent forms) were discussed with

patient/surrogate?

Place on chart., Pre-op

Routine, Once

Consent For: Percutaneous coronary intervention

Procedure:

Diagnosis/Condition:

Physician:

Risks, benefits, and alternatives (as outlined by the Texas

Medical Disclosure Panel, as appears on Houston Methodist

Medical/Surgical Consent forms) were discussed with

patient/surrogate?

Place on chart., Pre-op

Routine, Once

Consent For: Right and left heart catheterization, Selective

coronary angiogram, Left ventriculogram

Procedure:

Diagnosis/Condition:

Physician:

Risks, benefits, and alternatives (as outlined by the Texas

Medical Disclosure Panel, as appears on Houston Methodist

Medical/Surgical Consent forms) were discussed with

patient/surrogate?

Place on chart., Pre-op

Routine, Once

Consent For: Abdominal angiogram

Procedure:

Diagnosis/Condition:

Physician:

Risks, benefits, and alternatives (as outlined by the Texas

Medical Disclosure Panel, as appears on Houston Methodist

Medical/Surgical Consent forms) were discussed with

patient/surrogate?

Place on chart., Pre-op

Page 4 of 9

[ ] Complete Consent For Abdominal angiogram and

bilateral f emoral angiogram

[ ] Complete consent for right heart catheterization

[ ] Complete consent for intra-aortic balloon pump

[ ] Complete consent for ventricular assist device

[ ] Complete consent for carotid angiogram

[ ] Complete consent for subclavian angiogram

Printed on 6/15/2021 at 8:18 AM from SUP

Routine, Once

Consent For: Abdominal angiogram and bilateral femoral

angiogram

Procedure:

Diagnosis/Condition:

Physician:

Risks, benefits, and alternatives (as outlined by the Texas

Medical Disclosure Panel, as appears on Houston Methodist

Medical/Surgical Consent forms) were discussed with

patient/surrogate?

Place on chart., Pre-op

Routine, Once

Procedure:

Diagnosis/Condition:

Physician:

Risks, benefits, and alternatives (as outlined by the Texas

Medical Disclosure Panel, as appears on Houston Methodist

Medical/Surgical Consent forms) were discussed with

patient/surrogate?

Place on chart., Pre-op

Routine, Once

Procedure:

Diagnosis/Condition:

Physician:

Risks, benefits, and alternatives (as outlined by the Texas

Medical Disclosure Panel, as appears on Houston Methodist

Medical/Surgical Consent forms) were discussed with

patient/surrogate?

Place on chart., Pre-op

Routine, Once

Procedure:

Diagnosis/Condition:

Physician:

Risks, benefits, and alternatives (as outlined by the Texas

Medical Disclosure Panel, as appears on Houston Methodist

Medical/Surgical Consent forms) were discussed with

patient/surrogate?

Place on chart., Pre-op

Routine, Once

Procedure:

Diagnosis/Condition:

Physician:

Risks, benefits, and alternatives (as outlined by the Texas

Medical Disclosure Panel, as appears on Houston Methodist

Medical/Surgical Consent forms) were discussed with

patient/surrogate?

Place on chart., Pre-op

Routine, Once

Procedure:

Diagnosis/Condition:

Physician:

Risks, benefits, and alternatives (as outlined by the Texas

Medical Disclosure Panel, as appears on Houston Methodist

Medical/Surgical Consent forms) were discussed with

patient/surrogate?

Place on chart., Pre-op

Page 5 of 9

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