PHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG

Transcription

1 DRUG AND TREATMENT Available at: BMC-B BMC-D BMC-N BMC-S PACE Vital Signs Vital Signs PRE-OP, On arrival Nursing Orders Initiate ANES Anesthesia PACE PowerPlan Weigh Patient PRE-OP Pre op. Provide patient with incentive spirometry teaching with return demonstration PCA Instructions Instruct the Patient not to drink or eat anything after midnight except for medications with sips of water Laboratory GEN Pre-Operative Labs(SUB)* ***Reminder: Order GEN Pre-Operative Labs (SUB) as a separate form*** Liver Profile Routine, Blood, PRE-OP Urine Culture Routine, URINE, CLEANCATCH, PRE-OP (DEF)* Routine, URINE, CATHETER, PRE-OP ***(NOTE)***Obtain HCG Screen Qualitative Serum on all female patients of childbearing age unless history of surgical sterility/hysterectomy HCG Screen Qualitative Serum Pre-Op, Blood, ONCE Comments: On all female patients of childbearing age unless history of surgical sterility/hysterectomy Radiology XR Chest *1 view AP Portable Pre urologic procedure, Pre-op, ONCE Chest *2 view PA and LAT Pre urologic procedure, PRE-OP XR Abd (KUB) 1 view Pre urologic procedure, Pre-op, ONCE Cardiology ***(NOTE)***Patients LESS than 40 years old WITH POSITIVE medical history or ALL patients GREATER than or equal to 40 years of age ECG Standard Routine, PRE-OP Page 1 of 14

2 DRUG AND TREATMENT Pre-Op Non Categorized Surgical Care Quality Measures Diet NPO NPO except for meds with sip of water Diet Order Clear Liquid Diet Message Clear liquids until 0800 if surgery after 1400 Nursing Orders Initiate ANES Anesthesia Pre-Op PowerPlan Reason Beta Blocker Not Administered Peri-Operatively Sequential Compression Device Bilateral knee high (DEF)* Bilateral thigh high Pre op. Provide patient with incentive spirometry teaching with return demonstration Pre op. Provide turn, cough and deep breath instructions Start IV/INT May infiltrate insertion site w/lidocaine 1% prior if patient not allergic Medications SUB SURG Alvimopan Pre Op(SUB)* ***The above subphase is available at the end of the plan*** Lidocaine 1% MDV inj ml INFILTRATE inj ONCE Comments: For IV insertion site placement if non-diabetic patient ***(NOTE)***VTE Prophylaxis Reason Surgical Care VTE Mechanical Prophylaxis Not Ordered Reason Surgical Care VTE Pharmacological Prophylaxis Not Ordered enoxaparin (Lovenox) 30 mg inj SUBCUT ONCE GU Urology Minor Open Pre-Op(SUB)* ***Reminder: Order GU Urology Minor Open Pre-Op (SUB) as a separate form*** GU Urology Endoscopic Pre-Op(SUB)* ***Reminder: Order GU Urology Endoscopic Pre-Op (SUB) as a separate form*** GU Urology Artificial Implant, Removal or Revision Pre-Op(SUB)* ***Reminder: Order GU Urology Artificial Implant, Removal or Revision Pre-Op (SUB) as a separate form*** Page 2 of 14

3 DRUG AND TREATMENT IV Solutions ***(NOTE)***Choose IV only if not using Anesthesia Lactated Ringers Injection IV bag 125 ml/hour (DEF)* IV bag 100 ml/hour IV bag 75 ml/hour Sodium Chloride 0.9% IV bag 100 ml/hour (DEF)* IV bag 75 ml/hour IV bag 50 ml/hour Laboratory Complete Blood Count Routine, Blood, PRE-OP Basic Metabolic Panel Routine, Blood, PRE-OP Prothrombin INR Routine, Blood, PRE-OP Partial Thromboplast Time Routine, Blood, PRE-OP Liver Profile Routine, Blood, PRE-OP Urinalysis with Microscopic Routine, URINE, PRE-OP Urine Culture ***(NOTE)***Obtain HCG Screen Qualitative Serum on all female patients of childbearing age unless history of surgical sterility/hysterectomy HCG Screen Qualitative Serum Pre-Op, Blood, ONCE Comments: On all female patients of childbearing age unless history of surgical sterility/hysterectomy Radiology XR Abd (KUB) 1 view Pre urologic procedure, Pre-op Chest *2 view PA and LAT PRE-OP XP Chest PRE-OP Cardiology ***(NOTE)***Patients LESS than 40 years old WITH POSITIVE medical history or ALL patients GREATER than or equal to 40 years of age ECG Standard Routine, PRE-OP Page 3 of 14

4 DRUG AND TREATMENT Intra-Op Nursing Orders Start IV/INT Clip and Prep Sequential Compression Device Knee high at 40 mmhg bilaterally Indwelling Urinary Catheter (Foley)(SUB)* ***Reminder: Order Indwelling Urinary Catheter (Foley) (SUB) as a separate form*** Nasogastric/Orogastric Tube Activity ***(NOTE)***Select the "Transfuse Blood Previously on Hold" order below, to transfuse blood on hold Transfuse Blood Previously on Hold Medications Local Anesthetic Agents Marcaine 0.25% MDV inj soln 50 ml INFILTRATE PERIOP_ONCE Marcaine 0.5% MDV inj soln 50 ml INFILTRATE PERIOP_ONCE Marcaine 0.25%-Epinephrine 1:200,000 MDV inj 50 ml INFILTRATE PERIOP_ONCE Marcaine 0.5%-Epinephrine 1:200,000 MDV inj 50 ml INFILTRATE PERIOP_ONCE Xylocaine 1% MDV inj soln 50 ml INFILTRATE PERIOP_ONCE Xylocaine 1%-Epinephrine 1:100,000 MDV inj 50 ml INFILTRATE PERIOP_ONCE Contrast Media Iothalamate 43% (Conray 43) 50 ml IV PERIOP_ONCE Irrigants Glycine 1.5% Irrigation Solution 3000 ml IRRIGATE PERIOP_ONCE Ancef 1g/Normal Saline 500 ml 500 ml IRRIGATE PERIOP_ONCE Vancomycin 1g/Normal Saline 500 ml 500 ml IRRIGATE PERIOP_ONCE Vancomycin 500mg/Normal Saline 1000mL 1000 ml IRRIGATE PERIOP_ONCE Polymyxin B/ Bacitracin Irrigation 500 ml IRRIGATE PERIOP_ONCE (DEF)* Polymyxin B/ Bacitracin Irrigation 1000 ml IRRIGATE PERIOP_ONCE Bacitracin unit/garamycin 80mg/NS 1L 1000 ml IRRIGATE PERIOP_ONCE Page 4 of 14

5 DRUG AND TREATMENT Rifampin 600mg/Garamycin 180mg/NS 50 ml 50 ml IRRIGATE PERIOP_ONCE Comments: Combine rifampin 600mg and Garamycin 180 mg and NS 50 ml in a 60 ml syringe to soak Coloplast Implant --- NOT available at Baptist Nassau Vancocin 1g/Protamine Sulfate 50mg 500 ml IRRIGATE PERIOP_ONCE Comments: Combine vancomycin1g with Protamine sulfate 50 mg and Sterile Water 500mL for irrigation Methylene Blue IRRIGATE PERIOP_ONCE Hemostatic Agents Surgicel 1 unit TOPICAL PERIOP_ONCE Laboratory Type and Screen Blood ***(NOTE)***If wanting to place specific blood products on Hold, select the GEN Blood Administration subphase and select your products with a Transfusion Priority of Hold GEN Blood Administration(SUB)* ***Reminder: Order GEN Blood Administration (SUB) as a separate form*** Urine Culture Blood Culture Post-Op Minor Condition/Status Patient Status Inpatient Patient Status: Inpatient Place in Observation Patient Status: Outpatient- Refer for Observation Status Place in Outpatient to a Bed Status If patient requires overnight stay for extended recovery post procedure Discharge Patient (Depart Process) May discharge patient when meets Day Stay Unit discharge criteria met Vital Signs Vital Signs Q1H Int, 4 times, Pulse oximetry with vital signs Comments: Pulse oximetry with vital signs +4 Hours Vital Signs Q2H, 4 times +12 Hours Vital Signs Q4H, 4 times +28 Hours Vital Signs Q8H Notify Provider Vital Signs/Urine Output Temperature > 102F, HR > 120, SBP < 100, DBP < 60 Page 5 of 14

6 DRUG AND TREATMENT Activity Activity Ambulate with Assistance Diet NPO NPO except for ice chips, and meds (DEF)* No exceptions Diet Order Clear Liquid (DEF)* Advance as Tolerated to Clear Liquid Regular--adult menu Diabetic/ADA with HS Snack, 1800 kcal Diabetic/ADA without HS Snack, 1800 kcal Nursing Orders Notify Provider Routine, Notify surgeon for urine output less than 120mL/4 hour Intake and Output Q8H Shower May shower or bathe normally with soap and water after abdominal bandage has been removed Additional Discharge Instructions Discharge Patient with Indwelling Urinary Catheter in place. Provide patient education. Provide patient education with teach back regarding how to care for indwelling urinary catheter and/or leg bag Provide patient education with teach back regarding dressing changes Indwelling Urinary Catheter Care Drain Care Type of Drain: Bulb Suction, Drain Method: Compression, PRN, Empty and record drain, Change Bandage PRN Smoking Cessation Counsel ***(NOTE)***Order Blood Glucose (POC) if patient is on oral hypoglycemic agents or insulin Blood Glucose Monitor POC Notify Provider If blood sugar less than 90 mg/dl or greater than 200 mg/dl Abdominal Binder Change Dressing DAILY, Cover all drains with sterile dressing, change daily and PRN (DEF)* BID, All drains, Gauze Dressing Removal Remove bandage 24 hours post operatively (DEF)* Remove bandage 48 hours post operatively Page 6 of 14

7 DRUG AND TREATMENT Sequential Compression Device Knee high Turn and Cough Q2H, Encourage turn, cough, and deep breathe Range of Motion Q1HWA, Encourage leg motion in bed Provide patient with Incentive Spirometry teaching with return demonstration ***(NOTE)***Suprapubic Drain Care Type of Drain: Suprapubic Catheter, Drain Method: Gravity, keep secured to body Dressing Change DAILY, 4 X 4, Change suprapubic bandage, irrigate with 10mL Sterile Saline ***(NOTE)***Nephrostomy Drain Care Type of Drain: Nephrostomy, Drain Method: Gravity, keep secured to body Dressing Change DAILY, 4 X 4, Change suprapubic bandage, irrigate with 10mL Sterile Saline GU Continuous Bladder Irrigation (CBI)(SUB)* ***Reminder: Order GU Continuous Bladder Irrigation (CBI) (SUB) as a separate form*** Reason Referral for Addictions Treatment Not Provided Medications Reason Beta Blocker Not Administered Peri-Operatively Reason Alcohol/Substance Abuse Medication Not Prescribed Reason Tobacco Cessation Med Not Given Anticoagulants ***(NOTE)***VTE Prophylaxis Reason Surgical Care VTE Mechanical Prophylaxis Not Ordered Reason Surgical Care VTE Pharmacological Prophylaxis Not Ordered ***(NOTE)***PLEASE NOTE - Heparin to be started 12 hours after surgery. Please enter start date and time. heparin (subcutaneous) 5,000 unit inj SUBCUT Q12H (DEF)* 5,000 unit inj SUBCUT Q8H Int enoxaparin (Lovenox) 30 mg inj SUBCUT DAILY (DEF)* Comments: If Creatinine clearance less than 30 ml/min 40 mg inj SUBCUT DAILY Insulin -- Correction Dose GEN Correction Insulin (Sliding Scale)(SUB)* ***Reminder: Order GEN Correction Insulin (Sliding Scale) (SUB) as a separate form*** Page 7 of 14

8 DRUG AND TREATMENT Analgesics Ketorolac (Toradol) Dosing Guidelines ketorolac (Toradol) 15 mg inj IV PUSH Q6H, Duration: 48 hour (DEF)* Comments: Hold if significant bleeding 30 mg inj IV PUSH Q6H, Duration: 48 hour Comments: If patient age is GREATER than 65 or if patient has an estimated CrCl of 60 ml/min or LESS, reduce dose to 15 mg every 6 hours. Hold if significant bleeding hydromorphone (Dilaudid) 0.5 mg inj IV PUSH Q2H Int, PRN Pain Moderate/Severe (DEF)* Comments: If ineffective in 15 minutes, may give an additional 0.5 mg IV. If a second dose is required in 15 minutes, may begin next scheduled dose at 1 mg. Not to exceed 1 mg in a two hour period. ** If ineffective switch to Dilaudid PCA using the NO Basal Opioids Tolerant Standard Dosing.**Use for breakthrough pain not relieved by PO pain meds or if unable to tolerate PO. 1 mg inj IV PUSH Q2H Int, PRN Pain Moderate/Severe Comments: If ineffective in 15 minutes, may give an additional 0.5 mg IV. If a second dose is required in 15 minutes, may begin next scheduled dose at 1.5 mg. Not to exceed 1.5 mg in a two hour period. If ineffective switch to Dilaudid PCA using the NO Basal Opioids Tolerant Standard Dosing.Use for breakthrough pain not relieved by PO pain meds or if unable to tolerate PO. ***(NOTE)***If ineffective switch to Dilaudid PCA using the NO Basal Opioids Tolerant Standard Dosing PCA (Patient Controlled Analgesia) Dosing Guidelines No Basal ANES Patient Controlled Analgesia (PCA)(SUB)* ***Reminder: Order ANES Patient Controlled Analgesia (PCA) (SUB) as a separate form*** morphine 2 mg inj IV PUSH Q2H Int, PRN Pain Moderate/Severe (DEF)* Comments: If ineffective in 15 minutes, may give an additional 2 mg IV. If a second dose is required in 15 minutes, may begin next scheduled dose at 4 mg. Not to exceed 4 mg in a two hour perioduse for breakthrough pain not relieved by PO pain meds or if unable to tolerate PO. 4 mg inj IV PUSH Q2H Int, PRN Pain Moderate/Severe Comments: Use for breakthrough pain not relieved by PO pain meds or if unable to tolerate PO. phenol topical (Chloraseptic Spray) 1 spray TOPICAL Q2H, PRN Other (see comment) Comments: 1 spray PO Q2H PRN Discomfort/Sore throat, may give additional spray if required if patient has an NGT acetaminophen (Tylenol) 650 mg tab PO Q4H Int, PRN Other (see comment) (DEF)* Comments: PRN pain mild OR temperature GREATER than 101 degrees Fahrenheit. 650 mg supp PR Q4H Int, PRN Other (see comment) Comments: PRN pain mild OR temperature GREATER than 101 degrees Fahrenheit. acetaminophen-hydrocodone (Norco 325 mg-5 mg oral tablet) 1 tab PO Q4H Int, PRN Pain Moderate/Severe Comments: Once tolerating oral route. If ineffective in 30 minutes, may give an additional tablet. If a second dose is required in 30 minutes, may begin next scheduled dose at two tablets. Not to exceed two tablets in a four hour period Page 8 of 14

9 DRUG AND TREATMENT acetaminophen-hydrocodone (Norco 325 mg-7.5 mg oral tablet) 1 tab PO Q4H Int, PRN Pain Moderate/Severe Comments: Once tolerating oral route acetaminophen-oxycodone (Percocet 5 mg/325 mg) 1 tab PO Q4H Int, PRN Pain Moderate/Severe Comments: Once tolerating oral route. If ineffective in 30 minutes, may give an additional tablet. If a second dose is required in 30 minutes, may begin next scheduled dose at two tablets. Not to exceed two tablets in a four hour period acetaminophen-oxycodone (Percocet 7.5 mg/ 325 mg) 1 tab PO Q4H Int, PRN Pain Moderate/Severe Comments: Once tolerating oral route Gastrointestinal Agents SUB SURG Alvimopan Post Op(SUB)* ***The above subphase is available at the end of the plan*** pantoprazole (Protonix) 40 mg inj IV PUSH DAILY (DEF)* Comments: convert to PO once tolerating diet 40 mg tab EC PO ACBRKF docusate (Colace) 100 mg cap PO BID Comments: Hold for loose stools polyethylene glycol 3350 (MiraLax) 17 g packet PO DAILY Antiemetics ondansetron (Zofran) 4 mg inj IV PUSH Q6H, Nausea/Vomiting (DEF)* Comments: If Zofran ineffective in 30 minutes may give Phenergan 4 mg inj IV Q6H, PRN Nausea/Vomiting, Duration: 24 hour Comments: If Zofran ineffective in 30 minutes may give Phenergan ***(NOTE)***If Zofran ineffective in 30 minutes may give Phenergan promethazine (Phenergan) 12.5 mg inj IV PUSH Q6H Int, PRN Nausea/Vomiting (DEF)* Comments: If Zofran is ineffective in 30 minutes give Phenergan. Give additional 12.5 mg if no effect by 30 minutes. If the patient has an IV running, the promethazine (PHENERGAN) should be mixed in 10 ml of saline and administered slowly over at least 3 minutes at the port furthest away from the IV insertion site. If the patient does not have an IV running, the promethazine (PHENERGAN) should be mixed in 50 ml bag of saline and administered over 15 minutes 25 mg inj IV PUSH Q6H Int, PRN Nausea/Vomiting Comments: If Zofran is ineffective in 30 minutes give Phenergan. If the patient has an IV running, the promethazine (PHENERGAN) should be mixed in 10 ml of saline and administered slowly over at least 3 minutes at the port furthest away from the IV insertion site. If the patient does not have an IV running, the promethazine (PHENERGAN) should be mixed in 50 ml bag of saline and administered over 15 minutes Page 9 of 14

10 DRUG AND TREATMENT Antibiotics ***(NOTE)***If the patient weight is LESS than 80 kg cefazolin (Ancef) 1 g bag IVPB Q8H Int, Duration: 2 dose Comments: If the patient weight is LESS than 80 Kg cefotetan (Cefotan) 1 g bag IVPB Q12H Int, Duration: 1 dose Comments: If patient weight is LESS than 80 kg ***(NOTE)***If the patient weight is GREATER than or EQUAL to 80 kg cefazolin (Ancef) 2 g bag IVPB Q8H Int, Duration: 2 dose Comments: If the patient weight is GREATER than or EQUAL to 80 kg cefotetan (Cefotan) 2 g bag IVPB Q12H Int, Duration: 1 dose Comments: If patient weight is GREATER than or EQUAL to 80 kg Additional Antibiotics ceftriaxone (Rocephin) 1 g bag IVPB Q12H, Duration: 1 dose metronidazole (Flagyl) 500 mg premix IVPB Q8H Int, Duration: 2 dose levofloxacin (Levaquin) 250 mg premix IVPB DAILY (DEF)* Comments: Infuse over 60 minutes 500 mg premix IVPB DAILY Comments: Infuse over 60 minutes 750 mg premix IVPB DAILY Comments: Infuse over 60 minutes 250 mg premix IVPB ONCE Comments: Infuse over 60 minutes 500 mg premix IVPB ONCE Comments: Infuse over 60 minutes 750 mg premix IVPB ONCE Comments: Infuse over 60 minutes piperacillin-tazobactam (Zosyn) g bag IVPB Q8H, Clinical Instructions: Extended Infusion Dosing over 4 hours Comments: Pharmacy to adjust for renal dosing Reason for Extending PostOp Antibiotics Past 24 Hours Bladder Spasm oxybutynin (Ditropan) 5 mg tab PO Q6H Comments: PRN Bladder Spasms Page 10 of 14

11 DRUG AND TREATMENT Sleep Aids zolpidem (Ambien) 5 mg tab PO BEDTIME, PRN Sleep/Insomnia (DEF)* 10 mg tab PO BEDTIME, PRN Sleep/Insomnia Antihistamines diphenhydramine (Benadryl) 12.5 mg inj IV PUSH Q8H Int, PRN Itching, Clinical Instructions: For patients GREATER than or equal to 65 years old. If medication ineffective after 30 minutes, may give additional dose of 12.5 mg IV (DEF)* 25 mg inj IV PUSH Q8H Int, PRN Itching Comments: If patient age is LESS than 65 years old IV Solutions Dextrose 5% with 0.9% NaCl IV bag 100 ml/hour (DEF)* IV bag 125 ml/hour IV bag 150 ml/hour Dextrose 5% with 0.45% NaCl IV bag 100 ml/hour (DEF)* IV bag 125 ml/hour IV bag 150 ml/hour Dextrose 5% in Lactated Ringers Injection IV bag 100 ml/hour (DEF)* IV bag 125 ml/hour IV bag 150 ml/hour Sodium Chloride 0.45% IV bag 100 ml/hour (DEF)* IV bag 125 ml/hour IV bag 150 ml/hour ***(NOTE)***IV SOLUTIONS with POTASSIUM CHLORIDE ADDITIVES Dextrose 5% w/ Sodium Chloride 0.45% + potassium chloride 20 meq/l IV bag 100 ml/hour (DEF)* IV bag 125 ml/hour IV bag 150 ml/hour Sodium Chloride 0.9% + potassium chloride 20 meq/l IV premix 100 ml/hour (DEF)* IV premix 125 ml/hour IV premix 150 ml/hour LR + KCl 20 meq (IVS)* Lactated Ringers Injection IV bag 100 ml/hour potassium chloride (Additive) 20 meq Page 11 of 14

12 DRUG AND TREATMENT LR + KCl 20 meq (IVS)* Lactated Ringers Injection IV bag 125 ml/hour potassium chloride (Additive) 20 meq LR + KCl 20 meq (IVS)* Lactated Ringers Injection IV bag 150 ml/hour potassium chloride (Additive) 20 meq Laboratory Hemoglobin and Hematocrit Early AM, Blood, ONCE Basic Metabolic Panel Early AM, Blood, ONCE Radiology PACU Chest Xray (Portable) Major urologic surgery, Routine, Post op Respiratory O2 Therapy. Nasal Cannula, 2, Maintain oxygen saturation greater than 92% (DEF)* Nasal Cannula, 2, for 24 hours. Titrate to room air if oxygen saturation greater than 92% Nasal Cannula, 2, PRN for SOB and maintain oxygen saturation greater than 92% Incentive Spirometry Routine, Q 1H while awake Consults Consult Physician (BMCD) Baptist Primary Care Hospitalist (DEF)* Pulmonary / Critical Care Jacksonville Heart Center Southern Heart Center consult Consult Physician (BMCB) Baptist Primary Care Hospitalist (DEF)* Pulmonary / Critical Care Jacksonville Heart Center Southern Heart Center consult Consult Physician (BMCN) Hospitalist (DEF)* Pulmonary / Critical Care Southern Heart Center consult Dr. Farid Ullah -- Baptist Nassau ONLY Diagnostic Cardiology Page 12 of 14

13 DRUG AND TREATMENT Consult Physician (BMCS) Baptist Primary Care Hospitalist (DEF)* Pulmonary / Critical Care Jacksonville Heart Center Southern Heart Center consult Physical Therapy Consult Ambulation training Occupational Therapy Consult RD Consult TPN (DEF)* Tube Feeding Other - See Special Instructions, PO supplements SUB SURG Alvimopan Pre Op Medications ***(NOTE)*** ***EXCLUSION CRITERIA*** ***(NOTE)***If any of the following conditions are present. Alvimopan (ENTEREG) is contraindicated and should not be given: ***(NOTE)*** * Patient has received more than 3 doses of opioids within 7 days prior to surgery. ***(NOTE)*** * Patient has severe hepatic impairment * Patient has end stage renal disease.(note)* ***(NOTE)*** * Patient will be discharged and treated as outpatient. ***(NOTE)*** ***INCLUSION CRITIERIA*** ***(NOTE)*** Each of the following MUST be true for the patient to qualify for alvimopan therapy: ***(NOTE)*** * Operation includes a small or large bowel resection ***(NOTE)*** * The patient is an inpatient. ***(NOTE)*** * Alvimopan must be initiated pre-operatively. Treatment will not be initiated postoperatively. Entereg 12 mg cap PO PRE-OP, Duration: 1 dose Comments: Give with sip of water as a one time dose 30 minutes to 5 hours PRIOR to surgery. SUB SURG Alvimopan Post Op Medications *** (NOTE)*** ***EXCLUSION CRITERIA*** ****(NOTE)***If any of the following conditions are present. Alvimopan (ENTEREG) is contraindicated and should not be given: ***(NOTE)*** * Patient has received more than 3 doses of opioids within 7 days prior to surgery. ***(NOTE)*** * Patient has severe hepatic disease. ***(NOTE)*** * Patient has end stage renal disease. ***(NOTE)*** * Patient will be discharged and treated as outpatient. ***(NOTE)*** ***INCLUSION CRITIERIA*** ***(NOTE)***Each of the following MUST be true for the patient to qualify for alvimopan therapy: ***(NOTE)*** * Operation includes a small or large bowel resection. ***(NOTE)*** * The patient is an inpatient. Page 13 of 14

14 DRUG AND TREATMENT ***(NOTE)*** * Alvimopan must be initiated pre-operatively. Treatment will not be initiated postoperatively. +18 Hours Entereg 12 mg cap PO BID, Duration: 14 dose Comments: Start at 0900 on POD#1. Not to exceed 7 days (14 doses) after operation Page 14 of 14