DRUG AND TREATMENT Available ONLY at: BMC-B BMC-D BMC-N BMC-S PACE Nursing Orders ***NOTE*** Select the "Transfuse Blood Previously on Hold" order below, to transfuse blood on hold. Transfuse Blood Previously on Hold Laboratory ORSA NA Amplification Pre-Op, NASAL, ONCE Complete Blood Count Urinalysis with Microscopic Pre-Op, URINE, ONCE Comments: Clean catch Comprehensive Metabolic Panel Prothrombin INR Partial Thromboplast Time Hemoglobin A1C Routine, Blood, ONCE Comments: For known diabetics ***NOTE*** For possible latex allergic patients Latex IgE Comments: For possible latex allergic patients Blood Bank ***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) on a separate form.*** Radiology XR Knee L 2 view XR Knee R 2 view XR Hip L 2 view w/ Pelvis XR Hip R 2 view w/ Pelvis Page 1 of 15
DRUG AND TREATMENT XR Hip L 1 view XR Hip R 1 view XR Femur R, AP femur to include hip & knee joint on 36 inch cassette XR Femur L, AP femur to include hip & knee joint on 36 inch cassette Pre Op Non Categorized Surgical Care Quality Measures Condition/Status Patient Status Inpatient Patient Status: Inpatient, Level of Care: Med/Surg with Telemetry (3) Vital Signs Vital Signs Q4H (DEF)* Q2H Neurovascular Check Monitoring Q4H, 24 hour (DEF)* Q2H, 24 hour +26 Hours Neurovascular Check Monitoring Q8H, If stable. If not stable, continue with Q4H Activity Activity Up Ad Lib Diet NPO NPO except for meds with sip of water Nursing Orders Consent on Chart Clip and Prep Operative site, PRE-OP, Special Instructions: Chlorhexidine Gluconate (HIBICLENS) & electric clippers to operative site (DEF)* Operative site, PRE-OP, Special Instructions: Povidone Lodine (BETADINE) surgical scrub & electric clippers to operative site Sequential Compression Device Knee high at 40 mmhg NON-operative extremity for total knee patients(def)* Knee high at 40 mmhg to bilateral legs for Total Hip Replacement patients preoperative Elastic Stockings Apply knee high elastic stocking to both legs for total hip (DEF)* Apply knee high elastic stocking to non-operative leg for total knee Page 2 of 15
DRUG AND TREATMENT Void on Call ***NOTE*** Select the "Transfuse Blood Previously on Hold" order below, to transfuse blood on hold Transfuse Blood Previously on Hold Medications Reason Beta Blocker Not Administered Peri-Operatively Reason: Allergy (DEF)* Reason: Bradycardia (HR less than 50 bpm) Reason: Hypotension (SBP less than 100 mmhg) Reason: Concurrent use of IV inotropic med Reason: Other reason charted (MD/APN/PA/PharmD) tranexamic acid 1 g inj IVPB PRE-OP (DEF)* Comments: GIVEN ONLY in SURGICAL HOLDING/OR Suite 2 g inj IVPB PRE-OP Comments: GIVEN ONLY in SURGICAL HOLDING/OR Suite Antibiotics ***NOTE*** For ordering weight based antibiotics: 80 kg = 176 lbs 100 kg = 221 lbs cefazolin (Ancef) 1 g bag IVPB PRE-OP, Clinical Instructions: If patient weight is LESS than 80 kg unless allergic to Penicillin or has positive MRSA PCR (DEF)* Comments: TO BE GIVEN IN SURGICAL HOLDING. Begin within 60 minutes of incision time. Infuse over 30 minutes. 2 g bag IVPB PRE-OP, Clinical Instructions: If patient weight is between 80 kg to 120 kg unless allergic to Penicillin or has positive MRSA PRC Comments: TO BE GIVEN IN SURGICAL HOLDING. Begin within 60 minutes of incision time. Infuse over 30 minutes. 3 g bag IVPB PRE-OP, Clinical Instructions: If patient weight is GREATER than 120 kg unless allergic to Penicillin or has positive MRSA PRC Comments: TO BE GIVEN IN SURGICAL HOLDING. Begin within 60 minutes of incision time. Infuse over 30 minutes. Reason for Vancomycin Use Inpt stay for 24 hrs before procedure (DEF)* Beta-lactam allergy High risk: acute inpt hospital past yr High risk: nsg home or ECF in past year Chronic wound care or dialysis Increased MRSA rate MRSA colonization or infection Patient undergoing valve surgery Transfer from inpt hosp after 3 day stay Other Reason Page 3 of 15
DRUG AND TREATMENT vancomycin 1 g bag IVPB PRE-OP, Clinical Instructions: If patient weight is LESS THAN 100 kg if allergic to Penicillin or has positive MRSA PCR (DEF)* Comments: TO BE GIVEN IN SURGICAL HOLDING. Begin within 120 minutes of incision time 1.5 g bag IVPB PRE-OP, Clinical Instructions: If patient weight is GREATER than or EQUAL to 100 kg if allergic to Penicillin or has positive MRSA Comments: TO BE GIVEN IN SURGICAL HOLDING. Begin within 120 minutes of incision time clindamycin Cleocin 600 mg bag IVPB PRE-OP Comments: To be given in surgical holding - if allergic to Penicillin or Vancomycin. Begin within 60 minutes of incision time Laboratory Complete Blood Count Urinalysis with Microscopic Pre-Op, URINE, ONCE Comments: Clean catch Urine Culture Pre-Op, URINE, CLEANCATCH, ONCE (DEF)* Pre-Op, URINE, CATHETER, ONCE Comprehensive Metabolic Panel Prothrombin INR Partial Thromboplast Time ORSA NA Amplification Pre-Op, NASAL, ONCE Hemoglobin A1C Routine, Blood, ONCE Comments: For known diabetics ***NOTE*** For possible latex allergic patients Latex IgE Comments: For possible latex allergic patients Blood Bank ***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) on a separate form*** Radiology XR Knee L 2 view Page 4 of 15
DRUG AND TREATMENT XR Knee R 2 view XR Hip L 2 view w/ Pelvis Pre op ortho procedure, Pre-op, Pending Discharge - No XR Hip R 2 view w/ Pelvis Pre op ortho procedure, Pre-op, Pending Discharge - No XR Hip L 1 view Pre op ortho procedure, Pre-op, Pending Discharge - No XR Hip R 1 view Pre op ortho procedure, Pre-op, Pending Discharge - No XR Femur L, AP femur to include hip & knee joint on 36 inch cassette XR Femur R, AP femur to include hip & knee joint on 36 inch cassette Intra Op Nursing Orders Indwelling Urinary Catheter (Foley)(SUB)* ***Reminder: Order Indwelling Urinary Catheter (Foley) (SUB) on a separate form.*** Sequential Compression Device Knee high at 40 mmhg to bilateral leg intraoperative (DEF)* Thigh high at 40 mmhg to bilateral leg intraoperative Knee high at 40 mmhg on non operative leg intraoperative Cryotherapy Special Instructions: To Operative Area Medications Intra-Op Medication (Strength Medication) Kenalog 40 mg PERIOP_ONCE Comments: 40 mg (2 ml) Local Anesthetic Agents Marcaine 0.25% PF inj soln 1 dose INFILTRATE PERIOP_ONCE Comments: For intraoperative local injection Marcaine 0.5% PF inj soln 1 dose INFILTRATE PERIOP_ONCE Marcaine 0.25%-Epinephrine 1:200,000 MDV inj 1 dose INFILTRATE PERIOP_ONCE Marcaine 0.5%-Epinephrine 1:200,000 MDV inj 1 dose INFILTRATE PERIOP_ONCE Xylocaine 1% MDV inj soln 1 dose INFILTRATE PERIOP_ONCE Xylocaine-MPF 2% injectable solution 1 dose INFILTRATE PERIOP_ONCE Comments: For intraoperative local injection Page 5 of 15
DRUG AND TREATMENT Xylocaine 1%-epinephrine 1:100,000 MDV inj 1 dose INFILTRATE PERIOP_ONCE Comments: For intraoperative local injection Xylocaine 1%-epinephrine 1:200,000 MPF inj 1 dose INFILTRATE PERIOP_ONCE Naropin (5mg/mL) 1 dose INFILTRATE PERIOP_ONCE Lidocaine 0.5% PF 1 dose INFILTRATE PERIOP_ONCE Comments: For intraoperative local injection Irrigants Ancef 1g/500 ml NS 500 ml IRRIGATE PERIOP_ONCE Ancef 2g/3000 ml NS 3000 ml IRRIGATE PERIOP_ONCE Comments: 3L NS for intraoperative pulse lavage Vancomycin 1 g/500 ml NS 500 ml IRRIGATE PERIOP_ONCE Vancomycin 2 g/3000 ml NS 3000 ml IRRIGATE PERIOP_ONCE polymyxin B 500000 unit/bacitracin 50000 unit NS 500 ml IRRIGATE PERIOP_ONCE epinephrine 1:1000 topical solution 1 vial IRRIGATE PERIOP_ONCE (DEF)* Comments: Add to 0.9% Normal Saline 5,000 ml for Intra-Op Irrigation epinephrine 1:1000 topical solution 2 vial IRRIGATE PERIOP_ONCE Comments: Add to 0.9% Normal Saline 5,000 ml for Intra-Op Irrigation epinephrine 1:1000 topical solution 3 vial IRRIGATE PERIOP_ONCE Comments: Add to 0.9% Normal Saline 5,000 ml for Intra-Op Irrigation epinephrine 1:1000 topical solution 4 vial IRRIGATE PERIOP_ONCE Comments: Add to 0.9% Normal Saline 5,000 ml for Intra-Op Irrigation epinephrine 1:1000 topical solution 1 vial IRRIGATE PERIOP_ONCE (DEF)* Comments: Add to 0.9% Normal Saline 3000 ml for Intra-Op Irrigation (BCMB) epinephrine 1:1000 topical solution 2 vial IRRIGATE PERIOP_ONCE Comments: Add to 0.9% Normal Saline 3000 ml for Intra-Op Irrigation (BCMB) epinephrine 1:1000 topical solution 3 vial IRRIGATE PERIOP_ONCE Comments: Add to 0.9% Normal Saline 3000 ml for Intra-Op Irrigation (BCMB) epinephrine 1:1000 topical solution 4 vial IRRIGATE PERIOP_ONCE Comments: Add to 0.9% Normal Saline 3000 ml for Intra-Op Irrigation (BCMB) Hemostatic Agents Topical Hemostatic Agents Dressing Type: Floseal (DEF)* Dressing Type: Surgiflo Page 6 of 15
DRUG AND TREATMENT Surgicel 1 unit TOPICAL PERIOP_ONCE Intra-Op Medication (IV Infusion) Tranexamic Acid 1 g / Normal Saline 100 ml 1 g IV PERIOP_ONCE (DEF)* Comments: GIVEN ONLY in SURGICAL HOLDING/OR Suite. Not available at Baptist Nassau Tranexamic Acid 2 g / Normal Saline 100 ml 2 g IV PERIOP_ONCE Comments: GIVEN ONLY in SURGICAL HOLDING/OR Suite. Not available at Baptist Nassau ***NOTE*** Order Thrombin if needed for Hemostatic Agent thrombin topical 5000 units powder 1 dose TOPICAL PERIOP_ONCE Comments: Mix with Hemostatic Agent to surgical field for hemostasis thrombin topical 10000 units powder 1 dose TOPICAL PERIOP_ONCE Comments: Mix with Hemostatic Agent to surgical field for hemostasis. Not available at Baptist Nassau thrombin topical 20000 units powder 1 dose TOPICAL PERIOP_ONCE Comments: Mix with Hemostatic Agent to surgical field for hemostasis. Not available at Baptist Nassau Analgesics Intra-Op Medication (Strength Medication) fentanyl 25 mcg ITHECAL PERIOP_ONCE Comments: For intraoperative injection Intra-Op Medication (Strength Medication) Duramorph PF 5 mg IARTICULR PERIOP_ONCE Intra-Op Medication (Strength Medication) Toradol 15 mg IARTICULR PERIOP_ONCE (DEF)* Comments: For intraoperative local injection Toradol 30 mg IARTICULR PERIOP_ONCE Comments: For intraoperative local injection Corticosteroids Strength Medication Depo-Medrol 40 mg IARTICULR PERIOP_ONCE Comments: 40mg/1mL TOPICAL intraoperatively Strength Medication Celestone Soluspan 6 mg IARTICULR PERIOP_ONCE Post Op Vital Signs Vital Signs ASDIR, Q4H Neurovascular Check Monitoring Q2H Int, 24 hour, Capillary filling and sensation on affected extremity +26 Hours Neurovascular Check Monitoring Q4H, Capillary filling and sensation on affected extremity Activity Weight Bearing Page 7 of 15
DRUG AND TREATMENT None Activity Bedrest with BRP, Increase per Joint Center Regimen. Baptist Jacksonville ONLY (DEF)* Bedrest with BRP, Recommended for Baptist Beaches, Baptist Nassau, and Baptist South OR Baptist Jacksonville patients not in Joint Center Regimen Comments: Keep Knee immobilizer ON to ambulate ONLY. Begin exercises on arrival to floor. Diet Diet Order Clear Liquid, Advance as Tolerated to Full Liquid (DEF)* Comments: Then advance to regular when bowel sounds are present Regular--adult menu Nursing Orders Elevate Operative Extremity, Begin in PACU Cryotherapy To operative site, Q1H, Special Instructions: Begin in PACU. Apply for 20 minutes every hour Reference Text - Anterior Hip Precautions Reference Text - Posterior Hip Precautions Sequential Compression Device Knee high at 40 mmhg to bilateral legs for both Total Hip and Total Knee Replacement patients postoperative Elastic Stockings Knee high on non-operative leg for Knee Arthroplasty; apply thigh high to operative leg when ace wrap removed (DEF)* Knee high to bilateral leg for total hip Blood Glucose Monitor POC In PACU Drain Care Type of Drain: Hemovac, Begin in PACU. Record Output Q8H Discontinue when drainage is LESS than 30 ml/8 hours (DEF)* Type of Drain: Hemovac, Begin in PACU. Record Output Q8H Leave in until physician specifies Type of Drain: Hemovac, Begin in PACU. Record Output Q8H Discontinue In AM Type of Drain: Jackson-Pratt, Pulled by RN or MD on day 3 Straight Catheterization PRN, 24 hour, PRN Order, For symptoms of urgency and inability to void after 6 hours. May repeat X 2. If 700 ml residual volume, leave catheter in. Indwelling Urinary Catheter (Foley)(SUB)* ***Reminder: Order Indwelling Urinary Catheter (Foley) (SUB) on a separate form.*** +20 Hours Discontinue Indwelling Urinary Catheter Discontinue Criteria: POD #2 or when patient is able to sit at bedside or on commode (DEF)* Special Instructions: Do bladder scan if patient unable to void within 6 hours of removal of urinary catheter UNLESS other instructions are specified. If residual is GREATER than than 300 ml, contact physician for further orders. AVOID urinary catheter reinsertion if possible. Comments: An indwelling urinary catheter placed during/for surgery should be removed on POD# 1 or by the end of POD#2. If an indwelling urinary catheter should be Page 8 of 15
DRUG AND TREATMENT continued, MD needs to document rationale for continuing urinary catheter Discontinue Criteria: POD #1 or when patient is able to sit at bedside or on commode Special Instructions: Do bladder scan if patient unable to void within 6 hours of removal of urinary catheter UNLESS other instructions are specified. If residual is GREATER than than 300 ml, contact physician for further orders. AVOID urinary catheter reinsertion if possible. Comments: An indwelling urinary catheter placed during/for surgery should be removed on POD# 1 or by the end of POD#2. If an indwelling urinary catheter should be continued, MD needs to document rationale for continuing urinary catheter Orthopedic Device Immobilizer, Knee CPM Monitoring 0 degrees extension to 50 degrees flexion. Start POD #0; advance 15 degrees /day Dressing Change ABD Pad, POD #3, ABD Dressing and 4 x 4 gauze with Aquacel Medications ferrous sulfate 325 mg tab PO MEALS Antibiotics Reason for Extending PostOp Antibiotics Past 24 Hours Current bone tumor/operative extremity (DEF)* Demeclocycline administered postop Documentation of postop infection Erythromycin to improve gastric motility Pneumocystis PN prophylaxis with AIDS Dx Treatment of hepatic encephalopathy ***NOTE*** For ordering weight based antibiotics: 80 kg = 176 lbs 100 kg = 221 lbs +8 Hours cefazolin (Ancef) 1 g bag IVPB Q8H Int, Duration: 2 dose, Clinical Instructions: For weight LESS than 80 kg unless allergic to Penicillin (DEF)* Comments: first dose 8 hours after pre-op dose 2 g bag IVPB Q8H Int, Duration: 2 dose, Clinical Instructions: FOR weight GREATER than or equal to 80 kg unless allergic to Penicillin Comments: Give first dose 8 hours after pre-op dose Reason for Vancomycin Use Inpt stay for 24 hrs before procedure (DEF)* Beta-lactam allergy High risk: acute inpt hospital past yr High risk: nsg home or ECF in past year Chronic wound care or dialysis Increased MRSA rate MRSA colonization or infection Patient undergoing valve surgery Page 9 of 15
DRUG AND TREATMENT Transfer from inpt hosp after 3 day stay Other Reason +8 Hours vancomycin 1 g bag IVPB ONCE, Duration: 1 dose, Clinical Instructions: For weight LESS than 100 kg (DEF)* Comments: Give 12 hours after pre-op dose 1.5 g bag IVPB ONCE, Duration: 1 dose, Clinical Instructions: For weight GREATER than or EQUAL to 100 kg Comments: Give 12 hours after pre-op dose +8 Hours clindamycin (Cleocin) 600 mg bag IVPB Q8H Int, Duration: 2 dose Comments: Give first dose 8 hours after pre-op dose Analgesics ***NOTE*** Scheduled Pain Management +5 Hours oxycodone (OxyContin) 10 mg tab CR PO BEDTIME (DEF)* Comments: Begin POD #0 at bedtime when patient able to swallow and bowel sounds present. 20 mg tab CR PO BEDTIME Comments: Begin POD #0 at bedtime when patient able to swallow and bowel sounds present. +18 Hours oxycodone (OxyContin) 10 mg tab CR PO Q12H, Clinical Instructions: Begin POD #1 (DEF)* 20 mg tab CR PO Q12H, Clinical Instructions: Begin POD #1 celecoxib (Celebrex) 200 mg cap PO BEDTIME Comments: Begin POD #0 at bedtime when patient able to swallow and bowel sounds present. Do NOT give if sulfa allergic or serum creatinine GREATER than or EQUAL to 1.2. Begin AFTER intraspinal analgesic discontinued/completed ***NOTE*** ANES Patient Controlled Analgesia (PCA): Consider No Basal Rate, especially for patients with diagnosed or suspected OSA ANES Patient Controlled Analgesia (PCA)(SUB)* ***NOTE*** Moderate to Severe Parenteral Pain Medications Please choose only ONE parenteral: hydromorphone (Dilaudid) 0.5 mg inj IV PUSH Q2H Int, PRN Pain Moderate/Severe (DEF)* Comments: If pain control 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 two hour period. 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 pain control 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 two hour period.use for breakthrough pain not relieved by PO pain meds or if unable to tolerate PO. 1.5 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. morphine 2 mg inj IV PUSH Q3H, PRN Pain Moderate/Severe Page 10 of 15
DRUG AND TREATMENT Comments: If pain control ineffective in 15 minutes, may give an additional 2 mg IV. If second dose is required in 15 minutes, may begin next dose at 4 mg. NOT to exceed 4 mg in two hour period.use for breakthrough pain not relieved by PO pain meds or if unable to tolerate PO. ***NOTE*** Moderate to Severe PO Pain Medications Please choose only ONE PO: oxycodone 5 mg tab PO Q3H, PRN Pain Moderate Comments: When able to take PO, If pain control ineffective in 30 minutes, may give an additional tablet (5 mg). If second dose is required in 30 minutes, may begin next dose at 2 tablets (10 mg). acetaminophen-hydrocodone (Norco 325 mg-5 mg oral tablet) 1 tab PO tab Q4H Int, PRN Pain Moderate/Severe Comments: When able to take PO. If pain control ineffective in 30 minutes, may give an additional tablet. If second dose is required in 30 minutes, may begin next dose at 2 tablets. acetaminophen-hydrocodone (Norco 325 mg-7.5 mg oral tablet) 1 tab PO tab Q4H Int, PRN Pain Moderate/Severe Comments: When able to take PO. If pain control ineffective in 30 minutes, may give an additional tablet. If second dose is required in 30 minutes, may begin next dose at 2 tablets. acetaminophen-hydrocodone (Norco 325 mg-10 mg oral tablet) 1 tab PO tab Q4H Int, PRN Pain Moderate/Severe Comments: When able to take PO. hydromorphone (Dilaudid) 2 mg tab PO Q3H, PRN Pain Moderate/Severe Comments: When able to take PO. If pain control ineffective, may give additional tablet (2 mg). If second dose is required in 30 minutes, may begin next dose at 2 tablets (4 mg) ***NOTE*** Mild Pain or Fever Medications acetaminophen (Tylenol) 650 mg tab PO Q4H, PRN Other (see comment) Comments: PRN mild pain OR for fever GREATER than 101 degrees Fahrenheit. If patient received IV Tylenol, wait 6 hours to give PO Tylenol. Anticoagulants ***NOTE*** VTE Prophylaxis Reason Surgical Care VTE Mechanical Prophylaxis Not Ordered Bilateral amputations lower extremities (DEF)* Bilateral lower extremity trauma IV heparin 24 hrs before/after surgery Patient refusal Other Reason Reason Surgical Care VTE Pharmacological Prophylaxis Not Ordered Active bleeding (DEF)* Bleeding risk GI bleed Hemorrhage IV heparin 24 hrs before/after surgery Patient refusal Page 11 of 15
DRUG AND TREATMENT Thrombocytopenia Other Reason +16 Hours enoxaparin (Lovenox) 30 mg inj SUBCUT Q12H (DEF)* Comments: first dose 22 hours post anesthesia end time unless contraindicated on intraspinal anesthesia orders. Renal dose adjust per pharmacy recommendations 40 mg inj SUBCUT DAILY Comments: first dose 22 hours post anesthesia end time unless contraindicated on intraspinal anesthesia orders. Renal dose adjust per pharmacy recommendations ***NOTE*** Arixtra: consider only if calculated creatinine clearance is GREATER than 30 ml/min and patient weight is GREATER than 50 kg. NOT available at Baptist Nassau. +16 Hours fondaparinux (Arixtra) 2.5 mg inj SUBCUT DAILY Comments: if calculated creatinine clearance is GREATER than 30 ml/min and patient weight is GREATER than 50 kg. First dose 22 hours post anesthesia end time unless contraindicated on intraspinal anesthesia orders. +16 Hours rivaroxaban (Xarelto) 10 mg tab PO DAILY Comments: If calculated creatinine clearance is GREATER than 30 ml/min and patient weight is GREATER than 50 kg. First dose 22 hours post anesthesia end time. Do NOT give within 23 hours of any other anticoagulant. GEN Warfarin Initiation(SUB)* ***Reminder: Order GEN Warfarin Initiation (SUB) on a separate form.*** aspirin 325 mg tab EC PO BID Muscle Spasms/Relaxation methocarbamol (Robaxin) 750 mg tab PO Q6H Int, PRN Muscle Spasms Comments: Hold for systolic blood pressure LESS than 100 mmhg diazepam (Valium) 5 mg tab PO Q4H Int, PRN Muscle Spasms (DEF)* Comments: or PRN Sleep 5 mg inj IV PUSH Q4H Int, PRN Muscle Spasms Comments: or PRN Sleep Antiemetics ondansetron (Zofran) 4 mg inj IV PUSH Q6H, PRN Nausea/Vomiting Comments: May give PO if patient able to take PO. If Zofran ineffective in 30 minutes, may give Phenergan if ordered. ondansetron (Zofran ODT) 4 mg tab soluble PO Q6H, PRN Nausea/Vomiting promethazine (Phenergan) 6.25 mg inj IV PUSH Q4H Int, PRN Nausea/Vomiting (DEF)* Comments: FOR patients 65 years and older: If ineffective in 15 minutes, may repeat ONCE. If second dose is required in 15 minutes, may begin next dose at 12 mg. If patient has IV running, dilute promethazine dose in 10 ml of normal saline and administer slowly over 3 to 5 minutes at Page 12 of 15
DRUG AND TREATMENT the port furthest from the IV insertion site. If the patient does not have an IV running, dilute the promethazine in 50 ml normal saline and administer over 15 minutes. 12.5 mg inj IV PUSH Q4H Int, PRN Nausea/Vomiting Comments: FOR patients LESS than 65 years. If patient has IV running, dilute promethazine dose in 10 ml of normal saline and administer slowly over 3 to 5 minutes at the port furthest from the IV insertion site. If the patient does not have an IV running, dilute the promethazine in 50 ml normal saline and administer over 15 minutes. Antihistamines cetirizine (Zyrtec) 10 mg tab PO DAILY, PRN Itching Comments: May increase to BID if needed. diphenhydramine (Benadryl) 12.5 mg cap PO DAILY, PRN Itching Comments: If unable to tolerate Zyrtec. If patient LESS than 65 years of age and itching control ineffective, may repeat 12.5 mg PO once in 1 hour then increase next dose to 25 mg Sleep Aids temazepam (Restoril) 15 mg cap PO BEDTIME, PRN Sleep/Insomnia Comments: If patient is LESS than 65 years of age, may repeat once in one hour if needed. Gastrointestinal Agents docusate-senna (Peri-Colace) 2 tab PO tab BID Comments: Start day of surgery (POD 0) at bedtime when tolerating PO. If no BM by POD 1 at bedtime, increase to 4 tabs PO BID. Hold for loose stools polyethylene glycol 3350 (MiraLax) 17 g packet PO BID Comments: Start day of surgery (POD 0) when tolerating PO. Hold for loose stools bisacodyl (Dulcolax) 10 mg tab EC PO ASDIR, PRN Constipation, Duration: 1 dose Comments: On day of discharge if no bowel movement. May give PR if unable to take PO. Hold for loose stools bisacodyl (Dulcolax) 10 mg supp PR ASDIR, PRN Constipation, Duration: 1 dose Comments: On day of discharge if no bowel movement, if unable to take PO. Hold for loose stools +8 Hours pantoprazole (Protonix) 40 mg tab EC PO ACBRKF Comments: Start POD# 1 Reason Beta Blocker Not Administered Peri-Operatively Reason: Allergy (DEF)* Reason: Bradycardia (HR less than 50 bpm) Reason: Hypotension (SBP less than 100 mmhg) Reason: Concurrent use of IV inotropic med Reason: Other reason charted (MD/APN/PA/PharmD) Reason Alcohol/Substance Abuse Medication Not Prescribed Reason: Patient Refused (DEF)* Page 13 of 15
DRUG AND TREATMENT Reason: Allergy to FDA Approved Medication Reason: Drug Interaction to All FDA Approved Med Reason: Cognitive Impairment Reason: Left Against Medical Advice Reason: Does Not Meet Criteria ETOH Use Disorder Reason: Patient Expired Reason: Hospice Patient Reason: Not a Resident of United States Reason Tobacco Cessation Med Not Given Allergy to ALL tobacco cessation meds (DEF)* Drug interaction for ALL approved meds Other Reason IV Solutions Lactated Ringers Injection IV 75 ml/hour Comments: Discontinue POD#2 NS IV 75 ml/hour Comments: Discontinue POD#2 Laboratory Hemoglobin STAT, Blood Comments: In PACU Hemoglobin and Hematocrit Early AM, Blood, DAILY, 2 times CHEM 7 Blood Radiology XR Knee L 2 view Portable Post-Op, Pending Discharge - No, Patient in PACU XR Knee R 2 view Portable Post-Op, Pending Discharge - No, Patient in PACU XR Hip L 1 view Portable Post-Op, Pending Discharge - No, Patient in PACU XR Hip R 1 view Portable Post-Op, Pending Discharge - No, Patient in PACU XR Hip L 2 view w/pelvis Portable Post-Op, Pending Discharge - No, Patient in PACU XR Hip R 2 view w/pelvis Portable Post-Op, Pending Discharge - No, Patient in PACU Respiratory O2 Therapy. Nasal Cannula, 3, Liters overnight. May discontinue in AM POD #1 if O2 sats are greater than 92% on room air Page 14 of 15
DRUG AND TREATMENT Incentive Spirometry Routine, Q2H while awake Consults Consult Physician (BMCD) Baptist Primary Care Hospitalist, For post-op medical management (DEF)* Baptist Primary Care Hospitalist, STAT, Patient in PACU Hospitalist on call Hospitalist on call, STAT, Patient in PACU Consult Physician (BMCB) For post-op medical management Consult Physician (BMCN) For post-op medical management Consult Physician (BMCS) For post-op medical management Consult Physician Infectious Disease, STAT, patient in PACU Comments: Infectious Disease unavailable at Baptist Nassau Physical Therapy Consult Non weight bearing (DEF)* Partial weight bearing Toe touch weight bearing Weight bearing as tolerated Partial 30 pounds Occupational Therapy Consult Social Work Consult Discharge Planning, Physician, Discharge Pending (DEF)* Arrange home health care versus extended care facility as indicated Home Care Physical Therapy Eval and Treatment, Total joint replacement post op care, Physical Therapy daily for 2-4 days, starting day after discharge, then progress to 3x/week for 1-2 weeks as long as patient progressing with the therapy protocols. PT to eval (DEF)* Physical Therapy Eval and Treatment, THA post op care, As indicated for appropriate THA precautions., If PT assessment identifies need for specific OT followup or for more frequent home visits, contact surgeon for specific orders. Assist with transition Durable Medical Equipment (Home DME) Walker - Rolling, 99 mos, 2-wheel, 3:1 to be used at bedside Consult Cast Tech Page 15 of 15