Unique Plan Description: Bari Surg Paniculectomy (MH), Pre op
Plan Selection Display: Bari Surg Paniculectomy (MH), Pre op
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2012-10-30 17:56:54
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2019-03-15 16:30:50
Available at all facilities: Yes

Bari Surg Paniculectomy (MH), Pre op
Admit/Discharge/Transfer
	Admit to Inpatient Status
		T;N, Anticipated LOS 2 midnight or more
	Admit to Observation Status
		T;N
Diet
	NPO
		T;N, except for 8oz apple juice 3 hours prior to scheduled OR time
Laboratory
	Type and Screen (No Product on hold)
		Stat, spec type = Blood
	CBC with Diff
		Stat, spec type = Blood
	Hematocrit
		Stat, spec type = Blood
	INR - MH/WH/JE
		Stat, spec type = Blood
	Heparin Anti-Xa Heparin
		Stat, spec type = Blood
	Basic Metabolic Panel
		Stat, spec type = Blood
	Comprehensive Metabolic Panel
		Stat, spec type = Blood
Diagnostic Tests
	ECG
		
		Stat, Indication: Pre-op Release
IV Solutions
	Lactated Ringers Injection
		500 mL, IV, 1 Dose(s)/Time(s), Bolus
		1,000 mL, IV, 125 ml/hr
Medications
	Ancef (MH/WH)
		2,000 mg, Syringe, IV Push, PREOP, Surgical prophylaxis
			Comment: If penicillin allergy, give levofloxacin
	Mefoxin Syringe
		2,000 mg, Syringe, IV Push, PREOP, Surgical prophylaxis
	Levaquin IVPB
		750 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
	Flagyl IVPB
		1,000 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
		For patients < 80kg, select 1000mg dose, For patients 80-120kg, select 1500mg dose, For patients >120kg select 2000mg dose(NOTE)*
	vancomycin IVPB
		1,000 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment:  For patients < 80kg; Give over 60 minutes
		1,500 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment: For patients 80-120kg; give over 90 minutes
		2,000 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment: For patients >120kg; give over 90 minutes
	HEParin 5000 units/mL SUBCUTANEOUS
		5,000 units, Injection, SUBCUTANEOUS, PREOP
			Comment: Do not give in abdomen
Patient Care
	Obtain Consent/Permit for:
		
	Impulse Foot Pumps
		
Consults/Follow-up
	Consult Anesthesiologist
		Reason for Referral: thoracic epidural, intrathecal opiod, or tap block
			Comment: Single Intrathecal Dose (of preservative free morphine < or = to 0.2 mg). or Thoracic Epidural
		Reason for Referral: Neuraxial Pain Control
			Comment: Single Intrathecal Dose (of preservative free morphine < or = to 0.2 mg). or Thoracic Epidural

Multi-Modal Pre-Op Analgesics
Medications
	gabapentin
		300 mg, Capsule, BY MOUTH, PREOP
			Comment: Administer 1-2 hr prior to surgery; contact Anesthesia if not given. Give 300mg if patient < or = 60 years old and > or = 63.6kg (140 lbs); pharmacy to modify dose to 200mg if patient 61-70 years old or weighs 54.5-63.5kg (120-139 lbs); pharmacy to modify dose to 100mg if patient 71-75 years old or weighs < 54.5kg (< 120 lbs).  If patient 76 years old or older, discontinue order.
		200 mg, Capsule, BY MOUTH, PREOP
			Comment: If 61-70 years old or weighs 54.5-63.5kg (120-139 lbs); administer 1-2 hr prior to surgery; contact Anesthesia if not given.
		100 mg, Capsule, BY MOUTH, PREOP
			Comment: If 71-75 years old or weighs <54.4kg ( < 120 lbs); administer 1-2 	hr prior to surgery; contact Anesthesia if not given.
	meloxicam
		7.5 mg, Tab, BY MOUTH, PREOP
			Comment: Do not use if CrCl < 30ml/min or if systolic blood pressure <90mmHg; administer 1-2hr prior to surgery; contact Anesthesia if not given. Any post-operative NSAID dose should be given no sooner than 12hr after pre-op dose unless otherwise directed by Anesthesia.
		15 mg, Tab, By Mouth, PREOP
			Comment: Comment: Do not use if CrCl < 30ml/min or if systolic blood pressure <90mmHg; administer 1-2hr prior to surgery; contact Anesthesia if not given. Any post-operative NSAID dose should be given no sooner than 24hr after pre-op dose unless otherwise directed by Anesthesia.
	acetaminophen
		1,000 mg, Tab, BY MOUTH, PREOP
			Comment: For case duration < 6 hrs.
	Ofirmev
		1,000 mg, Solution-Injection, IVPB, Once, PRN, see comment, 1 Dose(s)/Time(s)
			Comment: Use only if strict NPO for all oral medications pre-op; Anesthesia to determine dose timing - pre-op or intra-op.

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase