Unique Plan Description: HN Onc Endocrine Pre-Op
Plan Selection Display: HN Onc Endocrine Pre-Op
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2016-10-24 13:39:29
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-04-09 13:46:19
Available at all facilities: No

HN Onc Endocrine Pre-Op
Admit/Discharge/Transfer
	Admit to Observation Status
		T;N, Phase II
		T;N
	Admit to Inpatient Status
		T;N, Anticipated LOS 2 midnight or more
Medications
Antibiotic Prophylaxis
		Clean Case(NOTE)*
	Do not give medication
		no antibiotic prophylaxis needed for clean head and neck cases
		If allergic to Beta-Lactams(NOTE)*
	clindamycin IVPB
		600 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
		If allergic to Beta-Lactams and Cleocin(NOTE)*
	Levaquin IVPB
		750 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment: Infuse over 1 hour
	Ancef IVPB (FH)
		2,000 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
	Ancef (JE)
		2,000 mg, Injection, IV Push, PREOP, Surgical prophylaxis
	Ancef (MH/WH)
		2,000 mg, Syringe, IV Push, PREOP, Surgical prophylaxis
		May be used in combination with Ancef (cefazolin)(NOTE)*
	Unasyn IVPB
		3,000 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
		1,500 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
	Unasyn IVPB (FH)
		3,000 mg, INT, IVPB, PREOP, Indication: Surgical prophylaxis
		1,500 mg, INT, IVPB, PREOP, Indication: Surgical prophylaxis
		If allergic to Beta-lactams(NOTE)*
	metroNIDAZOLE IVPB
		1,000 mg, Injection-Premix, IVPB, PREOP, Indication: Surgical prophylaxis
			Comment: Infuse over 1 hour
	Levaquin IVPB
		750 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
	clindamycin IVPB
		600 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
Patient Care

	Obtain Consent/Permit for:
		Total thyroidectomy with recurrent laryngeal nerve monitoring
		Left thyroid lobectomy with recurrent laryngeal nerve monitoring
		Right thyroid lobectomy with recurrent laryngeal nerve monitoring
		Thyroidectomy, possible neck dissection
		Thyroidectomy, possible neck dissection, recurrent laryngeal nerve monitoring
		Total thyroidectomy with recurrent laryngeal nerve monitoring
		Total thyroidectomy, neck dissection and recurrent laryngeal nerve monitoring
		Parathyroid Exploration
	Sequential Compression Device Pre Procedure
		T;N, Apply, Once
			Comment: knee high
	Anti Embolism Stockings Pre Procedure
		T;N, Apply, Once
			Comment: knee high
Consults/Follow-up
	Consult Anesthesiologist
		Reason for Referral: Non-invasive cardiac output monitor

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.
	acetaminophen 10 mg/mL intravenous solution
		1,000 mg, Solution-Injection, IVPB, Once, PRN for see comment, duration: 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