Unique Plan Description: Ortho Total Hip & Total Knee, Pre Op (MH)
Plan Selection Display: Ortho Total Hip & Total Knee, Pre Op (MH)
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2024-06-19 08:20:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-06-19 08:20:00
Available at all facilities: Yes

Ortho Total Hip & Total Knee, Pre Op (MH)
Admit/Discharge/Transfer
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	Admit to Inpatient Status
		T;N, Anticipated LOS 2 midnight or more
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	Admit to Observation Status
		T;N
Vital Signs
	Vital Signs
		T;N
			Comment: pre op
Diet
	NPO
		
Laboratory
	Type and Screen (No Product on hold)
		T;N, Stat, spec type = Blood
Medications
PreOp
		For patients < 120kg, select cefazolin 2,000mg dose, For patients >/= 120kg, select cefazolin 3,000mg dose(NOTE)*
	Ancef (MH/WH)
		2,000 mg, Syringe, IV Push, PREOP, Indication: Surgical prophylaxis
		3,000 mg, Syringe, IV Push, PREOP, Indication: Surgical prophylaxis
	Cleocin IVPB
		900 mg, Injection-Premix, IVPB, PREOP, Indication: Surgical prophylaxis
			Comment: If allergic to cephalosporins or if anaphylaxtic reaction or breathing difficulty with penicillin.
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	vancomycin IVPB
		1,000 mg, Injection-Premix, IVPB, PREOP, Indication: Surgical prophylaxis
			Comment: For patients <80kg; infuse over 1 hour. If allergic to other antibiotic options or documented reason for use.
		1,500 mg, Injection-Premix, IVPB, PREOP, Indication: Surgical prophylaxis
			Comment: For patients 80-120kg; infuse over 90 minutes. If allergic to other antibiotic options or documented reason for use.
		2,000 mg, Injection-Premix, IVPB, PREOP, Indication: Surgical prophylaxis
			Comment: For patients >120kg; infuse over 90 minutes. If allergic to other antibiotic options or documented reason for use.
	pregabalin
		150 mg, Capsule, By Mouth, PREOP
			Comment: Administer 1-2 hr prior to surgery;. Give 150mg if patient < or = 60 years old and > or = 63.6kg (140 lbs); pharmacy to modify dose to 75mg if patient 61-74 years old or weighs 54.5-63kg (120-139 lbs);  If patient 75 years old or older or less than 54.5kg (120lbs), discontinue order.
	celecoxib
		400 mg, Capsule, By Mouth, PREOP
			Comment: Decrease dose to 200mg if CrCl 30-60ml/min; do not give if CrCl < 30ml/min, history of peptic ulcer disease, or if history of (or active) coronary artery disease (MI, cardiac stent, angina).
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	meloxicam
		7.5 mg, Tab, By Mouth, PREOP
			Comment: Do not give if CrCl < 30ml/min, history of peptic ulcer disease, or if history of (or active) coronary artery disease (MI, cardiac stent, angina).
	Transderm-Scop 1 mg patch
		1 mg, Patch, TOPICAL, PREOP, PRN see comment, STAT
			Comment: h/o post-op nausea/vomiting, notify anesthesia prior to administration
	scopolamine Patch Removal
		Patch Removal, Patch, TOPICAL, Q3D, T+3;0900
Anesthesia Nerve Block
	dexam PF/buprenorphine/ropiv 0.5%
		4 mg, NERVE BLOCK, Once
		0.3 mg, EVERY BAG
		20 mL, EVERY BAG
Anesthesia Intra-op
	tranexamic acid
		1,000 mg, Solution, IV Push, Once
			Comment: To be given in OR by Anesthesia. 2nd dose at end of case
	magnesium sulfate IVPB
		2,000 mg, IVPB, Once
			Comment: To be given by Anesthesia in the OR
	ketamine
		0.25 mg/kg, Injection, IV Push, Once
			Comment: To be given by Anesthesia in the OR
		0.5 mg/kg, Injection, IV Push, Once
			Comment: To be given by Anesthesia in the OR
	dexamethasone Injectable
		8 mg, Injection, IV Push, Once
			Comment: To be given by Anesthesia in the OR for knees
		12 mg, Injection, IV Push, Once
			Comment: To be given by Anesthesia in the OR for hips
	ondansetron
		4 mg, Injection, IV Push, Once
			Comment: To be given by Anesthesia at time of closure
Surgeon Intra-op
	vancomycin topical
		1,000 mg, Powder, TOPICAL, Once, Indication: Surgical prophylaxis
			Comment: To be used by surgeon in OR
	bupivacaine-EPINEPHrine 0.25%-1:200,000 injectable solution
		60 mL, Injection, IntraArticular, Once
			Comment: To be given intraop by surgeon
	ropivacaine 0.2%/ketorolac 30mg/epi0.25mg/NS
		20 mL, IntraArticular, Once, Routine
			Comment: Pharmacy to dose per Allergies, Renal Function, and Cardiac Hx
		30 mg, EVERY BAG
		0.25 mg, EVERY BAG
		40 mL, EVERY BAG
Patient Care

	Obtain Consent/Permit for:
		Right Total Knee Arthroplasty
		Left Total Knee Arthroplasty
		Right Total Hip Arthroplasty
		Left Total Hip Arthroplasty
	Notify MD of Lab results
		T;N, if UA positive for bacteria, and or WBC >10.
	Surgical Prep
		T;N, Clipper prep
			Comment: operative extremity
	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 Anesthesia/Post Surgical Pain
		Reason for Referral: Consult Anesthesia for post-surgical pain management that is non-routine and requires the expertise of an anesthesia provider
			Comment: Consult Anesthesia for post-surgical pain management that is non-routine and requires the expertise of an anesthesia provider, uniquely trained and qualified to assist with post-surgical pain management, including but not limited to administration of nerve blocks or epidural catheter placement.

*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