Unique Plan Description: Ortho Total Joint, Pre Op
Plan Selection Display: Ortho Total Joint, Pre Op
PlanType: Medical                                 
Version: 3          
Begin Effective Date: 2023-12-12 14:52:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2023-12-12 14:52:00
Available at all facilities: Yes

Ortho Total Joint, Pre Op
Admit/Discharge/Transfer
		<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"><HTML><HEAD><META content="text/html; charset=windows-1252" http-equiv=Content-Type><STYLE> BODY margin:0; P margin:0 </STYLE><META name=GENERATOR content="MSHTML 11.00.9600.18817(NOTE)*
	Admit to Inpatient Status
		T;N, Anticipated LOS 2 midnight or more
		Note: To be used for Total Knee Replacement surgery, Unicondylar knee replacement procedures, Hemiarthroplasty procedures of the shoulder when there are no underlying co-morbidities that will increase the patients risk, require additional hospital resourc(NOTE)*
	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
	UA (Culture if Positive)
		Nurse Collect, Stat, Stat, spec type = Urine
			Comment: Urine via foley catheter, leave foley in place
	INR - MH/WH/JE
		T;N, Stat, spec type = Blood
	Prothrombin Time (PT) - FH
		T;N, Stat, spec type = Diagnostic Blood
		T;N, Stat, spec type = Therapeutic Blood
	hsCRP
		T;N, Stat, spec type = Blood
			Comment: if hip revision
	Sed Rate
		T;N, Stat, spec type = Blood
			Comment: if hip revision
	Blood Gases Arterial (ABG) - MH/WH/JE
		T;N, Stat, spec type = Blood
			Comment: if O2 sats <92%
	Blood Gases Arterial (ABG) - FH
		T;N, Stat, spec type = Blood
	BMP
		T;N, Stat, spec type = Blood
Diagnostic Tests
	Chest 2 View
		T;N, Stat, PREOP
Medications
	Ancef (JE)
		2,000 mg, Injection, IV Push, PREOP, Surgical prophylaxis
			Comment: 80-120kg. OK to give if pt allergic to penicillin unless history of anaphylactic reaction.
		1,000 mg, Injection, IV Push, PREOP, Surgical prophylaxis
			Comment: < 80kg. OK to give if pt allergic to penicillin unless history of anaphylactic reaction.
		3,000 mg, Injection, IV Push, PREOP, Surgical prophylaxis
			Comment: > 120kg.  OK to give if pt allergic to penicillin unless history of anaphylactic reaction.
	Ancef (MH/WH)
		2,000 mg, Syringe, IV Push, PREOP, Surgical prophylaxis
	Ancef (FH)
		2,000 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment: 80-120kg.  Give 1 hr preop.  OK to give if pt allergic to penicillin unless history of anaphylactic reaction.  Redose every 3 hours during surgery
		1,000 mg, INT, IVPB, PREOP, Surgical prophylaxis
			Comment: < 80kg.  Give 1 hr preop.  OK to give if pt allergic to penicillin unless history of anaphylactic reaction.  Redose every 3 hours during surgery
		3,000 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment: > 120kg.  give 1 hr Preop.  OK to give if pt allergic to penicillin unless history of anaphylactic reaction.  Redose every 3 hours during surgery
	Zinacef (JE)
		1,500 mg, Injection, IV Push, PREOP, Surgical prophylaxis
	Zinacef (MH/WH)
		1,500 mg, Syringe, IV Push, PREOP, Surgical prophylaxis
		750 mg, Syringe, IV Push, PREOP, Surgical prophylaxis
	Zinacef IVPB (FH)
		1,500 mg, INT, IVPB, PREOP, Surgical prophylaxis
	Cleocin IVPB
		900 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment: If allergic to cephalosporins or if anaphylaxtic reaction or breathing difficulty with penicillin.
		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; infuse over 1 hour. If allergic to other antibiotic options or documented reason for use.
		1,500 mg, Injection-Premix, IVPB, PREOP, 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, Surgical prophylaxis
			Comment: For patients >120kg; infuse over 90 minutes. If allergic to other antibiotic options or documented reason for use.
	vancomycin IVPB (FH)
		1,000 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment: For patients <80kg; infuse over 1 hour. If allergic to other antibiotic options or documented reason for use.
		1,500 mg, INT, IVPB, PREOP, 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, INT, IVPB, PREOP, Surgical prophylaxis
			Comment: For patients >120kg; infuse over 90 minutes. If allergic to other antibiotic options or documented reason for use.
	warfarin
		10 mg, Tab, By Mouth, PREOP
			Comment: not on warfarin, protime/INR not elevated
		5 mg, Tab, By Mouth, PREOP
			Comment: If under 70 years old or under 150 lbs and not on warfarin, protime/INR not elevated,
	aspirin
		325 mg, Tab, By Mouth, PREOP
	Lyrica
		150 mg, Capsule, By Mouth, PREOP
	CeleBREX
		200 mg, Capsule, By Mouth, PREOP
		400 mg, Capsule, By Mouth, PREOP
	Cyklokapron
		1,000 mg, Solution, IV Push, Once
		2,000 mg, Solution, IV Push, Once
		1,000 mg, Solution, IntraArticular, Once
		10 mg/kg, Solution, IV Push, Once
		15 mg/kg, Solution, IV Push, Once
Patient Care
	Obtain Consent/Permit for:
		Right Total Knee Arthroplasty
		Left Total Knee Arthroplasty
		Right Total Hip Arthroplasty
		Left Total Hip Arthroplasty
		Right Total Shoulder Arthroplasty
		Left Total Shoulder 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
Consults/Follow-up
	Consult Hospitalist
		Reason for Referral: If PCP does not make hospital rounds., Refer to/Consult with: Hospitalist on call
	Consult Anesthesiologist
		Reason for Referral: Block for Pain Management
	Consult Anesthesia/Post Surgical Pain
		Reason for Referral: Post-Surgical Pain, Refer to/Consult with: Anesthesia on Call, No Provider Notified
			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.

VTE Prophylaxis Pre Op
Medications
	HEParin 5000 units/mL SUBCUTANEOUS
		5,000 units, Injection, SUBCUTANEOUS, PREOP, T;N
	Lovenox
		40 mg, Syringe, SUBCUTANEOUS, PREOP, T;N
		30 mg, Syringe, SUBCUTANEOUS, PREOP, T;N
Patient Care
	Sequential Compression Device Pre Procedure
		T;N, Apply, Once
			Comment: knee high
	Anti Embolism Stockings Pre Procedure
		T;N, Apply, Once
			Comment: knee high

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