Unique Plan Description: URO Enhanced Recovery Major Surgery, Pre op
Plan Selection Display: URO Enhanced Recovery Major Surgery, Pre op
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2020-05-01 08:54:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2021-12-21 12:25:36
Available at all facilities: No

URO Enhanced Recovery Major Surgery, Pre op
Admit/Discharge/Transfer
	Admit to Observation Status
		T;N
	Admit to Inpatient Status
		T;N, Anticipated LOS 2 midnight or more
Diet
	NPO
		
Laboratory
	UA (Culture if Positive)
		T;N, Routine, Routine, spec type = Urine
	CBC with Diff
		Stat, spec type = Blood
	Basic Metabolic Panel
		Stat, spec type = Blood
	Type and Screen (No Product on hold)
		T;N, Stat, spec type = Blood
	Type and Crossmatch (Product Available)
		T;N, Stat, For Possible Transfusion
	HGB A1C
		T;N, spec type = Blood
Medications
	Mefoxin (JE)
		2,000 mg, Injection, IV Push, PREOP, Surgical prophylaxis
	Mefoxin Syringe
		2,000 mg, Syringe, IV Push, PREOP, Surgical prophylaxis
	Mefoxin (FH)
		2,000 mg, INT, IVPB, PREOP, Surgical prophylaxis
	ertapenem
		1,000 mg, IVPB, PREOP, Surgical prophylaxis
	Unasyn IVPB
		3,000 mg, IVPB, PREOP, Surgical prophylaxis
	Unasyn IVPB (FH)
		3,000 mg, INT, IVPB, PREOP, Surgical prophylaxis
		                                       For Penile Prosthesis patients, choose 1 of the 3 options below:(NOTE)*
		Option 1(NOTE)*
	Unasyn IVPB
		3,000 mg, IVPB, PREOP, Surgical prophylaxis
	Unasyn IVPB (FH)
		3,000 mg, INT, IVPB, PREOP, Surgical prophylaxis
		Option 2(NOTE)*
	Ancef (JE)
		2,000 mg, Injection, IV Push, PREOP, Surgical prophylaxis
	Ancef (MH/WH)
		2,000 mg, Syringe, IV Push, PREOP, Surgical prophylaxis
	Ancef (FH)
		2,000 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis, T;N
			Comment: 80-120kg
		1,000 mg, INT, IVPB, PREOP, Surgical prophylaxis, T;N
			Comment: <80kg
		3,000 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis, T;N
			Comment: >120kg
	gentamicin IVPB
		80 mg, IVPB, PREOP, Surgical prophylaxis
	gentamicin IVPB (FH)
		80 mg, INT, IVPB, PREOP, Surgical prophylaxis
		Option 3(NOTE)*
		Gentamicin and a dose of Vancomycin should be selected(NOTE)*
	gentamicin IVPB
		80 mg, IVPB, PREOP, Surgical prophylaxis
	gentamicin IVPB (FH)
		80 mg, INT, IVPB, PREOP, Surgical prophylaxis
	vancomycin IVPB
		1,000 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment: For patients weighing  <80kg, infuse over 60 minutes; document reason for vancomycin
		1,500 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment: For patients weighing  80-120kg, infuse over 90 minutes; document reason for vancomycin
		2,000 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment: For patients weighing  >120kg, infuse over 90 minutes; document reason for vancomycin
	vancomycin IVPB (FH)
		1,000 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment: For patients weighing  <80kg, infuse over 60 minutes; document reason for vancomycin
		1,500 mg, INT, IVPB, PREOP, Surgical prophylaxis
			Comment: For patients weighing  80-120kg, infuse over 90 minutes; document reason for vancomycin
		2,000 mg, INT, IVPB, PREOP, Surgical prophylaxis
			Comment: For patients weighing  >120kg, infuse over 90 minutes; document reason for vancomycin
		Additional Medications(NOTE)*
	mitoMYcin irrigation
		40 mg, Irrigation, IntraBladder, Once
			Comment: Mitomycin 40mg/40ml sterile water syringe (NMH), intrabladder, once. Bladder instillation, Intraop
	Botox
		300 units, IntraBladder, Once
			Comment: injection, intraop
		200 units, IntraBladder, Once
			Comment: injection, intraop
		100 units, IntraBladder, Once
			Comment: injection, intraop
	rifaMPin 600 mg-gentamicin 80 mg/60 mL
		1 appl, Solution-Injection, TOPICAL, Once, Other- type in, prophylaxis
			Comment: Use intra-op for penile prosthesis dip
Patient Care
	Obtain Consent/Permit for:
		T;N
Consults/Follow-up
	Consult Anesthesiologist
		Reason for Referral: thoracic epidural
		Reason for Referral: intrathecal opioid
		Reason for Referral: tap block
		Reason for Referral: Non-invasive cardiac output monitor. Goal directed therapy

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