Unique Plan Description: URO Enhanced Recovery URO Major, Post op EKM
Plan Selection Display: URO Enhanced Recovery URO Major, Post op
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2020-05-01 08:55:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2022-09-21 11:55:45
Available at all facilities: Yes

URO Enhanced Recovery URO Major, Post op EKM
Vital Signs
	Vital Signs
		T;N, Routine post op
Activity
	Up in Chair
		T;N, TID, 1, Day(s)
	Ambulate
		T+1;0001, With assistance, TID
			Comment: start day of surgery
Diet
	Clear Liquid Diet
		T;N
			Comment: 1, Day(s)
	Blenderized Liquid (Full) Diet
		T+1;0600
			Comment: 1, Day(s)
	Low Fiber Diet
		T+2;0600
	Oral Supplement
		Impact Advanced Recovery MH only, BID
Laboratory
STAT Lab
	Hemoglobin and Hematocrit
		Stat, spec type = Blood
	Basic Metabolic Panel
		Stat, spec type = Blood
Tomorrow's Lab
	Basic Metabolic Panel
		T+1;0400, Routine, Q24H 2 Dose(s)/Time(s), spec type = Blood
	CBC with Diff
		T+1;4000, Routine, Q24H, 2 Dose(s)/Time(s), spec type = Blood
IV Solutions

	Lactated Ringers Injection
		1,000 mL, IV, 40 ml/hr
Medications
	Mefoxin IVPB (MH/WH)
		2,000 mg, Injection-Premix, IVPB, Q8H, Surgical prophylaxis, 3 Dose(s)/Time(s)
	Mefoxin IVPB (FH)
		2,000 mg, INT, IVPB, Q8H, Surgical prophylaxis, 3 Dose(s)/Time(s)
	Zinacef (JE)
		1,500 mg, INT, IVPB, Q8H, Surgical prophylaxis, 48 hr
	Zinacef IVPB (FH)
		1,500 mg, INT, IVPB, Q8H, Surgical prophylaxis, 48 hr
	Ancef IVPB (MH/WH)
		1,000 mg, Injection-Premix, IVPB, Q8H, Surgical prophylaxis, 24 hr
	Ancef IVPB (FH)
		1,000 mg, INT, IVPB, Q8H, Surgical prophylaxis, 24 hr
	Pepcid
		20 mg, Injection, IV PUSH, BID
	Tylenol
		1,000 mg, Tab, By Mouth, Q6H
			Comment: Please be advised that the nonnarcotic pain meds are scheduled and not PRN.  Please give to the patients even if not in pain, do not give both oral and IV APAP, start 6 hr after any pre-op/intra-op dose.
		1,000 mg, Elixir, By Mouth, Q6H
			Comment: Please be advised that the nonnarcotic pain meds are scheduled and not PRN.  Please give to the patients even if not in pain, do not give both oral and IV APAP, start 6 hr after any pre-op/intra-op dose.
	acetaminophen 10 mg/mL intravenous solution
		1,000 mg, Solution-Injection, IVPB, Q6H, PRN for see comment, T;N+360, duration: 48 hr
			Comment: Administer only if unable to take oral or rectal formulation; convert to oral medication as soon as possible and discontinue IV order, start 6 hours after any pre-op/intra-op dose.
		NSAIDs cannot be used (ARE CONTRAINDICATED) in the following cases:  Allergy to aspirin or any NSAID, During pregnancy, During breast feeding, On blood thinning agents (anticoagulants), Suffering from a defect of the blood clotting system (coagulation), A(NOTE)*
	ibuprofen
		800 mg, Tab, By Mouth, Q8H, see comment, T;N+720, 4 Day(s)
			Comment: Do not give if systolic blood pressure is < 90mm Hg or if serum creatinine is greater than 1.5mg/dL (or creatinine clearance < 50ml/min).  Notify MD of any dose not given with a note in the chart.  Please be advised that the nonnarcotic pain meds are scheduled and not PRN.  Please give to the patients even if not in pain. Please give on scheduled basis. Start 6 hours after IV ketorolac ends.
		800 mg, Suspension, By Mouth, Q8H, see comment, T;N+720, 4 Day(s)
			Comment: Do not give if systolic blood pressure is < 90mm Hg or if serum creatinine is greater than 1.5mg/dL (or creatinine clearance < 50ml/min).  Notify MD of any dose not given with a note in the chart.  Please be advised that the nonnarcotic pain meds are scheduled and not PRN.  Please give to the patients even if not in pain. Please give on scheduled basis. Start 6 hours after IV ketorolac ends.
	ketorolac injectable
		15 mg, Injection, IV Push, Q6H, T;N+720, 2 Dose(s)/Time(s)
			Comment: Do not give if systolic blood pressure is < 90mm Hg or if serum creatinine is greater than 1.5mg/dL (or creatinine clearance < 50ml/min).  Notify MD of any dose not given with a note in the chart Comment: Please be advised that the nonnarcotic pain meds are scheduled and not PRN.  Please give to the patients even if not in pain. Begin 6 hrs after preop NSAID
		30 mg, Injection, IV Push, Q6H, T;N+720, 2 Dose(s)/Time(s)
			Comment: Do not give if systolic blood pressure is < 90mm Hg or if serum creatinine is greater than 1.5mg/dL (or creatinine clearance < 50ml/min).  Notify MD of any dose not given with a note in the chart.   Please be advised that the nonnarcotic pain meds are scheduled and not PRN.  Please give to the patients even if not in pain. Begin 6 hrs after preop NSAID; modify dose to 15mg for patients <50kg or >65 years old.
	traMADol
		50 mg, Tab, By Mouth, Q6H, PRN, pain-moderate
	oxyCODONE
		5 mg, Tab, By Mouth, Q4H, PRN, pain-severe
			Comment: for pain rated 4 or greater and greater than patient stated comfort goal after scheduled medications given. Give for pain rated 4-6. For patients who received intrathecal analgesia start 24 hours after intrathecal dose given. Note pain score before and after administration; may cause drowsiness.  Goal of ERAS order set is to limit opiates as they have a deleterious effect on return of bowel function.  Please limit the administration of opiates unless the pain score is more than 5.
	Buprenex
		0.15 mg, Injection, IV Push, Q4H, PRN, pain-breakthrough
	gabapentin
		200 mg, Capsule, By Mouth, TID, 2 Day(s)
			Comment: Start evening of surgery. Do not give if > 75years old.
		300 mg, Capsule, By Mouth, TID, 2 Day(s)
			Comment: Start evening of surgery. Do not give if > 75years old.
		100 mg, Capsule, By Mouth, TID, 2 Day(s)
			Comment: Start evening of surgery. Do not give if > 75years old.
Antiemetics
	ondansetron
		4 mg, Tablet-Disintegrating, By Mouth, Q6H, PRN for nausea and/or vomiting
		4 mg, Injection, IV PUSH, Q24H, PRN for nausea and/or vomiting
		4 mg, Injection, IV PUSH, Q6H, PRN for nausea and/or vomiting
	Reglan
		10 mg, Injection, IV Push, Q6H, PRN, nausea and/or vomiting
			Comment: Give if ondansetron, phenothiazine or other anti-nausea medications ineffective
		10 mg, Injection, IM-Intramuscular, Q6H, PRN, nausea and/or vomiting
			Comment: Give if ondansetron, phenothiazine or other anti-nausea medications ineffective
	Benadryl
		12.5 mg, Injection, IV Push, Q6H, PRN, nausea and/or vomiting
			Comment: Give if ondansetron, ineffective; avoid in patients > 65yo
	Phenergan (JE)
		25 mg, Tab, By Mouth, BID, PRN, nausea and/or vomiting
			Comment: Give if ondansetron, ineffective; avoid in patients > 65yo
	Phenergan (MH/WH)
		25 mg, Tab, By Mouth, BID, PRN, nausea and/or vomiting
			Comment: Give if ondansetron, ineffective; avoid in patients > 65yo
	Phenergan (FH)
		25 mg, Tab, By Mouth, BID, PRN for nausea and/or vomiting
			Comment: Give if ondansetron, ineffective; avoid in patients > 65yo
	prochlorperazine
		10 mg, Injection, IV Push, Q6H, PRN, nausea and/or vomiting
			Comment: Give if ondansetron, ineffective; avoid in patients > 65yo
Constipation
	docusate
		100 mg, Capsule, By Mouth, DAILY
			Comment: Hold for diarrhea
	Senokot S 50 mg-8.6 mg oral tablet
		2 TAB, Tab, By Mouth, QHS
	MiraLax oral powder for reconstitution
		17 gm, Packet, By Mouth, Q12H, PRN, constipation
			Comment: Mix in 6 oz juice or water
		17 gm, Packet, By Mouth, DAILY, PRN, constipation
			Comment: Mix in 6 oz juice or water
	Milk of Magnesia 8% oral suspension
		30 mL, Suspension, By Mouth, DAILY, PRN for constipation
			Comment: If Miralax not effective; do not use if creatinine clearance or GFR < 30mL/min
		30 mL, Suspension, By Mouth, Q12H, PRN for constipation
			Comment: If Miralax not effective; do not use if creatinine clearance or GFR < 30mL/min
Patient Care

	Resuscitation Status
		Full Code
		No Code
	VTE Advisor
		Urologic surgery
	Intake and Output
		Q6H-Sch
			Comment: Notify MD if urine output < 200ml/6 hr
		Q1H
			Comment: Notify MD if urine output < 30ml/ hr x 2 consecutive hours
	Foley Catheter
		Foley, Pt. undergoing abdominal/pelvic surgery
		Pt. undergoing abdominal/pelvic surgery, see comment
			Comment: Do not Remove Foley
	Enteral Tube
		Per Nasogastric Tube (NG), Connect to gravity drainage
	Nothing per Rectum
		
	Ureteral Stents
		Connect to gravity drainage
			Comment: Continuously
		T;N, DAILY, Irrigate with normal saline 5ml
		T;N, Irrigate with normal saline 5ml, as needed
	Wound Drain
		JP #1, Connect to compressed suction
	Dressing Care
		Change, DAILY as needed
		Change, as needed
		T+2;0001, Change, DAILY
			Comment: PRN; Starting post op day 2
		T+2;0001, Change, as needed
			Comment: Starting post-op day 2
	Ileoconduit Care
		T;N, Change ostomy bag prn. Do not remove stents. Urethral catheter is for drainage only, do not remove.
	Wound Drain
		Bulb Suction, Connect to compressed suction
Therapies
	Incentive Spirometer
		Q1HAWAKE
Consults/Follow-up
	Consult Wound Care
		
	Consult Care Management
		T+1
			Comment: to discuss post op hospital plans on postop day 1

DVT VTE Prophylaxis (FH)
Laboratory
	CBC with Diff
		T;N, Routine, spec type = Blood
		T+1;0500, Routine, EVERY OTHER DAY, spec type = Blood
		T+1;0500, Routine, Q24H 3 Day(s), spec type = Blood
		T+1;0500, Routine, Q24H, spec type = Blood
	BMP
		T;N, Routine, spec type = Blood
	Prothrombin Time (PT) - FH
		T;N, Routine, spec type = Diagnostic Blood
		T+1;0500, Q24H, spec type = Therapeutic Blood
	Partial Thromboplastin Time (PTT) - FH
		T;N, Routine, spec type = Diagnostic Blood
Medications
		See VTE Risk Assessment for patient risk score(NOTE)*
	Lovenox
		40 mg, Syringe, SUBCUTANEOUS, DAILY
			Comment: NOTIFY physician if platelets < 130,000
		30 mg, Syringe, SUBCUTANEOUS, BID
			Comment: NOTIFY physician if platelets < 130,000
		For CrCl < 30 mL/min(NOTE)*
		30 mg, Syringe, SUBCUTANEOUS, DAILY
			Comment: NOTIFY physician if platelets < 130,000. D/C lovenox if INR > 1.8
		For Patients > 150 kg(NOTE)*
		40 mg, Syringe, SUBCUTANEOUS, BID
			Comment: NOTIFY physician if platelets < 130,000
		40 mg, Syringe, SUBCUTANEOUS, DAILY
			Comment: NOTIFY physician if platelets < 130,000
Anticoagulants
		Baseline INR required for Coumadin(NOTE)*
	warfarin
		5 mg, Tab, By Mouth, Once
			Comment: Notify MD and Hold Coumadin if INR > 2.5
		2.5 mg, Tab, By Mouth, Once
			Comment: Notify MD and Hold Coumadin if INR > 2.5
		10 mg, Tab, By Mouth, Once
			Comment: Notify MD and Hold Coumadin if INR > 2.5
		5 mg, Tab, By Mouth, DAILY
			Comment: Notify MD and Hold Coumadin if INR > 2.5
		2.5 mg, Tab, By Mouth, DAILY
			Comment: Notify MD and Hold Coumadin if INR > 2.5
		10 mg, Tab, By Mouth, DAILY
			Comment: Notify MD and Hold Coumadin if INR > 2.5
		ORTHO ONLY(NOTE)*
	Xarelto
		10 mg, Tab, By Mouth, DAILY
	dabigatran
		150 mg, Capsule, By Mouth, BID
			Comment: Check renal function
	Eliquis
		2.5 mg, Tab, By Mouth, BID
			Comment: Hip Replacement: Duration of therapy 35 days  Knee Replacement: 12 days
	HEParin 5000 units/mL SUBCUTANEOUS
		5,000 units, Syringe, SUBCUTANEOUS, TID
		5,000 units, Syringe, SUBCUTANEOUS, BID
Patient Care

	Impulse Foot Pumps
		To be worn at all time while patient is not bearing weight
	Sequential Compression Device
		T;N, Wear, Both legs
			Comment: To be worn at all times while patient is not bearing weight
	Anti Embolism Stockings
		TED hose, knee high, Both legs
		TED hose, knee high, Left leg
		TED hose, knee high, Right leg
		TED hose, thigh high, Both legs
		TED hose, thigh high, Left leg
		TED hose, thigh high, Right leg
	Notify MD
		Contact Physician if INR < 1.8 on Day of Dismissal
Therapies
	Consult Physical Therapy, Evaluate and Treat
		
Consults/Follow-up
	Pharmacy Consult
		D/C Lovenox if INR > 1.8
		D/C Lovenox if INR > 2.0
		Contact MD and Hold Coumadin if INR > 2.5
		Contact MD and Hold Coumadin if INR > 3.0
		Contact MD and Hold Coumadin if INR > 3.5

*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