Unique Plan Description: Vasc Surg, Pre op
Plan Selection Display: Vasc Surg, Pre op
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2020-04-20 23:40:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2021-12-21 12:36:09
Available at all facilities: Yes

Vasc Surg, Pre op
Admit/Discharge/Transfer
	Admit to Inpatient Status
		T;N, Anticipated LOS 2 midnight or more
	Admit to Observation Status
		T;N
Diet
	NPO
		After Midnight
		NPO Except for: Medications
Laboratory
	CBC with Diff
		Stat, spec type = Blood
	Basic Metabolic Panel
		Stat, spec type = Blood
	Comprehensive Metabolic Panel
		Stat, spec type = Blood
	INR - MH/WH/JE
		Stat, spec type = Blood
	Prothrombin Time (PT) - FH
		T;N, Stat, spec type = Diagnostic Blood
		T;N, Stat, spec type = Therapeutic Blood
	PTT - MH/WH/JE
		Stat, spec type = Blood
	Partial Thromboplastin Time (PTT) - FH
		T;N, Stat, spec type = Diagnostic Blood
	UA (Culture if Positive)
		Stat, Stat, spec type = Urine, when foley inserted
	Type and Screen (No Product on hold)
		T;N, Stat, spec type = Blood
	Crossmatch Red Blood Cells
		T;N, Stat
Diagnostic Tests
	ECG
		Stat, Indication: Abnormal Electrolytes | Pre-op Release
IV Solutions
	Sodium Chloride 0.9%
		1,000 mL, IV, 20 ml/hr
			Comment: Start if no current IV order. Continue current IV if present.
		1,000 mL, IV, 300 ml/hr
			Comment: Start if no current IV order. Continue current IV if present.
	Sodium Chloride 0.45%
		1,000 mL, IV, 50 ml/hr
		1,000 mL, IV, 75 ml/hr
		1,000 mL, IV, 100, ml/hr
		1,000 mL, IV, 125 ml/hr
	Dextrose 5% in Lactated Ringers
		1,000 mL, IV, 50 ml/hr
		1,000 mL, IV, 75 ml/hr
		1,000 mL, IV, 100 ml/hr
		1,000 mL, IV, 125 ml/hr
Medications
	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, Once, 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, Once, 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, Once, 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
	vancomycin IVPB
		1,000 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment: For patients weighing < 80kg. To run over 60 minutes. Give with penicillin allergy unless history of anaphylactic reaction.
		1,500 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment: For patients weighing  80kg-120kg. To run over 90 minutes.  Give with penicillin allergy unless history of anaphylactic reaction.
		2,000 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment: For patients weighing > 120kg. To run over 90 minutes.  Give with penicillin allergy unless history of anaphylactic reaction.
	vancomycin IVPB (FH)
		1,000 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment: For patients weighing < 80kg. To run over 60 minutes. Give with penicillin allergy unless history of anaphylactic reaction.
		1,500 mg, INT, IVPB, PREOP, Surgical prophylaxis
			Comment: For patients weighing  80kg-120kg. To run over 90 minutes.  Give with penicillin allergy unless history of anaphylactic reaction.
		2,000 mg, INT, IVPB, PREOP, Surgical prophylaxis
			Comment: For patients weighing > 120kg. To run over 90 minutes.  Give with penicillin allergy unless history of anaphylactic reaction..
	No Antibiotic Prophylaxis Indicated
		
	Benadryl
		50 mg, Injection, IV Push, PREOP
			Comment: Sedation
	morphine  IV
		4 mg, Syringe, IV Push, PREOP
		6 mg, Syringe, IV Push, PREOP
		8 mg, Syringe, IV Push, PREOP
Patient Care
	Surgical Prep
		Shave prep
			Comment: Shave right and left groin, and abdomen
	Obtain Consent/Permit for:
		
	Patient Education
		Patient may take AM medications with sip of water
		If patient IDDM, administer 1/2 usual dose of Insulin
		If patient on glucophage (metformin), DO NOT give the morning of surgery
		If patient scheduled for VNUS/varicose vein surgery, tell them to bring special order compression stockings with them day of surgery
		Stop Coumadin 5 days before surgery
		Stop Xarelto 3 days before surgery
		Stop Eliquis 2 days before surgery
		Stop Pradaxa 3 days before surgery
		Do Not stop Plavix or Aspirin unless instructed to do so by your physician
	Notify MD
		If dialysis patient, notify Nephrologist and caremanager preoperatively of date and time of surgery	if patient does not bring special order compression stockings day of surgery
	No ACE (angiotensin converting enzyme) inhibitors
		stop nephrotoxic medications.
			Comment: stop nephrotoxic medications.
	No ARB (angiotensin receptor blocker)
		
	No NSAIDS (non steroidal anti-inflamatory)

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.

Rad Contrast Reaction Oral Pre Med orders
	predniSONE
		50 mg, Tab, By Mouth, Once
			Comment: 13 hours before contrast
		50 mg, Tab, By Mouth, Once
			Comment: 7 hours before contrast
		50 mg, Tab, By Mouth, Once
			Comment: 1 hour before contrast
		For JE patients, preferred medication is Benadryl:(NOTE)*
	Benadryl
		50 mg, Capsule, BY MOUTH, Once
			Comment: 1 hour before contrast.
		For FH/MH/WH patients, preferred medication is Claritin:(NOTE)*
	Claritin
		10 mg, Tab, By Mouth, Once
			Comment: 1 hour before contrast
	Medrol
		32 mg, Tab, BY MOUTH, Once
			Comment: 12 hours before contrast administration
		32 mg, Tab, BY MOUTH, Once
			Comment: 2 hours before contrast administration
	predniSONE 50 mg oral tablet
		See instructions, Take 1 tab by mouth 13 hours, 7 hours and 1 hour before radiology exam with contrast., # 3 TAB, 0 Refill(s)
	Claritin 10 mg oral tablet
		See instructions, Take 1 tab, BY MOUTH 1 hour before radiology exam with contrast., # 1 TAB, 0 Refill(s)
	Medrol 32 mg oral tablet
		See instructions, Take 1 tab by mouth 12 hours and 2 hours before radiology exam with contrast., # 2 TAB, 0 Refill(s)

*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