Unique Plan Description: Enhanced Recovery Colorectal Surgery PowerPlan
Plan Selection Display: Enhanced Recovery Colorectal Surgery PowerPlan
PlanType: Medical
Version: 1
Begin Effective Date: 04/05/2016 12:05 AM
End Effective Date: Current
Available at:	MMC

Enhanced Recovery Colorectal Surgery PowerPlan     
Non Categorized
   	Code Status
Patient Care
   	Indwelling Urinary Catheter
    Indications: Operative use-surgical procedure, Instructions: to Dependent Drainage | Remove POD #1 (DEF)*
    Indications: Operative use-surgical procedure, Instructions: to Dependent Drainage, PRN, leave in if needed to cath twice
    Indications: Operative use-surgical procedure, Instructions: to Dependent Drainage
   	Bladder Scanner Protocol
    Follow Bladder Scanner Protocol.
No NG tube unless condition deteriorates.(NOTE)*
   	NG Tube Low Continuous Suction
    .
   	NG Tube Clamp
    unclamp if any Nausea/Vomiting
   	Dressing(s) Task
    q8hr, wet to dry dressing change (DEF)*
    q8hr, wet to dry Dakin's 0.25 %, dressing change q 8 hrs
   	Cough & Deep Breathe
    q2hr WA
   	Incentive Spirometry
    10 times per hour while awake.
   	Call (specify)
    Temp greater than 38.9 C (102 F). SBP less than 90 or greater than 200, P less than 40 or greater than 120 . U/O less than 30 mL/hr x 2 hrs or less than 150 mL in 8 hrs., RR less than 8 or greater than 20.
   	Chemstrips (Nursing)
    q4hr
   	Communication to Nurse
    Discourage use of urinal and bedside commode.
Vital Signs
General Admission Vital Signs(NOTE)*
   	Vital Signs
    q4hr, with  I & O
   	I & O
    q4hr, with vital signs
ICU Admission Vital Signs(NOTE)*
   	Vital Signs
    q2hr, with  I & O
   	I & O
    q2hr, with vital signs
Activity
   	Out of bed
    day of surgery
   	+1 Days Out of bed
    4-6 hours per day.  Start POD #1
   	+1 Days Ambulate
    QID, start POD #1
   	+1 Days Up In Chair
    starting POD #1, 4-6 times daily and for all meals
Diet/Nutrition
   	Diet
    Clear Liquid (DEF)*
 Comments: as soon as able after surgery
    Clear Liquids - Advance as Tolerated
    Diabetic, Clear Liquid
    Diabetic, Full Liquid
   	NPO
    NPO Except Ice Chips & Meds
Radiology
   	CHEST 1 V - Now
    NOW, Bedside
   	CHEST 1 V - in a.m.
    A Routine, T+1;0030, Bedside
   	CHEST 1 V
    A Routine, Daily, Bedside
   	CT ABD + PELVIS W/O CONT (NO ORAL-NO IV)
    NOW
   	CT ABD + PELVIS W/O IV CONT (ORAL ONLY)
    NOW
   	CT ABD + PELVIS W/IV CONT (NO ORAL)
    NOW
   	CT ABDOMEN + PELVIS W/CONTRAST (ORAL+IV)
    NOW
Laboratory
   	CBC - Now
    NOW, Once
   	Lytes - Now
    NOW, Once
   	Creatinine - Now
    NOW, Once
   	Amylase, Serum
    NOW, Once
   	BNP - Now
    NOW, Once
   	Lactic Acid, Venous
    NOW, Once
   	Liver Profile
    NOW, Once
   	Protime
    NOW, Once
   	Troponin
    NOW, Once
   	Urinalysis w/ Culture if Indicated
    Routine, Once
 Comments: TODAY
   	Basic Metabolic
    NOW, Once
AM LABS
   	CBC - in a.m.
    Routine, In AM, 1, dose/occurrence
   	Lytes - in a.m.
    Routine, In AM, 1, dose/occurrence
   	Lactic Acid - in a.m.
    Routine, In AM, 1, dose/occurrence
   	Liver Profile - in a.m.
    Routine, In AM, 1, dose/occurrence
   	Potassium - in a.m.
    Routine, In AM, 1, dose/occurrence
   	Protime - in a.m.
    Routine, In AM, 1, dose/occurrence
   	Basic Metabolic - in a.m.
    Routine, In AM, 1, dose/occurrence
Daily Labs
   	CBC - Daily x 3 days
    Routine, Daily Lab, 3, day(s)
   	Lytes - Daily x 3 days
    Routine, Daily Lab, 3, day(s)
   	Creatinine - Daily x 3 days
    Routine, Daily Lab, 3, day(s)
   	Amylase, Serum
    Routine, Daily Lab, 3, day(s)
   	Lactic Acid, Venous
    Routine, Daily Lab, 3, day(s)
   	Protime
    Routine, Daily Lab, 3, day(s)
   	Liver Profile
    Routine, Daily Lab, 3, day(s)
   	Basic Metabolic
    Routine, Daily Lab, 3, day(s)
Cardiology
   	EKG
    NOW
Consults/Referrals
   	Add patient to My Provider List
   	Wound Care Consult - WOCN
    Colostomy (DEF)*
    Illeostomy
    Urostomy
    Fistula
    Wound
   	Case Management - See Pt According to Case-Finding Criteria
    Routine, Enhanced recovery patient.  When patient meets case qualifications case management members may activate the following; Chest x-ray protocol, Home Health Care Protocol
   	Pharmacy Consult
    pain management
   	Dietitian Consult
    Enhanced recovery program patient.  Assess for nutritional risk.
Therapies
   	O2 Per Protocol
   	PEP Therapy Per Protocol Task
    BID, with albuterol (DEF)*
    TID, with albuterol
    q6hr, with albuterol
    q4hr, with albuterol
   	Albuterol Neb SOLN
    2.5 mg, RT Inh (Med), Inhalant, RTBID (DEF)*
    2.5 mg, RT Inh (Med), Inhalant, RTTID
    2.5 mg, RT Inh (Med), Inhalant, RTq6hWA
    2.5 mg, RT Inh (Med), Inhalant, RTq4hr
   	CPT
    BID, Bilateral (DEF)*
    TID, Bilateral
    q6hr, Bilateral
   	Bronchodilator Protocol - RT
Continuous Infusions
   	Dextrose 5% -0.45% NaCl + KCl 20 mEq/L IV SOLN
    1,000 mL, IV, 50 mL/hr
   	Dextrose 5%-Sodium Chloride 0.45% IV SOLN
    1,000 mL, IV, 50 mL/hr
   	Sodium Chloride 0.9% IV SOLN
    1,000 mL, IV, 50 mL/hr
   	Sodium Chloride 0.45% IV SOLN
    1,000 mL, IV, 50 mL/hr
   	Lactated Ringers IV SOLN
    1,000 mL, IV, 50 mL/hr
   	Intermittent Lock - Peripheral Saline Flush(SUB)*
Bolus infusion
   	Sodium Chloride 0.9% IV BOLUS
    250 mL, IV, One Time, 30 minutes, 2 hour(s) (DEF)*
    500 mL, IV, One Time, 30 minutes, 2 hour(s)
    1,000 mL, IV, One Time, 30 minutes, 2 hour(s)
    1,000 mL, IV, One Time, 60 minutes, 2 hour(s)
   	Lactated Ringers IV BOLUS
    250 mL, IV, One Time, 30 minutes, 2 hour(s) (DEF)*
 Comments: Wide Open at 999 ml/hr
    500 mL, IV, One Time, 30 minutes, 2 hour(s)
 Comments: Wide Open at 999 ml/hr
    1,000 mL, IV, One Time, 30 minutes, 2 hour(s)
 Comments: Wide Open at 999 ml/hr
    1,000 mL, IV, One Time, 60 minutes, 2 hour(s)
 Comments: Wide Open at 999 ml/hr
Medications
Anticoagulants
If Heparin Drip needed order through Heparin Drip PowerPlan(NOTE)*
Pain
   	PCA(SUB)*
   	Dilaudid IVPush for RANGE ORDER
    0.2-0.8 mg, IVPush, Inject, q1hr, PRN Severe Pain
   	Tylenol
    1,000 mg, Oral, Tab, q6hSTD
 Comments: Maximum dose acetaminophen 4 grams in 24 hours
   	ibuprofen
    600 mg, Oral, Tab, q6hSTD
 Comments: HOLD if NPO or clear liquid diet. Continue until discharge.
Toradol Dosing : Maximum dose for greater than or equal to 65 years of age or less than 110 lb (50kg) = 15mg(NOTE)*
   	Toradol IVPush
    30 mg, IVPush, Inject, q6hr, PRN Pain (DEF)*
 Comments: May be used as a single agent or as adjunctive therapy with opioids or acetaminophen for mild, moderate, or severe pain.  Should not be administered with oral NSAIDs.  Maximum duration of therapy is 5 days.For patient 65 years and older or Weight of 50 kg or less, maximum dose to be 15 mg.
    15 mg, IVPush, Inject, q6hr, PRN Pain
 Comments: May be used as a single agent or as adjunctive therapy with opioids or acetaminophen for mild, moderate, or severe pain.  Should not be administered with oral NSAIDs.  Maximum duration of therapy is 5 days.
   	oxyCODONE
    5 to 10 mg, Oral, Tab, q4hr, PRN Pain
Gastrointestinal Agents
   	Senokot
    1 Tab, Oral, Tab, Daily
 Comments: Hold for loose stools
   	docusate sodium
    200 mg, Oral, Cap, BID
 Comments: Hold for loose stools
   	Miralax Powder for RECONSTITUTION
    17 gm 1 Packet, Oral, Powder, BID
 Comments: Hold for loose stools
   	Citrate of Magnesia 1.745 g/30 mL oral liquid
    150 mL, Oral, Liquid, Once, NOW (DEF)*
    300 mL, Oral, Liquid, Once, NOW
   	Constipation Prevention(SUB)*
Antiemetics
   	Nausea/Vomiting Protocol - Adult  Zofran and Phenergan(SUB)*
General
   	Sonata
    5 mg, Oral, Cap, QHS, PRN Sleep
   	Benadryl
    25 mg, Oral, Cap, q8hr, PRN Itching
   	Benadryl IVPush
    12.5 mg, IVPush, Inject, q8hr, PRN Itching
Insulins
If insulin wanted, use the appropriate INSULIN Powerplan to order.(NOTE)*
Wound Meds
   	Dakins 0.25% (Half Strength) for DRESSINGS
    1 Appl, Misc, Bottle, q8hSTD
 Comments: ***For Wet to Dry Dressing Use - NOT for wound irrigation***
   	Sodium Chloride 0.9% IRRIG intermittent only
    1 Appl, Irrig, Soln, q8hSTD
 Comments: Wet to dry dressing changes
Smoking Cessation
   	Subphase - Smoking Cessation(SUB)*
Antibiotics - Post-op Prophylaxis
Choose same pre-op antibiotic post-op prophylaxis if neededNote: Gentamicin is not needed for Post-Op ProphylaxisNote:  For post-intraabdominal surgery prophylaxis use the following subphase "Cefazolin + Metronidazole Post op Prophylaxis".  If PCN allergic use metronidazole alone (gentamicin was given pre-procedure).(NOTE)*
   	Subphase - Cefazolin + Metronidazole Post-op Prophylaxis(SUB)*
For Penicillin Allergic Patients select Flagyl(NOTE)*
   	Flagyl IVPB
    500 mg, IVPB, IVPB, q8hr, Start T;N+360, Infuse Over: 60 minute(s), 2 dose/occurrence
 Comments: x 2 doses post-op, give 8 hours after pre-op dose.
Antibiotic - Treatment Regimens
   	Ampicillin IVPB
    2,000 mg, IVPB, IVPB, q6hSTD
   	Augmentin 875 mg-125 mg oral tablet
    1 Tab, Oral, Tab, BIDWM
   	Cipro IVPB
    400 mg, IVPB, IVPB, q12hSTD
   	Cipro
    500 mg, Oral, Tab, BID
   	Flagyl IVPB
    500 mg, IVPB, IVPB, q8hSTD, Infuse Over: 60 minute(s)
   	Flagyl
    500 mg, Oral, Tab, TIDWM
   	Kefzol IVPush
    2,000 mg, IVPush (Syringe), Syringe, q8hSTD
 Comments: Give over 6-10 minutes. Give Kefzol 3 gm IVPB if patient weight greater than or equal to 120 kg
   	Pharmacy to Dose
    Medication to Dose: Gentamicin
   	Pharmacy to Dose
    Medication to Dose: Vancomycin
   	Zosyn IVPB
    3,375 mg, IVPB, IVPB, q8hSTD, Infuse Over: 4 hour(s)
 Comments: Infuse over 4 hours
Protocols/Standards
   	VTE Prophylaxis Guidelines Order
    General surgery
System Auto-Generated
   	Admission orders entered
   	DVT Rule Order

*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