Unique Plan Description: CT Surg Epicardial Surgical Ablation Enhanced Recovery Pre-op
Plan Selection Display: CT Surg Epicardial Surgical Ablation Enhanced Recovery Pre-op
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2020-10-15 08:48:48
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2022-09-21 09:51:10
Available at all facilities: Yes

CT Surg Epicardial Surgical Ablation Enhanced Reco
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
Laboratory
	CBC with Diff
		T;N, Stat, spec type = Blood
	Basic Metabolic Panel
		T;N, Stat, spec type = Blood
	Type and Screen (No Product on hold)
		Stat, spec type = Blood
		For lobectomy and pneumonectomy patients, order type and screen and crossmatch.(NOTE)*
	Type and Crossmatch (Product Available)
		T;N, Stat, For Possible Transfusion
Diagnostic Tests
	ECG
		Routine, Indication: Pre-op Release
Medications
	Ancef (JE)
		2,000 mg, Injection, IV Push, PREOP, Surgical prophylaxis
			Comment: Give within 30 minutes of surgical incision.
	Ancef (MH/WH)
		2,000 mg, Syringe, IV Push, PREOP, Surgical prophylaxis
			Comment: Give within 30 minutes of surgical incision.
	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.
	Peridex 0.12% oral rinse
		15 mL, Soln, MOUTHWASH, PREOP, 1 Dose(s)/Time(s)
			Comment: Use as mouth wash, swish and gargle for 30 seconds, then spit, do not swallow, once in POH
	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.
	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.
Patient Care
	Notify MD
		Thoracic Surgeon if patient has not been taking amiodarone for beta blocker if cardiac risk atrial fibrillation prophylaxis and Beta blocker if cardiac risk.
	Obtain Consent/Permit for:
		T;N, Surgical Ablation
		T;N, Left video assisted thoracoscopy (VAT)
		T;N, Left atrial appendage ligation
	Pre-op bath/shower
		T;2000
			Comment: Patient to shower with chlorhexadine gluconate evening before surgery
		T+1;0500
			Comment: Patient to shower with chlorhexadine gluconate morning of surgery
	Anti Embolism Stockings Pre Procedure
		T;N, Apply, Once
			Comment: knee high
Consults/Follow-up
	Consult Cardiac Rehab: Inpatient
		Indications CABG
			Comment: Incentive spirometer, activity, coughing and splinting, chest tube, comfort, pain management - discuss use of guided imagery videos pre op and post 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