Unique Plan Description: CT Surg Thoracic Surgery Enhanced Recovery Pre-op
Plan Selection Display: CT Surg Thoracic Surgery Enhanced Recovery Pre-op
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2012-11-04 20:53:48
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2023-10-17 14:19:59
Available at all facilities: Yes

CT Surg Thoracic Surgery Enhanced Recovery 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
Laboratory
	CBC with Diff
		T;N, Stat, spec type = Blood
	Basic Metabolic Panel
		T;N, Stat, spec type = Blood
	INR - MH/WH/JE
		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.
	aztreonam
		1,000 mg, INT, IVPB, PREOP, Indication: Surgical prophylaxis
			Comment: for patients with severe PCN allergy
	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
	Pacerone
		200 mg, Tab, BY MOUTH, TIDWM
			Comment: To be given TIDWM until patient goes to surgery.
	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.
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, Cervical mediastinoscopy
		T;N, Bronchoscpy
		T;N, Lobectomy
		T;N, Pneumonectomy
		T;N, Decortication
		T;N, Video assisted thoracoscopy (VATS)
		T;N, Lung Biopsy
		T;N, Excision of nodule
	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
	Notify Anesthesia if:
		T;N
			Comment: to see to insert thoracic epidural and pain management, if patient not receiving On-Q pain management
	Discontinue Medication
		T;N, Discontinue lovenox and heparin one day prior to surgery
	Pre Op Medication
		T;N, ok to take home dose of beta blocker and aspirin day of surgery
Consults/Follow-up
	Consult Pulmonary Rehab: Inpatient
		T;N, other
			Comment: incentive spirometer, activity, coughing and splinting, chest tube, comfort, pain management - discuss use of guided imagry videos pre op and post op

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

*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