Unique Plan Description: Enhanced Recovery Colon Post Op (MH/WH) EKM
Plan Selection Display: Enhanced Recovery Colon Post Op (MHWH)
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2016-02-26 11:14:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2022-09-21 10:55:57
Available at all facilities: Yes

Enhanced Recovery Colon Post Op (MH/WH) EKM
Vital Signs
	Vital Signs
		Routine
Activity
	Up in Chair
		T;N, TID
	Ambulate
		With assistance, TID
			Comment: start day of surgery
Diet
	Clear Liquid Diet
		T;N, 1, Day(s)
	Blenderized Liquid (Full) Diet
		T+1;0600, 1, Day(s)
	Low Fiber Diet
		T+2;0600
	Oral Supplement
		Impact Advanced Recovery, AM and PM
Laboratory
	UA (Cult Pos)
		T;N, Routine, Routine, spec type = Urine
Tomorrow's Lab
	CBC with Diff
		T+1;0400, Routine, spec type = Blood
	BMP
		T+1;0400, Routine, spec type = Blood
IV Solutions

	Dextrose 5% with 0.45% NaCl w/KCl 20 mEq
		1,000 mL, IV, 40 ml/hr
			Comment: Convert to peripheral lock when tolerating fluids and po intake at 500ml of oral intake
	Lactated Ringers Injection
		1,000 mL, IV, 40 ml/hr
			Comment: Convert to peripheral lock when tolerating fluids and po intake at 500ml of oral intake
Medications
	Mefoxin IVPB
		2,000 mg, Injection-Premix, IVPB, Q6H, Surgical prophylaxis, 3 Dose(s)/Time(s)
			Comment: start 6 hrs after pre op dose given
	Flomax
		0.4 mg, Capsule, By Mouth, QHS
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		Use for patients with no or mild hepatic disease(NOTE)*
	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
		If the patient has received an intrathecal/epidural anesthesia will order PO/IV opiods for the first 24hrs.(NOTE)*
	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
	prochlorperazine
		10 mg, Injection, IV Push, Q6H, PRN, nausea and/or vomiting
			Comment: Give if ondansetron, ineffective; avoid in patients > 65yo
Patient Care

	Resuscitation Status
		Full Code
		No Code
	VTE Advisor
		General surgery
	Patient Education
		T;N, Instructions: Educate on lovenox injections for up to 28 days if malignant, BMI >35, pelvic surgery, inflammatory bowel disease, history of DVT
		T;N, Instructions: If Patient has stoma (ileostomy/colostomy) please have patient view Emmi Videos: Taking Care of an Ostomy(Ileostomy/Colostomy), and living with an Ostomy(Ileostomy/Colostomy) in room before discharge.
		T;N, Instructions: At Discharge, please provide patient with stoma education materials.
	Discontinue Urinary Catheter
		T+1;0600
			Comment: If patient has epidural, or low anterior or abdominal perineal resection, confirm with surgeon prior to removal
	Intake and Output
		Q4H, 24, hr
			Comment: then routine
	Notify MD
		T;N, urine output less than 120ml/4 hours
		T;N, Temp >101.5, pulse <50, urine output <120 mL/4 hr
	IV-Convert to Peripheral Lock
		T+1;0600, See Order Comments
			Comment: when tolerating fluids and po intake at 500ml of oral intake
	On Q Pain Management System
		T;N, Do not change dressing. May reinforce, PRN Y/N
	Wound Drain
		T;N, Bulb Suction
	Foley Catheter
		T;N, To dependent drainage, Pt. undergoing abdominal/pelvic surgery
	Incentive Spirometer
		Q1HAWAKE, 10x per hour
	Patient to Chew Gum
		To increase GI motility
	May Shower
		T;N, 24 hours post op. Use CHG soap, if drains present use CHG wipes daily
Therapies
Consults/Follow-up
	Consult Dietitian
		T+2;1000
			Comment: to see prior to discharge to reinforce discharge diet of low fiber to be transition to high fiber in 2 weeks, unless otherwise determined by surgeon
	Consult Wound Care
		Reason for Referral: Ostomy | if ostomy present to initiate self care education
		Reason for Referral: Patient has stoma (ileostomy/colostomy) initiate stoma teaching on POD #0. Refer to/Consult with: Wound Ostomy care RN
	Consult Care Management
		T;N
			Comment: to discuss post op hospital plans on postop day 1. If patient has stoma please arrange home health care for assistance with stoma at home.

Oxygen Protocol
Therapies
Respiratory Therapy
	Oxygen Therapy
		T;N
	Pulse Oximetry Spot Check RT
		T;N, BID
	Continuous Pulse Oximetry Monitoring Check
		T;N, BID

*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