Unique Plan Description: Gen Surg Esophagectomy, Pre Op
Plan Selection Display: Gen Surg Esophagectomy, Pre Op
PlanType: Medical                                 
Version: 3          
Begin Effective Date: 2023-12-12 14:48:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2023-12-12 14:48:00
Available at all facilities: Yes

Gen Surg Esophagectomy, Pre Op
Admit/Discharge/Transfer
	Admit to Inpatient Status
		T;N, Anticipated LOS 2 midnight or more
Diet
	NPO
		T;N, After Midnight
Laboratory
	CBC with Diff
		T;N, Stat, spec type = Blood
	Hematocrit
		T;N, Stat, spec type = Blood
	INR - MH/WH/JE
		T;N, 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
		T;N, Stat, spec type = Blood
	Partial Thromboplastin Time (PTT) - FH
		T;N, Stat, spec type = Diagnostic Blood
	Basic Metabolic Panel
		T;N, Stat, spec type = Blood
	Comprehensive Metabolic Panel
		T;N, Stat, spec type = Blood
	Type and Crossmatch (Product Available)
		T;N, Stat, For Possible Transfusion
	UA (Cult Pos)
		T;N, Routine, Routine, spec type = Urine
Diagnostic Tests
	ECG
		T;N, Stat, Indication: Pre-op Release
	Chest 1 View
		T;N, Stat
Medications
	Ancef (JE)
		2,000 mg, Injection, IV Push, PREOP, Surgical prophylaxis
			Comment: 80-120kg. OK to give if pt allergic to penicillin unless history of anaphylactic reaction.
		1,000 mg, Injection, IV Push, PREOP, Surgical prophylaxis
			Comment: < 80kg. OK to give if pt allergic to penicillin unless history of anaphylactic reaction.
		3,000 mg, Injection, IV Push, PREOP, Surgical prophylaxis
			Comment: > 120kg.  OK to give if pt allergic to penicillin unless history of anaphylactic reaction.
	Ancef (MH/WH)
		2,000 mg, Syringe, IV Push, PREOP, Surgical prophylaxis
	Ancef (FH)
		2,000 mg, Injection-Premix, IVPB, PREOP, 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, PREOP, 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, PREOP, 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.
		If penicillin/cephalosporin allergic, select both orders below(NOTE)*
	Levaquin IVPB
		750 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
	Cleocin IVPB
		900 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
Patient Care
	Obtain Consent/Permit for:
		T;N
	Notify MD
		T;N, Anesthesia for Epidural Placement
	Do not give medication
		T;N, Do not administer Heparin before Anesthesia sees patient
Consults/Follow-up
	Consult Anesthesia/Post Surgical Pain
		Reason for Referral: Post-Surgical Pain, Refer to/Consult with: Anesthesia on Call, No Provider Notified
			Comment: Consult Anesthesia for post-surgical pain management that is non-routine and requires the expertise of an anesthesia provider, uniquely trained and qualified to assist with post-surgical pain management, including but not limited to administration of nerve blocks or epidural catheter placement.

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.

PICC line Access
Diagnostic Tests
	IV Team US Guidance
		T;N, PICC Line Insertion
Medications
	sodium chloride 0.9% flush injectable soln
		10 mL, Syringe, IV Push, BID
		10 mL, Syringe, IV Push, Q5MIN, PRN, IV line flush
		20 mL, Syringe, IV Push, Q5MIN, PRN, IV line flush
		30 mL, Syringe, IV Push, Q5MIN, PRN, IV line flush
	Sodium Chloride 0.9% IVPB Flush
		25 mL, IVPB, Q1H, PRN, IV line flush, 5 min(s)
			Comment: Use if medication not compatible with primary line or there is no primary line;  infuse 25mL.
	lidocaine 1% injectable solution (MH/WH/FH)
		5 mL, SUBCUTANEOUS, Q1H, PRN, see comment
			Comment: For PICC line insert
	sodium chloride bacteriostatic 0.9% injectable soln
		5 mL, Injection, SUBCUTANEOUS, Q1H, PRN, see comment
			Comment: For PICC line insert, use if patient has lidocaine allergy.
Patient Care
	PICC Line Insert (MH/WH)
		T;N
	PICC Line Insert (JE)
		T;N
	PICC line insert (FH)
		T;N

*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