Unique Plan Description: GI Endoscopy Outpatient
Plan Selection Display: GI Endoscopy Outpatient
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2020-04-14 23:08:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2021-12-20 10:34:28
Available at all facilities: Yes

GI Endoscopy Outpatient
Admit/Discharge/Transfer
	Discharge Conditional
		Conditions to be met: When ok with anesthesia
		Conditions to be met: To nursing unit or previous level of care with spontaneous and unassisted aldrete of 7 or greater or returns to pre procedure aldrete status
	Discharge
		to: Home
			Comment: when meet discharge criteria
	Discharge Instructions Other
		to be driven home by responsible adult.  May resume activities in the morning.
Vital Signs
	Vital Signs
		Routine, until awake and stable per sedation protocol
Activity
	Position Patient
		Left lateral position
Diet
	NPO
		
Laboratory
	INR - MH/WH/JE
		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
		Stat, spec type = Blood
	Partial Thromboplastin Time (PTT) - FH
		T;N, Stat, spec type = Diagnostic Blood
	Pregnancy Test Urine
		T;N, Stat, Stat, spec type = Urine
	Glucose POC - RN
		T;N
			Comment: Prior to initiating IV fluid if patient diabetic
		T;N
			Comment: If patient is on Insulin perform POC glucose before giving liquid tray
	CBC with Diff
		T;N, Stat, spec type = Blood
IV Solutions
	Dextrose 5% with 0.9% NaCl
		500 mL, IV, 20 ml/hr
	Lactated Ringers Injection
		1,000 mL, IV, 20 ml/hr
		1,000 mL, IV, 60 ml/hr
	Sodium Chloride 0.9%
		500 mL, IV, 20 ml/hr
Medications
	ampicillin IVPB
		2,000 mg, Solution, Injection, IVPB, Once, Other- type in, Surgical prophylaxis, T;N
	Ancef (MH/WH)
		2,000 mg, Syringe, IV Push, Once, Surgical prophylaxis, T;N
	Ancef (JE)
		2,000 mg, Injection, IV Push, Once, Surgical prophylaxis, T;N
	Ancef (FH)
		2,000 mg, Injection-Premix, IVPB, Once, 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, Once, 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, Once, 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.
	gentamicin IVPB
		80 mg, Injection-Premix, IVPB, Once, Surgical prophylaxis, T;N, 200 ml/hr
			Comment: In NS 100 mL.
	gentamicin IVPB (FH)
		80 mg, INT, IVPB, Once, Surgical prophylaxis, T;N, Infuse Over 200 ml/hr
	Levaquin IVPB
		500 mg, Injection-Premix, IVPB, Once, Surgical prophylaxis, T;N
	Cipro
		500 mg, Tab, By Mouth, Once, Surgical prophylaxis, T;N
	sodium chloride 0.9% flush injectable soln
		10 mL, Syringe, IV PUSH, Q5MIN, PRN, IV line flush
			Comment: IV line flush.
	Omnipaque 240 mg/mL 50mL vial
		50 mL, Injection, IntraDuctal, Once, T;N
			Comment: to be given in GI Lab
		IVSM - Intravenous Sedation with Monitoring(NOTE)*
	benzocaine topical 20% mucous membrane spray
		2 spray, Aerosol, By Mouth, Once, T;N
	Versed 5 mg/5 mL vial
		5 mg, Injection, IV Push, Q5MIN, PRN, sedation, 5 Dose(s)/Time(s)
			Comment: in GI lab. Titrate1-5mg to affect per MD. Maximum total dose 20mg
	fentaNYL
		25 mcg, Injection, IV Push, Q5MIN, PRN, sedation, T;N, 8 Dose(s)/Time(s)
			Comment: Titrate 25-50mcg to affect per MD. Maximum total dose 25mcg + 50mcg = 200mcg
		50 mcg, Injection, IV Push, Q5MIN, PRN, sedation, T;N, 8 Dose(s)/Time(s)
			Comment: Titrate 25-50mcg to affect per MD. Maximum total dose 25mcg + 50mcg = 200mcg.
	meperidine
		25 mg, Syringe, IV PUSH, Q5MIN, PRN, sedation, 4 Dose(s)/Time(s)
	acetylcysteine 20% inhalation soln
		3 mL, Solution, Irrigation, Once, T;N
	vancomycin IVPB
		1,000 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis, T;N
			Comment: on call to GI lab
	vancomycin IVPB (FH)
		1,000 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis, T;N
			Comment: on call to GI lab
Patient Care
	Obtain Consent/Permit for:
		Esophagogastroduodenoscopy with possible biopsies and/or dilation
		Esophagogastroduodenoscopy with Fluoroscopy, possible biopsies and/or dilation
		Esophagogastroduodenoscopy with PH capsule placement with possible biopsies and/or dilation
		Colonoscopy with possible biopsies and/or polypectomy
		Flexible Sigmoidoscopy with possible biopsies and/or polypectomy
		Pouchoscopy with possible biopsies and/or polypectomy
		Ilioscopy with possible biopsies and/or polypectomy
		Endoscopic Retrograde Cholangiopancreatogram with possible biopsies, brushings, dilation sphincterotomy, stent placement and/or stent removal
		Esophagogastroduodenoscopy & Flexible Sigmoidoscopy with possible biopsies, dilation, and/or polypectomy
		Esophagoscopy with Ablation with possible biopsies and/or dilation
		Esophagogastroduodenoscopy with Ablation with possible biopsies and/or polypectomy
		Colonoscopy with Ablation with possible biopsies and/or polypectomy
		Flexible Sigmoidoscopy with Ablation with possible biopsies and/or polypectomy
		Esophagogastroduodenoscopy with Double Balloon Enteroscopy with possible biopsies and/or dilation
		Colonoscopy with Double Balloon Enteroscopy with possible biopsies, dilation, and/or polypectomy
		Percutaneous Endoscopic Gastrostomy Tube Placement
		Percutaneous Endoscopic Gastrostomy Tube Replacement
		Liver Biopsy
		Paracentesis
		Small Bowel Capsule
		Small Bowel Agile Capsule
		Esophagogastroduodenoscopy with Small Bowel Capsule Placement with possible biopsies and/or dilation
		Esophagogastroduodenoscopy with Endoscopic Ultrasound with possible biopsies, dilation and/or fine needle aspiration
		Colonoscopy with Endoscopic Ultrasound with possible biopsies, dilation and/or fine needle aspiration
		Flexible Sigmoidoscopy with Endoscopic Ultrasound with possible biopsies, dilation and/or fine needle aspiration
		Esophagogastroduodenoscopy with Endoscopic Ultrasound & Endoscopic Retrograde Cholangiopancreatogram with possible biopsies, dilation fine needle aspiration, sphinterotomy, stent placement and/or stent
		Esophagogastroduodenoscopy with possible biopsies, dilation, and/or Endoscopic Mucosal Resection
		Colonoscopy with possible biopsies, dilation and/or Endoscopic Mucosal Resection
		Transanal Ultrasound
		Transrectal Ultrasound
		Transanal/Transrectal Ultrasound rectal Electromyogram, Anorectal Manometry, Pudendal Nerve Study
		Rectal Electromyogram, Anorectal Manometry, with Pudendal Nerve Study
		Esophageal Manometry
		Esophageal Manometry with 24h or 48h pH monitoring
		Proctoscopy with possible biopsies
		Esophagogastroduodenoscopy & colonoscopy with possible biopsies, dilation and/or polypectomy
		Endoscopic retrograde cholangiopancreatogram with possible biopsies
		Esophagogastroduodenoscopy with possible biopsies and/or dilation
		Esophagogastroduodenoscopy with Fluoroscopy, possible biopsies and/or dilation
		Esophagogastroduodenoscopy with PH capsule placement with possible biopsies and/or dilation
		Colonoscopy with possible biopsies and/or polypectomy
		Flexible Sigmoidoscopy with possible biopsies and/or polypectomy
		Pouchoscopy with possible biopsies and/or polypectomy
		Ilioscopy with possible biopsies and/or polypectomy
		Endoscopic Retrograde Cholangiopancreatogram with possible biopsies, brushings, dilation sphincterotomy, stent placement and/or stent removal
		Esophagogastroduodenoscopy & Flexible Sigmoidoscopy with possible biopsies, dilation, and/or polypectomy
		Esophagoscopy with Ablation with possible biopsies and/or dilation
		Esophagogastroduodenoscopy with Ablation with possible biopsies and/or polypectomy
		Colonoscopy with Ablation with possible biopsies and/or polypectomy
		Flexible Sigmoidoscopy with Ablation with possible biopsies and/or polypectomy
		Esophagogastroduodenoscopy with Double Balloon Enteroscopy with possible biopsies and/or dilation
		Colonoscopy with Double Balloon Enteroscopy with possible biopsies, dilation, and/or polypectomy
		Percutaneous Endoscopic Gastrostomy Tube Placement
		Percutaneous Endoscopic Gastrostomy Tube Replacement
		Liver Biopsy
		Paracentesis
		Small Bowel Capsule
		Small Bowel Agile Capsule
		Esophagogastroduodenoscopy with Small Bowel Capsule Placement with possible biopsies and/or dilation
		Esophagogastroduodenoscopy with Endoscopic Ultrasound with possible biopsies, dilation and/or fine needle aspiration
		Colonoscopy with Endoscopic Ultrasound with possible biopsies, dilation and/or fine needle aspiration
		Flexible Sigmoidoscopy with Endoscopic Ultrasound with possible biopsies, dilation and/or fine needle aspiration
		Esophagogastroduodenoscopy with Endoscopic Ultrasound & Endoscopic Retrograde Cholangiopancreatogram with possible biopsies, dilation fine needle aspiration, sphinterotomy, stent placement and/or stent
		Esophagogastroduodenoscopy with possible biopsies, dilation, and/or Endoscopic Mucosal Resection
		Colonoscopy with possible biopsies, dilation and/or Endoscopic Mucosal Resection
		Transanal Ultrasound
		Transrectal Ultrasound
		Transanal/Transrectal Ultrasound rectal Electromyogram, Anorectal Manometry, Pudendal Nerve Study
		Rectal Electromyogram, Anorectal Manometry, with Pudendal Nerve Study
		Esophageal Manometry
		Esophageal Manometry with 24h or 48h pH monitoring
		Proctoscopy with possible biopsies
		Esophagogastroduodenoscopy & colonoscopy with possible biopsies, dilation and/or polypectomy
		Endoscopic retrograde cholangiopancreatogram with possible biopsies
		Esophagogastroduodenoscopy with possible biopsies and/or dilation
		Esophagogastroduodenoscopy with Fluoroscopy, possible biopsies and/or dilation
		Esophagogastroduodenoscopy with PH capsule placement with possible biopsies and/or dilation
		Colonoscopy with possible biopsies and/or polypectomy
		Flexible Sigmoidoscopy with possible biopsies and/or polypectomy
		Pouchoscopy with possible biopsies and/or polypectomy
		Ilioscopy with possible biopsies and/or polypectomy
		Endoscopic Retrograde Cholangiopancreatogram with possible biopsies, brushings, dilation sphincterotomy, stent placement and/or stent removal
		Esophagogastroduodenoscopy & Flexible Sigmoidoscopy with possible biopsies, dilation, and/or polypectomy
		Esophagoscopy with Ablation with possible biopsies and/or dilation
		Esophagogastroduodenoscopy with Ablation with possible biopsies and/or polypectomy
		Colonoscopy with Ablation with possible biopsies and/or polypectomy
		Flexible Sigmoidoscopy with Ablation with possible biopsies and/or polypectomy
		Esophagogastroduodenoscopy with Double Balloon Enteroscopy with possible biopsies and/or dilation
		Colonoscopy with Double Balloon Enteroscopy with possible biopsies, dilation, and/or polypectomy
		Percutaneous Endoscopic Gastrostomy Tube Placement
		Percutaneous Endoscopic Gastrostomy Tube Replacement
		Liver Biopsy
		Paracentesis
		Small Bowel Capsule
		Small Bowel Agile Capsule
		Esophagogastroduodenoscopy with Small Bowel Capsule Placement with possible biopsies and/or dilation
		Esophagogastroduodenoscopy with Endoscopic Ultrasound with possible biopsies, dilation and/or fine needle aspiration
		Colonoscopy with Endoscopic Ultrasound with possible biopsies, dilation and/or fine needle aspiration
		Flexible Sigmoidoscopy with Endoscopic Ultrasound with possible biopsies, dilation and/or fine needle aspiration
		Esophagogastroduodenoscopy with Endoscopic Ultrasound & Endoscopic Retrograde Cholangiopancreatogram with possible biopsies, dilation fine needle aspiration, sphinterotomy, stent placement and/or stent
		Esophagogastroduodenoscopy with possible biopsies, dilation, and/or Endoscopic Mucosal Resection
		Colonoscopy with possible biopsies, dilation and/or Endoscopic Mucosal Resection
		Transanal Ultrasound
		Transrectal Ultrasound
		Transanal/Transrectal Ultrasound rectal Electromyogram, Anorectal Manometry, Pudendal Nerve Study
		Rectal Electromyogram, Anorectal Manometry, with Pudendal Nerve Study
		Esophageal Manometry
		Esophageal Manometry with 24h or 48h pH monitoring
		Proctoscopy with possible biopsies
		Esophagogastroduodenoscopy & colonoscopy with possible biopsies, dilation and/or polypectomy
		Endoscopic retrograde cholangiopancreatogram with possible biopsies
	Discontinue Peripheral Lock
		T;N
			Comment: prior to dismissal when patient awake
	Patient Education
		No aspirin or NSAIDS for _____ weeks
	Cardiac Telemetry Monitoring
		
Therapies

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

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

Peripheral Lock - Access
Medications

	sodium chloride 0.9% flush injectable soln
		10 mL Syringe IV PUSH BID
		10 mL, Syringe, IV PUSH, Q5MIN, PRN, IV line flush
	lidocaine 1% injectable solution (MH/WH/FH)
		0.1 mL, IntraDermal, Q1H, PRN, see comment
			Comment: For IV start
	sodium chloride bacteriostatic 0.9% injectable soln
		0.1 mL, Injection, IntraDermal, Q1H, PRN, see comment
			Comment: For IV start, use if patient has lidocaine allergy.
	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.
Patient Care
	Peripheral Lock-Insert
		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