Unique Plan Description: GI Inpatient Procedure
Plan Selection Display: GI Inpatient Procedure
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2020-04-19 21:43:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2021-12-14 09:02:35
Available at all facilities: Yes

GI Inpatient Pre Procedure
Vital Signs
	Vital Signs
		T;N
			Comment: Routine
Activity
	Activity-Up as Tolerated
		T;N
Diet
	NPO
		T;N, After Midnight
	Clear Liquid Diet, with no red, purple or blue Jello or Fluids
		T;N
			Comment: the day prior to scheduled colonoscopy
Laboratory
	Pregnancy Test Urine
		T;N, Stat, Stat, Urine Random, spec type = Urine
	Glucose POC - RN
		T;N, Once, Prior to initiating IV fluid
IV Solutions
	Dextrose 5% with 0.9% NaCl
		500 mL, IV, 20 ml/hr
			Comment: if no current IV orders
	Lactated Ringers Injection
		1,000 mL, IV, 20 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
	ampicillin IVPB (FH)
		2,000 mg, INT, IVPB, Once, Other- type in, Surgical prophylaxis, T;N
	Ancef (JE)
		2,000 mg, Injection, IV Push, Once, Surgical prophylaxis, T;N
	Ancef (MH/WH)
		2,000 mg, Syringe, IV Push, Once, Surgical prophylaxis, T;N
	Ancef (FH)
		2,000 mg, Injection-Premix, IVPB, Once, Surgical prophylaxis, T;N
	gentamicin IVPB
		80 mg, Injection-Premix, IVPB, Once, Surgical prophylaxis, T;N
			Comment: In NS 100 mL.
	gentamicin IVPB (FH)
		80 mg, INT, IVPB, Once, Surgical prophylaxis, T;N
			Comment: In NS 100 mL.
	Levaquin IVPB
		500 mg, Injection-Premix, IVPB, Once, Surgical prophylaxis, T;N
	vancomycin IVPB
		1,000 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis, T;N
	vancomycin IVPB (FH)
		1,000 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis, T;N
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 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 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
	Enema-Administer
		T;N, Tap water, as needed
	Notify MD
		T;N, if INR >1.5

GI Inpatient Post Procedure
Vital Signs
	Vital Signs
		T;N
			Comment: Routine, post GI lab procedure
Activity
	Bedrest
		T;N, On left side
			Comment: with head of bed elevated continuously, until fully awake
	Activity-Up as Tolerated
		T;N
	Activity-As Tolerated
		T;N
Diet
	NPO
		T;N
	Clear Liquid Diet, with no red, purple or blue Jello or Fluids
		T;N
	Clear Liquid Diet
		T;N
	Regular Diet
		T;N
IV Solutions
Patient Care
	Dressing Care
		T;N+1440
			Comment: Remove dressing 24 hours post procedure and leave site open to air
	Wound Care
		T;N, Cleanse with soap and water, gastrostomy tube, Q12H-Start of Shift
	GI Tube
		T;N, PEG, Connect to gravity drainage, 24, hr
			Comment: use for medications only for 24 hours
		T;N, may use tube for meds only now. May use in 6hr for feeding
		T;N, Maintain bumper at 0.5 cm at skin until further notice
		T;N, Maintain bumper at 1 cm at skin until further notice
		T;N, Maintain bumper at 1.5 cm at skin until further notice
		T;N, Maintain bumper at 2 cm at skin until further notice
		T;N, Maintain bumper at 2.5 cm at skin until further notice
		T;N, Maintain bumper at 3 cm at skin until further notice
		T;N, Maintain bumper at 3.5 cm at skin until further notice
		T;N, Maintain bumper at 4 cm at skin until further notice
		T;N, Maintain bumper at 4.5 cm at skin until further notice
		T;N, Maintain bumper at 5 cm at skin until further notice
		T;N, Maintain bumper at 5.5 cm at skin until further notice
		T;N, Maintain bumper at 6 cm at skin until further notice
	IV-Maintain
		T;N
			Comment: continue pre-procedure IV order
	Notify MD
		T;N, if temp > 101, if severe abdominal pain or unstable

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

GI Inpatient Bowel Prep
Diet
	Clear Liquid Diet, with no red, purple or blue Jello or Fluids
		T;N
	NPO
		T;N, After Midnight
Medications
		Nulytely/GoLytely Prep(NOTE)*
	NuLYTELY
		4,000 mL, Powder-Reconstitution, By Mouth, Once, T;1600
	GoLYTELY
		4,000 mL, Powder-Reconstitution, By Mouth, Once, T;1600
		Nulytely/GoLytely Split Prep(NOTE)*
	NuLYTELY
		2,000 mL, Powder-Reconstitution, By Mouth, Q12H, T;1600, 2 Dose(s)/Time(s)
	GoLYTELY
		2,000 mL, Powder-Reconstitution, By Mouth, Once, T;1600, duration: 2 Dose(s)/Time(s)
		 If patient unable to tolerate Nulytely Prep and no evidence of impaired renal function (creatinine < 2.0, GFR >25-30) use the following prep:(NOTE)*
	magnesium citrate
		300 mL, Liquid, BY MOUTH, PREOP
			Comment: 300 mL = 1 bottle.
	Dulcolax
		20 mg, Tablet-Enteric-Coated, BY MOUTH, Once, NOW
		If patient unable to tolerate Nulytely Prep and evidence of impaired renal function (creatinine >2.0, GFR <25-30) use the following prep:(NOTE)*
		10 mg, Tablet-Enteric-Coated, BY MOUTH, Once, constipation
			Comment: Give 2 hours prior to start of Miralax prep.
	MiraLax oral powder for reconstitution
		238 gm, Powder, BY MOUTH, Once
			Comment: Mix with 64 oz clear cold gatorade. If patient diabetic, change to 64 oz Crystal Light. (DO NOT USE red or purple). Patient to drink 8 oz every 20 minutes.
	Dulcolax
		10 mg, Tablet-Enteric-Coated, BY MOUTH, Once
			Comment: Give 2 hours after completion of Miralax Prep.
		Neomycin Sulfate plus Erythromycin(NOTE)*
	erythromycin base
		1,000 mg, Tab, By Mouth, Once, Prophylaxis, T;1300
		1,000 mg, Tab, By Mouth, Once, Prophylaxis, T;1400
		1,000 mg, Tab, By Mouth, Once, Prophylaxis, T;2300
	erythromycin 250 mg oral delayed release capsule
		1,000 mg, Capsule, By Mouth, Once, Prophylaxis, T;1300
		1,000 mg, Capsule, By Mouth, Once, Prophylaxis, T;1400
		1,000 mg, Capsule, By Mouth, Once, Prophylaxis, T;2300
	neomycin
		1,000 mg, Tab, BY MOUTH, Once, Other- type in, Prophylaxis, T;1300
		1,000 mg, Tab, BY MOUTH, Once, Other- type in, Prophylaxis, T;1400
		1,000 mg, Tab, BY MOUTH, Once, Other- type in, Prophylaxis, T;2300
		Neomycin Sulfate plus Metronidazole(NOTE)*
	metroNIDAZOLE
		500 mg, Tab, By Mouth, Once, Other- type in, Prophylaxis, T;1300
		500 mg, Tab, By Mouth, Once, Other- type in, Prophylaxis, T;1400
		500 mg, Tab, By Mouth, Once, Other- type in, Prophylaxis, T;2300
	neomycin
		1,000 mg, Tab, BY MOUTH, Once, Other- type in, Prophylaxis, T;1300
		1,000 mg, Tab, BY MOUTH, Once, Other- type in, Prophylaxis, T;1400
		1,000 mg, Tab, BY MOUTH, Once, Other- type in, Prophylaxis, T;2300
		Late Night Neomycin Sulfate plus Metronidazole(NOTE)*
	metroNIDAZOLE
		500 mg, Tab, By Mouth, Once, Other- type in, Prophylaxis, T;0230
		500 mg, Tab, By Mouth, Once, Other- type in, Prophylaxis, T;0300
		500 mg, Tab, By Mouth, Once, Other- type in, Prophylaxis, T;0330
	neomycin
		1,000 mg, Tab, BY MOUTH, Once, Other- type in, Prophylaxis, T;0230
		1,000 mg, Tab, BY MOUTH, Once, Other- type in, Prophylaxis, T;0300
		1,000 mg, Tab, BY MOUTH, Once, Other- type in, Prophylaxis, T;0330
Patient Care
	Enema-Administer
		T;N, Tap water
			Comment:  Stat, Tap water, up to 6 enemas for Nu-lytely prep, if any solid stool is present 3 hours before procedure.  To be done am of procedure.
		T+1;0400, Tap water
			Comment: T+1;0400, Tap water, up to 6 enemas for Nu-lytely prep, if any solid stool is present 3 hours before procedure.  To be done am of procedure.

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