Unique Plan Description: GYN Major Surgery, Pre Op
Plan Selection Display: GYN Major Surgery, Pre Op
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2020-04-14 23:12:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2023-07-18 12:47:13
Available at all facilities: Yes

GYN Major Surgery, 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
		
Laboratory
	Type and Screen (No Product on hold)
		Stat, spec type = Blood
	Type and Crossmatch (Product Available)
		T;N, Stat, For Possible Transfusion
	Pregnancy Test Urine
		Stat, Stat, spec type = Urine
	CBC with Diff
		T;N, Stat, spec type = Blood
	Pregnancy Test Whole Blood - JE
		T;N, Stat, spec type = Blood
Medications
	Ancef (JE)
		2,000 mg, Injection, IV Push, Once, Surgical prophylaxis
			Comment: Give 1 hr preop.  OK to give if pt allergic to penicillin unless history of anaphylactic reaction.  Redose every 3 hours during surgery
	Ancef (MH/WH)
		2,000 mg, Syringe, IV Push, Once, Surgical prophylaxis
			Comment: Give 1 hr preop.  OK to give if pt allergic to penicillin unless history of anaphylactic reaction.  Redose every 3 hours during surgery
	Ancef (FH)
		2,000 mg, INT, 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, 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
		For penicillin allergic patients choose either Quinolone and Flagyl, or Quinolone and Clindamycin(NOTE)*
		Quinolone and Flagyl:(NOTE)*
	Flagyl IVPB
		500 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
	Levaquin IVPB
		500 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
		Quinolone and Clindamycin:(NOTE)*
		500 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
	Cleocin IVPB
		900 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
		If Patient Beta Lactam AND Quinolone allergic, Give BOTH Azactam and Clindamycin.(NOTE)*
	Azactam IVPB
		1,000 mg, INT, IVPB, PREOP, Surgical prophylaxis
			Comment: give with clindamycin (Cleocin) if beta lactam allergic
	Cleocin IVPB
		900 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
		If patient allergic to penicillin or cephalosporin and quinolone with anaphylaxis reaction order Vancomycin AND Gentamicin(NOTE)*
	gentamicin IVPB
		5 mg/kg, INT, IVPB, PREOP, Surgical prophylaxis
			Comment: Dose based on Adjusted Body Weight; Give with Vancomycin Preop if patient has 		Cephalosporin or Quinolone allergy or anaphylactic penicillin allergy
	gentamicin IVPB (FH)
		5 mg/kg, INT, IVPB, PREOP, Surgical prophylaxis
			Comment: Dose based on Adjusted Body Weight; Give with Vancomycin Preop if patient has Cephalosporin or Quinolone allergy or anaphylactic penicillin allergy.
	vancomycin IVPB
		15 mg/kg, INT, IVPB, PREOP, Surgical prophylaxis
			Comment: Dose based on Actual Body Weight; Give with Gentamicin Preop if patient has 		Cephalosporin or Quinolone allergy or anaphylactic penicillin allergy
	vancomycin IVPB (FH)
		15 mg/kg, INT, IVPB, PREOP, Surgical prophylaxis
			Comment: Dose based on Actual Body Weight; Give with Gentamicin Preop if patient has Cephalosporin or Quinolone allergy or anaphylactic penicillin allergy
Patient Care
	Obtain Consent/Permit for:

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.

*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