Unique Plan Description: HN Onc Free Flap Pre op
Plan Selection Display: HN Onc Free Flap Pre op
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2016-09-13 11:19:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-04-09 15:29:58
Available at all facilities: Yes

HN Onc Free Flap Pre op
Admit/Discharge/Transfer
	Admit to Inpatient Status
		T;N, Anticipated LOS 2 midnight or more
Medications
Antibiotics
		Clean Cases(NOTE)*
	Ancef
		2,000 mg, Syringe, IV PUSH, PREOP, Surgical prophylaxis
	Cleocin IVPB
		900 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
		Clean Contaminated(NOTE)*
	Unasyn IVPB
		3,000 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
		1,500 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
		If allergic to Beta-Lactams(NOTE)*
	Flagyl IVPB
		1,000 mg, Injection-Premix, IVPB, PREOP, Indication: Surgical prophylaxis
			Comment: Infuse over 1 hour
	Levaquin IVPB
		750 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
		Skull base with dural resection(NOTE)*
	Rocephin IVPB
		2,000 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
	Rocephin IVPB (FH)
		2,000 mg, INT, IVPB, PREOP, Indication: Surgical prophylaxis
	Flagyl IVPB
		500 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment: Infuse over 1 hour
		Skull base with dural resection with known MRSA(NOTE)*
	Rocephin IVPB
		2,000 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
	Rocephin IVPB (FH)
		2,000 mg, INT, IVPB, PREOP, Indication: Surgical prophylaxis
	Flagyl IVPB
		500 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment: Infuse over 1 hour
	vancomycin IVPB
		1,000 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment: For patients <80kg; infuse over 1 hour. If allergic to other antibiotic options or documented reason for use.
		1,500 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment: For patients 80-120kg; infuse over 90 minutes. If allergic to other antibiotic options or documented reason for use.
		2,000 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment: For patients >120kg; infuse over 90 minutes. If allergic to other antibiotic options or documented reason for use.
	vancomycin IVPB (FH)
		1,000 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment: For patients <80kg; infuse over 1 hour. If allergic to other antibiotic options or documented reason for use.
		1,500 mg, INT, IVPB, PREOP, Indication: Surgical prophylaxis
			Comment: For patients 80-120kg; infuse over 90 minutes. If allergic to other antibiotic options or documented reason for use.
		2,000 mg, INT, IVPB, PREOP, Indication: Surgical prophylaxis
			Comment: For patients >120kg; infuse over 90 minutes. If allergic to other antibiotic options or documented reason for use.
		Skull base with dural resection, beta lactam allergic(NOTE)*
	Azactam IVPB
		2,000 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
	Flagyl IVPB
		500 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment: Infuse over 1 hour
	vancomycin IVPB
		1,000 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment: For patients <80kg; infuse over 1 hour. If allergic to other antibiotic options or documented reason for use.
		1,500 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment: For patients 80-120kg; infuse over 90 minutes. If allergic to other antibiotic options or documented reason for use.
		2,000 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment: For patients >120kg; infuse over 90 minutes. If allergic to other antibiotic options or documented reason for use.
	vancomycin IVPB (FH)
		1,000 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment: For patients <80kg; infuse over 1 hour. If allergic to other antibiotic options or documented reason for use.
		1,500 mg, INT, IVPB, PREOP, Indication: Surgical prophylaxis
			Comment: For patients 80-120kg; infuse over 90 minutes. If allergic to other antibiotic options or documented reason for use.
		2,000 mg, INT, IVPB, PREOP, Indication: Surgical prophylaxis
			Comment: For patients >120kg; infuse over 90 minutes. If allergic to other antibiotic options or documented reason for use.
Patient Care

	Obtain Consent/Permit for:
		
	Foley Catheter
		T;N, Foley, Insert, Once
Consults/Follow-up
	Consult Anesthesiologist
		Reason for Referral: Non-invasive cardiac output monitor

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