Unique Plan Description: HN TORS Pre op
Plan Selection Display: HN TORS Pre op
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2019-09-25 08:22:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2021-12-20 10:53:19
Available at all facilities: Yes

HN TORS Pre op
Admit/Discharge/Transfer
	Admit to Inpatient Status
		T;N, Anticipated LOS 1 midnight or less
Laboratory
	Prealbumin
		T;N, Stat, spec type = Blood
	CBC with Diff
		T;N, Stat, spec type = Blood
	Basic Metabolic Panel
		T;N, Stat, spec type = Blood
	Magnesium Level
		T;N, Stat, spec type = Blood
	Phosphorus
		T;N, Stat, spec type = Blood
	Comprehensive Metabolic Panel
		T;N, Stat, spec type = Blood
Medications
Antibiotic Prophylaxis
		Clean Case(NOTE)*
	Do not give medication
		no antibiotic prophylaxis needed for clean head and neck cases
	Unasyn IVPB
		3,000 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
		If allergic to Beta-Lactams(NOTE)*
	Cleocin IVPB
		600 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
		If allergic to Beta-Lactams and Cleocin(NOTE)*
	Levaquin IVPB
		750 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment: Infuse over 1 hour
		Clean Contaminated(NOTE)*
		If allergic to Beta-lactams(NOTE)*
	Flagyl IVPB
		1,000 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment: Infuse over 1 hour
	Levaquin IVPB
		750 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
	dexAMETHasone
		8 mg, IV Push, Once, STAT
Patient Care

	Obtain Consent/Permit for:
		Direct laryngoscopy, Transoral robotic Pharyngectomy, modified radical neck dissection
	Sequential Compression Device Pre Procedure
		T;N, Apply, Once
			Comment: knee high
	Anti Embolism Stockings Pre Procedure
		T;N, Apply, Once
			Comment: knee high
Consults/Follow-up
	Consult Anesthesiologist
		Reason for Referral: Non-invasive cardiac output monitor
		Reason for Referral: Nasal Intubation

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