Unique Plan Description: IR Inpatient Procedure, Pre op
Plan Selection Display: IR Inpatient Procedure, Pre op
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2020-04-19 21:54:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2023-08-01 09:41:26
Available at all facilities: Yes

IR Inpatient Procedure, Pre op
Diet
	NPO
		T;N, NPO Except for: Medications | Sips of Water
		T;N, After Midnight
	Clear Liquid Diet
		Breakfast
			Comment: then NPO except for meds
Laboratory
	Glucose POC - RN
		T;N, Once
	INR - MH/WH/JE
		T;N, 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
		T;N, Stat, spec type = Blood
	Partial Thromboplastin Time (PTT) - FH
		T;N, Stat, spec type = Diagnostic Blood
	CBC with Diff
		T;N, Stat, spec type = Blood
	Basic Metabolic Panel
		T;N, Stat, spec type = Blood
	BUN
		T;N, Stat, spec type = Blood
	Creatinine
		T;N, Stat, spec type = Blood
	Comprehensive Metabolic Panel
		T;N, Stat, spec type = Blood
	Pregnancy Test Urine
		T;N, Stat, Stat, spec type = Urine
			Comment: if still menstruating and has not had hysterectomy or tubal ligation
Diagnostic Tests
	Nasogastric Tube Placement IR
		Stat, NG Tube Placement
IV Solutions
	Sodium Chloride 0.9%
		1,000 mL, IV, 75 ml/hr
Medications
	midazolam
		2 mg, Injection, IV Push, Q5H, PRN for sedation
	fentaNYL
		25 mcg, Injection, IV Push, Q5MIN, PRN for sedation, T;N
	Ancef (JE)
		2,000 mg, Injection, IV Push, PREOP, Surgical prophylaxis
	Ancef (MH/WH)
		2,000 mg, Syringe, IV Push, PREOP, Surgical prophylaxis
	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, 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.
	Levaquin IVPB
		500 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
	Mefoxin (JE)
		1,000 mg, Injection, IV Push, PREOP, Surgical prophylaxis
	Mefoxin Syringe
		1,000 mg, Syringe, IV Push, PREOP, Surgical prophylaxis
	Mefoxin (FH)
		1,000 mg, INT, IVPB, PREOP, Surgical prophylaxis
	Cipro
		400 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment: on call to OR to be given on entry to IR procedure
	clindamycin IVPB
		600 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment: on call to OR to be given on entry to IR procedure
		900 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment: on call to OR to be given on entry to IR procedure
	vancomycin IVPB
		1,000 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment: on call to OR to be given on entry to IR procedure
	vancomycin IVPB (FH)
		1,000 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment: on call to OR to be given on entry to IR procedure
Patient Care
	Obtain Consent/Permit for:
		Ablation, Cryoablation
		Ablation, Microwave
		Ablation, RadioFrequency
		Ablation, Uterine Artery Embolization
		Biopsy, Flouroscopy guided
		Biopsy, Ultrasound guided
		Biopsy, Computed Tomography guided
		Drain tube exchange, fluoroscopy guided
		Drain tube exchange, Ultrasound guided
		Drain tube exchange, Computed Tomography guided
		Hepatic angiogram with embolization
		Kyphoplasty
		Lumbar puncture
		Lumbar puncture with instillation of chemotherapy
		Percutaneous nephrostomy tube Insertion
		Percutaneous nephrostomy tube Exchange
		Percutaneous nephrostomy tube Removal
		Vertebroplasty
		Arthrogram
		Myelogram
		Paracentesis
		Therapeutic Injection
		Thoracentesis
	Notify MD
		T;N, Nephrologist and Care Manager prior to any procedure for all patients who receive dialysis
	No Anticoagulants/antiplatelets/thrombolytics
		T;N
	Do not give medication
		T;N, Hold oral hypoglycemics except actos and avadia prior to IR procedures.
		T;N, anticoagulation, antiplatelet, or ASA as follows: SC/IV heparin 6hr, enoxaparin prophylaxis 12hr/treatment 24hr, fondaparinux 72hr, apixaban/rivaroxaban/dabigatran 48hr, clopidogrel/ticagrelor/aspirin 5d, prasugrel 7d prior
	Communication to HOSPITAL RN
		If IDDM administer half of usual dose of insulin in AM
Consults/Follow-up
	Pharmacy Consult
		T;N, RP review RX profile. Work with RN staff to ensure any AC/Antiplatelets held appropriately prior to IR procedure.  Refer to Patient Care section for hold details for medications.

Rad Contrast Reaction IV Pre Med orders
Medications
		It is recommended to wait 4-5 hours prior to administering IV Contrast. If the exam is urgent, the wait time can be waived at the discretion of a physician after 1 hour of administering both of the pre-medications.(NOTE)*
	Decadron injectable
		7.5 mg, Injection, IV PUSH, Once
			Comment: 4-5 hours prior to exam.
	Benadryl
		50 mg, Injection, IV Push, Once
			Comment: 1 hour prior to exam.   IV contrast can be administered after 1 hour of premedication.
	SOLU-Medrol
		40 mg, Injection, IV PUSH, Once
			Comment: Alternative to Decadron.  4-5 hours prior to exam.
Patient Care
	Fall Precautions
		T;N
			Comment: Use fall precaution protocol for 6 hours after Diphenhydramine given

Rad Contrast Reaction Oral Pre Med orders
Medications
	predniSONE
		50 mg, Tab, By Mouth, Once
			Comment: 13 hours before contrast
		50 mg, Tab, By Mouth, Once
			Comment: 7 hours before contrast
		50 mg, Tab, By Mouth, Once
			Comment: 1 hour before contrast
		For JE patients, preferred medication is Benadryl:(NOTE)*
	Benadryl
		50 mg, Capsule, BY MOUTH, Once
			Comment: 1 hour before contrast.
		For FH/MH/WH patients, preferred medication is Claritin:(NOTE)*
	Claritin
		10 mg, Tab, By Mouth, Once
			Comment: 1 hour before contrast
	Medrol
		32 mg, Tab, BY MOUTH, Once
			Comment: 12 hours before contrast administration
		32 mg, Tab, BY MOUTH, Once
			Comment: 2 hours before contrast administration
	predniSONE 50 mg oral tablet
		See instructions, Take 1 tab by mouth 13 hours, 7 hours and 1 hour before radiology exam with contrast., # 3 TAB, 0 Refill(s)
	Claritin 10 mg oral tablet
		See instructions, Take 1 tab, BY MOUTH 1 hour before radiology exam with contrast., # 1 TAB, 0 Refill(s)
	methylPREDNISolone 32 mg oral tablet
		See instructions, Take 1 tab by mouth 12 hours and 2 hours before radiology exam with contrast., # 2 TAB, 0 Refill(s)

*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