Unique Plan Description: IR Outpatient Procedure, Pre Op
Plan Selection Display: IR Outpatient Procedure, Pre Op
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2020-04-20 16:00:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-04-03 12:47:03
Available at all facilities: Yes

IR Outpatient Procedure, Pre Op
Admit/Discharge/Transfer
	Admit to Inpatient Status
		T;N, Anticipated LOS 1 midnight or less
	Admit to Observation Status
		T;N
Diet
	NPO
		Except for Medications | Except for Sips of Water
		After Midnight
			Comment: including tube feedings
Laboratory
	INR - MH/WH/JE
		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
		Stat, spec type = Blood
	Partial Thromboplastin Time (PTT) - FH
		T;N, Stat, spec type = Diagnostic Blood
	CBC with Diff
		Stat, spec type = Blood
	Basic Metabolic Panel
		Stat, spec type = Blood
	BUN
		Stat, spec type = Blood
	Creatinine
		Stat, spec type = Blood
	Comprehensive Metabolic Panel
		Stat, spec type = Blood
	Pregnancy Test Urine
		T;N, Stat, Stat, spec type = Urine
	Glucose POC - RN
		T;N, Once, NOW
Diagnostic Tests
	Nasogastric Tube Placement IR
		Stat, NG Tube Placement
IV Solutions
	Sodium Chloride 0.9%
		1,000 mL, IV, 75 ml/hr
			Comment: Start at least 1 hour prior to start of interventional procedure.
Medications
	Ancef (JE)
		2,000 mg, Injection, IV Push, PREOP, Surgical prophylaxis
			Comment: on call to OR to be given on entry to IR procedure
	Ancef (MH/WH)
		2,000 mg, Syringe, IV Push, PREOP, Surgical prophylaxis
			Comment: on call to OR to be given on entry to IR procedure
	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.
	Cipro
		400 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment: on call to OR to be given on entry to IR procedure
	Levaquin IVPB
		500 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment: on call to OR to be given on entry to IR procedure
	Mefoxin (JE)
		1,000 mg, Injection, IV Push, PREOP, Surgical prophylaxis
	Mefoxin Syringe
		1,000 mg, Syringe, IV Push, PREOP, Surgical prophylaxis
			Comment: on call to OR to be given on entry to IR procedure
	Mefoxin (FH)
		1,000 mg, INT, 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
	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
	ketorolac injectable
		30 mg, Injection, IV Push, PREOP
			Comment: procedure uterine artery embolization; Administer if NO prior NSAIDS in last 8 hours.
Patient Care
	Resuscitation Status
		T;N, Full Code
		T;N, No Code
	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
	Patient Education
		T;N, Instructions: if IDDM take half dose of AM insulin on day of interventional procedure
		T;N, Instructions: Do not take 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
	No Anticoagulants/antiplatelets/thrombolytics
		T;N
	Foley Catheter
		T;N, Insert, Pt. undergoing abdominal/pelvic surgery, Pre op
	Peripheral Lock-Insert
		T;N, large gauge.

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