Unique Plan Description: Ophth Eye Surgery, Pre Op
Plan Selection Display: Ophth Eye Surgery, Pre Op
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2021-05-17 09:19:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2021-12-21 10:27:52
Available at all facilities: No

Ophth Eye Surgery, Pre Op
Admit/Discharge/Transfer
	Admit to Observation Status
		T;N
Activity
	Up with Assistance
		
Diet
	NPO
		
Laboratory
	CBC with Diff
		T;N, Stat, spec type = Blood
	Urinalysis
		T;N, Stat, Stat, spec type = Urine
	Basic Metabolic Panel
		T;N, Stat, spec type = Blood
Diagnostic Tests
Radiology
	Chest 2 View
		Stat
Medications

	proparacaine 0.5% ophthalmic solution
		1 gtt, Solution, Eye, Affected, PREOP
		3 gtt, Solution, Eye, Affected, PREOP
		1 gtt, Solution, Eye, Right, PREOP
		3 gtt, Solution, Eye, Right, PREOP
		1 gtt, Solution, Eye, Left, PREOP
		3 gtt, Solution, Eye, Left, PREOP
	Ciloxan 0.3% ophthalmic solution
		1 gtt, Solution, Eye, Affected, Q5MIN, PRN for see comment
			Comment: x 3 doses
		3 gtt, Solution, Eye, Affected, PREOP
		1 gtt, Solution, Eye, Right, Q5MIN, PRN for see comment
			Comment: x 3 doses
		3 gtt, Solution, Eye, Right, PREOP
		1 gtt, Solution, Eye, Left, Q5MIN, PRN for see comment
			Comment: x 3 doses
		3 gtt, Solution, Eye, Left, PREOP
	Cyclogyl 1% ophthalmic solution
		1 gtt, Solution, Eye, Affected, Q15MIN, PRN for see comment
			Comment: x 3 doses
		3 gtt, Solution, Eye, Affected, PREOP
		1 gtt, Solution, Eye, Right, Q15MIN, PRN for see comment
			Comment: x 3 doses
		3 gtt, Solution, Eye, Right, PREOP
		1 gtt, Solution, Eye, Left, Q15MIN, PRN for see comment
			Comment: x 3 doses
		3 gtt, Solution, Eye, Left, PREOP
	Mydriacyl 1% ophthalmic solution
		1 gtt, Solution, Eye, Affected, Q5MIN, PRN for see comment
			Comment: x 3 doses
		3 gtt, Solution, Eye, Affected, PREOP
		1 gtt, Solution, Eye, Right, Q5MIN, PRN for see comment
			Comment: x 3 doses
		3 gtt, Solution, Eye, Right, PREOP
		1 gtt, Solution, Eye, Left, Q5MIN, PRN for see comment
			Comment: x 3 doses
		3 gtt, Solution, Eye, Left, PREOP
	Mydfrin 2.5% ophthalmic solution
		1 gtt, Solution, Eye, Affected, Q15MIN, PRN for see comment
			Comment: x 3 doses
		1 gtt, Solution, Eye, Affected, Q5MIN, PRN for see comment
			Comment: x 3 doses
		3 gtt, Solution, Eye, Affected, PREOP
		1 gtt, Solution, Eye, Right, Q15MIN, PRN for see comment
			Comment: x 3 doses
		1 gtt, Solution, Eye, Right, Q5MIN, PRN for see comment
			Comment: x 3 doses
		3 gtt, Solution, Eye, Right, PREOP
		1 gtt, Solution, Eye, Left, Q15MIN, PRN for see comment
			Comment: x 3 doses
		1 gtt, Solution, Eye, Left, Q5MIN, PRN for see comment
			Comment: x 3 doses
		3 gtt, Solution, Eye, Left, PREOP
	flurbiprofen 0.03% ophthalmic solution
		3 gtt, Solution, Eye, Affected, PREOP
		3 gtt, Solution, Eye, Left, PREOP
		3 gtt, Solution, Eye, Right, PREOP
	Pred Forte 1% ophthalmic suspension
		1 gtt, Suspension, Eye, Affected, Once
			Comment: in OR
		1 gtt, Suspension, Eye, Right, Once
			Comment: in OR
		1 gtt, Suspension, Eye, Left, Once
			Comment: in OR
	tobramycin 0.3% ophthalmic solution
		3 gtt, Solution, Eye, Affected, Q5MIN, PRN, see comment
			Comment: x 3 doses
		1 gtt, Solution, Eye, Affected, Q5MIN, PRN, see comment
			Comment: x 3 doses
		3 gtt, Solution, Eye, Right, Q5MIN, PRN, see comment
			Comment: x 3 doses
		1 gtt, Solution, Eye, Right, Q5MIN, PRN, see comment
			Comment: x 3 doses
		3 gtt, Solution, Eye, Left, Q5MIN, PRN, see comment
			Comment: x 3 doses
		1 gtt, Solution, Eye, Left, Q5MIN, PRN, see comment
			Comment: x 3 doses
	Tobradex ophthalmic suspension
		1 gtt, Suspension, Eye, Affected, Q5MIN, PRN for see comment
			Comment: x 3 doses
		1 gtt, Suspension, Eye, Right, Q5MIN, PRN for see comment
			Comment: x 3 doses
		1 gtt, Suspension, Eye, Left, Q5MIN, PRN for see comment
			Comment: x 3 doses
		1 gtt, Suspension, Eye, Affected, Q5MIN, PRN for see comment
			Comment: x 2 doses
		1 gtt, Suspension, Eye, Right, Q5MIN, PRN for see comment
			Comment: x 2 doses
		1 gtt, Suspension, Eye, Left, Q5MIN, PRN for see comment
			Comment: x 2 doses
	Vigamox 0.5% ophthalmic solution
		1 gtt, Solution, EYE, AFFECTED, Q5MIN, PRN for see comment
			Comment: x 2 doses
		1 gtt, Solution, Eye, Right, Q5MIN, PRN for see comment
			Comment: x 2 doses
		1 gtt, Solution, Eye, Left, Q5MIN, PRN for see comment
			Comment: x 2 doses
		3 gtt, Solution, EYE, AFFECTED, PREOP
		3 gtt, Solution, Eye, Right, PREOP
		3 gtt, Solution, Eye, Left, PREOP
	Xylocaine 2% topical gel
		1 appl Gel EYE, AFFECTED Q15MIN, 2 hr
			Comment: start after dilating drops and continue until patient goes to OR
		1 appl, Gel, Eye, Right, Q15MIN, 2 hr
			Comment: start after dilating drops and continue until patient goes to OR
		1 appl, Gel, Eye, Left, Q15MIN, 2 hr
			Comment: start after dilating drops and continue until patient goes to OR
	tetracaine 0.5% ophthalmic solution
		1 gtt, Solution, Eye, Affected, Q5MIN, PRN, see comment
			Comment: x 3 doses
		1 gtt, Solution, Eye, Right, Q5MIN, PRN, see comment
			Comment: x 3 doses
		1 gtt, Solution, Eye, Left, Q5MIN, PRN, see comment
			Comment: x 3 doses
		Pledget soaked ophthalmic orders are below:(NOTE)*
	Cyclogyl 1% ophthalmic solution
		1 gtt, Solution, SEE NOTES, PREOP
			Comment: Use 1mL in pledget (20 drops) solution.  Place pledget soaked in eyedrop solution in operative eye with sterile forceps at least 30 minutes prior to OR.
		1 gtt, Solution, SEE NOTES, PREOP
			Comment: Use 1mL (20 drops) in pledget solution.  Place pledget soaked in eyedrop solution in right eye with sterile forceps at least 30 minutes prior to OR.
		1 gtt, Solution, SEE NOTES, PREOP
			Comment: Use 1mL (20 drops) in pledget solution.  Place pledget soaked in eyedrop solution in left eye with sterile forceps at least 30 minutes prior to OR.
	Mydfrin 2.5% ophthalmic solution
		1 gtt, Solution, SEE NOTES, PREOP
			Comment: Use 1mL (20 drops) in pledget solution.  Place pledget soaked in eyedrop solution in operative eye with sterile forceps at least 30 minutes prior to OR.
		1 gtt, Solution, SEE NOTES, PREOP
			Comment: Use 1mL (20 drops) in pledget solution.  Place pledget soaked in eyedrop solution in right eye with sterile forceps at least 30 minutes prior to OR.
		1 gtt, Solution, SEE NOTES, PREOP
			Comment: Use 1mL (20 drops) in pledget solution.  Place pledget soaked in eyedrop solution in left eye with sterile forceps at least 30 minutes prior to OR.
	ketorolac 0.5% ophthalmic solution
		1 gtt, Solution, Eye, Affected, PREOP
		1 gtt, Solution, Eye, Left, PREOP
		1 gtt, Solution, Eye, Right, PREOP
	Vigamox 0.5% ophthalmic solution
		1 gtt, Solution, SEE NOTES, PREOP
			Comment: Use 1mL (20 drops) in pledget solution.  Place pledget soaked in eyedrop solution in operative eye with sterile forceps at least 30 minutes prior to OR.
		1 gtt, Solution, SEE NOTES, PREOP
			Comment: Use 1mL (20 drops) in pledget solution.  Place pledget soaked in eyedrop solution in right eye with sterile forceps at least 30 minutes prior to OR.
		1 gtt, Solution, SEE NOTES, PREOP
			Comment: Use 1mL (20 drops) in pledget solution.  Place pledget soaked in eyedrop solution in left eye with sterile forceps at least 30 minutes prior to OR.
Patient Care
	Obtain Consent/Permit for:
		
	Bladder Scan
		T;N, unable to void, Assess for Residual
	Surgical Prep
		T;N
			Comment: Pledget; place pledget soaked in eye drop solution in affected eye for 30 minutes prior to OR.
	Pre-op bath/shower
		Wash face and eyebrows pre-op

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

FH SC PRE OP
Medications
		PRE OP(NOTE)*
	Marcaine OPHTH
		0.2 mL, Solution-Ophthalmic, Eye, Affected, PREOP
			Comment: instill 1 drop into operative eye
		0.2 mL, Solution-Ophthalmic, Eye, Affected, Q5MIN, PRN for see comment
			Comment: 1-2 drops prior to being transported to OR room
		0.2 mL, Solution-Ophthalmic, Eye, Left, Q5MIN, PRN for see comment
			Comment: 1-2 drops prior to being transported to OR room
		0.2 mL, Solution-Ophthalmic, Eye, Right, Q5MIN, PRN for see comment
			Comment: 1-2 drops prior to being transported to OR room
		0.2 mL, Solution-Ophthalmic, Eye, Both, Q5MIN, PRN for see comment
			Comment: 1-2 drops prior to being transported to OR room
	Cyclomydril OPHTH
		0.4 mL, Solution-Ophthalmic, Eye, Affected, Q5MIN, PRN for see comment
			Comment: 1-2 drops prior to being transported to OR room
		0.4 mL, Solution-Ophthalmic, Eye, Left, Q5MIN, PRN for see comment
			Comment: 1-2 drops prior to being transported to OR room
		0.4 mL, Solution-Ophthalmic, Eye, Right, Q5MIN, PRN for see comment
			Comment: 1-2 drops prior to being transported to OR room
		0.4 mL, Solution-Ophthalmic, Eye, Both, Q5MIN, PRN for see comment
			Comment: 1-2 drops prior to being transported to OR room
	OPHTH Soln PreOp
		0.4 mL, Solution-Ophthalmic, Eye, Affected, Q5MIN, PRN for see comment, STAT
			Comment: Instill  1 drop 3-5 times with 5 mins. Between drops into operative eye of PRE-OP solution.

*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