Unique Plan Description: URO Radical Cystectomy, Pre Op
Plan Selection Display: URO Radical Cystectomy, Pre Op
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2023-12-12 14:54:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2023-12-12 14:54:00
Available at all facilities: Yes

URO Radical Cystectomy, Pre Op
Admit/Discharge/Transfer
	Admit to Inpatient Status
		T;N, Anticipated LOS 2 midnight or more
Diet
	Clear Liquid Diet
		T;N
			Comment: Day before Surgery
	Blenderized Liquid (Full) Diet
		T;N
			Comment: Day before Surgery
	NPO
		After Midnight
		After Midnight, NPO Except for: Medications
Laboratory
	CBC with Diff
		Stat, spec type = Blood
	Basic Metabolic Panel
		Stat, spec type = Blood
	INR - MH/WH/JE
		Stat, spec type = Blood
	PTT - MH/WH/JE
		Stat, spec type = Blood
	Type and Crossmatch (Product Available)
		T;N, Stat, For Possible Transfusion
	UA (Culture if Positive)
		Routine, Routine, spec type = Urine
IV Solutions
	Lactated Ringers Injection
		1,000 mL, IV, 125 ml/hr
		1,000 mL, IV, 150 ml/hr
Medications
	Mefoxin (JE)
		1,000 mg, Injection, IV Push, PREOP, Surgical prophylaxis
	Mefoxin Syringe
		1,000 mg, Syringe, IV Push, PREOP, Surgical prophylaxis
	Zinacef (JE)
		1,500 mg, Injection, IV Push, PREOP, Surgical prophylaxis
	Zinacef (MH/WH)
		1,500 mg, Syringe, IV Push, PREOP, Surgical prophylaxis
	Ancef (JE)
		1,000 mg, Injection, IV Push, PREOP, Surgical prophylaxis
	Ancef (MH/WH)
		1,000 mg, Syringe, IV Push, PREOP, Surgical prophylaxis
	Levaquin IVPB
		500 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
	Cipro IVPB
		400 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
Patient Care
	Obtain Consent/Permit for:
		
Consults/Follow-up
	Consult Wound Care
		
	Consult Anesthesia/Post Surgical Pain
		Reason for Referral: Post-Surgical Pain, Refer to/Consult with: Anesthesia on Call, No Provider Notified
			Comment: Consult Anesthesia for post-surgical pain management that is non-routine and requires the expertise of an anesthesia provider, uniquely trained and qualified to assist with post-surgical pain management, including but not limited to administration of nerve blocks or epidural catheter placement.

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.

GI Inpatient Bowel Prep
Diet
	Clear Liquid Diet, with no red, purple or blue Jello or Fluids
		T;N
	NPO
		T;N, After Midnight
Medications
		Nulytely/GoLytely Prep(NOTE)*
	NuLYTELY
		4,000 mL, Powder-Reconstitution, By Mouth, Once, T;1600
	GoLYTELY
		4,000 mL, Powder-Reconstitution, By Mouth, Once, T;1600
		Nulytely/GoLytely Split Prep(NOTE)*
	NuLYTELY
		2,000 mL, Powder-Reconstitution, By Mouth, Q12H, T;1600, 2 Dose(s)/Time(s)
	GoLYTELY
		2,000 mL, Powder-Reconstitution, By Mouth, Once, T;1600, duration: 2 Dose(s)/Time(s)
		 If patient unable to tolerate Nulytely Prep and no evidence of impaired renal function (creatinine < 2.0, GFR >25-30) use the following prep:(NOTE)*
	magnesium citrate
		300 mL, Liquid, BY MOUTH, PREOP
			Comment: 300 mL = 1 bottle.
	Dulcolax
		20 mg, Tablet-Enteric-Coated, BY MOUTH, Once, NOW
		If patient unable to tolerate Nulytely Prep and evidence of impaired renal function (creatinine >2.0, GFR <25-30) use the following prep:(NOTE)*
		10 mg, Tablet-Enteric-Coated, BY MOUTH, Once, constipation
			Comment: Give 2 hours prior to start of Miralax prep.
	MiraLax oral powder for reconstitution
		238 gm, Powder, BY MOUTH, Once
			Comment: Mix with 64 oz clear cold gatorade. If patient diabetic, change to 64 oz Crystal Light. (DO NOT USE red or purple). Patient to drink 8 oz every 20 minutes.
	Dulcolax
		10 mg, Tablet-Enteric-Coated, BY MOUTH, Once
			Comment: Give 2 hours after completion of Miralax Prep.
		Neomycin Sulfate plus Erythromycin(NOTE)*
	erythromycin base
		1,000 mg, Tab, By Mouth, Once, Prophylaxis, T;1300
		1,000 mg, Tab, By Mouth, Once, Prophylaxis, T;1400
		1,000 mg, Tab, By Mouth, Once, Prophylaxis, T;2300
	erythromycin 250 mg oral delayed release capsule
		1,000 mg, Capsule, By Mouth, Once, Prophylaxis, T;1300
		1,000 mg, Capsule, By Mouth, Once, Prophylaxis, T;1400
		1,000 mg, Capsule, By Mouth, Once, Prophylaxis, T;2300
	neomycin
		1,000 mg, Tab, BY MOUTH, Once, Other- type in, Prophylaxis, T;1300
		1,000 mg, Tab, BY MOUTH, Once, Other- type in, Prophylaxis, T;1400
		1,000 mg, Tab, BY MOUTH, Once, Other- type in, Prophylaxis, T;2300
		Neomycin Sulfate plus Metronidazole(NOTE)*
	metroNIDAZOLE
		500 mg, Tab, By Mouth, Once, Other- type in, Prophylaxis, T;1300
		500 mg, Tab, By Mouth, Once, Other- type in, Prophylaxis, T;1400
		500 mg, Tab, By Mouth, Once, Other- type in, Prophylaxis, T;2300
	neomycin
		1,000 mg, Tab, BY MOUTH, Once, Other- type in, Prophylaxis, T;1300
		1,000 mg, Tab, BY MOUTH, Once, Other- type in, Prophylaxis, T;1400
		1,000 mg, Tab, BY MOUTH, Once, Other- type in, Prophylaxis, T;2300
		Late Night Neomycin Sulfate plus Metronidazole(NOTE)*
	metroNIDAZOLE
		500 mg, Tab, By Mouth, Once, Other- type in, Prophylaxis, T;0230
		500 mg, Tab, By Mouth, Once, Other- type in, Prophylaxis, T;0300
		500 mg, Tab, By Mouth, Once, Other- type in, Prophylaxis, T;0330
	neomycin
		1,000 mg, Tab, BY MOUTH, Once, Other- type in, Prophylaxis, T;0230
		1,000 mg, Tab, BY MOUTH, Once, Other- type in, Prophylaxis, T;0300
		1,000 mg, Tab, BY MOUTH, Once, Other- type in, Prophylaxis, T;0330
Patient Care
	Enema-Administer
		T;N, Tap water
			Comment:  Stat, Tap water, up to 6 enemas for Nu-lytely prep, if any solid stool is present 3 hours before procedure.  To be done am of procedure.
		T+1;0400, Tap water
			Comment: T+1;0400, Tap water, up to 6 enemas for Nu-lytely prep, if any solid stool is present 3 hours before procedure.  To be done am of procedure.

*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