Unique Plan Description: UROGYN Sacral Neuromodulation, Pre op
Plan Selection Display: UROGYN Sacral Neuromodulation, Pre op
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2012-11-05 08:11:31
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2021-12-21 12:30:41
Available at all facilities: No

UROGYN Sacral Neuromodulation, Pre op
Admit/Discharge/Transfer
	Admit to Observation Status
		T;N
Diet
	NPO
		
Laboratory
	Pregnancy Test Urine
		Stat, Stat, spec type = Urine
			Comment: In child bearing age patient, if not done in past 48 hours and appropriate.
	Type and Screen (No Product on hold)
		Stat, spec type = Blood
Medications
	Ancef (MH/WH)
		2,000 mg, Syringe, IV Push, PREOP, Surgical prophylaxis
			Comment: OK to give if patient has penicillin allergy unless history of anaphylactic reaction.  Redose q3h during surgery
	Ancef (JE)
		2,000 mg, Injection, IV Push, PREOP, Surgical prophylaxis
			Comment: OK to give if patient has penicillin allergy unless history of anaphylactic reaction.  Redose q3h during surgery
	Levaquin IVPB
		500 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment: Give if penicillin allergic
	Cipro IVPB
		400 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
		Select both clindamycin (Cleocin) and azetreonam (Azactam) if beta lactam and quinolone allergic.(NOTE)*
	Cleocin IVPB
		600 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment: Give with aztreonam (Azactam) if beta lactam allergic
	Azactam IVPB
		1,000 mg, Injection-Premix, IVPB, PREOP, Surgical prophylaxis
			Comment: give with clindamycin (Cleocin) if beta lactam allergic
Patient Care
	Obtain Consent/Permit for:
		Interstim Stage 1 Lead Placement
		Interstim Stage 2 Neurostimulator Generator Implantation Possible Lead Removal
		Interstim Stage 1 Lead Placement and Stage 2 Neurostimulator Generator Implantation
		Interstim Lead Repositioning
		Interstim Generator Repositioning
		Removal of Interstim Leads and Generator

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

*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