Michigan Surgical Quality Collaborative



Code StatusFull ResuscitationResuscitation OrdersAICD DeactivationConsultsADVISORY: Consider social work consult for patient over 75 yearsPhysician ConsultCase Management ConsultEnhanced Recovery Patient for home care needsSocial Work ConsultRoutine, enhanced recovery patientWound Ostomy Continence ConsultPatient CareActivityActivity – up to chairWith assistance, day of surgery. Keep up in chair at least 2 hoursAmbulate5x per day, with assistance, starting POD1AssessmentsIntake and Output, per guidelineCardiac Monitoring, continuousWeight dailyInterventionsIncentive SpirometryCough and Deep BreatheFoley CatheterContinue to dependent drainage, routineDiscontinue urinary catheter at 6am POD1Bladder ScanAs needed for Post Void Residuals, inability to void with discomfortDrain Management, per guidelineCommunication Order Patient CareLeave incision open to airStraight CatheterizationAs needed for bladder scan greater than 350mlContingenciesNotify Physician for:Temperature greater than 38.3C/101FHR greater than 120 or less than _______________ProtocolsProtocol Initiate When NeededHypoglycemia – non-pregnant, initiate protocolAMI/ACS Blood Glucose Management, initiate protocolDiabetes NPO After Midnight, initiate protocolProtocol Urgent Measures Initiate When NeededProtocol Clinical Nutrition Initiate When NeededProtocol Social Work Case Mgmt Initiate when neededFor social work-case mgmt. Chest X-ray ECF PlacementDietClear liquid dietNutritional SupplementsBreakfast, Dinner, Lunch – High protein lactose-free supplementCommunication order patient careNursing to advance diet as tolerated from clear to postop ___________Primary InfusionsIV Convert to Saline Lock in RecoveryMedicationsAlvimopan – EnteregPostop Prophylactic AntibioticsCardiac: Beta BlockersADVISORY: Patients undergoing elective procedures who are at high risk for ischemia should receive a beta blocker preoperatively, postoperatively, and upon hospital discharge if taking beta blocker prior to hospital arrivalBeta Blockers for Non Cardiac SurgeryPain Management/AntipyreticsAcetaminophen (Tylenol)1000mg PO, Q6hADVISORY: Ketorolac should not exceed 15mg per dose for patients > 65 years, <50kg, or with CrCl <50mL/minute. Do not use in patient with CrCl <30mL/minuteKetorolac (Toradol inj)15mg IV push, Q6h x 4 Time(s)/Dose(s)Ibuprofen600mg PO w/meals+BedtimeOxycodone5mg PO Q4h PRN for Pain – ModerateHydromorphone PCA Standard – DilaudidMorphine PCA StandardAntiemeticsOndansetron (injection)4mg IV Push, Q6h PRN for Nausea/vomitingOndansetron (ODT)4mg PO, Q8h PRN for Nausea/vomitingLaxativesDocusate (Colace)100mg PO BIDLaboratoryBasic Metabolic Panel, routine next AM x 1 dayMagnesium Level, routine next AM x 1 dayPhosphorus Level, routine next AM x 1 dayCBC, routine next AM x 1 dayGlucose POCT TestingTherapyOxygen TherapySupplemental oxygen titration to maintain saturation greater than ________%Consider PT referral for patients over 75 yearsPT Evaluation and TreatmentIndication, postop enhanced recovery patient ................
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