PLACE LABEL HERE

ACETABULAR/PELVIC FRACTURE

POST-OP ORDERS

The following orders will be implemented. Orders with a “” are choices and are NOT implemented unless checked.

Initial all handwritten order modifications and the bottom of each page when indicated (multipage).

1. Do you expect that the patient’s condition will require a hospital stay that will cross two midnights (includes the time spent in outpatient- ED, surgery, OBS) and the patient has medical necessity for an inpatient admission?

Yes, admit as inpatient, proceed to # 2 No, place in observation No, outpatient, DC home

2. If admitted as inpatient, Inpatient Physician Certification:

Diagnosis: ______

Level of Care:  Critical  Intermediate  Acute Care Location/Specialty Unit Preference______

3. Telemetry: If patient Medical/Surgical, must complete form # 36084

4. Isolation:  Contact  Droplet  Airborne For: ______

PACU:

5. Labs: H&H CMP

6. X-ray:AP / pelvisReason:______

7. Neurovascular assessment every 2 hrs to: Right lower extremity  Left Lower extremity

POST-OP:

8. PT consult on ___ / ___ (date): Transfer training bed to chair  Gait training

 Therapeutic exercises

9. OT consult on ___ / ___ (date)

10. Bedrest x _____ hrs

11. Hip precautions

12.  Abduction pillow while in bed

13.Weight bearing status:NWB ______LE  ______% WB ______LE

 TDWB ______LE WBAT ______LE

14. Case Manager to arrange: Equipment for home use: ______

 Anticoagulant therapy for home

 Home health services: ______

 Referral to rehab facility: ______

 Other: ______

15. Hospitalist consult for medical management

16. H&H in AM & POD#2 (notify physician if HGB ≤ 7.0)

17. Neurovascular assessment q 2 hrs x 4, q 4 hrs x 4, then q 8 hrs to:Right lower extremity

Left Lower extremity

18. Diet:  NPO Regular Advance as tolerated Other: ______

19. Oral Nutritional Supplement Standing Orders (form # 31417), initiate if patient meets criteria

20. Foley catheter to bedside bag. Discontinue foley catheter on POD#1 at 6am

21. Foley Catheter Removal and Voiding Assessment/Interventions Standing Orders (form # 31620)

22. Monitor urine output q 2 hrs x 48 hrs. Call physician if urine output is 0.5ml/kg/hr over 4 hrs

23. Surgical drain to self suction. Record output q 8 hrs. Discontinue no sooner than the POD #1 when

drainage less than 25 ml for 8 hrs

24. Dressing:  Reinforce prn  Change ______ Other: ______

25. Incentive spirometerq one hr while awake

26. O2per Protocol (form # 34431)

Copy to pharmacyOrder writers initials ______

*3-17235*FORM 3-17235 REV. 08/2015 Page 1 of 3

PLACE LABEL HERE

ACETABULAR/PELVIC FRACTURE

POST-OP ORDERS

The following orders will be implemented. Orders with a “” are choices and are NOT implemented unless checked.

Initial all handwritten order modifications and the bottom of each page when indicated (multipage).

27. Notify physician if:

Copy to pharmacyOrder writers initials ______

FORM 3-17235 REV. 08/2015 Page 1 of 2

ACETABULAR/PELVIC FRACTURE

POST-OP ORDERS PLACE LABEL HERE

  1. Temp 102F
  2. HR less than 50 or 140
  3. RR less than 10 or 30
  4. DBP 50 or 100
  5. Changes in neurovascular status
  6. Excessive drainage from incision

Copy to pharmacyOrder writers initials ______

FORM 3-17235 REV. 08/2015 Page 1 of 2

PLACE LABEL HERE

ACETABULAR/ PELVIC FRACTURE

POST-OP ORDERS

SCHEDULED MEDICATIONS:

28. IVF: D5 ½ NS IV at 100 ml/hr D5 ½ NS IV at ______ml/hr

 Other: ______

 Discontinue IVF when tolerating oral fluids

29. Antibiotic:  Ancef (cefazolin) 1 gm IV q 8 hrs x 2 doses

 Other______

For antibiotic > 24 hrs, document indication REQUIRED:______

Post-op antibiotic will be automatically stopped within 24 hrs unless indication is documented above

30. VTE prophylaxis, Initiate Venous Thromboembolism (VTE) Prophylaxis Orders (form # 33058)

Apply/ maintain antiembolic stockings

 Sequential compression device foot compression device (document reason:______)

Lovenox (enoxaparin) 12 hrs post-op: 30mg SQ q 12hrs x 2 doses (1st dose due at _____hrs)

then Lovenox (enoxaparin) 40mg SQ q day for ______days (if CrCl < 30, give 30 mg SQ q day)

(if patient has an epidural, do not begin enoxaparin until epidural has been out for 12 hrs)

Arixtra (fondaparinux) 2.5 mg SQ, give 8 hrs post-op (1st dose due at ______hrs)

then 2.5 mg SQ q 24 hrs for ______days.

If CrCl < 30 or weight < 50 kg, Arixtra will be therapeutically interchanged to Lovenox

31. Bowel Management:

Senokot-S (docusate/senna) 2 tablets po at bedtime nightly

POD # 2, if no BM: Dulcolox (bisacodyl) 10 mg po x 1 dose on POD # 2

POD # 3, if no BM: Dulcolax (bisacodyl) 10 mg suppository per rectum x 1 dose, on POD # 3

If no BM 4 hrs post suppository, give Fleets Enema (sodium phosphate) per rectum x 1 bottle

32. NSAID:  Indocin (indomethacin) 25 mg po three times daily. Start in AM of ______

  1. PCA:  PCA (orders # 2119)  Sleep Apnea PCA (orders # 21261)  Epidural per Anesthesia

Discontinue PCA or Epidural on POD #2. IF PATIENT HAS EPIDURAL: HOLD ALL OTHER SEDATIVES AND NARCOTICS UNLESS ORDERED/ APPROVED BY ANESTHESIA UNTIL EPIDURAL discontinued

  1. If not on PCA, Oxycontin 10 mg 20 mg po twice daily

Copy to pharmacy Order writers initials ______

FORM 3-17235 REV. 08/2015 Page 1 of 3

PLACE LABEL HERE

ACETABULAR/ PELVIC FRACTURE

POST-OP ORDERS

The following orders will be implemented. Orders with a “” are choices and are NOT implemented unless checked.

Initial all handwritten order modifications and the bottom of each page when indicated (multipage).

PRN MEDICATIONSSee policy 520-06 for range orders and pain intensity guidelines.

If not ordered by Anesthesia during peri-operative phase:

  1. Electrolyte Replacement Protocol (form # 21340)
  2. Mild Pain, Temp>100.5F, HA: Tylenol (acetaminophen) 650 mg po or PR q 4 hrs prn
  3. Moderate Pain:

Norco (HYDROcodone/acetaminophen) 5/325 mg or 10/325mg 1 tab po q 4 hrs prn. DC if Percocet ordered.

or If patient cannot take tablet, Hycet elixir (HYDROcodone/acetaminophen 7.5/325 mg/15 ml) 15 ml po q 4 hrs prn instead of Norco. DC if Percocet ordered.

or Percocet (oxyCODONE/acetaminophen) 5/325 mg or 10/325 mg 1 tab po q 4 hrs prn. DC if Norco ordered.

and/or  Toradol (ketorolac) 30 mg IV (or IM if no IV access) q 6 hrs prn (15 mg if CrCl 31-50, > 65 y/o old or < 50 kg) or 10 mg po q 6 hrs prn (max combined duration of IV and po ketorolac is 5 days). DC if CrCl < 30.

  1. Severe Pain (Begin when Epidural or PCA has been discontinued)

Morphine 1-2 mg IV q 3 hrs prn, DC if CrCl < 30. Hold for excessive sedation. DC if Dilaudid ordered.

or  Dilaudid (HYDROmorphone) 0.25-0.5 mg IV q 3 hrs prn. If CrCl < 30, dose at 0.25 mg. Hold for excessive sedation. DC if Morphine ordered.

  1. Nausea/Vomiting: Zofran (ondansetron) 4 mg IV or po q 6 hrs prn

If N/V persists, add Reglan (metoclopramide) 10 mg IV q 6 hrs prn (5 mg if > 65 y/o)

  1. Sleep:  Ambien (zolpidem) 5 mg (female or males ≥ 65 y/o) or 5-10mg (male < 65 y/o) po at HS prn
  2. Indigestion: Maalox XS (aluminum/magnesium/simethicone) 30 ml po four times daily prn
  3. Stool Softener: Colace (docusate) 100 mg po bid prn; if patient has not had a bowel movement
  4. Constipation: Milk of Magnesia (MOM) 30 ml po daily prn

If no BM after 48 hrs,  Dulcolax (biscodyl) 10 mg per rectum daily prn

and/or Senokot-S (docusate/senna) 2 tablets po at bedtime nightly

44.Cough:Robitussin (guaifenesin) 15 ml po q 4 hrs prn

45.Sore Throat:Chloraseptic (phenol/sodium phenolate) throat spray q 2 hrs prn

ADDITIONAL ORDERS:

______

______

______

______

______

DateTimePhysician SignaturePID Number

Copy to pharmacy

FORM 3-17235 REV. 08/2015 Page 1 of 3