PLACE LABEL HERE

SPINE SURGERY

ANTERIOR CERVICAL DISKECTOMY FUSION (ACDF)

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

2.If admitted as inpatient, Inpatient Physician Certification:

Diagnosis: ______

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

  1. Telemetry: If patient Medical/Surgical, must complete form # 36084
  2. Isolation: Contact Droplet Airborne For: ______
  3. Hospitalist consult for medical management Notified
  4. Vital signs per unit routine
  5. Cervical collar: No collar needed Soft cervical collar  Aspen collar Philadelphia collar for showers

 Wear collar at all times Wear collar while out of bed only

  1. Dressing: Change prior to discharge and as needed
  2. TEDs and SCDs while in bed.
  3. Drain Type:______1/2 suction Full suction gravity

Discontinue drain:If drainage < 30 ml for 2 consecutive 8 hr periods

Discontinue by physician order only (Notify physician for drainage 100 ml in 6 hrs)

  1. Foley catheter to bedside bag.Reason: Surgical Procedure, DCwithin 12hrs post-op
  2. Foley Catheter Removal and Voiding Assessment/Interventions Standing Orders (form # 31620)
  3. Diet: NPO except ice chips for 4hrs. Advance diet as tolerated to______
  4. Oral Nutrition Supplement Orders (form # 31417), initiate if patient meets criteria
  5. Activity: Logroll. Out of bed with assistance within 6 hrs post-op. Progressive ambulation as tolerated.
  6. May consult Speech Pathologist/Occupational Therapy if not progressing
  7. Muscle strength/sensory check q1hr x 4hrs, then q 4 hrs
  8. Incentive spirometry q 1hr while awake

SCHEDULED MEDICATIONS

  1. IV Fluids: NS  LR  D5NS  D5 ½ NS with 20 KCl at ______ml/hr

Decrease to KVO when tolerating po

  1. Antibiotic: Post-op antibiotic will be automatically stopped within 24 hrs unless indication is documented

 Ancef (cefazolin) 2 gm IV q 8 hrs x 2 doses

or continue > 24 hrs for ______(Reason REQUIRED)

Other: ______x 24 hrs

or continue > 24 hrs for ______(Reason REQUIRED)

  1. Pain:  See PCA orders (form # 2119)  See Sleep Apnea PCA orders (form # 21261)

and

 Percocet (oxyCODONE/acetaminophen) 5/325 mg, 1 to 2 tabs po q 6 hrs NOT prn x 3 doses

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

Heparin 5,000 units SQ q 8 hrs (q 12 hrs if wt < 50 kg or age > 75)

or Lovenox (enoxaparin) 40 mg SQ q 24 hrs, in am on POD # 1 (30 mg if CrCl < 30 ml/min)

and/orMechanical devices: SCDs

Copy to pharmacyOrder writer’s initials ______

*3-15775*FORM 3-15775 REV. 11/2016 Page 1 of 2

PLACE LABEL HERE

SPINE SURGERY

ANTERIOR CERVICAL DISKECTOMY FUSION (ACDF)

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. Bowel management: Colace (docusate) 100 mg po twice daily
  2. No Nicotine patches, No Toradol (ketorolac)

PRN MEDICATIONS (If > one drug is ordered for the same indication, clinical assessment will be used per policy 520-06)

  1. Muscle relaxant: Flexeril (cyclobenzaprine) 10 mg po q 8 hrs prn

or Zanaflex (tizanidine) 4 mg po q 8 hrs prn

or Robaxin (methocarbamol) 500 mg po tid prn

or Valium (diazePAM) 5 mg po q 8 hrs prn

  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: Do not order these if Percocet is ordered as scheduled med.

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.

  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: Melantonin 5 mg po q HS prn

orAmbien (zolpidem)5 mg (female or males ≥ 65 y/o) or 5-10mg (male < 65 y/o) po at HS prn

  1. Indigestion: Maalox XS (aluminum/magnesium/simethicone) 30 ml po four times daily prn
  2. 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

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

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

ADDITIONAL ORDERS:

______

______

______

______

______

DateTimePhysician SignaturePID Number

Copy to pharmacy

FORM 3-15775 REV. 11/2016 Page 1 of 2