PLACE LABEL HERE

SPINE SURGERYLUMBAR FUSION

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: ______

5. Consults: Physical Therapy: Begin POD 1, Reason: Post Op Lumbar Fusion(PT to consult OT if indicated)

OR  Begin DOS

Pain Service consult for management of uncontrolled painNotified

 Hospitalist consult for medical managementNotified

  1. Diagnostics:H&H q am x 3 days. Notify physician for HCT _____ and/or HGB < _____gm/dl.

CBC in am  Chem 7 in am

  1. Vital signs per unit routine
  2. O2 per Protocol (form # 34431)
  3. Dressing:Change dressing PRN if saturated  Change POD 1  Change POD 2

 Remove dressing POD 2, leave open to air

  1. TEDs/SCDs while in bed.
  2. Foley catheter to bedside bag. Discontinue post-op day 1, Reason: Surgical procedure.
  3. Foley Catheter Removal and Voiding Assessment/Interventions Standing Orders (form # 31620)
  4. 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

  1. Diet: NPO except ice chips. Advance as tolerated to______
  2. Oral Nutrition Supplement Orders (form# 31417), initiate if patient meets criteria
  3. Brace: No Brace needed Patient to bring brace from home Consult for Prosthetic/Brace

 Apply brace when out of bed or sitting; remove when lying down

  1. Activity: Logroll. Post-op 6 hrs sit on edge of bed with nurse target 5 minutes

Post-op day 1 out of bed with brace and nurse or PT (may do in sittingposition)

Post-op day 2 progress as tolerated

Ambulate in hall today  Bedrest for _____ hours.

  1. Apply lumbar brace when out of bed or sitting; may be off when lying down
  2. Incentive spirometry q1hr while awake
  3. Muscle strength/sensory check q1hr x 4hrs, then q 4 hrs

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)

Copy to pharmacy Order writer’s initials ______

*3-9417* FORM 3-9417 REV. 11/2016 Page 1 of 2

PLACE LABEL HERE

SPINE SURGERYLUMBAR FUSION

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. 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 prnx 3 doses

24. 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

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

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

  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: Melatonin 5 mg po q HS prn

or Ambien (zolpidem) 5 mg (female or males ≥ 65 y/o) or 5-10 mg (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

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

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

ADDITIONAL ORDERS:

______

______

______

______

DateTimePhysician SignaturePID Number

Copy to pharmacy

FORM 3-9417 REV. 11/2016 Page 2 of 2