CHN4101 Orthopedic Surgery Post Operative.pdf - Carondelet

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P H Y S I C I A N ‘ S O R D E R USE BALL POINT PEN – PRESS FIRMLY CARONDELET HEALTH NETWORK HOSPITAL PROVIDED PRE-PRINTED PHYSICIAN’S ORDERS ORTHOPEDIC POST OPERATIVE ORDERS STAT/NOW (Check Box to Left) 8. HOME MEDICATIONS: SEE MEDICATION RECONCILIATION Antibiotics: Anesthesia End Time________________________ Last Dose Given: _____________________ NO postoperative prophylactic antibiotics IF ORDERING POSTOPERATIVE PROPHYLAXIS ANTIBIOTICS: Discontinue antibiotic within 24 hours after anesthesia end time UNLESS OTHERWISE INDICATED (prophylaxis per SCIP guidelines) Continue antibiotics beyond 24 hours (therapeutic) due to: Active Infection Open fracture Other:_____________________ Antibiotic Choices: First Choice: CeFAZolin (KEFZOL) 1 gram IV push, first postoperative dose to be given six hours after last dose , then every 8 hours x two more doses (total postoperative doses=3) For documented High Risk MRSA: Vancomycin 1 gram IVPB every 12 hours for 1 dose AND CeFAZolin (KEFZOL) 1 gram IV push, first postoperative dose to be given six hours after last does, then every 8 hours x two more doses (total postoperative doses=3) Alternate if Beta lactam Allergy: Clindamycin (CLEOCIN) 600 mg IVPB, first postoperative dose to be given six hours after last dose given, then every 8 hours x two more doses (total postoperative doses=3) Vancomycin 1 gram IVPB every 12 hours for one dose Vancomycin Reasons: Must have physician/ ANP/NPA documentation Beta-lactam (penicillin or cephalosporin) allergy MRSA colonization or infection High risk due to acute inpatient hospitalization within last year prior to admission High risk due to nursing home or extended care facility within last year prior to admission Facility wide or operation-specific increased MRSA rate Chronic wound care or dialysis Continuous inpatient stay of more than 24 hours prior to principal procedure Transfer of patient following a 3-day inpatient hospitalization at another facility Other:_____________________________________________________________ 9. Nausea: Check one line, or number to prioritize if more than one is selected ____ Ondansetron (ZOFRAN) 4 mg IV every 6 hours PRN nausea/vomiting ____ Promethazine (PHENERGAN) 12.5 mg IV/IM every 4 hours PRN nausea/vomiting 10. Bowel Routine Docusate Sodium (COLACE) 100 mg PO twice daily (hold for loose stools) Senna 8.6 mg PO twice daily (hold for loose stools) For Constipation: Check one line, or number to prioritize if more than one is selected ____ Milk of Magnesia 10 mL PO daily PRN constipation ____ Bisacodyl (DULCOLAX) 10 mg PO/PR daily PRN constipation Physician Signature: Date Signed: Time Signed: Physician Printed Name / License # / Telephone #: Patient Identification P MEC Approval CSJ – 05/23/13 CSM – 06/27/13 <strong>CHN4101</strong> Expires - 06/2016 Copy 08.22.13 Page 2 of 4 UNLESS NOTED AS DAW (DISPENSE AS WRITTEN), A FORMULARY EQUIVALENT MEDICATION MAY BE DISPENSED
P H Y S I C I A N ‘ S O R D E R USE BALL POINT PEN – PRESS FIRMLY CARONDELET HEALTH NETWORK HOSPITAL PROVIDED PRE-PRINTED PHYSICIAN’S ORDERS ORTHOPEDIC POST OPERATIVE ORDERS STAT/NOW (Check Box to Left) 11. Pain: NOTIFY PHYSICIAN IF PATIENTS PAIN IS NOT WELL CONTROLLED BY THE PRESCRIBED PAIN MEDICATIONS Surgeon would also like to be notified even if a hospitalist is assigned to the patient PCA (see PCA orders) Ketorolac (TORADOL) 30 mg IV now, then 15 mg IV every 6 hours for 24 hours Severe Pain (Prescribe One) Morphine 2 mg IV every hour PRN severe pain. May repeat once within same one hour time frame. Morphine _________ mg (NO RANGE ORDERS) IV every ________ hour(s) PRN severe pain. May repeat once within same time frame. HydroMORPHone (DILAUDID) 0.5 mg IV every 4 hours PRN severe pain. May repeat once within same four hour time frame (max dose: 1 mg in four hours) • May use Acetaminophen PRN in conjunction with severe pain medications if ordered below Moderate Pain (PRIORITIZE and Check one box within each category) ____ Acetaminophen 325 mg/OXYcodone 5 mg (PERCOCET) 1 tablet PO every 4 hours PRN moderate pain. May repeat once within same four hour time frame. (Total Acetaminophen not to exceed 4 grams/day) OR 2 tablets PO every 4 hours PRN moderate pain (Total Acetaminophen not to exceed 4 grams.day) ____ Acetaminophen 325 mg/HydroCODONE 5 mg 1 tablet PO every 4 hours PRN moderate pain. May repeat once within same four hour time frame. (Total Acetaminophen not to exceed 4 grams/day) OR 2 tablets PO every 4 hours PRN moderate pain (Total Acetaminophen not to exceed 4 grams/day) ____ Morphine _________ mg (NO RANGE ORDERS) IV every ________ hour(s) PRN moderate pain. May repeat once within same time frame. Pain or Temperature greater than 101 degrees F Acetaminophen (TYLENOL) 650 mg PO every 4 hours PRN (Total Acetaminophen not to exceed 4 grams/day) Other (No Range orders accepted) Drug:_________________________ Dose_____ Route_____ every _______ hours _______ PRN (indication) ______________________________________ 12. Glycemic Control: Choose one: Finger stick blood glucose every 6 hours Finger stick blood glucose before meals and at bedtime Finger stick – other _________________________________________________________________ Use Insulin sliding scale to cover: Meals only All finger sticks Other_________________ Prescribe one: Insulin Aspart (NOVOLOG) Sliding Scale Protocol: Mild Moderate Aggressive Physician Signature: Date Signed: Time Signed: Physician Printed Name / License # / Telephone #: Patient Identification P MEC Approval CSJ – 05/23/13 CSM – 06/27/13 <strong>CHN4101</strong> Expires - 06/2016 Copy 08.22.13 Page 3 of 4 UNLESS NOTED AS DAW (DISPENSE AS WRITTEN), A FORMULARY EQUIVALENT MEDICATION MAY BE DISPENSED
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CHN4101 Orthopedic Surgery Post Operative.pdf - Carondelet

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