NURSING UNIT

  • Identify patient as ERAS

  • Multimodal, non-opioid analgesics as first line

      • Acetaminophen 1g PO q8 (if dosing meets 3g/24hr limit, contact pharmacy to reschedule; do not skip dose)

      • Gabapentin elixir 300 mg PO qhs

      • Toradol 15 mg IV q6

      • IV opioid for breakthrough pain ***dose accordingly with pain score***

      • Transition to oral opioids when diet tolerated

      • Ensure appropriate medication given for patient's current pain score (take "Patient's Stated Pain Goal" into account too). ERAS Goal is to limit opioids

***If any of the multimodal medications are not ordered or not ordered correctly, contact surgeon ASAP for correction***

  • SCD

      • usage until discharge

  • Diet

      • Diet advancement protocol using bariatric clear liquids including clear protein and/or bariatric full liquids 30 cc @ 6 hr, 60 cc @ 8hr, 90cc @10 hr

  • Nutrition Consult

      • **stress adequate hydration**

  • HOB

      • elevated 30 degrees at all times

  • AMBULATION

      • **Document in Dimensions as "Ambulation in Hall" NOT "Up ad lib"**

      • Ambulate 4 times daily starting immediately- DOCUMENT IN DIMENSIONS

      • OOB at least 6 hours daily, in addition to walks

      • If patient is unable to ambulate due to fatigue, nausea, or refuses, please make note on Activity flowsheet. If patient does refuse, remind them they were educated on this prior to surgery, benefits of ambulation and risk of not ambulating

  • IVF

      • Minimize to less than 1L/POD 0-1

      • Then KVO vs 75cc/hr thereafter

      • Need parameters for continuing IVF

  • VTE prophylaxis

  • Ulcer prophylaxis

      • With PPI QD

  • Atelectasis prophylaxis

      • With IS

      • Mobilization

      • Albuterol nebs?

  • Maintain euglycemia

      • Via standard SSI order set

  • Defined Discharge Criteria

      • Discussed Preoperative and from POD 1

      • Reinforce expectations – discussed regularly among patient, RN staff, family

      • Discharge instructions per Bariatric RN Navigator

      • Anticipate Discharge needs

          • HHN for PT

          • Bariatric equipment

          • Follow-up appts, staple removal, nutrition

          • Laxative prn constipation

          • Gasx prn gas pain