POSTPARTUM

  • Identify patient as ERAS

  • Patient Guide to ERAS Booklet

      • Ask to see their booklet

      • Remind patient importance of documenting in booklet

      • Check diaries frequently for ambulation, diet, etc- Document info recorded in Dimensions

  • Limit TV

      • Encourage personal music (this promotes more mother/baby bonding time)

  • Abdominal Binder

      • Continue use of binder throughout whole stay

      • Binder to be on at all times. If POD 0 and RN still completing frequent fundal checks, okay to not be connected while in bed

      • Binder MUST be on patient with ALL Ambulation

  • AMBULATION

      • DOCUMENT IN DIMENSIONS as "Ambulation in Hall" NOT "Up ad lib"

      • Patient should be ambulating immediatly once neuraxial blockade resolved

      • POD 0: Ambulate in halls at least 1x (If unable to ambulate due to nausea or dizzyness then OOB to chair with assistance)

      • POD 1: ambulate in halls at least 3x

      • POD 2: ambulate in halls at least 4-6x

      • 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

  • Multimodal, non-opioid analgesics as first line:

      • Acetaminophen 1 g PO Q8 (if dosing meets 3g/24hr limit, contact pharmacy to reschedule; do not skip dose)

      • Ketorolac 15 mg IV Q6 (POD 0 only, then change to ibuprofen)

      • Ibuprofen 600-800mg PO Q6- BEGIN POD 1 after Ketorolac d/c

      • Oxycodone 5-10 mg PO Q4 PRN pain ≀7

      • IV opioids for severe breakthrough pain (VPS >7)

      • 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***

  • DIET

      • POD 0: Regular diet immediately, unless PONV

      • Document ALL solid and liquids consumed and type of diet patient consumes in Dimensions

      • Eat all meals out of bed

  • POD 2

      • RhoGAM given if necessary

  • Foley Catheter

      • removal 6 hrs after insertion (when patient can safely ambulate to bathroom)

      • if unable to remove at 6 hrs or earlier, document reason in Dimensions

  • No Ambien to be given

  • Pediatrician to examine baby

      • any indications for baby to remain in hospital?

  • Audiologist

      • To complete hearing test by POD 1

  • Circumcision

      • to be performed if necessary

  • Vaccinations

      • All necessary vaccinations to be completed by POD 2

  • Discharge prescription

      • Multimodal analgesia regimen to be continued

      • Minimal opioids for breakthrough pain.

  • Defined discharge criteria

      • Anticipated d/c POD #2

      • Discussed preoperatively and from POD 0

      • Ambulate independently (with abdominal binder on)

      • Tolerating diet

      • Pain controlled with oral pain medication

      • Afebrile

      • Able to urinate

  • Day after discharge

      • RN to call patient to confirm mother and baby are doing well