NURSING UNIT: 5D

• 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

• CONTINUE Amiodarone protocol:

  • • Amiodarone 400 mg PO BID with meals x 5 days

• Diet

  • • Allow cardiac carb control diet immediately

    • Continue protein supplementation 3x/day

    • Document all PO liquid and solid intake in Dimensions-please document type of diet being consumed

• HOB

  • • elevated 30 degrees at all times

Activity

• • • DOCUMENT in Dimensions as "Ambulation in Hall" NOT "Up Ad Lib"

    • Ambulate 3-4x/daily with increasing distance

    • Out of bed to chair if not ambulating or sleeping

    • 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

• Incentive spirometry

  • • 5-10x/hr while awake, able to decrease frequency with increased ambulation

• IVF

  • • D/C if tolerating PO intake, if IVF needed, balanced crystalloid (LR) preferred over 0.9% NS

• VTE prophylaxis

  • • SCD usage while in bed or chair until discharge

• Foley

  • • D/C on or before POD 1

• 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)

    • Gabapentin 300 mg PO TID (if > 65 years of age, then BID) starting POD 0

    • Oxycodone 5 mg PO Q4 PRN pain level 4-6

    • Oxycodone 10 mg Q4 PRN pain level 7-10

    • Tramadol 50-100 mg PO Q8 PRN pain level 1-3

    • 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 above multi-modal medications are not ordered, or not ordered correctly, contact Surgeon ASAP for correction***

• Bowel regimen

  • • Lactulose solution 20 gram/30ml PO daily prn

    • Dulcolax suppository 10mg daily x 2 days (start POD #1)

    • Colace capsule 100mg PO every HS (start POD #1)

    • Lactulose 20 gram/30ml x 1 on POD #2 (hold if BM in last 24hr)

    • Dulcolax 10mg PO daily (start POD #3) OR suppository 10mg if unable to take PO’s

• Glycemic control

• Consult

  • • Case Management if needed

• Defined discharge criteria

  • • Discussed preoperatively and from POD 0

    • Reinforce expectations with patient and family

    • Anticipate discharge needs

      • • Follow-up appointments