Nursing Unit
- 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
- 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 QHS starting POD 0
Ketorolac 15 mg IV q6 (not for more than 5 days)
Oxycodone 5-10 mg PO Q4 PRN pain β€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). 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***
- Diet
Allow regular diet or patient specific diet immediately if tolerating clears
Document all PO liquid and solid intake in Dimensions-please document type of diet being consumed
- Ambulation
DOCUMENT in Dimensions as "Ambulation in Hall" NOT "Up Ad Lib"
POD 0: Ambulate at least 1x in hallway
POD 1: Ambulate 3-4x in hallway, OOB 6 hrs in chair or ambulating
POD 2: Ambulate 4-6x in hallway, OOB 8 hrs in chair or ambulating
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
- HOB
elevated 30 degrees at all times
- Incentive spirometry
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
- GI Motility
Alvimopan 12 mg PO BID until d/c by physician (review d/c criteria)
If this medication has not been scheduled, please contact surgeon ASAP
- Glycemic control
FSBS <200
- Consults
Nutrition consult
PT consult
Consult wound nurse POD 0 if necessary
- Defined discharge criteria
Discussed preoperatively and from POD 0
Reinforce expectations with patient and family
Anticipate discharge needs
Follow-up appointments