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

      • Celebrex 200 mg PO BID x 5 days then D/C (Toradol 15mg IV Q6 may be given instead)

      • 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). Goal is to limit opioids

***If any of the above multimodal medications are not ordered, or not ordered correctly, contact surgeon/MD 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 Hallway" 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

  • Glycemic control

      • FSBS <200

  • Defined discharge criteria

      • Discussed preoperatively and from POD 0

      • Reinforce expectations with patient and family

      • Anticipate discharge needs

          • Follow-up appointments

  • Consult

      • Wound nurse POD 0 if necessary