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
- Diet
Immediately-Regular diet or patient specific diet if tolerating clears
Document all PO liquid and solid intake in Dimensions-please document type of diet being consumed
- PT consult
Goal for mobilization within 2 hours of arrival to floor if spinal block has resolved
- Ambulation
DOCUMENT in Dimensions as "Ambulation in Hall" NOT "Up Ad Lib"
POD 0: Ambulate at least 4x in hallway
POD 1: 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
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
- 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)
Celebrex 200 mg PO BID
Tramadol 50 mg Q6
Vitamin C 500 mg
Oxycodone 5-10 mg PO q4 PRN pain β VPS β€7
IV opioids for severe breakthrough pain β 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***
- 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