NURSING FLOOR

  • Identify patient as ERAS

  • Ambulation

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

      • POD 2: Ambulate 3-4x in hallway, OOB 6 hrs in chair or ambulating

      • POD 3 Until discharge: 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

  • 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

  • HOB

      • elevated 30 degrees at all times

  • Incentive spirometry

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

  • VTE prophylaxis

      • SCD usage while in bed or chair until discharge

      • Heparin/LMWH per MD order

  • Glycemic control

      • FSBS <200

  • GI Motility

      • Alvimopan (Entereg) 12 mg PO BID- If this medication has not been scheduled, please contact surgeon ASAP

      • D/C per MD

      • Know dosing criteria before administering

      • RN must be educated on dosing criteria before being able to administer

  • Multimodal, non-opioid analgesics as first line

      • Acetaminophen 1 g 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 Q12

      • Epidural 0.0625% Bupivacaine (NON NARCOTIC)

      • Epidural D/C POD 4-5, per MD order

      • Oxycodone 5-10 mg PO Q4 PRN pain ≀6

      • IV opioids for severe breakthrough pain (VPS >6)

      • ***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***

  • Defined discharge criteria

      • Discussed preoperatively and from POD 0

      • Ambulate independently

      • Tolerating diet

      • Pain controlled with oral pain medication

      • Afebrile

      • No obvious issues