PLACE LABEL HERE

LEFT ATRIAL APPENDAGE OCCLUSION (WATCHMAN)

POST PROCEDURE

ORDERS

The following orders will be implemented. Orders with a “” are choices and are NOT implemented unless checked.

Initial all handwritten order modifications and the bottom of each page when indicated (multipage).

ALLERGIES: ______

  1. Is this a CMS inpatient only procedure?  Yes, admit as inpatient, proceed to # 3  No, proceed to # 2
  2. Do you expect that the patient’s condition will require a hospital stay that will cross two midnights (includes the time spent in outpatient- ED, surgery, OBS)and the patient has medical necessity for an inpatient admission?

Yes, admit as inpatient, proceed to # 3No, place in observation

  1. If admitted as inpatient, Inpatient Physician Certification:

Diagnosis: ______

Level of Care:  Critical  Intermediate  Acute Care Location/Specialty Unit Preference______

  1. Telemetry: If patient Medical/Surgical, must complete form # 36084
  2. Isolation:  Contact  Droplet  Airborne For: ______

DIAGNOSTICS AND LAB:

  1. Labs:Chem 7 in AM

 CBC in AM

 Magnesium Level in AM

PT/INR on ______(date)

  1. Stat 12 Lead EKG prn chest pain or ST segment elevation ______to read

ACTIVITY:Bedrest ______hours after sheath removed. Then up ad lib.

ADDITIONAL ORDERS:

  1. Vital signs every 15 min x 1 hour then every 30min x 1 hour then every 1 hour x 2 hoursthe every q 4 hrs and as needed for pulse oximetry
  2. Neuro Checks: Every 15 min x 1 hour then every 30 min x 1 hour then every 1 hour x 2 hours
  3. Maintain IV access at all times
  4. Echocardiogram POD #1 ______to read
  5. Notify Physician for:
  6. SBP < 90 or > 160 mm Hg
  7. HR is < 50 or > 120, or any change in the baseline cardiac rhythm
  8. Temperature ≥ 101°F after 48 hrs post-op, obtain urine, sputum, and blood cultures x 2
  9. O2 Sat < 90% or SOB or increased work of breathing
  10. UOP < 150 ml in 4 hours unless ESRD
  11. Diet:  Cardiac  Diabetic______ Other: ______
  12. Maintain IV access at all times
  13. DC Foley Catheter after bedrest completeand initiate

Foley Catheter Removal and Voiding Assessment/Interventions Standing Orders (form # 31620)

  1. Dressings: Change incision dressings daily if applicable.
  2. O2 per Protocol (form # 34431)

Copy to pharmacy Order writer’s initials ______

*3-43018* FORM 3-43018 INITIATED 06/2017 Page 1 of 2

PLACE LABEL HERE

LEFT ATRIAL APPENDAGE OCCLUSION (WATCHMAN)

POST PROCEDURE

ORDERS

The following orders will be implemented. Orders with a “” are choices and are NOT implemented unless checked.

Initial all handwritten order modifications and the bottom of each page when indicated (multipage).

SCHEDULED MEDICATIONS:

  1. Venous Thromboembolism (VTE) Prophylaxis orders (form # 33058)

Heparin 5,000 units SQ q 8 hrs (q 12 hrs if weight < 50 kg or age > 75)

or Lovenox (enoxaparin) 40 mg SQ daily at 1700 (30 mg if CrCl < 30 ml/min)

and/or Mechanical devices: SCDs

  1. Stress Ulcer Prophylaxis: Pepcid (famotidine) 20 mg po bid

or  Protonix (pantoprazole) 40 mg po daily

  1. Aspirin 81 mg po daily
  2. Coumadin ____ mg po daily Start ______

PRN MEDICATIONS (See policy 520-06 for range orders and pain intensity guidelines)

  1.  Initiate Electrolyte Replacement Protocol (Form # 21340)
  2. Respiratory/wheezing:  Proventil (albuterol) 2 puffs MDI q 4 hr PRN for respiratory distress
  3. Mild Pain, Temp >100.5F, HA:  Tylenol (acetaminophen) 650 mg po or PR q 4 hrs prn
  4. Moderate Pain, when taking po:

 Norco (HYDROcodone/acetaminophen) 5/325 mg or 10/325mg 1 tab po q 4 hrs prn. DC if Percocet ordered.

or  Percocet (oxyCODONE/acetaminophen) 5/325 mg or 10/325 mg 1 tab po q 4 hrs prn. DC if Norco ordered.

  1. Severe Pain:

 Morphine 1-2 mg IV q 3 hrs prn, DC if CrCl < 30. Hold for excessive sedation. DC if Dilaudid ordered.

or  Dilaudid (HYDROmorphone) 0.25-0.5 mg IV q 3 hrs prn. If CrCl < 30, dose at 0.25 mg. Hold for excessive sedation. DC if Morphine ordered.

  1. Nausea/vomiting:  Zofran (ondansetron) 4 mg IV or po q 6 hrs prn

 If N/V persists, add Reglan (metoclopramide) 10 mg IV q 6 hrs prn (5 mg if > 65 y/o)

  1. Indigestion:  Maalox XS (aluminum/magnesium/simethicone) 30 ml po four times daily prn
  2. Stool Softener:  Colace (docusate) 100 mg po bid prn; if patient has not had a bowel movement
  3. Constipation:  Milk of Magnesia (MOM) 30 ml po daily prn

If no BM after 48 hrs, Dulcolax (biscodyl) 10 mg per rectum daily prn

and/or Senokot-S (docusate/senna) 2 tablets po at bedtime nightly

ADDITIONAL ORDERS:

______

______

______

______

DateTimePhysician SignaturePID Number

Copy to pharmacy

FORM 3-43018 INITIATED 06/2017 Page 1 of 2