Page 18 - HPB Handbook - May 30 2022 (Flipbook) v2

Page 18 of 22

Post Liver Surgery MD Order Set

OR Day POD#1 POD#2 POD#3 POD#4 D/C Day
Diet NPO diet diet diet DAT DAT
Activity Activity as per CPW If stableward If stableward Activity as per CPW OT/PT, D/C home
Activity as per CPW Activity as per CPW Activity as per CPW D/C letter
Vitals CIWA protocol, as Daily weights Nursing protocol Daily weights Daily weights
required Daily weights
Invest. & PACU: CBC,Lytes, Crea CBC,Lytes, Crea,LFT,Bili, CBC,Lytes, Alternate days
Blood Remove OG LFT,Bili, PT/INR,PTT PT/INR,PTT Crea,LFT,Bili, CBC,Lytes,
Work CBC,Lytes,Crea Glucose QID D/C glucose if PT/INR,PTT Crea,LFT,
PT/INR,PTT CXR normoglycemic Bili,PT/INR,PTT
Glucose QID
9ES:
CBC,LFTS, Bili
Lytes PT/INR,PTT
Glucose
Accucheck
Intervention Minimize drains D/C inv. Monitoring D/C central line CCAC assess D/C letter
D/C foley Social work FU Info
+ consults
Drugs Periop antibiotics Wean epidural D/C epidural PPI or H2 blocker PO pain meds D/C scripts on chart
Epidural, if appropriate APS to monitor Start PO pain meds VTE prophylaxis Add bowel regimen 28 days of VTE
VTE prophylaxis Restart preop meds & Hep VTE prophylaxis Vit K 10mg PO VTE prophylaxis prophylaxis for
Famotidine B antivirals, if appropriate PPI or H2 blocker PPI or H2 blocker oncology patients or
APS to monitor IV maintenance APS to monitor D/C letter & scripts high risk
IV maintenance Wean O2 Taper IV saline lock, when on chart
O2 VTE prophylaxis drinking well
PPI or H2 blocker Vit K 10mg PO
Vit K 10mg PO

Liver Surgery Multidisciplinary Clinical Pathway

Pre-Admit OR Day POD#1 POD#2 POD#3-4 D/C Day
a
nd
P

OT

d
Assess-ments Anaesthesia Admit PACU If stable to ward If stable to ward OT and PT, if needed
de

if

n
T
,

e
e
Nursing SDU/ward if minor Fall risk on arrival to CCAC, if needed CCAC, if needed
c
ti
o
n

r
Pharm –meds unit
e
e
s
CIWA protocol, if
required
Educa-tion Post-op course Orientation Reinforce activity Reinforce activity Introduce oral Home activity goals

oa
l
s

e
lg

i
a

s

a

a

n

s

g
l
oa
SDU 1 night for Lap and Use of pain meds Wound care
g

ound

a

to

s
e

r

wor

W

a

tur

p
e
n
DB
c

2 nights for open DB&C DB&C
&C
k

n

l
R
Pain management Post-op mobility Discuss transition Activity goals D/C scripts
Lap ~1wk right shoulder PCA/Epi PO Initiate return to work Confirm GP
pain & bloating analgesia plans
Post-op mobility
Alcohol and smoking
cessation
c
Observ-ation Invasive D/C invasive line Weigh
os
D/C

glu
if

Weigh
,
e

Ins/outs D/C staples POD10 (POD14 if
I

l

o

n

a

m

r

PIV

ts
s
n
/o
u

ig
We
Weigh diabetic)
D/C Foley

h
i
r
s
te
s
A
e
s
s
Drain outputs ss incision trips
pp

ly
A
s
I
n
O2 titrate /outs

Glucose qid Weigh
Page 1 of 2