Post-Op Order Templates—Order Entry has been enhanced to allow surgeons to write orders for post-operative care quickly and easily in the OR. Nearly 100 pre- and post-op orders sheets used by the various surgical services and care units have been recreated as electronic templates in Order Entry. The Post-Op Surgeon function opens the Surgery Orders Template player, which lists all of the nearly 100 departmentally approved surgical order templates. Each set of post-op orders is written in a session that you, another surgeon or advanced practitioner, your medical student, or an anesthesiologist can add to until the session is activated in the PACU.
Pre-admission—Post-op orders can be written in advance for patients who have yet to be admitted as inpatients. Simply access the patient record using Patient Lookup, as you would for a Pre-Admission session. See Selecting Patients.
PACU Activation and Expiration—Post-op orders are special in that they are inactive until the nurse in the PACU or other post-op care unit activates them. When the post-op orders are activated, any previous orders that weren't included in the post-op session are inactivated. Post-op orders expire after 72 hours if not activated. You can discard expired post-op orders (as well as orders awaiting activation, if not needed). However, you are not required to discard expired sessions; if you start writing new post-op orders after a session has expired, the expired orders are discarded automatically.
If Active Orders Exist When You Start a Post-Op Session—The Post-Op Surgeon function has two options for dealing with active orders while writing post-op orders:
First, you can include the patient's current active orders as part of the post-operative orders. If you review the previous orders and include what is needed, those current orders you don't include are permanently inactivated when the post-op orders are activated.
Your second choice is to ignore the current pre-operative orders and include only orders from the post-operative template and order session. When the post-op session is activated, all of the previous orders are permanently inactivated.
Automatically Continued Orders—Active orders for chemotherapy and total/peripheral parenteral nutrition (TPN/PPN) are continued automatically.
Cosigning Orders Written By a Medical Student—Orders written by medical students must be cosigned before a post-op session can be activated. This is also true for post-op orders flagged as needing cosign when written by a PA, NP, or APN. Even if a surgeon or surgical resident adds orders to the post-op session and signs it, the "cosign required" orders must be cosigned for any of the orders to be used. The Cosign function is accessible from the Surgery Orders template player as well as the main Unit Census Monitor (UCM). See Cosigning Orders From the Post-Op Surgery scratch pad.
Adding to Post-Op Orders After Activation—If post-op orders are written more than eight (8) hours after a set of post-op orders has been activated, the Post-Op function will create a new order session. The assumption is that the patient is returning to the OR. The new orders are inactive on signing. When activated, the new orders supersede the previous set of active post-op orders.
Post-op orders started within eight (8) hours of activation trigger a prompt to indicate whether to add to the active post-op orders, or (if the patient has returned to surgery) start a new post-op session.
If you choose to add to the active orders, the new orders are active on signing. These orders print automatically in the PACU, as long as the patient is still there.
If you choose to start a new post-op session when prompted, the new orders are inactive on signing. When activated, the new orders supersede the previous set of active post-op orders.
If the Patient Remains in the PACU Overnight—If your patient remains in the PACU overnight, write transfer orders to cover the care needed on the surgical care unit. See Writing Transfer Orders.
Surgical Admissions in the ED—The Post-Op Surgeon and Post-Op Anesthesia functions are available in the ED.