StayCurrentMD · Pectus Excavatum Pathway
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Video5 min·Published Dec 2019Older

Pectus Excavatum Pathway

With Dr. Rebecca L. Brown · StayCurrentMD
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What the experts said23 expert statements
The clinical care pathway has five major components: pain management, mobility, lung recruitment, daily intake, and daily output
ClinicalRebecca Brown
Preoperative antibiotic prophylaxis is ANF or vancomycin if the patient is MRSA positive
GuidelineRebecca Brown
Preoperative washes of Dynahex or Hibiclens scrub are applied to prevent infection after surgery
GuidelineRebecca Brown
Patients are given clear liquids and advanced as tolerated to a full regular diet on postoperative day 0
ClinicalRebecca Brown
Incentive spirometry is performed 10 times per hour throughout the postoperative course
ClinicalRebecca Brown
Postoperative antibiotics are ANF times 3 doses, or clindamycin if MRSA positive
GuidelineRebecca Brown
Epidural analgesia is routinely used and supplemented with Valium, Robaxin, Toradol, IV Tylenol, methadone times 1, and scheduled Zofran
ClinicalRebecca Brown
Patients are encouraged to chew gum 5 separate times a day for 20 minutes if fully awake postoperatively
ClinicalRebecca Brown
Bowel management includes Senna and MiraLax twice a day as well as Movantik
ClinicalRebecca Brown
The Foley catheter is removed on postoperative day 1 to encourage ambulation
ClinicalRebecca Brown
Oral oxycodone is started on postoperative day 1 once patients are tolerating a diet
ClinicalRebecca Brown
Maintenance IV fluids are continued until the patient is drinking well and urinates after Foley removal
ClinicalRebecca Brown
Zofran is changed from scheduled every 8 hours to as needed on postoperative day 1
ClinicalRebecca Brown
The epidural catheter is stopped at 6 AM on postoperative day 2
ClinicalRebecca Brown
The epidural is removed when the pain team rounds later in the morning of postoperative day 2
ClinicalRebecca Brown
Patients are transitioned to all oral pain medications on postoperative day 2, including oxycodone, Valium, Robaxin, Motrin, and Tylenol
ClinicalRebecca Brown
A two view chest X-ray is obtained on postoperative day 2 to evaluate bar location and to rule out pleural effusion or pneumothorax
ClinicalRebecca Brown
Dressings are removed and the chest is washed daily starting on postoperative day 2
ClinicalRebecca Brown
Patients are encouraged to ambulate at least 3 times in the halls starting postoperative day 2
ClinicalRebecca Brown
PT and OT work with the patient on postoperative day 3 to help them walk up and down stairs, and sign off once able
ClinicalRebecca Brown
Patients are discharged home on postoperative day 3 if pain is well controlled and they are tolerating oral intake
ClinicalRebecca Brown
Since institution of the clinical care pathway 2 to 3 years ago, length of stay has been reduced from 4.5 days to 3 days
EpidemiologicalRebecca Brown
Patient satisfaction has increased since institution of the clinical care pathway
EpidemiologicalRebecca Brown