Left Atrial Appendage Occlusion Watchman Pre Procedure Orders

PLACE LABEL HERE LEFT ATRIAL APPENDAGE OCCLUSION (WATCHMAN) PRE-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). 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 3. If admitted as inpatient, Inpatient Physician Certification: Diagnosis: ______Level of Care:  Critical Care  Intermediate Care  Acute Care Specialty/Unit Preference: ______4.  Telemetry: Med/Surg Complete form # 36084 5.  Isolation:  Contact  Airborne  Droplet For: ______6. Procedure scheduled Date: ______Estimated time: ______

Procedure:  Left Atrial Appendage Occlusion Device

7. Diagnostics, if not done within the last 72 hours:

12 Lead EKG

CBC w diff, Chem 7, Serum Magnesium, PT/INR, PTT

Serum HCG for females 12-60 years old, if pregnancy test not already done

8.  Bedside blood glucose monitoring:  q 4 h x2  q 6 h x2 (Notify physician if BG is > 180 mg/dl)

9. Notify physician: if K+ ≤ 3.7 or ≥ 5.2, INR > 1.5, creatinine > 1.5, or INR < 2.0 for Afib ablation and on warfarin

10. Clip hair on left and right groin areas

11. Cleanse groin area with soap and water

12. Obtain patient height and weigh patient

13. Vital Signs as routine

14. Initiate Oxygen for Adults Initiation and Weaning Protocol (form # 34431)

15.  Insert Foley catheter prior to procedure

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

17. Diet:  NPO except medcations

 NPO after midnight, except for medications

 Regular  ____ gm Sodium  Cardiac  ______calorie diabetic diet

 NPO after clear liquid breakfast and medications

18. Activity:  Up ad lib  Bed rest with BRP Copy to pharmacy

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19. IV Access: Insert and maintain INT in left arm, if possible. (Minimum size 20 gauge)

20. Education: Provide patient with LAAO device information if not provided previously. SCHEDULED MEDICATIONS: 21. Procedure IVF start time:______ NS at ______ml/hr  1/2 NS at ______ml/hr LR at 75ml/hr 22. If history of contrast reaction, give below medications as prophylaxis 60 minutes prior to procedure: Benadryl (diphenhydramine) 25 mg IV x 1 dose Solu-Medrol (methylprednisolone) 125 mg IV x 1 dose Pepcid (famotidine) 20 mg IV x 1 dose 23. Ancef (cefazolin) 2 gm (or 3 gm if weight is >120 kg) IV x 1 dose to be administered by anesthesia 24. If allergic to Penicillin and Cephalosporin or history of or current MRSA colonization/positive nasal screen: If <90 kg: Vancomycin 1 gm IVPB infused over 60 minutes prior to incision If >90 kg: Vancomycin 1.5 gm IVPB infused over 90 minutes prior to incision

______Date Time Physician Signature PID Number

Copy to pharmacy

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