PLACE LABEL HERE
SPINE SURGERY
Anterior Cervical Diskectomy Fusion (ACDF)
POST-OP 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. Diagnosis Same as preprocedure plan __________ (initials)
and
Admit as Inpatient __________________________________________(reason for admission)
Status:
Place in Observation ________________________________________(reason for observation)
2.  Hospitalist consult for medical management
3. Cervical collar:
 Soft cervical collar
 Aspen collar
 Philadelphia collar for showers
 Wear collar at all times
 Wear collar while out of bed only
4. Dressing: Change prior to discharge and as needed
5. Antiembolic device while in bed
6. Discontinue drain: __________________ (Notify physician for drainage > 100 mls in 6 hrs)
7.  Foley catheter to bedside bag. DC within 12 hrs post-op
8. Urinary Retention Orders (form # 31620), initiate if patient has urinary retention or difficulty voiding
9. Diet: NPO except ice chips for 4 hrs. Advance diet as tolerated.
10. Nutrition Supplement Orders (form # 31417), initiate if patient meets criteria
11. Activity: Logroll. Out of bed with assistance within 6 hrs post-op. Progressive ambulation as tolerated.
12. May consult Speech Pathologist/Occupational Therapy if not progressing
13. Muscle strength/sensory check q 1 hr x 4 hrs, then q 4 hrs
14. Incentive spirometry q 1 hr while awake
SCHEDULED MEDICATIONS
15. IV Fluids: ______________________________ Decrease to KVO when tolerating po; DC when PCA DC’d
16. Antibiotic: Ancef (cefazolin) 1 gm IV q 8 hrs x 2 doses  Other: ______________________________
Post-op antibiotic will be automatically stopped within 24 hrs unless indication is documented,
Document indication for > 24 hrs: _________________________________________________
 See PCA orders (form # 2119)  See Sleep Apnea PCA orders (form # 21261)
and
 Percocet (oxyCODONE/acetaminophen) 5/325 mg, 1 to 2 tabs po q 6 hrs NOT prn until PCA
DC’d
18. Discontinue PCA between 12-18 hrs post-op
17. Pain:
19. Colace (docusate) 100 mg po twice daily
20. No Nicotine patches, No Toradol (ketorolac)
Order writer’s Initials___________
Send copy to pharmacy
*3-15775*
FORM 3-15775
REV. 09/2013
Page 1 of 2
PLACE LABEL HERE
SPINE SURGERY
Anterior Cervical Diskectomy Fusion (ACDF)
POST-OP 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).
PRN MEDICATIONS (If > one drug is ordered for the same indication, clinical assessment will be used per policy 520-06)
21. Severe Pain:  Morphine 1-4 mg IV q 3 hrs prn (DC if epidural or PCA is ordered)
22. Moderate Pain (begin after PCA has been discontinued):
Norco (HYDROcodone/acetaminophen) 5/325 mg or 10/325mg 1 tab po q 4 hrs prn
or
 DC Norco. Percocet (oxyCODONE/acetaminophen) 5/325 mg or 10/325 mg 1 tab po q 4 hrs prn
23. Mild pain/temp greater than 101.5F/HA: Tylenol (acetaminophen) 650 mg po q 4 hrs prn
24. Muscle relaxant:
Flexeril (cyclobenzaprine) 10 mg po q 8 hrs prn
or
 DC Flexeril. Give Zanaflex (tizanidine) 4 mg po q 8 hrs prn
25. Nausea/Vomiting:  Zofran (ondansetron) 4 mg IV q 6 hrs prn
 Phenergan (promethazine) 12.5-25 mg po or per rectum q 4 hrs prn
26. Sleep:
Ambien (zolpidem) 5-10 mg po at HS prn. If 5 mg given, may repeat x 1 dose after 2 hrs
If > 65 year old, begin with 5 mg po at HS, may repeat x 1 dose after 2 hrs
 DC Ambien. Give: ___________________________________________________________
27. Indigestion:
Maalox XS (aluminum/magnesium/simethicone) 30 ml po four times daily prn
28. Constipation:
Milk of Magnesia (MOM) 30 ml po daily prn
Dulcolax (bisacodyl) 1 suppository rectally daily prn
29. Sore Throat:
Chloraseptic (phenol/sodium phenolate) throat spray q 2 hrs prn
ADDITIONAL ORDERS:
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________
Date
___________________
Time
_________________________________
Physician Signature
__________
PID Number
Send copy to pharmacy
FORM 3-15775
REV. 09/2013
Page 2 of 2