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CLINICAL PATHWAY - Hospital Forms

CLINICAL PATHWAY . Bariatric Gastric Bypass Surgery DRG NO 288 PATIENT IDENTIFICATION. Initiating UNIT: Initiating DATE: Initiating TIME: DRG NO: 288 Length of Stay: < Pre-Op Day 1 - OR / PACU Day 1 - Post-Op IN UNIT Day 2. DATE: DATE: DATE: DATE: Bedrest OOB (same day of surg) Ambulate in corridor as tolerated ACTIVITY Turn, cough, deep breathe Ambulate in corridor (evening of surgery). Outpatient CBC Gastrograffin UGI. TEST CBC BMP. SPECIMENS EKG Ca+. CXR Mg+. BMP P04. EGD PT / INR. Cardiac Clearance PTT. Check box if more tests are needed PFT. Ultrasound of Abdomen Urinalysis Serum B12 & Folate T3. T4. TSH. BETA Type & Screen NPO NPO Ice chips and sugar-free popsicles NPO until negative UGI.

Initiating UNIT: Initiating DATE: Initiating TIME: DATE: DATE: DATE: DATE: Bedrest OOB (same day of surg) Ambulate in corridor as tolerated

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