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March 2020Name:Surgeon:Surgical Procedure:Surgery is scheduled for:Date: Time: GBMC Location: Patients UNDER 12 years of age, arrive 1 hour prior to scheduled surgery. Patients OVER 12 years of age, arrive 2 hours prior to scheduled surgery in theVirginia Sherwood General Operating Room and 1 1/2 hours prior to surgery inthe Women’s and Outpatient Surgical Center.**Bring the Packet with you to ALL appointments regarding surgery**For Questions about the Enhanced Recovery Program Please Contact:Tanika Thompson, DNP, RN, NEA-BC, CPHQOffice: (443) 468-1642 Office Hours: Monday-Friday 8am-4pm1

March 2020TABLE OF CONTENTSGBMC ENHANCED RECOVERY PATHWAYPERSONALIZED ENHANCED RECOVERY PATHWAY .3SURGERY TIMELINE .4-7NASAL SWAB INFO . 8-9DEEP BREATHING EXERCISES .9PRE-OP SKIN PREPARATION .10DIRECTIONS 11MAP AND GENERAL REMINDERS .12KNEE/HIP CLASS INFORMATION .13NECK/SPINE CLASS INFORMATION .14RESOURCES .15-162

March 2020Pre-Surgical Personalized Enhanced Recovery PathwayEducator or Surgeon will check the boxes that apply to you: Practice Deep Breathing Exercises Nasal Swab Use Incentive Spirometer Increase Exercise See Exercise Trainer See Dietician Shower with Hibiclens/CHG Solution (Theraworx if CHG allergic) Meet with Brittany Boyce-ECIP coordinator to determine plan ofaction for post-surgical care Sign-up for Joint class with April Asuncion Higgins Schedule In-house physical therapy assessment Schedule physical therapy3

March 2020Surgery TimelineFollow this timeline based on the medications you currently take, and theEnhanced Recovery Pathway created for you:Consult your Primary Care Physician or Cardiologist if you are taking Blood thinners (Coumadin, Xarelto, Plavix, Warfarin, Celebrex, Pradaxa, orEliquis). Aspirin or salicylates including Alka-Seltzer and Pepto-Bismol. Non-Steroidal Anti-inflammatory Drugs xcedrinMeloxicamMobicEtodolacDuexis (ibuprofen/famotidine)Vimovo (naproxen/esomeprazole)Treximet (sumatriptan/ naproxen) Consult your Primary Care Physician if you are taking Erectile DysfunctionDrugs (Viagra, Cialis, or Levitra). Consult your Primary Care Physician if you are currently on HormoneReplacement Therapy. Consult your Primary Care Physician and/or Endocrinologist if taking insulin orusing an insulin pump. TAKE Heartburn/Ulcer medications/acid blockers (Axid, Pepcid, Prilosec,Propulsid, Reglan and Zantac) TAKE Anti-depressants TAKE Anti-anxiety medications TAKE Psychiatric medications TAKE Anti-Seizure medications TAKE Asthma Inhalers/medications TAKE Birth Control Pills4

March 2020 TAKE Eye Drops TAKE Thyroid medications TAKE Cholesterol medications TAKE Blood Pressure medications except for Angiotensin ConvertingEnzyme (ACE) inhibitors and Angiotensin Receptor Blockers (ARB)s (SeePg. 7 included in this packet) Try to increase walking/exercise to 30 minutes a day. If you have not already, stop smoking cigarettes/cannabis, vaping Perform Daily oral care-Brush your teeth 3-4 times a day to reduce risk ofdeveloping pneumonia and other associated infections Eat a healthy diet – this helps you to recover faster Appoint a friend or a family member to be your support person. This person canhelp you prepare for surgery and can also help you recover by picking up yourprescriptions, shopping, completing household tasks. Sign up for Joint class at GBMC STOP All diet/ weight loss medications (Phentermine, Glucomannan, CLA(conjugated linoleic acid), Orlistat (Alli), Garcinia cambogia, Hydroxycut,Raspberry ketones, Meratrim, green tea extract, Forskolin, Synephrine) STOP All herbal medications and non-vitamin supplements (Fish oil/OmegaVitamin E, Glucosamine, Gingko Biloba, Garlic, Ginseng, Tumeric, CoQ10) Do NOT Shave.3 Days Before Surgery Shower with the Hibiclens/CHG solution. (Theraworx if CHGallergic Nardil [Phenelzine], Emsam[Selegline], Marplan [Isocarboxazid], Parnate [Tranylcypromine].5

March 2020 Shower with the Hibiclens/CHG solution. (Theraworx if CHGallergic) STOP Metformin 24 hours prior to surgery. STOP the following blood pressure medicationsAce InhibitorsAceon (perindopril)Accupril (quinapril)Accuretic (quinapril/HCTZ)Altace (Ramipril)BenazeprilCapoten (captopril/HCTZ)Captozide (captopril/HCTZ)CaptoprilEnalaprilFosinoprilLexxel (enelipril/felodipine)LisinoprilLotensin (benazepril)Lotrel (amlodipine/benazepril)Mavik (trandolapril)MoexiprilMonopril (fosinopril)Monopril HCT (fosinopril/HCTZ)PerindoprilPrinivil (lisinopril)QuinaprilRamiprilTarka (trandolapril/HCTZ)TrandoliprilUniretic (moexipril/HCTZ)Univasc (moexipril)Vaseretic (enalapril/HCTZ)Vasotec (enalapril)Zestoretic (lisinopril/HCTZ)Zestril (lisinopril)Angiotensin Receptor BlockersAtacand (candesartan)Atacand HCT (candesartan/HCTZ)Avalide (Irbesartan/HCTZ)Avapro (Irbesartan)Azor (olmesartan/amlodipine)Benicar (olmesartan)CandesartanCozaar (Losartan)Diovan (valsartan/HCTZ)Doivan HCT (valsartan/amlodipine)EprosartanExforge (valsartan/amlodipine)Exforge HCT (valsartan/HCTZ/amlodipine)Hyzaar (losartan/HCTZ)IbesartanLosartanMicardis (telmisartan)Micardis HCT (telmisartan/HCTZ)OlmesartanTelmisartanTeveten (eprosartan)Teveten HCT (esprosartan/HCTZ)Valsart Practice Deep Breathing Exercises and Incentive Spirometer ifrecommended by surgeon.6

March 2020 Do simple things to make your homecoming easier such as: putthings you use frequently between waist and shoulder height toavoid having to bend down or stretch too much to reach them. Put clean sheets on the bed Buy the foods you like and other things you will need. Shower with the Hibiclens/CHG solution. (Theraworx if CHGallergic) Scopolamine Patch (if recommended by your surgeon). STOP Oral Diabetes Medication the morning of surgery:ActoPlus lyburide GlipizideInvokametJentaduetoJanumetKombiglyze ardySegluometSTOP Topical medications (creams and ointments).STOP Diuretics.STOP Theophylline.STOP Antacids (Carafate, Maalox, or Tums). Shower with Hibiclens/CHG solution. Take Medications, if any, as prescribed or recommended by thesurgeon or healthcare provider. NO SOLID food, NO MILK products, NO Gum or Mints.7

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March 2020Deep Breathing Exercises1)2)3)4)5)Sit upright.Take a few slow breaths, then take a slow, deep breath in through your nose.Hold your breath for 2-5 seconds.Gently and Slowly breathe out through your mouth making an “O” shape.Repeat 10-15 times.9

March 202010

March 2020Your Surgery is Scheduled at the following location on GBMCCampus General Operating Room (GOR)/Virginia Sherwood OperatingRoomFrom Charles Street, bear left at the fork towards the ERPark in Lily Park Garage (which is left of the ER).If you park on the level that you rode in on then--walk through the automaticdoors toward the main hospital.Once inside, you will pass a sitting area on the LEFT.Continue until you reach elevator E.Take Elevator E on the left to the 4th floor.When you exit the elevator walk straight forward to the GOR registrationdesk.If you park on a level in the garage other than the level you rode in on—takethe garage elevator to the 3rd level (hospital level) - make a right off the garageelevator, then another right toward the main hospital inside - pass a sitting area onthe LEFT, take Elevator E on the left to the 4th floor. When you exit the elevator,walk straight forward to the GOR registration desk.If dropping off a patient: Pull around to the Hospital Main entrance. Once you enterthe hospital continue past the main desk until you reach elevator E on your right.Take Elevator E on the right to the 4th floor.When you exit the elevator, walk straight forward to the GOR registration desk.11

March 2020MapGeneral Reminders Keep all your jewelry, piercings and valuables in a safe place at home. Do not eat any solid foods, gum, mints or smoke cigarettes! You may brush your teeth and rinse your mouth. Make sure you have your photo ID and insurance card with you before leavinghome. Make sure you have your small hospital bag, walker or other assistive deviceand/or CPAP machine packed and loaded in your car—leave these in the car orwith someone you trust until you are settled in your hospital room aftersurgery.12

March 202013

March 202014

March 2020ResourcesEnhanced Recovery After Surgery (ERAS) at GBMC Facebook page.Use this social media page to connect with and gain support from other GBMCERSI program patients.Search: Enhanced Recovery Surgical Innovation (ERSI)at GBMCAunt BerthaAunt Bertha will ask you for your zip code and allows you to search for free orreduced cost services like food, nutrition andhealth education, medical supplies, homeaides, transportation, insurance, financialassistance, and more!www.AuntBertha.comMend WellYou are an athlete getting ready for a big race. Your Race is your Surgery! Youneed to train, and get yourself ready totake on the challenge. We’re here to beyour coach!https://mendwell.com/15

March 2020ResourcesTanika Thompson, DNP, RN, NEA-BC, CPHQGBMC ERSI Clinical Program Nurse Managertathompson@gbmc.orgOffice: 443-468-1642Office Hours: Monday-Friday 8am-4:00pmWebsite: https://www.gbmc.org/ERSIApril Asuncion HigginsGBMC Joint and Spine Clinical Program Nurse bmc.orgOffice: 443-849-6281Brittany BoyceGBMC Episode Care Improvement Program CoordinatorOffice: 443-849-3828Fax: 443-849-3840Beverly J. Bye, EdD, MS, CRNP- Family / PMH, FNP-BC, PMHNP-BC, CNE, CHSE,SANE-A, CFN, FACFEI, CCESGBMC Perioperative Testing Center Nurse PractitionerDual Board-Certified Nurse PractitionerBoard Certified Family and Psychiatric Mental Health Nurse PractitionerBbye@GBMC.orgOffice:443-849-8062Active Life Physical TherapyPhone:(443) 849-6210Fax:(443) 849-6326Email:tduda@activelifesports.comGBMC Joint and Spine CenterPhone: (443) 849-6261Website: https://www.gbmc.org/jointandspine16

GBMC Perioperative Testing Center Nurse Practitioner Dual Board-Certified Nurse Practitioner Board Certified Family and Psychiatric Mental Health Nurse Practitioner Bbye@GBMC.org Office:443-849-8062 Active Life Physical Therapy Phone:(443) 849-6210 Fax:(443) 849-6326 Email:tduda@activelifesports.com GBMC Joint and Spine Center