DEPARTMENT OF SURGERY

Negros Oriental Provincial Hospital

CLINICAL PATHWAY FOR

REDUCIBLE INDIRECT OR DIRECT OR RECURRENT INGUINAL HERNIA

PHYSICIAN’S ADMITTING ORDER SHEET

Expected LOS: _____ Days

Inclusion criteria:All patients presenting with clinical signs of reducible indirect, direct, or recurrent inguinal hernia
Exclusion criteria:incarcerated/strangulated hernia, significant comorbidities

Date: : Day ______

Patient’s Name Age: Weight: Hospital #:

Height:
Last Name First name Middle Name BMI:

ORDERS
PHYSICIAN’S NOTES: Admit to _______ under the service of Variance Sign
S: Subjective Complaints/ Symptoms Dr. _________________

Vital Signs Monitoring Q

Diagnostics/ Procedures:
● CBC
● Blood typing
€ Inguino-scrotal ultrasound (if
O: Objective, Physical/ Lab Findings warranted)
VS: € Attach labs taken in OPD
BP: HR: RR: T:
For CP Evaluation for patients 40 years and
C/L: older
€ Chest Xray PA
Abd: € Serum creatinine
€ 12 L EKG
€ CBG/ FBS
Rectal: € Attach labs taken in OPD

Start venoclysiswithPLR @ 30 gtts/min once

on NPO
A: Assessment/ Working Impression/ Clinical
Diagnosis Start meds:
Cefazolin 1 gram IVTT on call to OR
INDIRECT INGUINAL HERNIA REDUCIBLE Ranitidine 50mg IVTT q 8h once on NPO
€ Right
€ Left Diet: NPO 8H prior to OR
€ Bilateral
€ Recurrent Activity: no limitation

Consults/ Co-management orders:

P: Plan of Care ● Refer to Anesthesia for pre-op
evaluation
Diagnostics/ Imaging: € Refer to IM for CP clearance (for
CBC, Blood typing, Inguino-scrotal Ultrasound (if patients 40 years old and above)
warranted)
Procedures:
Therapeutics For Mesh Hernioplasty
Surgery € Left
€ Mesh hernioplasty € Right
€ Tissue Repair € Bilateral
€ Laparoscopic € Laparoscopic
o TEP o TEP
o TAP o TAP
Secure consent for procedure

Rehabilitative:
Provide for psychosocial needs
● Patient appraised of the clinical
situation and the need for surgery
and also appraised of the risk,
Others: benefit and possible complications
 Provide patient/Family education
Patient’s family appraised of current situation

Discharge Plan:
Discharge patient if without complications and
if there is return of bowel function. Discharge
instructions to be given including take home
meds, wound care and follow-up schedule

Activated by: Acknowledged by:

______________________ _________________________
Surgical Resident on Duty Nurse in charge

NOTE: THIS PATHWAY WILL BE ACTIVATED ONCE SIGNED BY THE SURGICAL RESIDENT ON DUTY AND NURSE IN
CHARGE AND SHOULD BE STOPPED WHEN AN ADVERSE REACTION IS NOTED

● Both AP and NIC must sign at the bottom of the pathway form to activate it
● The pathway will be discontinued by anyone whenever:
1. The patient’s primary diagnosis changes
2. The patient’s condition significantly worsens
3. The patient fails to meet clinical outcomes for 24-48 hours
● Variance codes:

A. PATIENT/FAMILY B. CLINICAL C. SYSTEM D. COMMUNITY

a.1 Non-adherence to b.1 Development of a c.1 Lack of available d.1 Unable to contact
plan of care new medical Equipment / Community Health
a.2 Patient or family /surgical problem Medicines Service
refuses discharge b.2 Exacerbation of c.2 Failure to perform a d.2 Delay in availability
a.3 Financial constraints underlying condition recommended of recommended
a.4 Home per b.3 Delay in response to procedure support
request/against medical treatment c.3 Delay in response to
medical advice interdepartmental
a.5 Absconded referral (co-
management,
consult, or transfer
of service)