ccDEPARTMENT OF SURGERY

Negros Oriental Provincial Hospital

CLINICAL PATHWAY FOR

BLUNT ABDOMINAL TRAUMA

PHYSICIAN’S ADMITTING ORDER SHEET

Inclusion criteria: All patients presenting with blunt abdominal trauma WITH CLINICAL SIGNS OF PERITONITIS
Expected LOS: _____ Days
Exclusion criteria: no signs of peritonitis, significant comorbidities
Date : : Day ______

Patient’s Name Age : Weight: Hospital #:

Height:
BMI:
Last Name First name Middle Name
ORDERS
PHYSICIAN’S NOTES: Admit to _______ under the service of Variance Sign
S: Subjective Complaints/ Symptoms Dr. __________________________

Vital Signs Monitoring q

Diagnostics/ Procedures:
▪ Bloodtyping
● HBsAg
€ ABG
O: Objective, Physical/ Lab Findings € PROTIME
VS: € CBC
BP: HR: RR: T:
IVF with double line using PLR @ 30 gtts/min
Pain Score: each

C/L: Start meds:

▪ Cefuroxime 750mg IVTT q 8h
Abd: ▪ Metronidazole 500 mg IV drip q 8h
€ Ranitidine 50 mg IVTT q 8h
€ Tramadol 50 mg IVTT q 6h
Rectal:
€ Insert NGT Fr16 open to drain
€ Insert FBC Fr16 attach to urobag

A: Assessment/ Working Impression/ Diet: NPO

Clinical Diagnosis Activity: Complete bed rest without toilet
privileges
Acute Abdomen sec to Blunt abdominal trauma
Consults/ Co-management orders:
€ Refer to Anesthesia for pre-op evaluation
P: Plan of Care
Procedures:
Diagnostics/ Imaging: Direct to OR for Exploratory Laparotomy
Blood typing, HBsAg Secure consent for procedure and
photodocumentation

Therapeutics: Provide for psychosocial needs

● Patient appraised of the clinical
Surgery situation and the need for emergency
Exploratory laparotomy surgery and also appraised of the
Antibiotic therapy risk, benefit and possible
complications

Provide patient/Family education

Patient’s family appraised of current situation

Discharge Plan:
Discharge if without complications once with
normal GI function
Take home medications, wound care and follow
up instructions to be given

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)