1. Tuesday, August 18, is the kick off for the PERMS ORCA PowerPlan The Post-Op orders are located in the new order set: PERMS Major Spine Surgery Pathway ICU and Acute Care Multiphase HMC Search for it in the Search field by typing in “PERMS” When searching, you will also find the PERMS Ketamine Low Dose Infusion powerplan. OR Anesthesia will write these orders. PERMS PATHWAY ORCA POWERPLAN 1

2. PERMS POWERPLAN IS MULTIPHASED 2 General Care phase is always initiated post op. If patient goes to ICU post op, initiate ICU phase If patient goes to Acute Care post op, initiate Acute Care phase When transferring from ICU to Acute Care, discontinue the ICU phase and initiate the Acute Care phase. The General Care phase remains and is updated as needed ICU phase contains an order for RN to discontinue ICU phase if not done by practitioner.

3. All PERMS patients come from the OR/PACU with a Ketamine infusion running. OR Anesthesia writes the Ketamine Low Dose Infusion order The primary team manages this Ketamine infusion for 24 hours post-op. After 24 hours, the infusion is terminated. KETAMINE 3