The Start of Care Admission In the Hospice House Inpatient Unit IPU 1
Adding a Patient from the Site Go to the Census 1. In the Census tap Unassigned. If you do not see the patient in the Unassigned list, tap the Add Icon 2. Search for a patient with the following fields: last name, first name, MRN, date of birth and Site (MCH, MVH, Site 1 etc.) Tap to Include Discharges Admissions if the patient is discharged. 2 3 4 3. Tap Find Patients 4. Select the desired patient from the search list. 5. Tap the Add Patient button and Done to add selected patient to your Patient List. The chart will download and will be found on the Unassigned list. Removing a patient from the Unassigned list. If a patient is on the unassigned list because they transferred to the community, changing the patient location will remove the patient from the unassigned list. 2
Adding the Unassigned patient to the Census 1. Go to the Census 2. Tap Unassigned 3. Select the desired patient-the referral will display to the right if the patient has not yet been admitted 4. Tap Chart in the patient Banner Go to Attributes 1. Add Patient Location (MVH Hospice House) and Level of Care from In the Hospice category. 2. Add Room number from the Hospice House Category. Once the room number is entered, the patient will display on the Census. For further instructions regarding Attribute entry, See Attributes on pages 44-46 in the Chart section of the training materials. 3
Starting a shift for a new Hospice House Patient For a new Admission or transfer you will need to add the new patient to your open shift. Go to the Census and tap: Tap the patient check box to add the new patient to your open shift. Admission work flow will default when not completed. If the patient comes in toward the end of your shift, and you will not be completing the admission, you may Select the Standard workflow instead. The admission will then appear in the next Shift. Note-You will not perform an Admission workflow for Patients transferring from MVH Community Hospice Selecting the Admission workflow will bring all necessary admission forms into the Shift document. Enter the correct start time for the patient shift, as a new admission patient shift start time is when they enter the Hospice House facility, not at the start of your shift. (This is a Pop up when you add a patient to an open shift.) 4
Accessing the SOC workflow for the new Patient Go to the Care Dashboard to access the new Patient. Tap the Open workflow with the pencil icon to access the admission/ Review Section *Verify patient demographic Info and Insurance information. +Use the Pencil icon to Edit any incorrect Information and the + to add any new information to the Primary info fields. + Tap Verified Patient and Insurance at the bottom of the page. Change PCP to Medical Director if needed. Diagnosis Copy from referral when available. Use the Add button to enter another DX. Tap the Enter after populating the search field. Select and Add a new DX from the. Tap Verified when Dx entry completed. See Diagnosis Instructions for further details. 5
ALLERGIES The Patient Chart will display all current patient Allergies. Allergies can be changed in the Review Component in certain visit Workflows, as well as in the Medications section in the Patient Chart. MODIFYING THE ALLERGY LIST To make changes to the Allergies List within the Patient Chart, enter the chart, and then tap the Medications section on the left. Then tap the Allergies tab at the top of the page. Changes made to these allergies will need to be signed from the To Do List. ADD AN ALLERGY If a patient has an allergy that is not included on the patient s Allergy List, it is necessary to add the allergy. Any allergies that are added to the list will be marked as unsigned until you have verified and signed the changes made to the Allergy List. In order to add an allergy to a patient s Allergy List, do the following: 1. Access the Allergy List. 2. Tap on the Add button at the top of the Allergy List For patients with No Known Allergies You MUST Tap the Add button and Select No Known Allergies 6
Medications at Start of Care The Patient Chart will display all current patient Medications. Before a SOC is performed, the medication list will display the patient Referral, medication section. In the Admission workflow, Review component, the clinician will be prompted to copy the medications from the Referral Medications list. Please see Medication Instructions for : Discontinuing Medications and Batch DC option. Adding Medications. Drug Interaction checking After making any changes to the Medications List, be sure to check Check/Resolve drug Interactions. Note that any interactions which arise between Comfort Kit meds only may be resolved immediately as MD Approved. All other interactions, inform MD, then resolve. 7
Review Section-Attributes Verify that Location and Level of Care are entered and correct. Note when making changes to Attributes, you must enter the correct date of the change, since the date defaults to the date that the Attribute was initially entered. Add any known patient Precautions at this time. Add any relevant Directives and DNR Add Veteran Status if known (Veteran Status may be completed by MSW) Note that Highlighted Attributes as well as Alerts and Allergies will display for quick access in the i Button in the patient banner See Attribute instructions in the Chart for full explanation of Attribute entry and functions. **CTI-Will be Address by the MD 8
Document- Section 2 in the Shift workflow The Document section will contain all of the forms you need to complete the admission, when the Admission workflow is selected at the start of the patient shift. Access the Admission Document forms from the dropdown arrow next to the Document section. The following forms must be completed in the Hospice Admission: 1. Integrated Assessment 2. NHPCO Core Measures 3. Hospice Item set 4. Narrative- complete the Hospice SOC Narrative Template. The Narrative is located in the Flowsheet Section of the Shift workflow. 9
Required forms for Hospice House Admission Complete all Hospice Item Set (HIS) MSP-required for Medicare patients NOE & Mass Health form Signed on Paper NHPCO Core Measures Hospice Integrated Assessment Religion MAR/Medication verify times assigned for all scheduled meds Narrative- Use Hospice SOC template (Flowsheet section) Emergency prep- State will follow HPH emergency policy Diagnosis - make sure Hospice DX is in top slot Attributes Location Level of Care Precautions Veteran service/status Safety Assess- Complete Oxygen Safety checklist and add Safety teaching to POC Initial Assessment Comprehensive Assessment-If patient may not be seen by MSW and clergy Bereavement Risk Vitals Pain-must select pain scale and give score- if patient has pain must document at least 5 qualities of the pain Review of all systems: EENT, Integumentary/ Wound, Respiratory, Cardiac, GU, Nutrition, GI, Endocrine, Mental status, Neuro ADL/Mobility IV,Equip and labs only if they apply Infection control checklist Rights Supervision (HCA for Care Partner) Unipolicy- 1 st part and disease specific Clinical findings- Edmonton PPS or KPS (Choose 1) Assessment Plan = 24 hour care Locators-All sections Flowsheet- complete all goals, interventions, DC plan *Add HCA Plan of Care (for care Partner) Verify Primary MD is correct & update if needed Sign all orders to primary MD 10
Locators Check all that apply in each category 11
Flowsheet Care Plan Complete goals and Interventions for SN and HCA (Care Partner) see guidelines on checklist. Be sure to Add the Head to Toe Assessment! 1 Use the Add Orders Button to complete the Plan of Care. To view the goals, Tap Goal Add Discharge Plan for SN (Note rehab or Outcome potential not required) Tap Discharge 3 2 2 3 1 Narrative- Complete SOC Narrative using Hospice SOC template. Tap Add Note then select SOC template from the dropdown. Complete template and Save 12
MAR in the Flowsheet Verify there are times assigned to all scheduled Medications. 1 The Calendar Icon next to a medication indicates the scheduled meds needs times assigned. 2 1 To Add schedule times to a Med from the MAR: 1. Tap the medication to highlight 2 2. Tap edit Med 3. Tap Schedule 3 4 4. Tap Edit 5. Enter the times in the Schedule 3 4 13
Complete the Start of Care Visit, Validate and Sign Visit In the Complete section of the workflow the shift may be ended in the Visit section, or when all shifts are ended from the Census. Validate In the Validate section- any required Workflow that is missed will display in red. Use the Correct button to access the work to be completed. Sign and Complete In this section, review all orders which will be sent to the physician for signature on the Plan of Care. Verify that the primary MD is correctly displaying in the Provider to sign. Changes to the Primary MD may be made in the Review section of the workflow, Patient, Primary Info- tap the pencil icon and change the primary MD prior to signing orders. Clinical Summary-Use the Info Wizard to Attach the SOC Narrative 14
Guide for Hospice Goals/Interventions at Start of Care Admissions checklist: MUST BE COMPLETED BY RN Unipolicy Part 1 on all patients Disease specific MSP form (for Medicare patients only) HIS NHPCO Core measures Hospice Integrated Assessment Pain assessment Must document 5 qualities of pain if verbal Med reconciliation Bowel regime in place for any pt on opiates POT RN Interventions Under High Tech Feeding Add appropriate interventions if ng/ g tube present IV Add appropriate interventions if pt has IV access (use the policy on the laptop as a guide) Under Hospice House, select Visit order and add 24 hour care until end of certification period Order sets- Add Head to Toe assessment Under Hospice Interventions : You will use specific interventions as appropriate for each pt on an individual basis, but these are guidelines that should be applicable to each patient at HH. You should select specific interventions for the GIP pt. s symptoms ( i.e. S/O nausea and vomiting, assess respiratory status and select goals that are appropriate) Elimination Add assess and document bowel status Add teach and review side effects of opiates Dying process Add teach pronouncement procedure Do not select the goal that comes up with this as it pertains to community death Add teach what to expect at the time of death DO not select the goal that comes up with this as it pertains to community death 15
HPH Plan of Care continued Nutrition/ Hydration Add assess food/fluid Other Add alternative therapies that pt/family have identified that they are interested in Pain status Add assess client s pain Personal goal Add identify personal goals prior to death Under Hospice Level of care Select the appropriate Level of care ( on Inpatient, you must add the symptoms that qualified the admission) Under Integument Status Pressure ulcers: treat as follows if appropriate I1: Free text wound location, cleansing treatment and order for wound care/ frequency Use the wound protocol as a guide for orders. Under Safety Add teach falls risk r/t dx meds And Oxygen safety teaching. Under Standing orders Add Activity as tolerated Add Agree with Hospice plan Add consultation with Medical Director Add diet as tolerated Add Do not resuscitate after verifying documentation Add Medication orders read back Add plan of care reviewed Add RN to pronounce (if DNR present) Add Telephone call to MD DO NOT ADD FOLEY PRN IV CARE PER PROTOCOL OR WOUND CARE PER PROTOCOL These require specific orders. 16
HPH Plan of Care continued Precautions ( if applicable) belong in attributes. Clinical manager enters these, so please leave a message on x9015 if not entered RN Goals Specific to disease process Specific to symptoms being managed RN Discharge Requires support until death Narrative- using Hospice SOC template- attach narrative to clinical summary in the Sign visit/orders screen. HCA Interventions In (CW) folders: Under catheter care Add catheter care (if foley present) Urine output (if foley present) Under elimination Record BM Ostomy (if appropriate) Under mobility Call bell within reach Turn pt every two hours ( if bed bound) Bed alarm/ Chair alarm if appropriate Any other mobility issues needed Under partial/ complete bath Choose appropriate bathing Add whirlpool if being used! Under personal care Enter any specifics that should be performed Under precautions Falls prevention program (always choose) One of these must be chosen(more than one if appropriate): C diff MRSA VRE Standard Universal 17
HCA (Care Partner) Plan of Care continued Under report BP Pulse Pain intensity (or non verbal pain if appropriate) Respirations Temp (temporal) Pain level (nonverbal if appropriate Choose intervention for symptom (i.e. Were there behavior changes? if pt in with agitation) Under HCA (not CW folder) Personal care must be selected in order to populate the POT. (select goal attached) ADL status will be maintained HCA Goals Under Hospice Improve comfort 18
Patients transferred from MVH community to high Pointe House Patients transferred from MVH community Hospice to the High Pointe House will not require a new Start of Care (Admission) When a patient transfers from MVH community to the Hospice House, follow the same instructions as for a new Admission to get the patient to display on the Census (page 2-3). Then update the following: 1. Clinical orders- you may Batch DC orders that are not relevant to patient at the Hospice House by going into the Chart, then Care Plan. Use the Batch DC button to remove selected goals and interventions for SN and HCA. Add new clinical orders as needed, including the order for 24 hour care. 2. Medications- The medication list can be updated via the Review section in the Shift workflow. You may use the batch DC button to discontinue multiple meds as ordered by the Medical Director. 3. Attributesa) Update Location to MVH Hospice House b) Update Level of Care if needed. (Routine to Inpatient) c) Add precautions as need 19