Direct Admit to Hospital from Office or Other Facility Trainer Notes Section Name Duration Objective Direct Admit N number of minutes to teach, N number of minutes for practice, N minutes for questions Orient students to. You ll Need Parking Lot Train Domain up Job Aid #1, 2, 3 Other Other notes, concerns, points to make re: this section Introduction With the addition of Clarity CPOE the direct admission process will have a new improved process. Entering Admit PowerPlans from your office or home. Able to perform admission Med Rec. from your office. Able to enter allergies from office. Last edited: 5/27/11 Page 1 of 15 Clarity@pph.org www.pph.net
Identifying the need for Admission Obtaining FIN A need for admission identified this is a patient in the office or physician to physician communication from another facility. Admitting physician notifies bed management about admission If patient is coming from another facility case management is involved. If it is an OB patient the Obstetrician calls directly to the floor. New process; quick registration performed to create encounter. FIN number obtained. Admit PowerPlan (planned) Physician searches for patient By FIN number to open correct encounter and Places an Admit Power Plan in a planned state. Process steps 1. Open patient s chart. 2. Click Add from the orders component. 3. Type admit in find box. Change the search by field to contains. Last edited: 5/27/11 Page 2 of 15 Clarity@pph.org www.pph.net
4. Click on PowerPlan. PowerPlan highlights blue. Instruct the MD to use their specific PowerPlan for their specialty Type of MD/Specialty Hospitalist/general practice Name of PowerPlan Admit CCU ICU Admit Med surg Comprehensive Med Surg Admit DKA HHNS Admit Stroke (Ischemic) Admit Stroke (Ischemic,post tpa) Admit Sepsis Admit ICU Intracerebral Hemorhage Pulmonologist/Intensivest Admit CCU ICU Sepsis Admit ICU Stroke (Ischemic) Admit Stroke (Ischemic,post tpa) Admit Admit Med surg CCU Ischemic stroke Admit Intracerebral Hemorhage Comprehensive Med Surg Admit DKA HHNS Admit Cardiologist Admit CCU ICU Admit Med Surg Last edited: 5/27/11 Page 3 of 15 Clarity@pph.org www.pph.net
Type of MD/Specialty Name of PowerPlan Cardiac Surgery Admit Cardiology Admit Comprehensive Med Surg Admit Neurologist/Neurosurgeon Admit CCU ICU Admit Med surg Comprehensive Med Surg Admit ICU Admit, Post Neuro Intervention Intracerebral Hemorhage CCU Ischemic Stroke Admit Stroke (Ischemic,post tpa) Admit Surgeon/Trauma Admit CCU ICU Admit Med surg Post op Admit Comprehensive Med Surg Admit CCU Trauma admit IMC Trauma Admit Bariatric surgery Admit (Pomerado) Orthopedic Surgery Pre op Gynecologist/Obstetrician/Labor delivery Preterm Labor Admit Antepartum Admit Labor and Delivery C Section Admit Last edited: 5/27/11 Page 4 of 15 Clarity@pph.org www.pph.net
Type of MD/Specialty Pediatricians Name of PowerPlan GYN Admit Newborn Admit Newborn Admit Medications SP Oncology Febrile Neutropenia Admit Admit Med surg Comprehensive Med Surg Admit Acute rehab Psychiatry Anesthesia ARU (Acute Rehab Unit)Admit Admit Behavioral health (General) Continuous Nerve Block Analgesia Intraspinal Narcotic Continuous Intraspinal Narcotic Non Continuous Labor Epidural PACU Pre Op Trainer Note: examples are of Med surg admit. All Admit orders should have the same look. Last edited: 5/27/11 Page 5 of 15 Clarity@pph.org www.pph.net
5. Click Done. PowerPlan is displayed in the order profile window. 6. Review the Layout of the PowerPlan. All Admit PowerPlans have the same basic layout. 7. Point out the Blue bands that divide the order categories. 8. Instruct MD to scroll down the PowerPlan to get familiar with its contents. 9. Instruct MD to add to phase in their specific PowerPlan. Last edited: 5/27/11 Page 6 of 15 Clarity@pph.org www.pph.net
10. Select Add order. 11. Enter a common order for their specialty. 12. Enter order details. Remind them that this will be a part of the PowerPlan and in the future may save to favorites. 13. Click orders for signature 14. Click Sign. The PowerPlan is now in a planned state. This how the Plan should look when the patient arrives at the hospital. Patient arrives at the hospital 1. Patient arrives to assigned floor 2. Admitting Physician called 3. Nurse initiates PowerPlan Last edited: 5/27/11 Page 7 of 15 Clarity@pph.org www.pph.net
Admit Medication Reconciliation Admitting provider evaluates patient, performs admission med Rec. This can only be done once the home meds have been entered. Introduction There are three events in which Medication Reconciliation will be completed by a physician: 1. admission 2. transfer 3. discharge Advantages of the enhanced medication reconciliation: You can: See when and by whom a patient's medication history was last updated for a given encounter. View a patient's medication history status from the Orders or Medication List. Add orders and manage PowerPlans from medication reconciliation window. Convert history meds to inpatient administration or prescription in a more streamline manner. Suspend, modify or cancel medications from medication reconciliation window. Note: The Registered Nurse does not have the system access to complete Medication Reconciliation. Last edited: 5/27/11 Page 8 of 15 Clarity@pph.org www.pph.net
Medication Reconciliation at Admission Process Steps 1. Go to Orders component. The Medication window displays.. 2. Review Orders, Medication List, Documents In Plan tabs on Navigator. 3. Review the Orders View /Screen. Last edited: 5/27/11 Page 9 of 15 Clarity@pph.org www.pph.net
Admission Reconciliation 1. Click the Reconciliation button in the profile of the Medication List or Orders component and select Admission. 2. The Order Reconciliation: Admission view displays. Note the two sections of the window: Medications Prior to Admission and Medications after Admission Reconciliation. 3. Hover over the not taking as prescribed icon on Aspirin 81mg. This icon displays the previous documented information about the patient s non compliance. Last edited: 5/27/11 Page 10 of 15 Clarity@pph.org www.pph.net
4. The previously documented compliance info for patient not taking as prescribed displays for the MD. An orange Icon in front of the medication indicates this medication should be addressed on the current reconciliation process. The physician can perform a partial reconciliation on the admission reconciliation. The physician can choose to ignore a listed medication and the system will flag that medication with the icon. The system will not recognize the task as being complete even if Reconcile and Sign has been clicked. Some medications will need to be addressed in each Medication Reconciliation event (Admission, Transfer, and Discharge). Upon subsequent reconciliations the system displays orders and order groups that have been reconciled and what reconciliation action was taken. Status listed as Documented or icon indicates that medication is a home medication. These medications can be charted by any provider when entering patient s home meds. 5. Click Continue button on Aspirin 81mg order. The medication then appears in the Medication After Admission Reconciliation section and is ordered as an inpatient medication. Last edited: 5/27/11 Page 11 of 15 Clarity@pph.org www.pph.net
6. The status changed on the Aspirin under the header Medication Prior To Admission changes from documented to suspended. 7. Click on Continue radial button for Colace. 8. Click on the Colace 100mg order under Medication After Admission Reconciliation section and a icon appears. When there are required details, a blue box with an X inside appears in front of the medication. 9. Click Colace 100mg order and the Order Details tab on lower left corner of screen appears. 10. Fill in missing information (dose form cap) 11. The blue box in front of medication disappears and Missing required details button on lower right hand corner will read 0 missing requirements. Last edited: 5/27/11 Page 12 of 15 Clarity@pph.org www.pph.net
12. Click on Continue button for Prilosec OTC. If a home medication is not part of PPH formulary, the Convert to Inpatient Medication communication window opens. DO NOT use this pathway to Available Alternatives. It does not link to PPH formulary. 13. Click the Cancel button. 14. Click Do Not Continue on Prilosec OTC order sentence on Medication Reconciliation window. 15. Finish Medication Reconciliation for all other medications. 16. Click on Reconcile And Sign button in lower right hand corner. The Reconciliation window closes. 17. The Orders page appears. The Status of the medication is Ordered. In the Details, the start date and time displays. Last edited: 5/27/11 Page 13 of 15 Clarity@pph.org www.pph.net
Note the Status bar at the top; the Admission Meds Reconciliation should now be marked complete if all the meds were addressed and reconciled. Aspirin and Colace is converted to an inpatient medication and order has been received by pharmacy for review. Prilosec OTC is suspended. A substitution needs to be ordered. (in TRAIN domain, do not click on Add button from the Med Rec window. This crashes the system. Instead, click the Add button from the Orders component.) Adding a Medication Substitution 1. While on the Orders component click to open the Add Order window. 2. Point out drop down menu to add order, All Orders or Document Medication by History. 3. Select All Orders. Last edited: 5/27/11 Page 14 of 15 Clarity@pph.org www.pph.net
4. Type Prilosec in search field. 5. Hover over Prilosec so entire information is viewable. 6. Click Prilosec order is highlighted blue. 7. Therapeutic Substitution window opens giving suggested PPH formulary substitutions and doses. 8. Click on Pantoprazole. 9. Click Orders for Signature. 10. Click Sign. 11. Click Refresh. 12. The Orders page appears. Pantoprazole is ordered via PPH formulary with dose and instructions. The start date and time displays. Admitting MD reviews orders MD reviews orders and adds any additional orders and leaves the patient in the competent care of the RN :o) Last edited: 5/27/11 Page 15 of 15 Clarity@pph.org www.pph.net