All patient admissions should be facilitated with the Admission Navigator. The only exception is when an admission to a Connect Care inpatient setting is the result of transfer from another Connect Care inpatient setting.
It is vitally important to use the admission navigator when admitting patients because some steps in an admission (e.g., order set options) are contingent upon earlier steps (e.g., problem list review). In addition, an admission cannot proceed without completion of some navigator actions.
The most important admission navigation steps, in order, include:
Problem List and History Review ("Admission Problem List", "History", "Implants")
Allergies Review ("Allergies/Contraindications")
Medication Review ("Review Home Medications")
Admission Orders (includes "Review Current Orders", "Reconcile Home Medications", "Order Sets")
History & Physical (admission documentation can be started at any time, but embedded SmartLinks and SmartPhrases should be refreshed after completing the above because values may have changed)
It is critically important that the problem list be reviewed and updated. The Problem List display is unique in the Admission Navigator, making the following tasks easier:
Add any problems that need to be on the list but do not yet appear.
Remove or move any problems that are resolved or merit shifting to the Medical or Surgical History.
Select "Hospital Problems". Prominent buttons allow list entries to be flagged as "hospital" problems that will be addressed during the present inpatient encounter. Note norms for deciding whether a problem is active (and should be on the list) or not.
Select a "Principal" problem. This will automatically populate the "admitting diagnosis" when an admission order is entered (later).
Optionally use the "Priority" column and pick-lists to identify problems that are high, medium or low priority for this admission.
There is no need to complete the "Present on Admission" or "Chronic" problem status at this stage (can be done as part of discharge problem reconciliation).
It is suggested that the patient's medical, surgical, family and social histories (via the "History" navigator section) be updated at the same time as problem list management. It is easy to move problems to the medical history and vice versa. Completing this documentation simplifies preparation of an admission history and physical (which pulls in this information).
A patient's allergies need review at every admission and must be checked before any medication orders are contemplated. This information is often entered by other team members and can be "marked as reviewed" if current.
Review Home Medications
This is where a "Best Possible Medication History" (BPMH) is entered or confirmed (if entered by other team members). It is essential (and mandated by AHS policy) that this be done.
All medications taken by the patient pre-admission ("Home" meds) need to be entered, with an indication if they are being taken as prescribed.
Once reviewed, select "Prescriber Complete" from the "Med List Status" at the bottom of the section.
Click on the "BPMH Source" link, then enter ".bpmh" SmartPhrase and select 2 sources from the available SmartList to indicate where medication information came from.
By this point there is enough information in the system to allow medication-allergy, medication-medication and medication-problem interactions to be checked, and so admission orders to be entered. Click on the link to "admission orders".
Orders Needing Cosign
Start with a check of any existing (usually emergency) orders to continue or discontinue; then
Reconcile Home Medications
by deciding which home meds to continue, hold or discontinue; and finally
by entering any additional admission orders (ideally, admission order sets that help guide the prescriber with suggestions for relevant investigations and treatments). If not using an order set, be sure that both an admission order and goals of care order are entered and signed.
H & P Notes
This section facilitates preparation of the admitting History and Physical.
Med Rec Status
This section provides a final reminder related to whether home medications have been reviewed.
An "Admission Checklist" highlights essential tasks that must be completed for an admission to proceed without deficiencies. The same checklist appears in the default page showing in the chart "Sidebar" (rightmost column of an open chart).