Admission Navigator 

All patient admissions should be facilitated with the Admission navigator. The only possible exception is when admission to a Connect Care facility setting results from transfer from another Connect Care facility. Use of the Admission navigator ensures that:

• key patient safety considerations are addressed, including possible needs for isolation or exceptional care plans,

• mandatory information review occurs, including problem, medication and adverse reaction reconciliation, 

• important admission orders are not missed, including an admit order with a principal problem, primary provider team and expected discharge date set,

• required documentation is completed with the correct format and content.

The most important Admission navigator steps, in order, include reviewing information, taking actions and completing documentation:

• Review

  • Check a patient’s possible isolation requirements. 

  • Enter or update a patient’s problem list and history, and consider any active exceptional care plans. 

  • Enter or confirm a Best Possible Medication History (BPMH).

  • Enter or confirm any allergies or adverse reactions.

• Action 

  • Consider pre-admission support needs when estimating an expected discharge date.

  • Enter an “admit to inpatient” order (with principal problem, expected discharge date and primary provider team), goals of care designation and other admission orders or order set(s).

• Documentation 

  • Prepare an admission History and Physical (H&P) examination summative document, or link to a prior H&P or Consult that will serve this documentation requirement.

Following the navigator steps in order saves time. Earlier steps address dependencies for later steps. For example, while the History and Physical (H&P) note can be started at any time, use of a standardized note template after other Navigator steps are complete ensures that information entered is automatically pulled into the note, saving documentation time and avoiding double data-entry.

Problem List

It is critically important that the problem list be reviewed and updated, complying with how hospital problems are defined, marked as principal, and prioritized. The Problem List display is unique in the Admission navigator, making the following tasks easier:

1. 1. Add problems that need to be on the list but do not yet appear. 

   2. Remove or move any problems that are resolved or merit shifting to the Medical or Surgical History.

   3. 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.

   4. Select a "Principal" problem. This will automatically populate the "admitting diagnosis" when an admission order is entered (later).

   5. Use the "Priority" column and pick-lists to identify problems that are high, medium or low priority for this admission.

The patient's medical, surgical, family and social histories (via the "History" section) be updated at the same time as the problem list is managed. 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).

Allergies and Adverse Reactions

A patient's allergies and adverse reactions need review at every admission and must be checked before any medication orders are contemplated. This information may be entered by other team members and can be "marked as reviewed" if validated. 

Review Home Medications

This is where a "Best Possible Medication History" (BPMH) is entered or validated (if entered by other team members). It is essential (and mandated by AHS policy) that this be done. Note that changes made by other team members can be viewed via the "Medication Document Review Audit" report (see Support: Home Medications History).

1. All medications taken by the patient pre-admission ("Home" meds) need to be entered, with an indication if they are being taken as prescribed.

2. Once reviewed, select "Prescriber Complete" from the "Med List Status" at the bottom of the section.

3. 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.

Transition Planning

An interactive (click on text items to edit) "transition planning at admission" section allows quick entry of information about a patient's pre-admission community supports, frailty and home oxygen requirements. Interactive text also facilitates quick validation of the admitting provider, admitting service and primary provider team.

Admission Orders

By this point there is enough information in the system to allow medication-allergy, medication-medication and medication-problem interactions to be checked. Click on the link to "admission orders".

1. Orders Needing Cosign
   Start with a check of any existing (usually emergency) orders to continue or discontinue; then 

2. Reconcile Home Medications
   by deciding which home medications to continue, hold or discontinue; and finally

3. Order Sets
   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.
   The "admit to inpatient" order must include a principal problem (reason for admission, automatically pulled in from the problem list principal problem selected above), expected discharge date and primary provider team.

H & P Notes

This section facilitates preparation of the admitting History and Physical. Sometimes an Emergency provider note, Emergency consultation note or prior outpatient note (for surgery admissions) can serve as the H&P note which is required documentation for an admission. A "H&P Link" section lists eligible prior notes and allows one to be selected so that a new H&P does not need to be prepared.

Admission Checklist

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).

More Information

• Manual: Problem List Management

• Manual: Medication Reconciliation

• Manual: Goals of Care Orders

• Manual: Direct Admissions

Resources

• Tip: Admission Navigator

• Demo: Admission Navigator

• Tip: Admission from Clinic

• Support: Home Medications History