Long-term Care (LTC)

Clinical Context

Persons living in long-term care (LTC) facilities receive "continuing", not "acute", care. However, from a Connect Care perspective, they are admitted to a "facility" and so physician and nurse practitioner prescribers interact with the chart in ways that most closely resemble inpatient care, including inpatient workspace activities and care navigators (e.g., admission, transfer, discharge). 


LTC ordering tools include the "Facility Living Admission" and "Hospice Admission" order sets, as well as repeating labs and restraint orders designed to align with Continuing Care Health Service Standards. 

Medication Ordering

The care of patients in LTC facilities generally follows inpatient workflows. Orders are entered as they would be in any other facility. When a service, test or treatment is not available within the LTC facility, external orders may need to be placed because the requested action is to be performed outside of the facility. 

It is important for prescribers working in Connect Care LTC facilities to be aware of whether the facility has an internal pharmacy or, instead, contracts out pharmacy services to an external provider. 

Internal Pharmacy Services

Internal pharmacies use Connect Care for medication information management. Accordingly, medication orders, pharmacy checks, medication dispensing and administration, etc., all occur in-system and are seamlessly integrated. Medication reconciliation dove-tails with admission and discharge activities in the same way as done in any other inpatient facility using Connect Care as the record of care.

External Pharmacy Services

Where a LTC facility uses an external (community) pharmacy for the provisioning of patient medications, integrated medication management cannot be taken for granted. The external pharmacy, by definition, uses a medication management system that is not interfaced with Connect Care. Accordingly, prescribers order and discontinue medications as external orders. New medication orders take the form of a prescription. Discontinued medications are explicitly communicated to the pharmacy. Indeed, the workflow resembles outpatient medication management in that a patient's relationship to medications is similar to that of a patient receiving home care.

This outpatient-style medication management changes the meaning of "medication reconciliation". Rather than comparing home (pre-admission) to inpatient medications, the focus shifts to building and maintaining a definitive outpatient medication list. This is shared with the external pharmacy, ensuring a common understanding about everything the patient should, and should not, be taking.

A dedicated "External Orders - LTC" chart activity supports prescribers when working in facilities with externally contracted pharmacy services. This includes the needed ordering tools for generating and faxing external prescriptions. It also provides reports summarizing all the medications a patient should be taking and communications that can share that information with the relevant pharmacy.


Special LTC reports, including "LTC Resident Annual Physical Needed" and "LTC Resident Pharmacy Medication Review Needed", help prescribers quickly navigate to required tasks. 

LTC Workflow Resources 

The resources linked below explore workflows designed for use in facility-living settings, including information about appropriate login departments and illustrations of LTC-optimized reports and flowsheets.