Clinical Context: Designated specifically for individuals with complex, unpredictable medical needs who require 24-hour onsite Registered Nurse assessment and/or treatment.
Electronic Health Record (EHR): Continuing Care Home Type A facilities are inpatient build. Connect Care will be set up similarly to a hospital with one encounter. Depending on the pharmacy that supplies medication, orders will be managed differently; some facilities will have an AHS pharmacy, and some will have an external/contracted pharmacy.
Admission
Continuing Care Home Type A ordering tools include the “Continuing Care Home Type A and Type B Admission - with community pharmacy”, “Continuing Care Home Type A and Type B Admission - with inpatient orders and ePrescribe fax”, and "Hospice Admission - Adult" 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 Continuing Care Home Type A 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 Continuing Care Home Type A 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 Continuing Care Home Type A 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 Continuing Care Home Type A facility uses an external (community) pharmacy for the provisioning of patient medications, prescribers order and discontinue medications as external orders using a workspace called "External Orders – Community". New medication orders take the form of a prescription. Discontinued medications are explicitly communicated to the pharmacy. The workflow resembles outpatient medication management.
The "External Orders – Community" chart activity supports prescribers when working in facilities with externally contracted pharmacy services. This includes the needed ordering tools for generating, modifying, and faxing external prescriptions.
When external medication orders are entered, and the ordering prescriber is not physically on site, a nursing communication order will be required to complete the ordering workflow.
Some Continuing Care Home Type A facilities will be using ePrescribe fax where inpatient orders are used for external pharmacies. For more information, see the Inpatient ePrescribe fax section of the Manual.
Managing Orders for Continuing Care Home Type A Residents on Dialysis
If a Continuing Care Home Type A (or B) resident requires hemodialysis, peritoneal dialysis, or an Alberta Kidney Care clinic appointment, there is a specific workflow that needs to be followed so that information flows appropriately through Connect Care. This will allow medication orders to work correctly and help to mitigate patient safety concerns. The specific workflow is dependent on whether the facility is on Connect Care, and, if it is, whether the facility has an on-site pharmacy (e.g., CareWest or Capital Care facilities) or uses a contracted/community pharmacy.
Special Continuing Care reports, including "LTC Resident Annual Physical Needed" and "LTC Resident Pharmacy Medication Review Needed", help prescribers quickly navigate to required tasks.
Additional Continuing Care Home Type A Workflows
