Admissions time savers

1. Admissions time savers Prepared by: Ameen Al-Aghil PGY-2- Categorical

2. Overall Admission steps • Check Vitals- Chief complaint – Triage if you have multiple admissions • Quick chart review: ED note- last H&P/discharge summary • Print latest med list available • See patient, go over med list/pharmacies, don’t forget code status • Admission orders – Pre-hold if still in ED • Medication reconciliation • Additional orders • Consults • H&P- note

3. Flowsheet

4. Overall Admission steps • Check Vitals- Chief complaint – Triage if you have multiple admissions • Quick chart review: ED note- last H&P/discharge summary • Print latest med list available • See patient, go over med list/pharmacies, don’t forget code status • Admission orders – Pre-hold if still in ED • Medication reconciliation • Additional orders • H&P- note

6. Overall Admission steps • Check Vitals- Chief complaint – Triage if you have multiple admissions • Quick chart review: ED note- last H&P/discharge summary • Print latest med list available • See patient, go over med list/pharmacies, don’t forget code status • Admission orders – Pre-hold if still in ED • Medication reconciliation • Additional orders • H&P- note

7. Admission orders • Today- add the following order sets: • Admission order sets • General: Admit order set CMC and ICU admission • Cardiology: ACS order set • Pulm: COPD • Heme: Sickle cell crisis acute cmc • Useful disease specific order sets • Emergencies: Hyperkalemia, cord compression 911 and upper GI bleed • Cardiology: Heart failure • Pulm: Asthma, PE, Thoracentesis • ID: Pneumonia, acute diarrhea, Neutropenic fever, acute meningitis and acute septic arthritis • Rheumatology order set

9. My favorite sets

10. Overall Admission steps • Check Vitals- Chief complaint – Triage if you have multiple admissions • Quick chart review: ED note- last H&P/discharge summary • Print latest med list available • See patient, go over med list/pharmacies, don’t forget code status • Admission orders – Pre-hold if still in ED • Medication reconciliation • Additional orders • Consults • H&P- note

11. Medication Rec! Very Important! 1- Outpatient Medication Review 2- Obtaining Accurate Medication list • Patient/family • EMR/ Pharmacy- next slide • If came from SNF- Call SNF to FAX the list 3- Order Reconciliation

14. Overall Admission steps • Check Vitals- Chief complaint – Triage if you have multiple admissions • Quick chart review: ED note- last H&P/discharge summary • Print latest med list available • See patient, go over med list/pharmacies, don’t forget code status • Admission orders – Pre-hold if still in ED • Medication reconciliation • Additional orders / Consults • H&P- note

15. ISBAR tool • Identification: “ Hello, My name is Ameen with Weisman Team calling for a New consult, Pt is Name, location and MRN (three identifiers) • Situation: Consult question, What is going on with the patient? • Background: Context and relevant hx • Assessment: State what you think the problem is. • Recommendation: State your recommendation about what could be done to correct the problem.

16. Overall Admission steps • Check Vitals- Chief complaint – Triage if you have multiple admissions • Quick chart review: ED note- last H&P/discharge summary • Print latest med list available • See patient, go over med list/pharmacies, don’t forget code status • Admission orders – Pre-hold if still in ED • Medication reconciliation • Additional orders / Consults • H&P note: Chart review

17. Chart review • Specialty Teams: State who the Primary oncologist, nephrologist, cardiologist…. • Refer to Student handbook for rotation specific instructions • Physician portal- notes, EKG, prior Echo, EGD, Scopes (relevants) • Clinical summary • Medications received- useful for MICU/CICU transfers

18. Clinical summary

19. Medications

20. Acronym expansion

21. Questions?