Inpatient updates

Sorry it’s a little long. It’s been awhile since I sent out any updates.

 

Medicine:

 

ALTO (alternatives to opiates) implementation in ED

• This is a new program being rolled out at many EDs. Our ED has started to implement it to decrease the amount of opiates prescribed. Unique treatments being used by the ED are ketamine and lidocaine.
• At this time, these orders should be one-time only in the ED. We are unable to perform lidocaine or ketamine infusions on the floor until nursing/provider education is completed (date TBD). If they are ordered as infusions, you will need to cancel them as an inpatient.

 

At-Risk Patient Order (please see your required health stream module for more information)

• New “at-risk patient” order in epic
• Use in addition to M1 order or independently if not meeting M1 criteria, but need more precautions
• Needs to be renewed after 72 hours
• Doesn’t replace the M1 hold
• If patients are not on an M1 hold, there are options for excluding them from certain restrictions. Don’t pick these options if they are on an M1
• Physicians need to discontinue the order when no longer meeting criteria, d/c’d, or transferred
• In patient header, also add FYI Flag “At-risk” that will alert staff about he patient care. Cancel this flag on d/c

 

No kayexalate in hospital

• Need to use Valtessa for hyperkalemia instead

 

Discontinue prn medications if not effective or not using

• We have been cited multiple times by joint commission for duplicate prn medications for the same indication (ie: nausea, pain). Please make sure you discontinuing medications that are not effective or the patient is not using. If they are using all the medications provide a different indication for the medications (ie: mild, mod, or severe pain, use if Zofran not effective, etc)

 

Inpatient Note if Patient Doesn’t discharge

• The coders can use the discharge note as the progress note for that day if the patient does not discharge. In the attestation just explain why the patient stayed again
• No additional progress note is needed for the day the patient stayed
• For the actual day of discharge you will write another discharge note

 

OB:

 

AM C-section arrival time

• Please have patients arrive at 5:30 AM to L&D for 8 AM c-sections.

 

Chlorhexidine night before C-sections

• Please give chlorhexidine wash to C-section patients to use the night before or day of their scheduled section. We will be stocking these in clinic.

 

Transfer process for pregnant patients

• Make sure to request “Critical Care / Fetal Monitoring” from Centura Connect when transferring moms to outside facilities. This will ensure more timely transfer

 

 

Krystal Tamura

St. Anthony North Family Medicine Faculty

Inpatient Medical Director

St. Anthony North Health Campus | 14300 Orchard Pkwy Westminster, CO 80021

 

krystaltamura@centura.org

Office: 303.430.5560 | Cell: 720.352.4874

 

 

centura.org

 

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