Medworxx - Daily Patient Status Entry and Discharge Planning - MENTAL HEALTH

In this course we cover the status entries you are required to complete for a patient on a daily basis. This includes the operational comments, the status entry screen, and any flags that need to be put in place to alert the team that special care needs to be taken for a patient.

At the end of the course we will review how to run reports. These reports assist with bullet rounds which are an important part of Plan Patient Discharge at Health Sciences Centre.

 

A Few Tips for This Course:

            1. Copy and paste this link into Internet Explorer: https://medworxx-test.manitoba-ehealth.ca

            2. Use any username in this range: train02 - train40

            3. Use "medworxx" (all lower case) as a password

            4. Ensure the domain is not checked. 

        Here is a document giving an in-depth overview of how to access the training version of Medworxx.

 

Before We Start

About This Course

Workflow Recap

Do you remember how to set the patient list?

Before you get started, remember to set the patient list to show only the patients that are relevant to you at this time.

  • I remember the steps.
  • I don't remember the steps. Please show me the video one more time.

What is the correct order of steps to enter the daily status updates for all of your assigned patients in the most efficient way?

  • Set the patient list
  • Enter the operational comment for the first patient.
  • Enter the status update for the first patient.
  • Enter any flags if required for the first patient.
  • Click the right arrow above the Encounter Details to move to the second patient on your list.
  • Enter the operational comments, status updates, and any required flags for any subsequent patients on your list.
  • Print the Patients by Bed by Unit report.

Operational Comments - "GoAHEAD"

The Operational Comment Box - An Overview

 

For questions or comments about the video, or if you have any technical issues viewing it, please click here to email the course administrator.

Please answer the following statements as True or False.

  • GoAHEAD helps the care team plan for discharge.
  • GoAHEAD is an acronym to help document key points for care and discharge, such as allergies, medical history, and discharge.
  • GoAHEAD indicates the patient is ready for discharge.
  • The Operational Comment box is included in the reports used in bullet rounds.
  • The information recorded in the GoAHEAD format allows bullet rounds and other rounds to be more efficient.
  • Using the GoAHEAD acronym in the Operational Comments box helps create consistency in the data entered for each patient and avoids confusion among the care team members.

Where on the Status Entry screen is the GoAHEAD recorded?

Click on the screenshot below to indicate where you would record the GoAHEAD.

How often should the Operational Comment box be updated?

  • When the patient's disposition or circumstances change.
  • Once every 24 hours.
  • Upon admission.
  • Upon admission and then at least once every shift.

Handouts & Resources

Click the links below to download a copy of the most current Operational Comment Guide:

 

QRG - Operational Comment Box

 

Please note: the link goes to the Plan Patient Discharge Unit Resources SharePoint. You can find other resources here as well, so it's a good page to bookmark for yourself. You need to be on the HSC network to access it and you might need to log in. If you have any trouble accessing the SharePoint, please click here to email the course administrator.

Status Updates, Part 1 - Reasons for Stay in the "MET" Category

Daily Status Updates, Part 1 - An Overview

 

For questions or comments about the video, or if you have any technical issues viewing it, please click here to email the course administrator.

Please answer the following statements as True or False about the MET category.

  • MET means they've met the criteria to be discharged.
  • MET means the patient meets the criteria to justify an acute stay in hospital.
  • If the patient meets any criteria in the MET section, record as many criteria that are applicable to the patient's situation.

Handouts & Resources

Click the links below to download a copy of the most current Criteria Guides for the Not Met category:

 

Definitions of the Met Criteria Set

 

Please note: the link goes to the Plan Patient Discharge Unit Resources SharePoint. You can find other resources here as well, so it's a good page to bookmark for yourself. You need to be on the HSC network to access it and you might need to log in. If you have any trouble accessing the SharePoint, please click here to email the course administrator.

Status Updates, Part 2 - Reasons for Stay in the "NOT MET" Category

Daily Status Updates, Part 2 - An Overview

 

For questions or comments about the video, or if you have any technical issues viewing it, please click here to email the course administrator.

Define each of the NOT MET subcategories.

  • Physician
    Delay of discharge due to physician directive or lack of a discharge plan.
  • Hospital
    Delay in non-physician related in-hospital services.
  • Community
    Delay in arrangements from community services to be finalized.

Please answer the following statements as True or False about the NOT MET category.

  • If the patient does not meet any criteria in the MET section but cannot be discharged, record only the main reason in the NOT MET section.
  • NOT MET means the patient is clinically stable but is either not functionally ready for discharge or, if they are functionally ready for discharge, is waiting for the arrangement for follow up care, such as placements, programs, etc.
  • Record as many barriers for discharge as are applicable.
  • MET and NOT MET criteria are mutually exclusive: if the patient meets any criteria in the MET category, you cannot record any criteria in the NOT MET category and vice versa.
  • The sub-categories and criteria in the NOT MET category are listed in order of priority. If the patient faces two or more barriers to discharge, record the one that's of the highest priority.

Handouts & Resources

Click the links below to download a copy of the most current Criteria Guides for the Not Met category:

 

Definitions Not Met Physician Subcategory

Definitions Not Met Hospital Subcategory

Definitions Not Met Community Subcategory

Definitions RFD

 

Please note: the link goes to the Plan Patient Discharge Unit Resources SharePoint. You can find other resources here as well, so it's a good page to bookmark for yourself. You need to be on the HSC network to access it and you might need to log in. If you have any trouble accessing the SharePoint, please click here to email the course administrator.

Case Study 1 - Angela

Before we start...

Case Study 1 - Introduction

Case Study 1 - Introduction

Angela - Day 1 - Operational Comment - Part 1

Please indicate on the screenshot below which part of the information given about Angela you would put in the E for Entrance Complaint in the GoAHEAD by clicking on the boxes next to the correct statements.

Hint: There are more than one answer to this question; select all of the correct responses.

Angela - Day 1 - Operational Comment - Part 2

What part of the information given about Angela would you put in the H for History in the GoAHEAD?

Angela - Day 1 - Status Update - Part 1

Angela has been settled into her room and it is time to do the status update in Medworxx for her.

Please indicate on the screenshot below which criterion or criteria Angela meets.

NOTE: If you are not sure, click on each "i" in the screenshot of the criteria set above: much like if you were in Medworxx, hovering over a criterion, it opens a pop-up with information about what that criterion entails.

Angela - Day 1 - Status Update - Part 2

Let's focus on the Met categories more closely. When you mark a criterion as Met, you must give reasons and details as to why the patient qualifies for that particular criterion.

You have indicated Angela is "MET" for Mental Status. Which item(s) would you check on the reasons and details page as per the example given?

Angela - Day 1 - Status Update - Part 3

You have also indicated Angela is "MET" for Intensive Therapy. Which item(s) would you check on the reasons and details page as per the example given?

Angela - Day 2 - Status Update - Part 1

It's day 2 (March 9th) for Angela. She has been isolated to her room, with attempts to strike out at staff when they attempt to assist with her ADL’s or give her medications. She has been yelling delusional thought content with belief that nursing staff are trying to poison her with needles. Angela remains alert and oriented and is angry about hospitalization. She is willing to continue using Olanzapine and is agreeable to increase to 10mg. Angela remains on close observation. A family meeting is set for March 11th.

The Operational Comment might say something like this:

Please indicate on the screenshot below which criterion or criteria Angela meets.

NOTE: If you are not sure, click on each "i" in the screenshot of the criteria set above: much like if you were in Medworxx, hovering over a criterion, it opens a pop-up with information about what that criterion entails.

What does it mean to click "Yes" to the question "Is the patient clinically stable?"

On any day where the patient is in a particular MET category, if they have been in that MET category the day before, Medworxx will ask "Is the patient clinically stable?".

What does it mean?

  • It means the patient no longer requires acute care for this particular criterion and no information can be entered in the MET category for that criterion (though the patient might still require acute care for any of the other criteria).
  • It means the patient is ready for discharge.
  • It means the patient is automatically moved to the NOT MET category

What does it mean when Medworxx asks if the patient is clinically stable?

  • Answering with "Yes" to the question if the patient is clinically stable will close the window and not record an "M" in that Met criterion.
  • Answering with "No" to the question if the patient is clinically stable will open the Reasons & Details screen with the information from yesterday brought forward. All I have to do is update what is different if anything.

Angela - Day 2 - Status Update - Part 2

  • Since the Olanzapine is to be increased, when entering the reasons and details for the Intensive Therapy criterion, we should update also the note to indicate this. It may read something along the lines of "March 9th: Increase Olanzapine, continue to monitor intensity of delusional thoughts."

Angela - Day 4 - Status Update - Part 1

Let's fast forward to day 4 (March 11th). Angela bathed with staff assistance. Delusional thought content persists, but there is decreased intensity and frequency. She is continuing to use Olanzapine. The family meeting with her son confirmed that she cannot return home.  Now, Social Work is to begin social history in preparation for alternative living arrangements. Occupational Therapy is to begin functional assessment. Form 4 has expired, and Angela has agreed to a voluntary admission.

The Operational Comment might say something like this:

Which criterion is the main reason for stay?

NOTE: If you are not sure, click on each "i" in the screenshot of the criteria set above: much like if you were in Medworxx, hovering over a criterion, it opens a pop-up with information about what that criterion entails.

Angela - Day 4 - Status Update - Part 2

How would you enter the requested consult?

Tip: Select both the reason (the numbered item) and as many details as apply. It may be more than one reason and/or detail. In this case, there are more than one.

Angela - Day 4 - Status Update - Part 3

How would you answer the Readiness for Discharge/Transition assessment for day 4?

Click on the screenshot for the appropriate answers.

Just as a reminder, a recap of where Angela is at for today: She bathed with staff assistance. Delusional thought content persists, but there is decreased intensity and frequency. She is continuing to use Olanzapine. Family meeting with son confirmed she cannot return home.  Social Work is to begin social history in preparation for alternative living arrangements. Occupational Therapy is to begin functional assessment. Form 4 has expired, and Angela has agreed to a voluntary admission.

Angela - Day 7 - Status Update - Part 1

Let's fast forward to day 7 (March 14th). Angela has been settled. Minimal delusional thought content verbalized. Angela requires prompts and assistance with ADLs. Functional assessment completed, and residential care recommended.  Social Work is to begin residential care application process. Angela now has escorted 30 min walks with family.  A suicide risk assessment was completed and is low .

The Operational Comment it might say something like this:

Which criterion is the main barrier for discharge?

NOTE: If you are not sure, click on each "i" in the screenshot of the criteria set above: much like if you were in Medworxx, hovering over a criterion, it opens a pop-up with information about what that criterion entails.

Angela - Day 7 - Status Update - Part 2

How would you enter the reasons and details for this criterion in Angela's case?

Tip: Select both the reason (the numbered item) and as many details as apply. It may be more than one reason and/or detail.

What does it mean if the N in Not MET is green?

  • The patient is clinically stable but functionally not ready for discharge.
  • It means the patient meets all statements in the Ready for Discharge / Transfer assessment, so the patient is clinically stable and functionally ready for discharge, however there is a barrier for their discharge, such as waiting for placement at a long term facility, in-hospital services, etc.
  • The patient is clinically stable and is being discharged today.

Angela - Day 8 - Status Update - Part 1

Angela’s application for residential care has been completed and submitted. Angela is to tour residential care, Malvern House. Mental status at baseline. 

The Operational Comment it might say something like this:

Which criterion is the main reason for stay?

NOTE: If you are not sure, click on each "i" in the screenshot of the criteria set above: much like if you were in Medworxx, hovering over a criterion, it opens a pop-up with information about what that criterion entails.

Angela - Day 8 - Status Update - Part 2

 

The information from the previous day is carried forward, including the note.

  • You don't have to do anything at all at this stage, just click OK.

Angela - Wrap

Angela's tour went well and Malvern House has accepted her application. The final arrangements will be made and Angela will move to her new home in 2 days.

Case Study 2 - George

Case Study 2 - Introduction 1

Let's take a look at another case.

Case Study 2 - Introduction 2

George - Day 1 - Operational Comment

It's the day of George's admission (March 5th). He just settled into his room. You're now filling out Medworxx for this patient. Match the important pieces of information into the correct section of the GoAHEAD acronym.

  • Go - Goals for Discharge
    Assist with detox from alcohol; restart Clozapine with goal of titrating dose until psychotic symptoms stabilize.
  • A - Allergy, ACP, ARO
    Allergy to Sulfa and Codeine, ACP-R, No ARO
  • H - History
    Cirrhosis (followed in Hepatology Clinic), Hypertension, withdrawal seizures (Dec 31/16), Schizoaffective disorder, Follow up with CODI and Dr. Tinelle (missed last 2 CODI appointments due to increased drinking.
  • E - Entrance Complaint
    Transferred from Concordia to PX2 for alcohol use disorder, and schizoaffective disorder. Has not been using Clozapine for one week.
  • A - Actions
    March 5th: - Monitor psychotic & withdrawal symptoms according to alcohol withdrawal assessment. Monitor hours of sleep.
  • D - Discharge Plan
    Has his own apartment, on EIA, has previous follow up with CODI and Hepatology Clinic.

George - Day 1 - Status Update - Part 1

Please indicate on the screenshot below which criterion or criteria George meets.

NOTE: If you are not sure, click on each "i" in the screenshot of the criteria set above: much like if you were in Medworxx, hovering over a criterion, it opens a pop-up with information about what that criterion entails.

George - Day 1 - Status Update - Part 2

Let's focus on the Mental Status criterion:

Which of the Reasons and Details do you think apply to George's case (remember, it could be more than one, and in some cases all listed reasons)?

George - Day 1 - Status Update - Part 3

Which of the Reasons and Details do you think apply to George's case for the Intensive Therapy criterion?

George - Day 2 - Operational Comment

  • When you do your status updates for a patient, you do need to copy forward the GoAHEAD, but not all items will always need to be updated every day. Not to say that goals for discharge never change or allergies and ACP status never change, but on most days, it's just the A for Actions that needs to be updated, and if the patient's details for discharge change then the D for Discharge might need to be updated.

George - Day 2 - Status Update - Part 1

On his second day of stay George is still disoriented to place and time. He continues to believe he is in BC and thinks the year is 1995. His gait is unsteady and ataxic. Although disoriented, George follows direction from nursing staff.

George’s blood pressure has been high 180/100; pulse has been running between 100-120.  He is flushed, sweaty, and tremulous. George has been voicing beliefs that the police are out looking for him, but he doesn’t know why. George has used 3 doses of prn Quetiapine 50mg which has been helpful for reducing distress related to command hallucinations. He has received 100mg Valium po daily, for alcohol withdrawal symptoms and re-started using Clozapine 25mg as ordered. His sleep has been poor, accruing 3 hours total, due to waking up with withdrawal symptoms. It was confirmed that CODI will continue to follow George and will come and see him on March 9th.

Please indicate on the screenshot below which criterion or criteria George meets.

NOTE: If you are not sure, click on each "i" in the screenshot of the criteria set above: much like if you were in Medworxx, hovering over a criterion, it opens a pop-up with information about what that criterion entails.

George - Day 2 - Status Update - Part 2

The Reasons & Details screen brings forward the information saved on the previous day. You should always update it as necessary. If everything is still the same, you still need to update the note's date to reflect that you have checked the note for accuracy and relevance to today.

In George's case this is how the Reasons & Details for Mental Status looks when you enter it for the 2nd day. What would you do at this point?

  • Accept the information that's carried forward as is since not much has changed since the last time Medworxx was updated.
  • Accept the information that's carried forward and just change the date to reflect today's date.
  • In George's case the second Mental Health reason is no longer applicable, so I would take out the note and uncheck it. I would then update the first reason to reflect today's details (including the date).

George - Day 4 - Status Update - Part 1

Let's fast forward to the 4th day of George's stay. He is no longer disoriented and his acute alcohol withdrawal has resolved. George slept 6 hours. He continues to think that he did something, that police may be looking for him, but able to reality test. Auditory hallucinations remain but George is less distressed by voices and has no intention of acting on the voices. Suicide risk assessment remains low. Has used Quetiapine 50mg po prn X two doses for symptoms of psychosis. His Clozapine was increased to 75mg daily. Changed to routine observation. May be escorted to AA Meetings accompanied by sponsor.  

His GoAHEAD for today might look something like this:

Which category do you think George is in at this point; MET or NOT MET?

  • He is still in MET.
  • He is NOT MET.

George - Day 4 - Status Update - Part 2

Which NOT MET criterion is most appropriate for George's case?

NOTE: If you are not sure, click on each "i" in the screenshot of the criteria set above: much like if you were in Medworxx, hovering over a criterion, it opens a pop-up with information about what that criterion entails.

(Remember in the NOT MET category you can only select the main reason for stay.)

George - Day 4 - Status Update - Part 3

Which of the Reasons and Details do you think apply to George's case for the Therapy/Treatments criterion (remember, it could be more than one, and in some cases all listed reasons)?

George - Day 4 - Status Update - Part 4

How would you answer the Readiness for Discharge/Transition assessment for day 4?

Click on the screenshot for the appropriate answers.

Just as a reminder, a recap of where George is at for today: He is no longer disoriented. Acute alcohol withdrawal resolved. George slept 6 hours. Continues to think that he did something, that police may be looking for him, but able to reality test. Auditory hallucinations remain but George is less distressed by voices and has no intention of acting on the voices. Suicide risk assessment remains low. Has used Quetiapine 50mg po prn X two doses for symptoms of psychosis. Increase Clozapine to 75mg daily. Changed to routine observation. May be escorted to AA Meetings accompanied by sponsor.  

George - Day 10 - Status Update - Part 1

At this point we're going to forward to Day 10. George has been using walks with no issue. George is no longer voicing delusional beliefs about police tracking him and is no longer experiencing command hallucinations. Suicide risk assessment remains low. He has been using Clozapine consistently with no reported troublesome side effects. No  longer using prn Quetiapine. George met with the inpatient team, indicating he wants to go home now. The team and George would like to trial an overnight pass prior to discharge. Dad is agreeable with this plan.  

Which NOT MET criterion is most appropriate for George's case?

NOTE: If you are not sure, click on each "i" in the screenshot of the criteria set above: much like if you were in Medworxx, hovering over a criterion, it opens a pop-up with information about what that criterion entails.

(Remember in the NOT MET category you can only select the main reason for stay.)

George - Day 10 - Status Update - Part 2

Which of the Reasons and Details do you think apply to George's case for the Therapy/Treatments criterion (remember, it could be more than one, and in some cases all listed reasons)?

George - Day 11 - Status Update

George’s overnight pass was successful as confirmed by both George and Dad. Dad is willing to stay with George for 2 weeks after discharge, however, he needs an additional day to make arrangements. Discharge is set for the following day (Day 12). Social worker and George to book a follow up appointment with Dr. Tinelle and CODI as an outpatient. Discharge prescriptions faxed to community pharmacy. Given blood work requisitions for Clozapine protocol. George is aware of community AA support groups. 

His GoAHEAD for today might look something like this:

Which NOT MET criterion is most appropriate for George's case?

NOTE: If you are not sure, click on each "i" in the screenshot of the criteria set above: much like if you were in Medworxx, hovering over a criterion, it opens a pop-up with information about what that criterion entails.

(Remember in the NOT MET category you can only select the main reason for stay.)

George - Wrap

George is picked up by his dad the following day and since that is the discharge day, you do not have to enter anything in Medworxx (unless the discharge was at night and there was an entire day spent at this care facility.

Flags and Alerts

Isolation Flag - An Overview

 

For questions or comments about the video, or if you have any technical issues viewing it, please click here to email the course administrator.

Please answer the following statements about the Isolation flag.

  • The isolation flag is used to indicate when a patient requires isolation precautions, regardless of the type of precautions or the reason for isolation.
  • If a patient is flagged as being on isolation it should be reflected in the first A of GoAHEAD in the Operation Comment box.
  • Flagging a patient as being on isolation is an indicator that the patient must be in a MET category.

Where would you click to flag a patient as requiring isolation precautions?

Staff Reports

Printing Reports

For bullet rounds, print the Patient List by Bed/Unit report. It is the most comprehensive and will include your operational comments.

Handouts & Resources

Click the link below to download a copy of the most current Quick Reference Guide for Printing Reports:

 

Report Printing Patient List by Bed and Unit

 

Please note: the link goes to the Plan Patient Discharge Unit Resources SharePoint. You can find other resources here as well, so it's a good page to bookmark for yourself. You need to be on the HSC network to access it and you might need to log in. If you have any trouble accessing the SharePoint, please click here to email the course administrator.

Resources & Course Help

Handouts & Resources

Click the links below to download a copy of the most current Quick Reference Guides:

 

Training Tips

QRG - Operational Comment Box

Definitions Met Criteria Set

Definitions Not Met Physician Subcategory

Definitions Not Met Hospital Subcategory

Definitions Not Met Community Subcategory

Definitions RFD

Report Printing Patient List by Bed and Unit

 

Please note: the link goes to the Plan Patient Discharge Unit Resources SharePoint. You can find other resources here as well, so it's a good page to bookmark for yourself. You need to be on the HSC network to access it and you might need to log in. If you have any trouble accessing the SharePoint, please click here to email the course administrator.

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