Medworxx - Daily Patient Status Entry and Discharge Planning - CHILD 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.

To review the SOP mentioned at the end of the video, click here.

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 - update link

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.

To review the SOP mentioned at the end of the video, click here.

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.

To review the SOP mentioned at the end of the video, click here.

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 - update link

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 - Laura

Before we start...

Laura Case Study 2 - Introduction

Laura Day 1 - Operational Comment - Part 1

Please indicate on the screenshot below which part of the information given about Laura you would put in the A for Actions in the GoAHEAD.

Laura Day 1 - Operational Comment - Part 2

What part of the information given about Laura would you put in the E for Entrance Complaint in the GoAHEAD?

Laura Day 1 - Status Update

Laura has been settled into her room. She has been placed Cefotaxime IV q12h. We are monitoring her pain every 4 hours.

  • Laura is in the MET category in the Vital Assessment criterion to monitor TPR, BP, RR and her pain every 4 hours.
  • Laura is in the MET category in the Injection / IV criterion due to the IV antibiotics.

Laura Day 2 - Status Update - Part 1

It's day 2 (Sep 28th) for Laura. At this point she no longer qualifies to be in the MET category; she is now down to only getting 1 IV antibiotic every 12 hours, and her pain is managed with Tylenol. Her CBC shows elevated white blood cells (wbc).

The Operational Comment it might say something like this:

After reviewing the operational comment, 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.

Laura Day 2 - Status Update - Part 2

How would you enter the requested Infectious Disease consult?

Laura Day 2 - Status Update - Part 3

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

Click on the screenshot for the appropriate answers.

Laura Day 3 - Status Update - Part 1

It's day 3. The Infectious Disease team saw the patient this morning and completed the consult. Laura requires 14 days of clindamycin, a consult for a PICC line and a consult for the home IV program (CIVP).

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.

Laura Day 3 - Status Update - Part 2

How would you enter the requested consult?

Laura Day 3 - Status Update - Part 3

How would you answer the Readiness for Discharge/Transition assessment for day 3?

Click on the screenshot for the appropriate answers.

Just as a reminder, a recap of where Laura is at for today: The Infectious Disease team saw the patient this morning and completed the consult. She requires 14 days of clindamycin, a consult for a PICC line and a consult for the home IV program (CIVP). Her WBC is now improving within normal range. And the GoAHEAD for today was:

Laura Day 5 - Discharge

  • Today is the patient's discharge. Unless it is in the evening, you don't have to enter an operational comment nor a status update.

Case Study - Tom

Tom Introduction

Let's take a look at another case.

Tom Day 1 - Operational Comment

It's the day of Tom's admission (September 27th). He just came up from Emergency and has settled into his room. You're now filling out Medworxx for this patient. Drop the important pieces of information into the correct section of the GoAHEAD acronym.

(Please note, for the purposes of this exercise, we had to use some abbreviations. Abbreviations are not encouraged to be used when you are working with real patients.)

  • Resolution of respiratory symptoms & on room air
  • Penicillin allergy, ACP-R, No ARO
  • 3 wks pneumonia, done PO antibiotics 1 week ago, healthy prior
  • Dec.7 to ED, left side chest pain, increase RR & r/a sats 84%
  • X-ray shows pleural effusion, surgery consulted, IV antibiotics
  • Lives with parents and two siblings, family out of town

Tom Day 1 - Status Update - Part 1

Lab work from the Emergency department came back indicating WBC is elevated and he has respiratory acidosis.

He requires oxygen (O2 2L nasal prongs) to keep his oxygen sats at or above 92% as per doctor's orders. Vital signs are ordered Q4H.

Please indicate on the screenshot below which criterion or criteria Tom 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.

Tom Day 1 - Status Update - Part 2

Let's focus on Tom's needs for today: He requires oxygen (O2 1L nasal prongs) to keep his oxygen sats at or above 92% as per doctor's orders. Vital signs are ordered Q4H.

You have indicated Tom meets the MET criteria for Airway. Which item(s) would you check on the reasons and details page as per the example given?

Tom Day 2 - Operational Comment

It is now the next day (Sept. 27) and time to do the status update. Tom is still requiring 1L NP to maintain oxygen sats above 92%, repeat x-ray reveals no improvement so surgery schedules a procedure to insert a chest tube.

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. Please indicate which section(s) you would update and which you wouldn't.

Go  

A     

H     

E      

A      

D     

Tom Day 2 - Status Update - Part 1

It is still day 2. Tom's oxygen needs have not changed, except that he required a chest tube which is was inserted today.

When you double-click on the date-field for Airway, a pop-up asks if the patient is clinically stable.

What is the correct answer in Tom's case?

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

  • It means the patient no longer meets the reasons and details for this particular criterion (though the patient might still meet the reasons and details for other MET criteria).
  • It means the patient is ready for discharge.
  • It means the patient is automatically moved to the NOT MET category

Tom Day 2 - Status Update - Part 2

Tom's oxygen needs have changed from 2 to 1L nasal prongs.

When you answer "No" to the question if a patient is stable, Medworxx will copy the information from the previous day to today to make your data entry faster. Always make sure you review and make any edits as necessary. This is what Medworxx copied from the previous day in Tom's case.

How would you answer the below statement?

  • The note should be updated from saying "O2 2L nasal prongs, keep as sats > 92%" to "O2 1L nasal prongs, keep as sats > 92%".

Tom Day 2 - Status Update - Part 3

It is still the 2nd day (Sep 28). Tom required a chest tube which was inserted by Surgery today. His Oxygen needs and vital monitoring needs have not changed. He is therefore still in the MET category.

Please indicate on the screenshot below in which Met criterion you would capture the chest tube.

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.

Tom Day 4 - Status Update - Part 1

Let's fast forward to the 4th day of his stay (Sep 30th). Physio has begun working with Tom towards increasing his activity and is encouraging 3 walks a day. His pain is well managed with continuous infusion of morphine.  ID recommends a repeat X-ray tomorrow.

Tom no longer requires continuous oxygen; his sats are at 94% on room air. Vital signs are stable and chest tube is still in, but with minimal drainage and he tolerates having his chest tube to straight drain when he ambulates.

This means Tom no longer falls in the MET category.

Please indicate on the screenshot below which NOT MET criterion Tom 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.

Tom Day 4 - Status Update - Part 2

In the last exercise Treatment was indicated as the main reason for stay in Tom's case. Let's focus on the reasons and details of the NOT MET criteria. We will disregard the work with Physio at the moment. His pain is well managed with continuous infusion of morphine.  He is also still on IV antibiotics and ID recommends a repeat X-ray tomorrow and will determine length of antibiotic course. Surgery will re-assess the removal of the chest tube tomorrow.

Tip: Don't forget the chest tube; as mentioned in the previous question, both the IV and the chest tube are covered by Treatment.

Which item(s) would you check on the reasons and details page as per the example given?

Tom Day 4 - Status Update - Part 3

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

Click on the screenshot for the appropriate answers.

Please elaborate your answer for the previous question.

In the previous question, both "No" and "Yes" could be considered appropriate answers for statement number 1.

Please indicate which you chose and elaborate on your rationale.

Tom Day 4 - Bonus Question

The family is wondering if the chest tube is removed, if Tom can be transferred to the home community hospital.

Where would you enter that information?

  • In the notes field of the Reasons & Details screen for the main reason for stay.
  • In the GoAHEAD under D for discharge
  • In the GoAHEAD under Go for goals
  • This does not need to get documented in Medworxx

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

  • The patient is clinically stable but functionally not ready for discharge.
  • 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.

Tom Day 6 - Status Update

Let's fast forward to day 6 of Tom's stay. The chest tube has been removed yesterday. ID ordered a 14 day course of IV antibiotics. Based on the parent's request to transfer him to his home community, we checked with the health care centre there to see if they would accept the transfer. Tom has been accepted by the attending physician. A bed will be available for him tomorrow afternoon.

Indicate in the screenshot below which criterion captures this.

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.

Flags and Alerts

High Risk Indicator 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 as True or False about the High Risk Discharge flag.

  • The High Risk Discharge flag denotes a patient who requires more complex discharge planning.
  • The High Risk Discharge flag should be set as early as possible which might be at the time of admission.
  • The High Risk Discharge flag automatically puts a patient in isolation.

Where would you click to flag a patient as a high risk discharge?

Which of the following are indicators for a high risk or complex discharge?

For this question, please consult the High Risk Discharge Indicators document. You can download it from the link below. It is also a good handout to keep for future reference.

High Risk Discharge Indicators

Note:

  • This link going to the Planned Patient Discharge SharePoint site. It's a good page to bookmark for easy access to all the Medworxx reference materials in the future.
  • You may need to log in. If so, use your personal network login.

Mark all that apply.

  • Multiple medical problems or progressive/chronic disease
  • Hospitalized > 3 times, and/or multiple Emergency Department visits within the last 12 months due to similar conditions
  • Inability to manage instrumental activities of daily living and have inadequate supports
  • Falls
  • Evidence of caregiver stress
  • Evidence of physical, financial, or emotional abuse
  • Funding and accommodation issues
  • Family lives out of town
  • Cognitive impairment that is interrupting the delivery of the Patient Care Plan
  • History of substance abuse

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?

Handouts & Resources

Click the link below to download a copy of the most current High Risk Indicator Guide:

 

High Risk Indicators

 

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.

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 - MedSurg

 

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.

Course Help and Resources - update links

Handouts & Resources - update links

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

High Risk Indicators

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.

Course Help

  • Do not use the browser's back button; it takes you to the website you visited before this one; it does not go back a page within the course.
  • To navigate between lessons, use the menu on the left hand side. If it's hidden, the icon for it is a square with three horizontal lines in it.
  • You can click through questions without submitting answers, but you must click the submit button for a question to be counted as completed.
  • Every browser works a little differently depending on the settings and if there are any plug-ins, etc. It is impossible to predict and accommodate every browser setup installed at HSC. If you have any issues, please click here to email the course administrator.
  • Don't forget to SUBMIT YOUR COURSE at the end. Sometimes people just close the window but that doesn't submit your results and then it looks like you are still in the middle of your course. We want you to get credit for it.

Learner Feedback

Learner Feedback

Please help us understand how well the training is going and if there are ways in which we can make it stronger. Please take a few minutes to complete the following survey once you have finished the course. The survey should take no more than few minutes.

Take Survey

Please Note: The survey opens a new tab in your browser next to the LMS. This course is most likely open in a pop-up. Don't forget to come back here to submit your course, otherwise the LMS doesn't mark your coursework as complete. Thank you!