Medworxx - Daily Patient Status Entry and Discharge Planning - ADULT MED-SURG

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.

 

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        Here is a document giving more information on how to access the training version of Medworxx.

 

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

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.

  • A Not Met Status means the patient does not meet or no longer meets (if they were previously captured in Met) any of the acute Met Criteria, but they may still face functional, socioeconomic or alternate level of care barriers that delay discharge.
  • 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 - Ashley

Before we start....

Ashley Introduction

Ashley Day 1 - Operational Comment - Part 1

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

Ashley Day 1 - Operational Comment - Part 2

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

Ashley Day 1 - Status Update

Please answer "true" or "false" to these statements.

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.

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

Ashley Day 2 - Status Update - Part 1

It's day 2 (Oct. 8th) for Ashley. 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 T3’s. 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.

Ashley Day 2 - Status Update - Part 2

How would you enter the requested Infectious Disease consult?

Ashley Day 2 - Status Update - Part 3

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

Click on the screenshot for the appropriate answers.

Ashley Day 3 - Status Update - Part 1

It's day 3. The Infectious Disease team saw the patient this morning and completed the consult. Ashley 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.

Ashley Day 3 - Status Update - Part 2

How would you enter the requested consult?

Ashley 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 Ashley is at for today: The Infectious Disease team saw the patient this morning and completed the consult. Ashley 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. And the GoAHEAD for today was:

Ashley 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 - Pat

Pat Introduction

Pat Day 1 - Operational Comment

It's the day of Pat'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.

  • Stabilize cardiac status, assess for home care
  • Penicillin allergy, ACP-R, No ARO
  • CHF, walks with cane, 3 week Hx of not managing ADLs
  • Sep. 27 to ED, left side chest pain and shortness of breath
  • Cardiac lab work daily, needs OT/PT consult
  • Lives alone, 3 stairs to access home, family out of town

Pat Day 1 - Status Update - Part 1

Let's say it's still the first day (Tuesday, Sept. 27th). The lab work from the Emergency department came back: Pat's cardiac enzymes are within normal limits.

He requires oxygen (O2 3L 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 Pat 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.

Pat Day 1 - Status Update - Part 2

Let's focus on Pat's needs for today: He requires oxygen (O2 3L nasal prongs) to keep his oxygen sats at or above 92% as per doctor's orders. Vital signs are ordered Q4H.

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

Pat Day 2 - Operational Comment

Let's say it is the second day for Pat. The OT/PT consult has occurred. A chest X-ray has been ordered for today.

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     

Pat Day 2 - Status Update

It is now the next day and time to do the status update. Pat's oxygen needs have not changed.

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 Pat's case?

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

  • 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

Pat Day 4 - Status Update - Part 1

It's now the 4th day of his stay (Friday, Sept. 30th). Pat no longer requires continuous oxygen; his sats are at 94% on room air. Vital signs are stable and are now monitored 2x a day.

Physio has begun working with the patient towards increasing their activity tolerance. They are also assessing his needs for a mobility aid due to the stairs at his home and his difficulty with them, even prior to admission.

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

Pat Day 4 - Status Update - Part 2

In the last exercise Activation was indicated as the main barrier for discharge in Pat's case. Let's focus on the details of the NOT MET criteria. Physio has begun working with him towards increasing his activity tolerance. They are also assessing his needs for a mobility aid due to the stairs at his home and his difficulty with them, even prior to admission.

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

Pat Day 4 - Status Update - Part 3

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

Click on the screenshot for the appropriate answers.

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 are 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.

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

 

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

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.

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