The Inpatient review admissions order Flashcards
what is the disposition in the ER?
where the patient goes next
what are the levels of care in the hospital
observation status
inpatient status
what level of care is typically less than 24-48 hrs in the hospital
observation status
what level of care is typically more the 24-48 hrs in the hospital
inpatient status
if a patient is needing to be admitted for basic needs what floor will they go to
med/surg
if a patient needs continuous cardiac monitoring what floor what they need to be on?
telemetry
if the patient is intubated, needs IV vasopressors or etc. what floor would they need to be on
critical care (ICU/step down)
what is the rationale behind patient transfer
we want to stabilize the patient and assess the need for definitive care
consider the needs of the patient and if there are limitations at the current hospital transfer
**transfer to the nearest appropriate hospital
tertiary care-
larger hospital with wide variety of specialty care
trauma level category levels
I-V
level 1 is the highest level of care with 24 hour immediate care from specialty services
level 2- 24 hour immediate surgical care (not specialty)
level 3- 24 hour emergency ER physician
trauma level category levels
I-V
level 1 is the highest level of care with 24 hour immediate care from specialty services
level 2- 24 hour immediate surgical care (not specialty)
level 3- 24 hour emergency ER physician
what is the emergency medical treatment active labor act?
EMTALA
this is a requirement of all hospitals to screen and treat emergencies - to at least stabilize their condition no matter their race, insurance, or ability to pay
**hospitals must treat if they can, if not must transfer. (hospitals that can take care of the situation MUST accept the transfer)
what are hand offs/reports
verbal communication during any transfer of care that reduces the risk of medical errors and improves patient safety
examples of handoffs and reports
I-PASS
SBAR
beware of _ _ which is the tendency to lock onto first piece of information
anchoring bias
with anchoring bias you can overlook?
important considerations
(can lead to incorrect primary diagnosis, missed secondary diagnosis)
ROS in _ systems
physical screens in _ systems
10
8
what is the mnemonic for admission orders
ADC VANDALISM
what does ADC VANDALISM stand for
admit to
diagnosis
condition
vitals
allergies
nursing orders
diet
activity
labs
IV fluids
studies/special instructions
medications
admit to should have what components
level of care (telemetry/ICU)
service (internal medicine) including the admitting physician cell phone and contact info
code status (full code, DNR, DNI)
what should diagnosis include?
primary diagnosis for admission
secondary diagnosis/chronic conditions that are listed as present on admission
what categories does condition include
good
fair
serious
critical
good condition
vitals are stable and WNL the patient is conscious and the indicators are excellent
fair condition
vitals are stable and WNL the patient is conscious but indicators are questionable
serious condition
vitals may be unstable and not in WNL, patient is actually ill and indicators are questionable
critical condition
vitals signs are unstable and not WNL. may be unconscious and indicators are unfavorable
assess your patients clinical status with
objective data
frequency of vital signs needs to be determined by the physician based off?
severity of illness
vitals section should include?
how frequently you are gonna take their vitals
allergies section should include
allergy and type of reaction
nursing orders should include
guidance on type of care/interventions needed on a regular basis
(fall precautions, wound care, SCD’s, Foley catheter) etc.
diet section should include
dietary restrictions (no carbs, salt etc. )
if no restriction give them a regular diet.
what should the activity section include?
what the limitations of the patient might include: should they be on bed rest, ambulate with assistance, activity is tolerated etc.
what are the kinds of labs that can be included?
STAT labs (immediate)
Timed labs ( troponin at 3:00pm)
morning labs (avoid routine labs for routine sake) - have a purpose to obtaining labs
with IV fluids make sure you specify ?
type, rate and amount
never order continuous fluids without ?
a stop time
studies section includes
imaging/tests with urgency of test
special instructions section could include
call parameters, isolation precautions etc.
what is medication reconciliation
when you confirm home meds for accuracy with patient, pharmacy, family etc. in order to reduce medical errors
- you then decide to give them home meds, or hold off on them while in the hospital
medication section should include
medication reconciliation
medication dose/frequency, and PRN medications with reason and specific parameters
PRN medications should have
reason and parameters
it is estimated that over 50% of hospitalized patients are at risk for?
DVT/PE
what are the risk factors for DVT
immobility greater than 3 days, over the age of 60, prior DVT
with DVT prophylaxis in medications section you should assess?
risk of bleeding, GI or intracranial bleeding
if there is a risk of bleeding sand no pharmacological DVT prophylaxis what should you do
SCD
sequential compressive devices, mechanical DVT prophylaxis
early ambulation (young)
if there is a moderate to high risk of DVT what should you do
pharmacological DVT prophylaxis
LMW heparin /enoxaprin/lovenox
order entries are put into the
electronic medical record
this decreases risk of error, allows for standardization
must adjust for specific patient
how can we decrease error using a EMR order entry
adjust for specific patient
what is the most important step to decrease infection transmission?
hand washing
wash hands when you enter and leave the patient room
compliance to hand washing is poor in health care how can we mitigate this?
ensure hand sanitizer stations in each room
have immediate feedback
standard precautions are for? and include?
all patients
hand hygiene, PPE only if exposed to blood or bodily fluids, cough etiquette
contact precautions should be used when?
includes what?
when there is a multi drug resistant bacteria like MRSA or C. diff
wear gown and gloves, dedicate equipment to one patient
enteric: use soap and water
droplet precautions risk
examples
procedure:
risk: respiratory droplets greater tan 5 microns
examples: neisseria, influenza, covid 19
procedure: ask within 6ft
droplet precautions risk
examples
procedure:
risk: respiratory droplets greater tan 5 microns
examples: neisseria, influenza, covid 19
procedure: ask within 6ft
airborne precautions
risk
examples
procedure:
risk : respiratory secretions less than 5 microns (stays for an extended period of time)
examples: COVID-19 with aerosol generating procedures, tuberculosis
procedure: negative pressure room, wear a respirator (N-95)
what are some examples of aerosolizing procedures
nebulizer treatments
biPAP
and intubation
burn out
prolonged excessive stress that leads to medical errors due to reduced professional efficacy
fatigue
sleep deprivation that leads to medical errors due to cognitive impairments
