Tips on doing the job...
Tips on doing the job...
Embedded Files
Dotphrases
Dotphrases
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FMCOBPRENATAL - Problem list Overview in OB
FMCOBPPCLINIC
Inpatient OB
Inpatient OB
OBED Flow:
PVP -> PVP Attending
FMC -> FMC Attending
No Doc -> PVP Attending
Salud -> FMC Attending
Go to OB Navigators and create OBED note
Within OB Navigators, med rec and sign (NOT sign and hold) OB ED Triage Order Set
Note: .fmcobed
Spicy Note: .AAMOBED
Postpartum Discharge Flow:
With every patient discuss Pre-E, safe sleep
PVP/FMC Postpartum Person -> telephone encounter, route to PVP or FMC Sched and Monica for follow-up
Inpatient Pediatrics
Inpatient Pediatrics
Newborn discharge flow:
Newborn discharge flow:
Telephone encounter, route to scheduling, .fmcnbndc
Every newborn needs follow up within 3 days with either FMC, pediatrician, or lactation home nurse.
Look at bilirubin level and plug into the bilitool for specific follow up recommendations.
If clinical follow up recommended on weekend for bili, consider bili lab drawn to be done over weekend if unable to get appointment in 3 days.
LEAVE BILI FOLLOW-UPs ON LIST
Can ask TCRNs for help scheduling FMC or Salud
Newborn admission flow:
.fmcnbnhp
Every newborn needs a newborn exam within 12 hours of delivery, can do as early as 1 hour.
Use .fmcnbnprob for problem list
Add additional problems such as maternal risk factors or exam abnormalities (ex: GBS positive mother, mother with GDM, Small Gestational Age, heart murmur)
WHERE DO BABY GO?
FMC PP-> FMC baby
Salud PP-> FCYC baby
PVP PP-> FCYC baby
No Doc PP-> FCYC baby
This is currently a hot topic, as your UL for more info
Inpatient Medicine
Inpatient Medicine
Admitting a Patient
Admitting a Patient
1. Admission Orders!
Admission tab
- med rec-sign&hold tab - review current orders
- med rec-sign&hold tab - new orders - use your order sets
2. H&P Note
.fmcmedHP
3. Set primary team
-On handoff, right click under primary provider team
4. Home med rec
Admission tab
-Reconcile prior to admission medications - if "ready for provider," can order home meds, then change to "provider done"
Discharging a Patient
Discharging a Patient
1. Discharge Orders!
Discharge tab
-Med rec/discharge tab - review orders for discharge
-Med rec/discharge tab - discharge orders - use your order sets
- *Take out actual discharge order = "Discharge Patient" - the TCRNs will be discharging the patient rather than their RN
2. Discharge Summary
.fmcmeddc
- TCRN number: 970-495-8938
- FMC number: 970-495-8800
3. Once discharge summary and orders signed, they become a bedcheck
-Write "bedcheck" on handoff To Dos
Consult Guide
Consult Guide
If you place consult order, you must reach out to consultant
- name, intern with FMC at PVH
- calling about NEW consult vs SHARED patient
- QUESTION - calling about recommendations for ___
- patient name, room #//MRN?
- one liner
- pertinent labs and imaging
- treatment so far
- clinical question
Dan's Unofficial Guide to Admissions
Chart stalk the patient.
- Ensure they have ANY medical interaction with FMC (NOT including the walk-in clinic) in the past 3 years OR Fort Collins Salud in the past 2 years. Refills count.
- To check Salud: eClinical Work (UN: benjamin.smith@uchealth.org, password changes--check call room whiteboard)
- You should also check to see if they were discharged by us in the last 30 days and that they haven't switched PCPs in that time frame
- Try Care Everywhere as well to ensure we aren't missing any Salud records
Chart stalk the ED notes, labs, imaging, vitals, and attempt to chart review past medical history. Pro tip: you can sort of do this PTA if looking at the track board, seeing a "pink," and using the side bar to get an overview.
Call the ED back. Write in the chat from the consult that you returned the call. Must call back within 30 min of consult and communicate if it will be longer.
Decide where the patient should go
Add patient to our Medicine list.
Share an H&P so you and the upper level can access it. Cosigner = attending.
Go see the patient! Yay!
Create H&P with all associated problems (in order of relevance/most important--chronic conditions go at the bottom). Come up with a plan for each problem but don't write the full note now.
Write orders for the patient based on A/P under "Admission Orders" tab.
Call/find the attending to sign patient out. Can do this before or after placing admission orders based on your + upper level comfort.
Make us the primary team and contact on the Medicine list.
Update handoffs: .sonew1, .sonew2.
Finish H&P.
Double check orders.
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