How To Admit A Patient In Epic

Summary

This video offers a detailed step-by-step guide on how to admit a patient in a hospital setting, focusing on order sets, medication management, and necessary consultations. The process covers key aspects like pain management, bowel care for opioid use, VTE prophylaxis, lab work, smoking cessation, and sleep aids. The physician also emphasizes the importance of personalized care, adjusting orders as needed, and completing comprehensive documentation. Throughout the video, viewers gain insights into how to effectively navigate hospital admission orders and ensure holistic patient management.

Takeaways

• 😀 Regularly update admission orders to reflect the patient’s changing needs, including medications and labs.
• 😀 Always order PRN Tylenol for pain management in case it’s forgotten, as patients will likely need it.
• 😀 Include a bowel regimen for patients on opioids to prevent constipation, with default options like Miralax or Senna.
• 😀 Schedule melatonin for sleep at night rather than making it PRN, as hospital sleep quality is often poor.
• 😀 Ensure smoking cessation orders and nicotine replacement therapy are provided for patients with a smoking history.
• 😀 Use a standardized approach to VTE prophylaxis, including Lovenox for most patients, with adjustments for renal function and bleeding risk.
• 😀 Customize lab orders by removing automatic occurrences to prevent premature discontinuation of necessary daily labs.
• 😀 Review all admission orders for completeness and relevance, adjusting them as needed based on the patient's condition.
• 😀 Document patient assessments thoroughly, including physical exam findings like JVD, crackles in the lungs, and pitting edema.
• 😀 Ensure all imaging results, like chest x-rays, are reviewed and incorporated into the patient's assessment and plan for accurate diagnosis.
• 😀 Use custom order sets and frequently revisit orders during the day to ensure all necessary care is being provided and updated.

Q & A

What is the primary focus of the speaker in the video?

The primary focus is on the process of admitting a patient, specifically how to use order sets and manage various aspects of the patient's care such as medications, labs, and consults. The speaker also provides a detailed walkthrough of how to complete admission orders and notes.

Why is Tylenol (acetaminophen) prescribed as PRN for patients during admission?

Tylenol is prescribed as PRN (as needed) to ensure that the patient has a basic pain management option. The speaker emphasizes that without this, the care team may be paged later, highlighting its importance in routine patient care.

What is the speaker’s default approach for bowel care in hospitalized patients?

The speaker's default approach is to start patients on Miralax, a stool softener, unless there is diarrhea. If constipation is expected, Senna (a stimulant laxative) is added as needed. The speaker mentions that while they initially prescribed both Miralax and Senna, they now typically use Senna alone to avoid over-treatment.

Why does the speaker prefer to schedule melatonin instead of giving it PRN?

Melatonin is scheduled to ensure the patient receives it consistently, as sleep disruption is common in the hospital. The speaker argues that scheduling melatonin increases its effectiveness and reduces the chances that patients will forget or fail to ask for it when needed.

What is the role of smoking cessation orders in the admission process?

Smoking cessation orders, including nicotine replacement therapy, are prescribed to help patients avoid withdrawal symptoms while hospitalized, especially if they have a significant smoking history. This helps manage cravings and ensures better patient comfort during their stay.

How is VTE (venous thromboembolism) prophylaxis handled during patient admission?

VTE prophylaxis is typically managed by prescribing medications like Lovenox (enoxaparin) or Heparin, depending on the patient’s kidney function. If a patient is on anticoagulants like Apixaban, the decision to continue or hold them depends on the clinical situation, particularly bleeding risk.

What is the significance of customizing order sets in the speaker’s workflow?

Customizing order sets helps streamline the process by ensuring that common orders, such as CBC or BMP, are automatically included and tailored to the patient’s needs. This reduces the risk of missing important orders and enhances efficiency in patient care.

What labs and diagnostic tests does the speaker suggest ordering upon admission?

The speaker suggests ordering CBC with differential, BMP (Basic Metabolic Panel), magnesium levels, iron panels, chest X-rays, and EKGs, depending on the patient's clinical presentation. Additional tests like a UA (urinalysis) and a drugs of abuse screen are considered if there's a concern for substance use.

What does the speaker mention about the use of physical and occupational therapy consultations?

Physical therapy is considered if the patient has mobility needs, and occupational therapy is ordered if the patient has difficulty performing daily activities or requires durable medical equipment (DME). These consults help address functional limitations during hospitalization.

What is the process for completing a patient’s admission note after orders are placed?

After placing orders, the speaker reviews and refreshes the orders to ensure accuracy, then updates the patient’s history, physical exam, and assessment plan. The physical exam section includes findings such as edema, crackles, and other relevant symptoms, while the assessment plan details the patient’s medications, interventions, and follow-up needs.