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Inpatient Wards Resources


LT Flynn, CPT Ullmann, and LT Cresta created a Google Classroom that outlines the inpatient admission and discharge process in a step-by-step format.

Pro Tip: Turn off email notifications (settings tab on the left side of screen) so you do not get notified each time the team updates resources in the classroom.

 

Google Classroom

Inpatient Wards Team Rooms

  • MOD and ONC – Bldg 10, 5C – Rm 5155

    • Door code: 5155*

    • Sign-out occurs here at 0600 and 1730

    • Night teams sit here

  • White and Blue – Bldg 10, 5C – Rm 5056

    • Door code: 5056*

  • Red and Yellow – Bldg 10, 5C – Rm 5024

    • Door Code: 5024*​

  • iCards – Bldg 10, 3C – Rm 3278

    • ​No Door Code

  • MICU - Bldg 9A, 4th Floor - MICU A​

    • Sign out 0600 and 1800​

  • Hospitalists' Office – Bldg 10, 5C – Rm 5054

    • Door code: 2642*

    • Medical service US can be checked out here

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MICU Nights​

One resident covering the MICU Monday through Saturday Nights (off Sunday)

iCards Nights​

One resident covering the iCards list and Cards consults Monday through Sunday Nights (off Wednesday)

NAR - Night Alternating Resident​

Swing position filling in on the following schedule to allow each night team member a night off:

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Night Team

How to Get Stuff Done

Printing

  • Map your team room printer:

    • Desktop search bar > Printers and Scanners > Add device > “The printer I want isn’t listed” > enter device name (e.g. \\mdusocpsvip\wrnm_int_mf06 ) > “Next” or “Finish”

    • Do NOT print double sided

    • Ensure STAPLE is on > printer will auto-staple your lists for you!

  • A step-by-step visual guide is in the Orientation PPT above!

    • Go to "Rounds List"

    • Click the "Select List" drop down > "Manage Care Team Lists"

    • Select facility "0067A" for Walter Reed.

    • Select Cardiology, Critical Care, Oncology, and Internal Medicine for access to all inpatient medicine lists.
       

  • Once you've set up your lists, you can add new patients​

    • Select "Add Patient" in the top right​

    • Enter the patient's DOD ID and hit "Search"

    • You can then complete their IPASS

      • Don't forget to include their DOD, Point of Contact, Code Status, and clear To-Do's with contingencies!​
         

  • To Print your IPASS / Rounds List:​

    • Select the Checklist icon in the top right​

    • Select all patients

    • Print "Detailed List"

Setting up your Rounds List

Admitting

  • Call to Admit triaged by MOD (or call resident) from ED, OSH, clinic

    • MOD triages admits from 0600 - 1500 on weekdays and assigns per trickle order

    • Call resident takes all admissions from 1500 - 1730 and acts as MOD on weekends

    • If patient going to ONC, iCards, or MICU, those teams will initiate process

    • Night MOD will admit from 1730 - 0600 including overnight ONC patients
       

  • Admitting resident will call NOD and PAD at same time to verify bed space and admission eligibility if OK for floor

    • Provide primary medical team, attending, and admitting diagnosis

    • Obtain ward location and ensure inpatient chart created
       

  • Once patient chart created by PAD (may already be active if coming from ED):

    •  Place Patient Status Order (PSO)

    •  Utilize “MED General Admission Order” Set

    •  Perform admission medication reconciliation​

      •  The "Meds History" must be exactly correct or it will negatively affect the discharge medication reconciliation

      • Use "Admission" to continue or hold home meds as necessary

    •  Document allergies and pertinent “Histories” (Social, Family, Procedure)

    •  Place Team communication orders (pager numbers, contact hours, etc)

    •  Place Code status order using “Life Sustaining Treatment” pane

    •  Write your H&P – Sign to Attending, Review to Senior resident

    •  Add Patient to your Rounds List & create an IPASS

Transferring Team

  • Rename daily progress note as "Transfer Note" and include a summary of care on your service

  • Make orders floor-appropriate if coming from MICU (alter vitals, no push meds, etc)

  • Delete ALL "To-Do's" from your IPASS

  • Remove from your Rounds List

Accepting Team

  • Determine if patient appropriate for your service

  • Place "Change Attending to" and "Transfer Order"

  • Ensure all orders are appropriate for your level of care

  • Write "Accept Note" including physical exam and updated plan of care

  • Add patient to Rounds List

Transfers

Rapids & Codes

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These are MUST-CALL and MUST-DOCUMENT events! You will notify your attending immediately and write a free text note describing the event afterwards (You can steal .smmRRTcode from Shane Mudrinich).

 

PLEASE BRING A WOW to handle orders!

  • Inform family members of your purpose and invite them to remain if wanted

  • Perform 4-system exam:

    • Attempt arousal with vigorous sternal rub and verbal stimuli

    • Observe pupils (fixed and dilated), pupillary light reflex, corneal reflex

    • Auscultate cardiac and respiratory sounds for 1 min

    • Palpate carotid pulse for 1 min

  • Call official time of death and clearly communicate it to family

  • Ask if religious services are desired

  • Inquire about autopsy (may be legally required in some cases despite family not wanting)

  • Call Infinite Legacy about organ donation candidacy (800-923-1133)

  • Must call attending

  • Complete Death Note (free text), discharge summary, death certificate (must be signed by licensed physician), and hospital death form (provided by nursing)

  • “Patient Expired” order (will trigger a preliminary cause of death PowerForm)

  • Maryland Death Certificate to be completed by licensed physician in Maryland Vital Statistics website (may be attending - PAD may email you)

  • If any further questions, team members can call Decedent Affairs (295-5815)

Inpatient Deaths

Discharging

  1. Patient is deemed medically ready for discharge

  2. Open the Discharge Workflow in Genesis

  3. Complete the discharge medication reconciliation

  4. Fill in the shared hospital course with dotphrase .DChospitalcourse

  5. Fill in the patient instructions using the dotphrase .DCpatientinstructions followed by dispo-appropriate patient activity instructions (.DCactivitySAR or .DCactivityhomeservices, etc)

    1. May include patient education forms generated by Genesis

  6. Generate and save the discharge summary note

  7. Place a Discharge Pharmacy consult order

  8. Continue editing the Discharge Summary

  9. Once pharmacy has signed off and resident has reviewed DC summ, you can place a discharge patient order

Discharge Summaries

A legible summary of the hospital course with clear To-Do’s for the following primary care and specialty providers

 

NOT a copy-and-pasted A&P from the last progress note

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Discharge summaries contain two key components:

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1. Hospital Course

  • Built in the "Shared Hospital Course" section of the Discharge Workflow, updated daily with the events of this hospital stay

  • A standardized dotphrase is available and can be taken from any resident

  • Narrative of the hospital stay (may have to pull info from multiple progress notes!)

  • Follow-up items for PCM or specialty docs are EXPLICITLY DELINEATED

​

2. Patient Instructions

  • Utilize the "Patient Instructions" section of the Discharge Workflow

  • A standardized dotphrase is available and can be taken from any resident

  • Briefly describe what happened during the hospital stay in patient-friendly language ONLY

  • Provide self-care, medication changes, return precautions, & activity and diet instructions

  • Can include educational handouts from Genesis

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The views of the authors are their own and do not purport to reflect the position of the residency program, institution, military services or the Department of Defense. All information here-within is a reflection of individual residents. 

This website is made by residents for educational and informational purposes.
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