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MUPC ER AU Missouri University Psychiatric Center Emergency Room Assessment Unit Operation Instructions 1
NOTICE o o o o Changes are made often. Please check the News for the Week. Phone numbers to know: Emergency Response 2 -7979 Overhead page: Use Red Phone Nurse Sup: cell 268 -6627 Security 2 -7147
Before you take a call o Please read and know the admission criteria. o Be familiar with referral sources, i. e. , n n Crisis hotlines Geri-psych facilities for patients over 55 Options for pediatric beds Options for DD sources (Developmental Disabilities) n Options for Alcohol/Substance abuse
Admission Coordinator Taking calls o All calls must be recorded on a Consumer Referral Information form. See front of referral book for highlighted areas that must be completed. Please write something in every section even if it is pt. refused or uncooperative. o If call is from a consumer in the public, behavioral health facility or other facility, collect critical info such as age, location and assess level of acuity. * When we have available beds: -If patient is suicidal with a plan or at a risk of harming others, advise to come to UMH ER or nearest hospital for medical stabilization. -If patient is over 55 years of age, a Geri-psych referral to another facility should be considered (i. e. : if patient age, is not able to participate in our treatments or if their safety is compromised due to their inability to get away from dangers). and referral information given. We DO admit patients over 55 who are able to attend groups and participate in treatment. -If patient is seeking a “psych eval. ” or refills of meds or just in need of a counselor, refer to Administrative Agent in their county. You can find this in the resource/referral book 1&2. *When we are at capacity: -Advise the caller that we are at capacity and give recommendations to other area psychiatric hospitals. -If the caller is in a crisis situation, direct them to our ER and we will assist them in finding a bed if necessary.
o o o If call is from another hospital, gather information for Referral form, if we have an available bed, fax the 2 page information sheets for completion by the referring physician. Our doctor is only giving approval for the patient to come for an evaluation, (this does not guarantee an admission), nor do we hold beds (with the exception of holding for in-house admits that have had their assessment done by our docs). When any patient is coming from a long distance, have them arrange their own transportation home in the case they are not accepted for admission after the psychiatric evaluation is completed. Fax MULES/Warrant Check also if the patient is on 96 o hold. Once the information is received back page 397 -9800 for physician review. If accepted for evaluation, you will need to call the other hospital back and let the ER know they are coming.
ALL PATIENTS Except transfers from UMH In-Patient o We need to Call the ER when we know a patient from another hospital is on the way in for evaluation. o All patients go through the ER for registration and medical clearance. Even if they are coming from another hospital, or Green Meadows, our ER doctor has to review the records from the other hospital, labs etc and give a medical clearance.
Arrival to the MUPC ER AU o Patients names are written in on the sign in log. o Security meets the patient in the AU and does a safety screening before nursing staff can start their process. Psych Aids may collect the patient’s bags and sign them into a locker for safety, but security is still responsible to use the metal detector wand after having the patient empty their pockets. Lock up all their belongings except prescription bottles which are to be placed in a clear security bag and given to the admission nurse. o Psy. Aide can start by doing the vital signs and getting the Authorization for evaluation form signed. A photo is also taken of the patient for the chart. o For involuntary commitments brought in by police or committed by a judge, their 96 hours start at the time of registration (on their patient label). We have a 3 hour time frame to read the patient rights. Watch times on the First. Net board. Ask the ER to fax over the 96 hour papers so we can verify that they are legal (see the posted information on what is needed for a legal hold. )
• All patients going to the Unit MUST have: 1. Admission paper: one of the following n n A voluntary admission form A voluntary by guardian or parent A judge signed 96 Hour commitment form with affidavits. An imminent harm form completed by a doctor or local police. 2. 3. Psychiatric Nursing Assessment (unless direct admit. ) Send labels with correct visit number and if necessary print new armband. See index for how to print labels and armbands. Patient picture Patient belongings. Voluntary patients do not need security to escort staff and patient to the unit, Involuntary patients do. Report called to unit nurse 4. 5. 6. 7.
UMH In-patient transfers to MUPC The psychiatric consult team does in-house consults during the day, Monday through Friday. -Patients needing to transfer from UMH in-patient will have their admission assessment already done by our psych consult team and they will write orders. Orders must be in the EMR before sending the patient to the Inpatient unit. Text page the new VN to the appropriate physician so that orders can be entered by the physician. (see next page for obtaining new VN number. ) -Print a new armband a page of stickers with the new VN. -Direct admissions (transfers from UMH medical unit that have already seen psychiatry consult team) will have all the nursing assessment/admission forms done on our inpatient unit. -AU will get the patient’s picture, sign Voluntary if needed, inventory belongings before sending the patient to the inpatient unit.
Obtaining new VN o o o Get patients name, age, unit where they are presenting the problem, Dr. who is requesting the direct admit, medical record number, admitted diagnosis, status (Vol/96). Contact floor room number. Assign attending physician. Call bed board at 2 -2233 and tell them you want to register for direct admit. Give them patient medical record number, unit and room number where the patient is going, attending Dr. , diagnosis. They will give you the new VN. Text page the new VN to the physician.
Patients sent from Green Meadows o o o These patients have been seen by our psychiatry staff at Green Meadows for the evaluation. The doctor at Green Meadows can dictate/type in the admission note. Text the new VN to them. The doctor can write admission orders in the EMR. Text page the new Visit Number to the Green Meadows Psychiatrist for orders to be put in. These patients must go through the ER for medical clearance and registration. Then to MUPC ER AU for security check and picture. These patients are also considered Direct Admissions since their Psychiatric Evaluation is already done. However, if for some reason the Green Meadows Psychiatrist does not enter the admission orders or do the Admission note, the Resident will have to do it here therefore the Nursing Assessment is done in the AU.
Pediatric patients seen in ER for evaluation o Walk ins are always accepted via the ER where they are registered and triaged for any medical issues to be addressed first. They are then quickly sent to the MUPC AU o Pediatric patients are seen by the Child Fellow (Resident) during the daytime hours. Use the Child Fellow beeper. o After hours pediatric patients are seen by the ROC or Moonlighter. o The patient comes to MUPC ER AU for the security check and picture and nurse admission assessment. o Consents for admission are signed in MUPC ER AU. Other consents are done on the unit.
Pediatric Phone Screenings Phone screens are done Mon – Fri from 8 to 5. The assigned attending reviews the phone screen and either 1)accepts the patient for direct admit, 2)suggests an ER medical eval and or 3)come in for face to face psychiatric screen. If accepted, they must arrive within 8 hours. The nurse can make the decision after taking the information on the phone screen. If the patient is not actively suicidal/homicidal or threat of harm to siblings, advise them to come in for a screening. The physician should be consulted if the patient is demonstrating obvious signs of psychiatric problems q. Accepted patients come directly to the Welcome Desk and are remotely registered by the AU nurse. Vol/G is signed, photo taken and patient is taken to the inpatient unit for the entire nursing psychiatric assessment/admission process. q. Page attending physician upon patients arrival to the A. U.
Patients in Room 160 (EER) o When we are at capacity, use room 160 to keep the patient comfortable until transportation is arranged or until an in-patient bed opens up. n n n n Meds and meals will be dispensed in the AU. Each meal will still have to be “requested” prior to each mealtime by entering the order into the patient’s chart. These patients may not have visitors. Patients can have reasonable snacks, no food from outside the hospital. Phone rules are 1 call per shift and staff needs to be near when call is made, especially in the case of patients awaiting transport. This is to monitor the patient who may attempt to make plan for elopement during transport. Voluntary or voluntary by guardian form must be signed if patient is not committed. Precautions or CIWA’s should be done as they are on the inpatient unit as well as progress note. Rounds are also done on the rounds board.
Transporting Patients on an involuntary status or voluntary by guardian or parent may be in escort devices for safety. Must have a physicians order for Escort Devices. o Voluntary patients can be transported after signing release. o NO stopping while en route to destination hospital. o Complete transport record and return to MUPC ER AU.
Transport Documents o Commitment forms and/or amended commitment forms. o Printed Physician’s note, including any labs and medication list. o Doctors order for escort devices on committed patients and voluntary by guardian as applicable. o Cobra Papers. o Transport tracking record.
Discharge from MUPC ER AU o If the patient does not need admission, physician, nurse and/or social worker gives referrals. o At times we may be asked to call and make an appointment for the patient. o Physician can write scripts for 30 days or less. Copy these scripts for our records. o Discharge note/Suicide Risk assessment to be completed by physician. o Patient given the discharge instructions and any other helpful information and aftercare instructions.
Transporting patients back home When admission criteria is not met o Patients who are committed, call the county of origin on the commitment form. Ask the Sheriffs department to pick the patient up. There is the Missouri Statute 632. 310 paragraph 3 that can be quoted to verify this. o Other patients should be encouraged to arrange for their own rides i. e. : family, taxi, Tri-C, etc. o We can provide taxi passes in extreme situations when no ride can be found. o Transporting patients home by hospital vehicle or staff is not to be used unless absolutely necessary. If this is done, transport tracking form must be completed and returned to MUPC ER AU.
Changing the destination facility on a 96 hour commitment signed by a Judge o Fax to the following to the judge (contact the Boone Co Sheriff Dept (573 -875 -1111) for the appropriate judge and fax number n original commitment papers n letter of acceptance from receiving facility n Amendment of placement on prior order for 96…. . n MUPC pre-typed letter re: no beds here, we will transport to… n Notice of admission of involuntary patient to MUPC form (sign as M. Smith’s designee) n Request for change of placement during 96 hour detention n Copy of the patient’s rights o Wait for judge to fax back amended commitment forms o Send copies of all these to the receiving facility Boone County Probate Court 573 -886 -4000 / 4090 Fax 573 -886 -4095
INDEX o How to print labels o How to print armbands o How to print Admission Home med reconciliation & orders (for pt. ’s transferred from in-pt at UMH)
Labels Barcode Labels are printed as an Order. In the MUPC ER AU § From the Orders screen, click on the +Add button on the left side of the screen. § To search for the barcode labels order, type barcode in the Find: blank then press Enter § Click on Barcode Labels University Hospital/Clinics to select the order. § To complete the order, click the Sign button in the lower right corner of the window. You may need to scroll down to view the Sign button. § The order is Processing. Click the Refresh button (blue arrows) on the upper right side of the screen to complete the order. § The order to print barcode labels is now complete. The labels should print at the printer assigned for that function
Armbands/ Labels Go to ID Band Reprint in My Apps page Sign in with user name and password click OK First time you use this, go to User Options Next screen, click OK Click patient visit number at the filter column Click on ‘contains’ in the operator column Enter the visit number into the filter value column Click apply filter Check the box next to the patient’s visit number Click on print selected record Choose UH Tray 2 Adult arm bands with labels Choose printer MUPC assessment 114 Click OK
Medication orders Pull up patient in Power Chart Click ‘task’ (top left screen) Click ‘reports’ Check box ‘Admission Home Medication Reconciliation and Orders’ o Choose printer with pull-down arrow o o