PUH Discharges

• Go to the regular "Orders" section of Cerner

• Search "Home Care Referral Order Set" and the window in screenshot below will pop up.

• If you order HHPT/HHOT, you must inform the Care Manager on the floor you are doing this and make sure they set it up before the patient leaves. If patient leaves, care manager can still call them to setup but ideally you do not do this frequently to them.
• NOTE: Home Health PT and Home Health OT are NOT the same as outpatient scripts for PT/OT (discussed separately later). HHPT/HHOT means someone comes to patient's house for 2 days a week while outpatient PT/OT means they physically go take a script to a random physical therapist and tell them this is my prescription.

• If you need to order home equipment (e.g. bedside commodes/wheelchair), select the box "Durable Medical Equipment Referral Order Set." Once you hit OK, another window will launch that lets you choose items. Inform the Care manager/nurse you are ordering this and to please set it up before they leave. Not all insurance covers all this stuff so if a patient asks for an item you let them know you will order it but they may have to pay out of pocket and that the Care Manager will discuss that with them (you sign yourself off of this discussion at this point).

I. Medication Reconciliation

• Don't prescribe new home meds unless patient asks, just hit the "continue" button on med rec

• If patient is on AC/AP, need to have a chief plan for when to restart. Make this a box and ask on morning rounds. If you forget and are discharging, you need to find a senior and ask. It may be safe to just say hold until 2 week follow-up but you cannot guess. Moreover, hit the "cancel" button on the medrec so it shows as "stop taking" to the patient.

• If patient is going to SNF or IPR, can just hit green play button on literally everything, accepting facility will deal with all their meds. In fact many centers will not accept meds you send with them so you really shouldn't bother.
• EXCEPTION: If patient is going to SNF and needs narcotics (oxy/valium/etc.) you need to physically go to the floor nursing station, ask for a prescription pad like the good old days, and write a physical prescription.

II. Discharge Meds / Prescriptions

• Unless explicitly instructed otherwise, all patients should be discharged with ≥ 2 pain meds, ≥ 2 bowel meds, ≥ 1 antiemetics as listed below.

• TIP 1: make a favorites folder in your discharge meds part of the depart, this should take you < 30 seconds eventually.

• TIP 2: on morning rounds on day of suspected discharge, ask the patient where they want their meds sent or tell them you will send downstairs to pharmacy so you can save them a stop on the way out. In general it is better for patients to just pick them up downstairs so you are not paged by random pharmacies from the outside world when there are inevitable questions about your orders.

• TIP 3: MEDS TO BEDS If you think a patient might have trouble physically picking up meds on way out or anything that will delay discharge, just send everything to Presby pharmacy, put "meds to beds" in the comment of any random prescription and call Presby outpatient pharmacy and make sure they see that. They will deliver the meds to patient at bedside but this requires at least 1 hour so call them ASAP.

• OUTPATIENT LAB SCRIPTS:
• this is very applicable on Blue patients who often will need BMP/pituitary labs post-op day 7
• Put the exact lab you are ordering under "Order(s) and "Special Instructions."
• If it's an EEA patient getting a BMP/pituitary lab, page Endo and ask them where to fax results to. This is important as they often will not see patients unless there is an aberration in labs, so they do actually need to receive the results.
• IT WILL PRINT AN ACTUAL SCRIPT WHEN YOU SIGN. EITHER TAKE THIS PHYSICALLY TO PATIENT OR KINDLY ASK NURSE TO PRINT IT AND GIVE TO PATIENT.

• OUTPATIENT PT / OT SCRIPTS
• just put in comments what you are ordering and print out and give to patients (again can ask nurse to give it too).

III. DiagnosisEdit

IV. Discharge DetailsEdit

• Do not drive until follow-up visit

• No driving while taking pain medication

• May shower

• No tub baths

• Do not soak incisions

• No lifting greater than 5 pounds

• No bending or twisting at waist (esp. spine)

V. Discharge Depart OrderEdit

VI. Discharge Instructions / Education

VII. Follow-up Information Edit

General

• Anyone with nylon stitches or staples needs to be seen around POD14 for removal

• In general safe to just schedule everyone for a 2 week wound check with PA clinic and to discuss AC/AP restart if applicable if you don't know what to do, but you don't want to clog clinics with these visits either.

Attending Specific Discharge Instructions

VIII. Warfarin Follow-Up

IX: Discharge Summary