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Having difficulties with the admit order?

21 Aug 2016

By: Claire O’Brien, MD, chief medical information officer

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If you are being paged to place an admit order when you have (or thought you had) already placed it, there is a fix for you.

If you can’t sign your discharge orders because the Admit Order was not signed at the time of discharge, there is a fix for you too!

My admit order is not showing up!

Upon admission of a patient, you may choose to use the adult admission order set and use the admit orders within it. The first choice in the dropdown list is ‘telemetry’, but telemetry is not an admission order.  Even though it is in the list with the admission orders (because we must know what bed to order), you still must choose either ‘ED Admit’ or ‘Direct Admit’ to have actually written an admission order.  To clarify, we will be moving the telemetry order to the bottom of this list and will add clarifying language to remind you that you must still place an admit order.

If the admit order is placed within the admission order set, those orders may be held because the patient is in the ED.  The order will not be visible to bed control or to care management.  To fix this, the ED care manager will first check to see if there are any ‘held’ orders and will release the admit order on your behalf, thus preventing this confusion.

The admission orders within the admit order will default to being ‘unbuttoned’. The heading under ‘admit bed type’ is currently ‘patient care within the hospital’.  This will be changed to ‘admit orders/telemetry orders.’   Telemetry will be moved to the bottom of the list and parentheses will be added with the instruction ‘Must also place admit order above’. 

I lost all my discharge orders because the admit order had not been signed!

This is truly frustrating.  If you have done your discharge med rec, your discharge order, etc. and when attempting to sign you get the message that the admit order has not been placed or has not been signed, how do you save the work you have already done? 

You can sign everything except the discharge order, so all you have to do is REMOVE the discharge order itself and then you can sign your orders before you attempt to sign or to write the admit order. Then, place the admission order and sign.   At this point, the discharge order can be placed and signed without error.  This will prevent the loss of any other discharge work you have already done! 

Your thoughts and questions are welcomed!