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Work Prior to Admitting to CDU
Work Prior to Admitting to CDU
Who Decides to put a patient in CDU?
Patients that are candidates for CDU are identified by the initial acute care physician or mid-level. CDU patients come from the main ED. "Direct to CDU" is not an established process.
What should be done before placing patient in ED CDU?
When patients are identified as CDU candidates in the Main ED, the provider should order a “Medication Reconciliation by Pharmacy”. There is a pharmacist available to do medication reconciliation from 11 am to 9 pm. In most cases ordering a CBC and BMP should be ordered as well, although exceptions to this are possible.
Endorse patient to the CDU Provider
If you think you have a good patient for CDU you will need to tell the CDU provider about the patient. If the patient falls into one of the established protocols and does not rule out by any general or protocol specific exclusion criteria, the patient should go to the CDU. If there is uncertainty or disagreement on the appropriateness of a patient for CDU, the decision will default to the lead attending.
Admit Patient to CDU
Admit Patient to CDU
Once the patient has been accepted to CDU, and if there is capacity in the unit for the patient then the patient can be physically transferred to the CDU. The process for actually doing the admission is below. As a general rule from 8 am to 5 pm, the ED CDU provider is expected to do the work of the admission. Outside of these hours, the provider in the main zone, including PAs and residents are expected to complete these steps.
Med Rec Order - If not already ordered, please order "Medication Reconciliation by Pharmacy"
2. Dispo From Main Zone
The main zone provider who is "sending" the patient to CDU should choose the Disposition "Send to ED Obs" in the Dispo Tab.
Note: This only applies to patients going to the CDU, Please do not choose this option if the patient is to be "Obs in the Zone"
3. Notify Nursing Staff of CDU Admission
Initial ED provider should notify the nurse in the main zone of expected transfer
CDU provider should notify the CDU nursing staff of the admission
4. Complete Home Medication Reconciliation if outside of pharmacy hours (11:00 - 21:00) you will have to do this yourself
Please be sure to "Mark as Reviewed" during Med Rec, otherwise the Discharge Med Rec cannot be completed
5. Order any home medications needed while patient is in CDU
6. Complete CDU Order set in particular be sure to: (CDU Specific Order set is in the Works, for now please use the legacy order set)
Order Patient Status "Initiate Observation Status"
Order PRNs (Pain, Nausea, Sleep, etc)
Order PT and Care Management as appropriate
Order and specific tests or therapies for the particular patient
7. CDU Admission Note
The CDU admission note is the responsibility of the CDU provider.
If you are placing a patient in the CDU outside of the hours of CDU provider coverage, please document your specific Assessment of the patients condition and plan for CDU in the MDM section of your main ED note.
Use the smartphrase ".iescduacutezoneplan" to document the CDU plan until the next day provider takes over.
The CDU provider the next morning will write the admission note.
8. Alert Crosscover Physician of Admission and Add Patient to Signout Sheet (only if admission done outside of CDU Provider Coverage Hours (0800-1800)
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