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The following applies to CDU admissions outside of normal coverage hours (0800-1800)
The following applies to CDU admissions outside of normal coverage hours (0800-1800)
Depending on how busy the provider is, this may also apply during the end of the CDU providers shift, especially in the last 30-45 minutes
Which Patients can be admitted to CDU Off Hours?
The same criteria apply for CDU admits off hours as during the day. Please see CDU Protocols for a complete list of diagnoses eligible for CDU.
Steps for overnight CDU Admission
Confirm that patient meets criteria for a CDU protocol and does not trigger any exclusion criteria.
Confirm physical and nursing capacity in CDU
Make sure the patient wants to / is willing to stay
Collect Key Information from patient
CODE Status - please confirm this with the patient / MDPOA at bedside
Necessary Home Medications - while a formal medication reconciliation is not required for overnight admits, you must review outpatient medications to make sure that there are no home medications that should not be missed while awaiting a formal med rec. Most of the time a formal med rec will not happen until noon the next day. Examples include Anti-Epileptics, Anti-Psychotics, Significant Cardiac medications (Amio) etc. Use your excellent clinical judgement.
Place Obs Status Order. See How to Admit to CDU "Patient Status" section for details on how to do this
Order "Medication Reconciliation by Pharmacy" - this will alert the pharmacist to the need for a med rec in the morning
Verbally Communicate plan for CDU to Nursing
Document the CDU Plan in the Main ED Note
Use the SmartPhrase ".iescduacutezoneplan"
This will add the following to your note:
Please document your assessment of the patient and your plan for their treatment in CDU in this Note. Remember that this is the only information that the provider in the morning will have to go from when caring for this patient, so take a moment to explain your thought process.
Consider the following example of a patient placed in CDU under the back pain protocol
GOOD CDU Note Example
Problem 1 description and plan: Patient with acute on chronic back pain, likely musculoskeletal, without red flags for infection or cauda equina. Needs pain control overnight and ambulatory assesment in AM. Given remote history of cancer, if pain not controlled in AM may benefit from further imaging
a. Plan: Prednisone, Ketoralac, Acetaminophen, Gabapentin overnight. Oxycodone PO PRN. PT eval in AM. If pain not controlled in AM, consider MRI Lumbar Spine w and wo contrast to assess for metastatic disease.
BAD CDU Note Example
Problem 1 description and plan: Back Pain
a. Plan: Pain control and MRI in AM.
Prompts for PRNs, Repeat Labs, Diet etc are reminders of the orders necessary for a patient overnight prior to CDU provider arrival. These are here because these have been frequently missed with overnight admits.
9. Open and enter orders from the "ED Observation" Order Set.
Please BE SURE TO ORDER Diet (even if NPO, order an NPO diet), PRN medications for pain, nausea, sleep at a minimum.
10. Order any specific things your patient will need for their condition, but are not part of the ED Observation Order Set.
example: Vertigo, order Meclizine 25 mg PO Q8h PRN, PT eval for vestibular therapy.
11. Record the patient on the "CDU Signout Sheet". This takes like 30 seconds max.
What do I not need to do?
It is no longer required to complete the following overnight for CDU Admissions
CDU Admit Note
Formal Medication Reconciliation
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