IRF Late night admits

[Ogliodendrocyte]

For those that do IRF work at stand alone at an Encompass or alike- how do you guys handle late admissions/med recs. I'll be getting direct ED admissions in the evening/ night time and I can at least put in the admission orders ahead of time but it's really frustrating to be paged about med recs after 10PM. Curious how you handle it

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[DMBandFan86]

Isn’t it within 24 hours of admit to have admission orders signed to be in compliance?

If you’re already pending admit orders, just have some good PRNs available and tell them you’ll do the med rec in the morning. There isn’t any standard med times after 2100-2200 at most places anyways. I mean what do they really need overnight if they were stable enough to transport from the ED directly to rehab after normal hours? If something out of the ordinary, can do a one time verbal. Can address pain, DVT ppx, ect in the morning.

Or can have nursing read med rec over the phone and verify verbally. You’ll have to sign later. At encompass pharmacy should be putting the meds in and I’ve found they are pretty good about it.

 

[Ogliodendrocyte]

The pharmacist will enter the outside meds but won't be administered until i perform the med rec. I just don't like getting paged after 10PM telling a med rec is ready. Seems like something can wait unless they specifically tell me a particular medication that they need

 

[Momentum70]

AT encompass the pharmacists should be reviewing. You can give them authorization to change all meds to formulary. This saves any calls on statins, ppi, etc. You also should be pending your orders as soon as you know admit is coming. In Ace it when you make your admit templates make sure to add every prn for any situation, nausea, constipation, diarrhea, sob, pain, etc. This will make you able to do admit orders in just a few minutes. You can create specific templates like Stroke with HD, Post Hip, Ant Hip, Cardiac etc. I had at least 10 different order sets saved and never took more than a few minutes to do any admit orders.

The charge nurse should be able to look over the orders with dc instructions that come for anything missing as far as weight bearing but it should not matter much. If they arrive late they should have gotten scheduled meds or if they arrive in evening then only evening meds. Therapy wont start eval until in the morning and they stay in bed through the night. Nurses almost NEVER try to get them out of bed at night and use bedpans. If they arrive with a foley, leave it in, take it out in the morning.