ADT Workflows Guide

Table of Contents
ADMISSION FROM ED – TO SAME LOCATION .................................................................................................. 2
Place the Admit Patient order ............................................................................................... 2
ADMISSION FROM ED – OBSTETRICS SPECIFIC WORKFLOWS .............................................................................. 6
ADMISSION FROM ED – TO ANOTHER CAMPUS ............................................................................................... 8
Admission Navigator .............................................................................................................. 9
ADMISSION FROM C LINIC/E XTERNAL ......................................................................................................... 11
Place Direct Admission order............................................................................................... 11
Place admission orders to sign and hold ............................................................................. 15
ADMISSION FROM ATLAS ALLIANCE PARTNER .............................................................................................. 18
READMISSION TO HOSPITAL WITHIN 72 HOURS ............................................................................................ 18
ADMISSION POST DISCHARGE/READMIT .................................................................................................... 20
ADMISSION ORDERS AND MEDICATION RECONCILIATION ................................................................................ 21
Review Home Medications .................................................................................................. 22
Review Current Orders ........................................................................................................ 23
Reconcile Home Medications .............................................................................................. 24
Order Sets ............................................................................................................................ 26
MEDICATION RECONCILIATION ONCE BPMH HAS BEEN COMPLETED ................................................................... 27
TRANSFER ......................................................................................................................................... 29
Transfer Navigator ............................................................................................................... 29
Place the Transfer Patient order .......................................................................................... 31
Psychiatry Off Service .......................................................................................................... 32
DISCHARGE ........................................................................................................................................ 33
Discharge order.................................................................................................................... 33
Discharge navigator ............................................................................................................. 34
Deceased navigator ............................................................................................................. 39
Send Patient Home from ED navigator ................................................................................ 40
LEAVE OF ABSENCE (LOA) ..................................................................................................................... 41
Procedural LOAs................................................................................................................... 41
LOAs Off Unit ....................................................................................................................... 43

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With the upgrade to Epic August 2019 version, workflows for patient movement and physician ordering have
been simplified. This guide shows you the updated workflows.

Admission from ED – to same location

This section covers how to admit a patient from the ED to the same location. There is a separate section for
Obstetrics specific workflows.

First, before placing any orders, ensure the patient is roomed.

You can easily check room status from the Storyboard.
Place an Admit Patient order as soon as you make the decision to
admit. This will notify Bed Control and update the patient class to
inpatient.
All previous admission orders have now been combined into one
order. (There are no longer separate orders for Admit to Birthing
Unit, Admit to Mental Health, etc.)
Any orders placed while the patient is in ED are active immediately.

Place the Admit Patient order

1. From within the patient’s chart, open the Orders activity. (Note: The look of your activity tabs along
the top of your screen may be different than shown depending on how you have chosen to promote
your tabs.)

2. Search for the admit order by typing “Admit” into the search field. Hit enter.

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3. Double click the Admit Patient order to open it.

4. Make sure to fill out the order from top to bottom, and from left to right. You must enter the Future
Attending (MRP).

5. Once the attending is chosen, all services specific to the provider will appear as quick buttons. Click the
button for the appropriate service.

6. The Service field will then populate with your selection.

IMPORTANT! It is imperative that you select the appropriate service by clicking the button. Do NOT fill in the
Service field manually as this may result in delays with Bed Control. If the appropriate service does not appear
as a button, this is an error. If that is the case, please create a ServiceNow ticket so that the necessary changes
are made to Epic provider profiles.

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7. Enter the Admitting Physician next. If the Admitting Physician is the same as the Future Attending,
type “=” and the name will appear.

8. Service Level options appear as buttons and are now site specific (i.e., options will vary). Click the
appropriate button.

9. Enter the Diagnosis using an ICD-10 diagnosis code. You can use the magnifying glass to search.

10. The remaining fields of the Admit Patient order are optional.
• A Provider Care Team can be added if applicable.
• Use the Special bed requests buttons to indicate special needs.
• Use the Bed request comments field to free text any other pertinent information for the Bed
Control team.

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Once the Admit Patient order is signed, the patient will automatically be admitted under the Future
Attending physician indicated in the order, the patient will become an inpatient, and a bed will be requested.

The admission order can now be modified up until the time the patient is physically transferred to their
inpatient bed. Any updates to the order will also update Bed Control. If the patient no longer requires an
admission, you could also discontinue the Admit Patient order, and Bed Control will be notified via an
autogenerated In Basket message.

All admission orders do not have to be completed at the same time as the Admit Patient order is placed.

Once you are ready to place admission orders, use the Admission navigator. Work through the navigator from
top to bottom. You will notice it is the same navigator as before, only the Admission Instructions section has
been updated with the new ADT order information. Click Admission Orders to find and place order
sets/individual orders.

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Admission from ED – Obstetrics Specific Workflows
This section covers the different scenarios for patients presenting to the ED and who are then transferred to the
Obstetric Assessment Unit (OAU).

Scenario 1
The patient is 20+ weeks and presents to the ED. If the patient has not yet been roomed and they can
physically make it to the OAU, the ED Triage nurse will set the Dispo to Send to Labour & Delivery.

Scenario 2
The patient is 20+ weeks and presents to the ED. The patient has been roomed (for example, the patient
presented with a non-obstetrical chief complaint). Obstetrics has been consulted. If Obstetrics would like the
patient to go to OAU, they will tell the nurse to send them to OAU. The ED RN will then set the Dispo to Send
to Labour & Delivery (same Dispo as above.)

Scenario 3
The patient is 20+ weeks and presents to the ED. The patient has been roomed and is expected to give
birth. The obstetrician can place an Admit order while the patient is in the ED.

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Place the Admit Order as described in the Admission from ED – to same location section above. The Admit
Patient order works the same way for the Obstetrics Specific Workflows.
Please make sure to read the Admission from ED – to same location section for full details. To quickly recap:
1. Use the Orders activity.
2. From the sidebar, search for the admit order by typing “admit” into the search field. Hit enter.
3. Double click the Admit Patient order to open it.
4. Fill out the order from top to bottom, and from left to right. Enter the Future Attending first.
5. Once the attending is chosen, all services specific to the provider will appear as quick buttons. Click the
button for the appropriate service.
6. The Service field will then populate with your selection.

IMPORTANT! It is imperative that you select the appropriate service by clicking the button. Do NOT fill in the
Service field manually as this may result in delays with Bed Control. If the appropriate service does not appear
as a button, this is an error. If that is the case, please create a ServiceNow ticket so that the necessary changes
are made to Epic provider profiles.

7. Enter the Admitting Physician next. If the Admitting Physician is the same as the Future Attending,
type “=” and the name will appear.
8. Service Level options appear as buttons and are now site specific (i.e., options will vary). Click the
appropriate button.
9. Enter the Diagnosis using an ICD-10 diagnosis code. You can use the magnifying glass to search.
10. The remaining fields of the Admit Patient order are optional.
• A Provider Care Team can be added if applicable.
• Use the Special bed requests buttons to indicate special needs.
• Use the Bed request comments field to free text any other pertinent information for the Bed
Control team.

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Admission from ED – to another campus
This section shows you how to admit a patient from the ED to another campus.

Place the Admit Patient order via the Orders activity as soon as you know the patient requires admission. This
is the same Admit Patient order as used for Admission from ED – to same campus.

Use the Service Level to indicate the receiving location. The buttons that appear for Service Level are site
specific and will vary based on where you currently are. A discharge order is NOT required.

Please make sure to read the Admission from ED – to same location section for full details re how to Place
the Admit Patient order. To quickly recap:
1. Use the Orders activity.
2. From the sidebar, search for the admit order by typing “admit” into the search field. Hit enter.
3. Double click the Admit Patient order to open it.
4. Fill out the order from top to bottom, and from left to right. Enter the Future Attending first.
5. Once the attending is chosen, all services specific to the provider will appear as quick buttons. Click the
button for the appropriate service.
6. The Service field will then populate with your selection.

IMPORTANT! It is imperative that you select the appropriate service by clicking the button. Do NOT fill in the
Service field manually as this may result in delays with Bed Control. If the appropriate service does not appear
as a button, this is an error. If that is the case, please create a ServiceNow ticket so that the necessary changes
are made to Epic provider profiles.

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7. Enter the Admitting Physician next. If the Admitting Physician is the same as the Future Attending,
type “=” and the name will appear.
8. Service Level options appear as buttons and are now site specific (i.e., options will vary). Click the
appropriate button.
9. Enter the Diagnosis using an ICD-10 diagnosis code. You can use the magnifying glass to search.
10. The remaining fields of the Admit Patient order are optional.
• A Provider Care Team can be added if applicable.
• Use the Special bed requests buttons to indicate special needs.
• Use the Bed request comments field to free text any other pertinent information for the Bed
Control team.

Admission Navigator
Work through the Admission navigator. When sending a patient to another campus, you must also complete
the Reconcile orders for site transfer tab. This ensures the orders cross from the current encounter to the
next encounter.

For example, this would apply to patients in the Civic ED who are being transferred to the Heart Institute, or for
patients in the General ED who are going to the Civic and vice versa (Civic ED going to the General).

Notice there are quick instructions for you to reference from within the navigator itself.

From within the Reconcile orders for site transfer tab, click Go to Orders for Next Admission.

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Once you click the link, all current orders for the patient will display.

To quickly reconcile and continue all orders, click “Mark Unreconciled CONTINUE”.

Alternatively, you can discontinue all orders by clicking “Mark Unreconciled DON’T CONTINUE”. Or you can
use the buttons to continue, discontinue or modify orders individually.

Keep in mind, any orders placed after reconciliation is done must be reconciled in this navigator to ensure the
order will continue when the patient is transferred. You will get a “reminder” warning when adding new orders
on the current encounter.

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Admission from Clinic/External
This section shows you how to admit a patient you have reviewed in clinic (within Epic or not).

Place Direct Admission order

If you do not have an encounter for the patient, you have two options to place the Direct Admission order.
You may create an Orders Only encounter (Option A) or use Place Amb Orders (Option B).

Option A - To create an Orders Only encounter:

Use Patient Lookup to search for your patient. (Patient Lookup will be in the Epic Toolbar along the top
of your screen. The order sequence may be different than shown, depending on your Epic profile.)

Enter the criteria for your search. Click Enter.

Double click the patient name to open the patient chart.

The chart will open in the Chart Review activity. Click the Create activity (tab).

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Enter a Type of Orders Only.

Then click Accept.

You will be taken to the Orders activity within the patient’s chart.

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Option B – Use Place Amb Orders:

Click the Epic button in the top left corner

of your screen.

The first time you

access Place Amb Orders you will need to
first select Patient Care. Then
select Place Amb Orders.

Thereafter, it will appear on your “Recent”

listing once you click the Epic button.

The Patient Lookup screen will appear. Search for your patient. Double click the patient name. Click
Accept at the “Automatic Selection for…” screen. You will be taken to the Orders activity within the
patient’s chart.

If you already have an outpatient encounter for your patient, open the encounter.

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Once the patient chart is open (using whatever above option works best), use the +ADD ORDER bar at the
bottom left of your screen to find and place the admit order.

Search for “admit” and hit Enter. Epic will use completion matching to find appropriate orders. Notice the
house icon indicating this is an Ambulatory order.

Double click to open the Direct Admission order.

Fill out the order from top to bottom, making sure all mandatory fields are addressed.

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Once you select a Hospital, further site-specific options will appear.

Select the appropriate Service Level using the buttons. The field will then display with your selection.

Note: With the upgrade to Epic August 2019 version, workflows for patient movement and physician ordering
have been simplified. All admission orders are now combined into one order. There are no longer separate
orders for Admit to Birthing Unit, Admit to Mental Health, Admit to Complex Continuing Care, Admit to Rehab.

When done filling in the details for your order, click Accept at the bottom right of the order. Then click Sign
Orders (bottom right corner of your screen).

This will notify Bed Control of your bed request. If the bed is needed within 48 hours, call Bed Control to
escalate your request. If no bed is available, it may be suggested that you send the patient to Emergency.

Place admission orders to sign and hold

At this point, you could also place orders to sign and hold for the upcoming admission. You have two options.
Option A – Chart Search:
Go to the top right corner of your screen and chart search “Orders for Admission”.

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Option B – Use Orders for Admission:

Either option will take you to the Orders activity. You can then place inpatient order sets and/or individual
orders, and you can sign and hold them.

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When signing, you will get a prompt to choose an order context. If these orders are not related to a procedure,
use free text to describe the patient’s admission. The intention of entering a context is to group the orders
together to ensure the orders are released at the appropriate time. Some patients will have multiple groups of
orders (each with its own context) signed and held at the same time. This will show the nurse which context
the orders belong to so they can release the orders appropriate for the encounter.

Once the patient is registered and arrives on the unit or is roomed in Emergency, nurses can release the
inpatient orders.

An inpatient Admit Patient order is required on each admission for legal documentation (either as part of an
order set or placed using the orders activity). Once the patient arrives, the system will continue to prompt you
until the Admit Patient order is placed.

The outpatient order notified Bed Control of your request. You must still place the inpatient Admit Patient
order. This order has the bed icon, indicating it is being used in an inpatient context.

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Admission from Atlas Alliance Partner
Readmission to Hospital within 72 hours
If you have received a patient after discharge from an Atlas Alliance partner, or the patient is being readmitted
with 72 hours of discharge, follow these instructions.

This will apply to patients transferring between TOH, HGH, RVH and SFMH. For these purposes, TOH and UOHI
are considered the same hospital as they share a formulary and order list.

Go to the Admission navigator. Click Admission Orders.

You will see the Restart from previous admission tab. Click the tab to review the order reconciliation done by
the sending site (or done on previous admission).

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Make sure to pay attention to the orders marked “Not available at this location”. Reordering/releasing such
orders may not behave as intended. Some examples include diet orders—as each site has their own dietary
system, and as well there are differences in formulary medications between hospitals.

The same principles apply for Readmissions, as this tab will appear for any admission within the Atlas
Alliance. The difference being there will be no reconciliation decisions already made in the navigator.

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Admission Post Discharge/Readmit
If you have received a patient after a discharge/readmit from within your hospital, follow these instructions for
admission.

For example, this would include patients being transferred to or from:

• Psychiatry
• Rehab
• Complex Continuing Care (CCC)
• Inter-campus transfers (excluding transfers to Psychiatry Off Service, i.e., patient who is under
Psychiatry but not in a Psychiatry bed)

Once the patient has been registered and arrived on the unit, the nurse can release the orders without waiting
for a physician reconciliation. Once the orders are released, they will be active.

Nurses will NOT be able to release any orders that were signed and held from a different hospital.

Keep in mind, when orders are released by the nurse, the authorizing provider on the order is from the
sending Service/Campus.

Physicians can release orders using the Admission navigator.

Go to the Restart from previous admission tab. Previously reconciled orders will display here showing the
decision from the sending provider.

You have the option to reorder any orders that have been marked as Discontinue.

If the orders were not reconciled prior to discharge from the sending provider, you can reorder from this
screen using the Reorder button.

If orders have already been released by a nurse, they are active, and can be reviewed in the Admission
navigator within the Review Current Orders tab.

Continue with reconciling home medications and placing new orders as shown previously.

Each admission requires an admit order. If the patient is already admitted to a unit, certain fields are no longer
required as Bed Control does not require this information.

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Admission Orders and Medication Reconciliation

Use the Admission navigator (activity tab) to place admission orders and perform medication reconciliation.

Click Admission Orders from the navigator table of contents (along the left side).

This will take you to Admit Orders and will open by default on the Review Current Orders tab.

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Review Home Medications
If you want to first review home medications, click the Review Home Medications tab.

Patient reported medications will be indicated by the person with speech bubble icon

Medications previously prescribed in Epic are indicated by the house icon

Clinic-administered medications are indicated by the syringe icon

Long-term medications are marked by the pin icon

• If the prescription was not renewed in Epic, and the medication was marked as long term, the
medication will appear as expired on this list.
• You can now discontinue expired medications, and it will strikethrough the medication to indicate it
is no longer active.
• Because it was originally ordered as a long-term medication, it will continue to show on the
patient’s medication list for 540 days after the expiry of the prescription. This will prompt clinicians
to follow up with the patient.

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Add a new medication using the +Add button. Use the buttons to indicate the Last Dose. (When verifying
orders, a pharmacist can adjust due times based on this information.)

Clinicians can also enter a med note that will be highlighted for the physician in the Reconcile Home
Medications tab. To do so, click the Order Note icon to the right of the new medication. The Medication
Notes window will display. Enter your note and click Accept. Your note will then appear below the new
medication.

At the bottom of the listing, there is a Mark as Reviewed button. This will time stamp the review with the
date, time and user. It is important that a clinician marks this as reviewed AFTER the last home medication
is added.

Review Current Orders

Back to the Review Current Orders tab. Any active orders that were placed in Emergency will show here.

Use the buttons to continue, discontinue or modify orders.

The red status bar indicates there are unreviewed current orders in this ordering session. This will reset
each time you open the Admission navigator; however, you do not need to click continue each time.

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Reconcile Home Medications
Move on to the Reconcile Home Medications tab.
At the top of the listing, there is the Med List Status indicating which stage the Best Possible Medication
History has been done and updated in the Home Medication List.

Possible options include:

• BPMH complete
• RN Initial Review – a first pass has been done by nursing
• In Progress – Med Rec techs or nursing has started the BPMH
• Unable to assess – set by clinicians if the patient condition does not allow for a BPMH
• Not appropriate – set by clinicians if the patient condition does not require a BPMH (e.g., palliation)
• MD Initial Review – a first pass has been done by physicians
• Change to BPMH – this is a new status that means a change has been made to the BPMH since the
physician last reviewed it

The same icons ( ) as shown previously are used in the Reconcile Home Medications listing.

Use the buttons on each line to mark items individually.

Use the buttons at the top of the listing to mark items in groups.

You could use both sets of buttons. For example, if you have a long list of medications and only want to
order one of them, mark the medication to be ordered using the “Order” button and then click the “Mark
Unreconciled DON’T ORDER” button to mark the remaining.

Select “Order” to continue the home medication for the admission.

• If non-formulary, the system will prompt you with an auto-substitution.
• For example, if you would like to continue a patient’s ASA while they are admitted.

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Select “Don’t Order” if you do not want the home medication to be continued during the admission, but
you do want to keep it on the patient’s home medication list for review on discharge.
• For example, you would like to stop the home medication of Ibuprofen PRN for the admission, but
you do not want to remove it from the patient’s home medication list.

Select “Replace” to order a different medication instead of the patient’s home medication.
• For example, you would like to replace a Ventolin inhaler with Ventolin nebulizer due to the
patient’s condition.

Select “Remove” to discontinue the medication for the admission and to remove the medication from the
patient’s home medication list. Use this option if this medication does not require further review upon
discharge.
• For example, if the patient had an adverse reaction to a medication and should not be taking it
during the admission or after discharge, you will want to select remove.

On the right sidebar, the red status bar will indicate the unreviewed home medications.

Once all home medications have been actioned, the status bar will turn green with a checkmark.

If home medications are added after reconciliation is done, the status bar will turn back to red. However, if
home medications are MODIFIED after reconciliation, the status bar will not turn back to red. The system is
only looking to see that each medication has been actioned, not if the home medication has been changed.

Please see section on Medication Reconciliation once BPMH has been completed for further details.

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Order Sets
Move on to the Order Sets tab.

This is where you can place admission order sets and any other orders you will need. Order sets may be
suggested for you.

Once signed, the orders are active immediately.

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Medication Reconciliation once BPMH has been completed

From your patient lists, you can quickly see a patient’s Med List Status within the BPMH Status column. To the
right of that column is the Admission Med Rec Complete? column.

The display options for the Admission Med Rec Complete? column include:
Blank – indicates an admission medication reconciliation has not been started
Yellow Yield icon – indicates the Current orders and Home medications have not been reconciled, the
Home medication list has not been marked as reviewed, and/or the med list status is not set to BPMH
Complete.
Yellow check mark – indicates the Home Medication list is set to BPMH Complete, but the
reconciliation has not been completed.
Green check mark – indicates the Home medication list has been review, the med list status is set to
BPMH Complete, Current orders have been reviewed, and each Home medication has been reconciled
once for this admission.

Because there is no mechanism in Epic to automatically flag modifications made to home

medications after reconciliation has been completed, we added a new status of “Change to BPMH”.

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Clinicians can now revert the Med List Status to “Change to BPMH” whenever any modifications are made.

This new status of “Change to BPMH” reverts the green check mark in the Admission Med Rec
Complete? column within patient lists back to the yellow yield sign, thus alerting physicians of any changes to
the med list that need to be re-reconciled. Clinicians should also add a med note to highlight the change in
the MD admission navigators.

To re-reconcile medications, double click on the icon to be taken directly to the Admission orders navigator.

Click on the Reconcile Home Medications tab to see what has changed. Make sure to set the Med List status
back to BPMH Complete before leaving this tab.

Unfortunately, since the “reconciled home meds” are now current inpatient orders, if modifications are
required, you need to go back to the Review Current Meds tab.

To view Home medications at the same time, you can open the Summary Report in the sidebar and click Home
Meds.

Make any needed modifications here, then sign the orders.

Once that is complete, we can see the icon in the patient list has changed back to a green check mark.

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Transfer
This workflow should be used for patients being transferred within the same hospital. For example:
• Transfer between services
• Transfer to and from ICU
• Transfer to and from TCU
• This excludes transfer to and from Psychiatry, Rehab, and Complex Continuing Care (CCC), as well as
transfer to another campus
o Exception is Psychiatry Off Service (workflow included below)

There is now only one transfer order and one transfer navigator. If a bed request is required, place the transfer
patient order as soon as possible to notify Bed Control.

If you attempt to order a transfer to services that require a discharge/readmit, the system will stop you from
signing the order and will direct you to the Discharge navigator.

You can place the transfer order in the Orders activity to start the bed request prior to order reconciliation.

The higher level of care service is responsible for transfer order reconciliation by default. However, you may
discuss with the transferring team for other solutions.

For example, for transfers out of ICU, order reconciliation will be completed by ICU. And for transfers to TCU,
order reconciliation will be done by the sending service.

Transfer Navigator
1. From within the patient’s chart, click the Transfer tab. There are instructions for when the transfer
order should be used within the navigator itself.

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2. Click Transfer Orders from the navigator table of contents.

3. From here you can choose to continue, modify or discontinue orders. These changes will take effect
immediately, regardless if the transfer of care to the new service/physician is delayed until patient
transfer. Nurses will see the new orders as soon as they are signed.

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Place the Transfer Patient order

4. The Transfer Patient order will be listed in the right sidebar. Click on the order to open the order
composer window.

5. Make sure to fill out the order from top to bottom, and from left to right. Once the attending is chosen,
all services specific to the provider will appear as quick buttons. Click the button for the appropriate
service and the Service field will then populate with your selection.

IMPORTANT! It is imperative that you select the appropriate service by clicking the button. Do NOT fill in
the Service field manually as this may result in delays with Bed Control. If the appropriate service does not
appear as a button, this is an error. If that is the case, please create a ServiceNow ticket so that the necessary
changes are made to Epic provider profiles.

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6. Select the appropriate option for Transfer of Care effective. Further questions will cascade in
depending on your choice.

7. Make sure to include a Diagnosis.

8. The remaining fields of the Transfer Patient order are optional.

Psychiatry Off Service

For patients at the Civic and General who will be admitted under Psychiatry Off Service, use the Transfer
navigator until there is a bed on the Psychiatry Unit. Orders will be active immediately.
Once there is a bed on the Psychiatry Unit, you must follow the Discharge/Readmit workflow.

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Discharge
There are various scenarios for discharging a patient and associated order reconciliation processes. The
discharge process has been streamlined to have 1 Discharge order, 1 Discharge navigator, 1 Deceased
navigator and 1 Send patient home from ED navigator.

Discharge order
The one discharge order now has 4 choices built in:
• Discharge
• Discharge to Hospital (including to/from Psych, Rehab, CCC)
• Discharge Against Medical Advice
• Deceased

If Discharge to Hospital is selected, further questions will keep cascading in based on the selections
made. This information will be sent to Bed Control at both the sending and receiving locations to start the
planning process.

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Fill in all mandatory fields (indicated by the ).

Discharge navigator
The Discharge navigator has been reorganized as follows:

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1. The Rx Printing (prescription printing) section allows you to choose a default behavior for medications
prescribed in the discharge orders navigator if the patient is going home.
o Print all – This is the default behavior and does not need to be set, unless it has been set before and
needs to be changed.
o Do not Print – Any new medication prescribed in the Discharge Home Orders navigator will not
generate a prescription, but it will update the patient’s Home Medication list in Epic.

2. The D/C Orders section now offers three choices for discharge orders. Each choice will be explained
further below.

3. The Discharge Documentation section has been adjusted slightly to improve the workflow.
o The patient discharge instructions added to the Misc instructions section will automatically pull
into the Discharge Summary.

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o The patient discharge instructions added to the Misc instructions section will automatically pull
into the Discharge Summary.

Here is more information specific to the D/C Orders section.

Discharge Home/LTC/RH Orders (Discharge Home / Long Term Care/ Retirement Home) will:
• Generate a prescription.
• Update the patients’ home medication list.

The patient’s previous home medications will appear on the left.

o If you continue a medication that is patient reported, it will continue without printing a
prescription. Such medications will appear in the Continue portion of the AVS.
o If you continue a medication that was previously prescribed in Epic, it will generate a new
prescription (unless you have selected Do Not Print from within the Rx Printing section). Such
medications will appear in the Continue portion of the AVS.
o If you modify a home medication, it will generate a new prescription (unless you have selected Do
Not Print from within the Rx Printing section). Such medications will appear in the Change how you
take portion of the AVS.
o If you discontinue a home medication, it will appear in the Stop taking portion of the AVS, and it will
be removed from the Home Medication List in Epic.
o If you start a new medication or prescribe an inpatient medication, it will generate a prescription,
and it will display in the Start Taking section of the AVS as well as update to the Home
Medication List in Epic.
o To quickly find unreviewed medications, click Find Unreviewed to highlight and jump to them.
o Once all orders are reconciled, you will see a green checkmark in the orders sidebar.

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Discharge/Readmit to <site> (Discharge/Readmits within the same hospital*) will:

• Dynamically update the button based on the patient’s location.
• Be used for transfers within a hospital to services such as Psychiatry, Complex Continuing Care and
Rehab, as well as inter-campus transfers.
• Allow physicians to sign and hold orders for the next encounter with the option to continue, modify or
discontinue orders.
• Allow a phase of care with the location to be automatically added to the orders.
• Allow nurses at the same hospital* to release orders immediately without waiting for a physician to
reconcile orders upon the second admission.

*Since TOH and the Heart Institute generally share a formulary and list of orders, discharge/ readmitting and
immediate release of orders by nursing is allowed.

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Discharge to Other Hospital Orders will:

• Be used when sending a patient to another hospital.
o Within the Atlas Alliance, however, uses a different formulary/order list; or,
o Outside the Atlas Alliance.
• Add a phase of care of Discharge to Other Hospital.
• Allow reconciled current orders to be signed and held for review, and then released during the next
encounter.
• Not allow nurses to release these orders upon receiving the patient.
• Allow physicians to reconcile the orders (as they must do) using the Admission navigator. The receiving
physician will be able to review the orders and replace any orders that are not available at their
location.

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Deceased navigator
The Deceased navigator has been streamlined to only show pertinent sections for physicians. Instructions are
included in the navigator.

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Send Patient Home from ED navigator
Instructions are included in the navigator.

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Leave of Absence (LOA)
This section will show you how to order a Leave of Absence and how to order medications to send with the
patient. The LOA navigator is used for both procedural LOAs and passes off the unit.

Procedural LOAs
This is used for patients going on LOA for a procedure, such as a cath or MRI at a different hospital.

In emergency cases, it is not necessary for an LOA order to be placed; nurses can drag and drop the patient
into the Patient’s on Leave section within the Unit Manager.

However, if you have advance notice, you can place an LOA order using the navigator. Notice that instructions
are included within the navigator.

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Click Orders for LOA. Click on the Order details link to open the order composer.

Fill in all mandatory fields (indicated by the ).

Click Meds for LOA to order any medications for the LOA.

The receiving site can use the Restart from Previous Admission navigator to continue any medications while the
patient is at the procedure hospital site.

Once the patient arrives back on the unit, and the nurse returns them from leave within the Unit Manager, the
orders will automatically be active (the hold will be removed) without intervention from the physician.

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LOAs Off Unit
This is for patients leaving the unit with or without medications, and who will then be returning to the
hospital.

Please place the LOA order and order the medications as far in advance as possible to allow Pharmacy to
prepare the leave medications as applicable.

Place the LOA order indicating when the patient will leave and what time they are expected back. It is
important this is accurate, as Pharmacy will prepare any medications for the leave based on the times specified
in the LOA order.

To order medications for a pass, click Meds for LOA link.

You will only need to mark medication orders as Continue on Pass or Do Not Continue on Pass. You can
click non-medication orders, however, doing so will not affect anything.

Medications will be dispensed for the timeframe specified in the LOA order. Controlled and PRN medications
must have a dose specified (the quantity you want to dispense) in order for pharmacy to provide,
as Pharmacy will not auto-calculate doses for these medications.

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