CHCS Virtual Classroom (VC) Instructor Guide For Patient - PDF - PDF

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					                       DEFENSE HEALTH INFORMATION MANAGEMENT SYSTEM




  CHCS Virtual Classroom (VC) Instructor Guide
                       For
         Patient Administration (PAD):
Admissions, Dispositions, Transfers (ADT) and ADT
                     Reports




                                       Visit Us Online at:
                                    http://dhims.health.mil

The DHIMS Program Office is a component of the Military Health System Office of the Chief Information Officer.
                              Course Notes

              Purpose of Course

              Target Audience

              Environment for Application Shares

              Pre-
               Pre-positioned Data Needed

              Pronunciations/Acronyms/Key Words

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Purpose of Course:
This virtual classroom course will enable designated site personnel to create
admissions, dispositions, and transfers of patients as well as perform special ADT
functions such as a cancellation or correction. In addition, personnel will learn how
to access and view ADT reports.
Target Audience:
Site personnel tasked with creating admissions, dispositions, and transfers and/or
accessing and viewing ADT reports
Environment for Application Share:
CHCS Training database
Pre-Positioned Data Needed:
Mother must be admitted for newborn demo (see details on data required in Lesson
2, Topic 1 Instructor Notes).
Pronunciations/Acronyms/Key Words:
Acronym       Pronunciation             Meaning
ACT           A-C-T                     Activation of ADT order
A&D           A and D                   Admitting and Dispositions
L&D           L and D                   Labor and Delivery
PAD           Pad                       Patient Administration
CHCS          C-H-C-S                   Composite Health Care System




                                                                                        2
                        Course Notes: (cont.)

             Pronunciations/Acronyms/Key Words:




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Pronunciations/Acronyms/Key Words:


Acronym       Pronunciation                Meaning
MTF           M-T-F                        Military Treatment Facility
ADT           A-D-T                        Admissions/Dispositions/Transfers
VC            V-C                          Virtual Classroom
POC           P-O-C                        Point of Contact
HCDP          H-C-D-P                      Health Care Delivery Program
EC/NOK         E-C/N-O-K                   Emergency Contact/Next of Kin
PCM            P-C-M                       Primary Care Manager
RON           R-O-N                        Remaining Over Night
DEERS         Dears                    Defense Enrollment Eligibility
                           Reporting System
MEPRS         Mepers                   Medical Expense and Performance
                           Reporting System
ICD-9         I-C-D-9                      International Code of Diseases




                                                                                3
                 Patient Administration (PAD):
               Admissions, Dispositions, Transfers
                    (ADT) and ADT Reports




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Acronyms:
PAD = Patient Administration
ADT = Admissions/Dispositions/Transfers
Instructor Notes:
Be sure to perform sound checks before starting presentation.
Text:
Welcome to the Patient Administration (PAD): Admissions, Dispositions, Transfers
(ADT) and ADT Reports Virtual Classroom (VC) presentation. This training is
designed for hospital Points of Contact (POCs) and site personnel responsible for
patient admissions, dispositions, transfers, and ADT Reports.
My name is _________, and I will be your presenter today. __________ is my co-
moderator.
Now let’s take a look at our agenda.




                                                                                    4
                           Table of Contents

           Agenda                                               6
           Course Objectives                                    7
           Introduction                                         8
           Lesson 1: Perform Basic Admissions, Dispositions,
                      and Transfers                             9
           Lesson 2: Perform Special ADT Functions             92
           Lesson 3: ADT Reports                               118
           Course Summary                                      134
           References                                          135

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Instructor Notes:
Skip this slide. It is intended for the hard copy reader.




                                                                         5
                                     Agenda

              Introduction
              Lesson 1: Perform Basic Admissions, Dispositions, and
                          Transfers
              Lesson 2: Perform Special ADT Functions
              Lesson 3: ADT Reports
              Course Summary
              References
              Questions



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Instructor Notes:
Read the bulleted items at the appropriate time in the text.
If possible, use drawing tools, such as a pointer, to emphasize each bullet as it is
mentioned.
Text:
Let’s take a look at the agenda for this course. [Read slide.]




                                                                                       6
                           Course Objectives

           Upon completion of this course, you will be able to:
            Manage basic admissions, dispositions, and transfers in
             CHCS
            Perform special functions with admissions, dispositions,
             and transfers
            Access and view ADT reports




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Acronyms:
CHCS = Composite Health Care System
Instructor Notes:
If possible, use drawing tools, such as a pointer, to emphasize each bullet as it is
mentioned.
Text:
Upon completion of this course, you will be able to:
    [Read objectives listed in bullets.]


Let’s move on to our course introduction.




                                                                                       7
                                  Introduction

              Target Audience

              Benefits of ADT

              Methodology




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Instructor Notes:
If possible, use drawing tools, such as a pointer, to emphasize each bullet as it is
mentioned.
Text
This course was created to assist lead clerks and super users to become adept at
managing admissions, dispositions and transfers in addition to accessing and
viewing ADT reports.
Proper ADT use will reduce medical errors and allow patient access to medical
care.
This course will utilize a PowerPoint presentation and a demonstration of the CHCS
using a simulated training environment. Time will be allotted for student interaction
through questions, comments, and interactive polling and quiz questions.
If there are no questions at this time, let’s proceed with our first lesson.




                                                                                        8
                        Lesson 1: Perform Basic
                        Admissions, Dispositions,
                             and Transfers

              Topic 1: ADT Process Methods: Active Versus Inactive
               Wards
              Topic 2: Create an Admission
              Topic 3: Create a Transfer
              Topic 4: Create a Disposition
              Topic 5: Impact of ADT Actions on Orders




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Instructor Notes:
If possible, use drawing tools, such as a pointer, to emphasize each bullet as it is
mentioned.
Text:
Our first lesson in this course explains the two methods used at sites for ADT
processing. Once we determine what method your site is using, you will be
instructed in how to manage basic admissions, dispositions, and transfers of
patients in CHCS based on the scenario at your site.
Now, let’s review the objectives for this lesson.




                                                                                       9
                             Lesson Introduction

                           Two Methods Used at Sites
                           Security Keys and FileMan Code




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Instructor Notes:
If possible, use drawing tools, such as a pointer, to emphasize each bullet as it is
mentioned.
Text:
Our first lesson in this course centers on performing basic admissions, dispositions,
and transfers of patients in CHCS. There are two approaches used at sites for PAD
processing. One involves centralized PAD processing of admissions, transfers and
dispositions. The other includes the involvement of Clinical users’ orders in
performing ADT functions.
One thing to note is the assignment of security keys and FileMan codes necessary
for ADT processing. You should have the ampersand (&) FileMan code to be able to
process registrations. You would also need the DG ADT SECURITY key to be able
to process admissions, dispositions and transfers. In the unlikely chance that you’re
missing these keys, contact your CHCS database administrator or PAD supervisor.
Let’s begin with Topic 1, where we will explain the two main approaches for PAD
processing at sites.




                                                                                        10
           Topic 1: ADT Process Methods: Active
                   versus Inactive Wards
           Objective: Upon completion of this topic, you will be able to
                                                              active”
           describe the difference in PAD processing using “active”
                   inactive”
           versus “inactive” wards.




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Acronyms:
ADT = Admissions, Dispositions, Transfers
Instructor Notes:
If possible, use drawing tools, such as a pointer, to emphasize the item as it is
mentioned.
Text:
In this topic, you will receive an overview of the differences between PAD
processing methods for sites using “active” versus “inactive” wards. We will go over
basic definitions of the two scenarios so you can assess which method your site is
using. This will determine what type of instruction you require to process ADTs at
your site. Both methods are addressed in this course, but we will only go over the
information relevant to the method used as your site (unless the class wants
detailed instruction on both methods).
Now, let’s get started with our topic.




                                                                                       11
            Introduction/Overview of Active vs.
                      Inactive Wards
             Definition of Active and Inactive Wards
             PAD-                CLN-
              PAD-centered vs. CLN-centered process
             Which method does your site use?




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Instructor Notes:
Point to items as discussed. Circle or check items if possible. It’s recommended
that you ask students at the end of this slide which applies at their site – active or
inactivated wards?
Text:
The first question to ask is – Does your site have active or inactive wards? This will
determine which method you will use for processing ADTs at your site. So let’s start
with definitions of Active and Inactive wards.
The Clinical software contains a parameter called “Bring Up Ward for Order ‘Entry.”
This parameter will determine if a ward is clinically “Active” or “Inactive” for CHCS.
Active Ward: All order actions (in the ORE option) are available to the ordering
health care provider (HCP). Orders of any type, including ADT (Admission/
Transfer/Disposition) could potentially be entered by Clinical users via the CLN
order entry option.
Inactive Ward: Wards are not activated in the parameters. For Clinical users,
inpatient order actions are limited to viewing orders, but not entering or changing
them. No new inpatient orders may be entered by Clinical users. Only ancillary
users [Laboratory (LAB), Radiology (RAD), Pharmacy (PHR)] may enter orders for
inpatients via their subsystem order entry options. All ADT orders must be placed
and/or processed by PAD. One exception would be the admission, which could
potentially be placed by the HCP from the Outpatient page, if necessary.
You can see by these definitions that the status of the wards in CHCS determines if
your ADT processing is PAD or CLN-user centered. Which is the case at your site?
If you’re not sure, the following slides should help.


                                                                                         12
                        PAD VS. CLN: Differences

              PAD: ADT processes are initiated by PAD users
              CLN: ADT processes are initiated by CLN users




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Instructor Notes:
Point to the items as they are discussed.
Text:
If wards are inactive, PAD users initiate all admissions, transfers and dispositions
for patients via the PAD menu options. Clinical users would not be able to activate
these actions. A clinical user could enter an admission order from the outpatient
page, but not activate it or have the ability to transfer or disposition a patient on the
system.
If wards are activated, on the other hand, Clinical users, normally doctors, would
initiate all admissions, transfers and dispositions. In addition, they would “activate”
this order once the patient arrived for admission, is physically transferred to a new
ward, or dispositioned from the inpatient facility.
In summary, one method gives the primary control to the PAD Department for the
timing of ADT processing. The other method (CLN) puts the primary responsibility
on the clinical providers.




                                                                                            13
                        Overview of CLN Method

              Provider/Clinical user centered
              Initiated through clinical menu option (ORE)
              Two step process
              Clinical users control transfers/dispositions (PAD cannot
               initiate)
              Primary responsibility for ADT order timing is on CLN
               user




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Instructor Notes:
Point to the items as they are discussed. Log onto the training database (TDB) after
this slide.
Text:
We won’t go into too much detail on the CLN method unless this is what’s used at
your site (in which case, we’ll cover details in later topics). However, an overview
here would be of benefit in understanding this method.
As mentioned, this method is provider-centered. The provider (typically, a physician)
enters an admission (or transfer/disposition) order via the clinical Order Entry (ORE)
option. This is the first step. Next, when the patient physically arrives on the ward,
in the case of an admission or transfer, the order is “activated.” This is done by an
action entered in ORE called “ACT.” This “ACTing” of the order is usually performed
by a nurse, or in some cases by a ward clerk when the patient arrives. This tells the
system that the patient is now located on this ward so that inpatient orders may be
entered either by the providers or ancillary personnel.
This process puts the timing of the order and activation of ADTs on the Clinical
users. PAD users will do one more step of processing once the ADT order is
activated, but we won’t go into detail on this quite yet. First, I’ll do a quick demo of
how this clinical process looks on the system.




                                                                                           14
                        Demo: CLN ADT Functions

              Order Entry of ADT orders
              Sample admission
              ACT action (to activate admission)
              Transfer/disposition Overview




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Instructor Notes:
Log into the TDB as Dr. Lamp (Access/Verify codes: DRLAMP/DRLAMPV). You will
demo entry of an admission order. Then log on as a nurse
(NURSELAMP/NURSELAMPV) and activate the admission. Patient for demo is
Oliver Mackey. Go to your slides next.
Text:
For this demonstration, I will first log on as a doctor and place an admission order
for my patient Oliver Mackey. [I-Note: place a basic admission order to ward 8B,
“Direct to MTF.”] I won’t go into details on the admission order entry here, but you
can see how it is entered. Notice that a “page” is created for this ward. The
asterisks, however, are on the outpatient page, indicating that the system still sees
this patient as an outpatient. Once my patient is admitted, the nurse would typically
be the user to activate the order. I will log on as a nurse now and activate it. [I-Note:
as the nurse user, activate (ACT) the order.] I type ACT at the action prompt to
activate the order. Notice that now the asterisks have moved to the inpatient ward
page so the system sees this patient as an inpatient. Inpatient orders may be
entered for the patient on this page. From the Clinical user standpoint, the work is
done. However, there is one further step that PAD must do in this scenario. Let’s
look at this next.




                                                                                            15
                               RPA OPTION

              Overview/Purpose
              ONLY necessary with CLN (active wards) method
              Menu Path: PAD  ADT  RPA




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Instructor Notes:
You are exited from the TDB.
Text:
Though the Clinical method does not require PAD to initiate ADT orders, they still
must be processed by a PAD user through the RPA option. This option lists all the
pending activated admissions, transfers, and dispositions activated by Clinical
users. We will only cover this in detail if you are using activated wards at your site.
Otherwise, this option does not apply. This option gives PAD the ability to assign
register numbers for admissions and keep a record of the activated clinical ADT
orders in PAD for billing and recording purposes.
Again, this will be covered in detail later for those students who have activated
wards at their site. Now, let’s discuss the PAD method for processing ADTs.




                                                                                          16
                        Overview of PAD Method

              PAD-
               PAD-centered process
              CLN users have little to no input on CHCS (except
               possibly Admission/Preadmission order)
              One step process (after registration)
              PAD must initiate Transfers/Dispositions (CLN users
               cannot)
              Primary responsibility for timing of ADT input with PAD




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Instructor Notes:
Point to items as discussed. Circle or check items if possible.
Text:
If wards are inactivated, PAD has centralized control of the ADT processes as we
stated previously. All the processing would be done via the PAD options by PAD
users. The only exception, would be for a provider to enter an admission order or
future (preadmit) order via the outpatient page (if your site workflow and training
included the providers in this process). However, this is rare and the provider would
not fully activate the order even in this scenario.
Recall that with the CLN-centered method, there is a two step process for ADT
orders. First, entry of the order via ORE, then activation of the order (ACT action).
When wards are inactive and PAD initiates the admission, transfer, or disposition,
there is one step in that there is no “ACT” of an order. There is no entry of a future
admission through the PAD software. PAD users enter the admission, transfer, or
disposition through PAD options as soon as the paperwork is available with
information. The primary responsibility for getting the ADT information into CHCS is
therefore with PAD.
Next, let’s take a look at this process on the software using the TDB.




                                                                                         17
                         Demo: PAD Method

              Registration
              Admission
              Transfer/disposition Overview




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Instructor Notes:
Log on as JABBER/WOCKY in the training database. Access the CLN, then PAD
subsystem as detailed in the text. Go to your slides again after this demo.
Text:
First, let’s look at the CLN ORE option using a scenario with inactive wards. We
access the patient Kenneth Crockett, an inpatient on ward 9B, an inactive ward.
You can see that there is a message displayed to let you know you are in an
inactive ward. This means you are prevented from entering any inpatient orders. I
enter N at the ‘ACTION’ prompt to demonstrate that you cannot enter orders. This
means a provider cannot enter a transfer for this patient.
Let’s go to the PAD subsystem now and look at the PAD options. Registration
options are located under the ROM option. Let’s access this for a moment. You
have options to do a mini or full registration. For admissions, full registration is
required, but you don’t have to have this completed to initiate an admission. Let’s go
to the ADT Processing Menu. The first three options are used to enter admissions,
transfers, and dispositions. These options are used if you are at a site where wards
are inactive and Clinical users do not enter inpatient orders. We will look at these in
detail in the next few topics for those who use this method.




                                                                                          18
                        Summary/Conclusion

             Two Methods: CLN (active wards) vs. PAD (inactive
              wards)
             Each site uses one or the other
             Determine which method your site uses




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Instructor Notes:
Point to bulleted items as they are discussed. After inquiring with students on which
method is used at their site, you will be able to determine which sections should be
covered in subsequent topics.
Text:
This topic has given you an overview and definition of the two methods used at
different sites. Each site uses one or the other method in 90% of the cases, so we
must decide which your site uses. There is an exception in the rare case where a
site may have some wards inactivated and some activated. This is an exceptional
instance and will not be covered in this course. Let’s find out from each of you which
is applicable so we can cover the appropriate portions of the lesson. This course is
designed to cover either method.
Before concluding this topic, I have a question for you.




                                                                                         19
                                  Question
          You are a PAD user at a site that uses inactive wards
          (PAD-
          (PAD-centered). Who may enter a transfer or disposition on
          CHCS?
                 a) You – the PAD user

                 b) Nurse

                 c) Physician

                 d) All of the above




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Instructor Notes:
Read the question and possible answers.
Correct answer: a
Text:
(Note: Read the slide.)
The correct answer is a – You, the PAD user. If wards are inactivated, the Clinical
users cannot enter a transfer or disposition. A PAD user would have to do this via
the PAD options.
Now let’s move on to Topic 2.




                                                                                      20
                        Topic 2: Create an Admission

           Objective: Upon completion of this topic, you will be able to
           process a patient admission.




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Instructor Notes:
In this topic, tailor your instruction to the students you are teaching. If they are at a
site using inactive wards, start with the PAD admission process in the beginning of
this topic, and then skip the CLN method covered at the end. If they use the CLN
method (i.e., there are active wards at their site), follow the PAD instruction through
registration, then skip to the latter portion of this topic where CLN admissions are
discussed.
Text:
In this topic, we will discuss how admissions are created and processed. We will
cover the method relevant to the way your site does business – whether through the
PAD-centered or CLN-centered method.
Let’s get started.




                                                                                            21
                            PAD Menu Path

             PAD System Menu
             ADT Processing Menu

                          Menu Path: CA -> PAD -> ADT




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Acronyms:
PAD = Patient Administration
ADT = Admissions, Dispositions, Transfers
Instructor Notes:
If possible, use drawing tools, such as a pointer, to emphasize each item as it is
mentioned. Log into the TDB after this slide.
Text:
Let’s start by looking at the menu PAD users access to perform ADT functions. It is
called the ADT Processing Menu.
Note that CHCS users have various primary or initial menus when they sign onto
the system. You may have a different primary menu in the live system, or you may
access ADT through a secondary menu option. Here we are starting with the
System Manager Menu.
To get to the ADT Processing Menu, we follow the path of CA -> PAD -> ADT.
From the ADT Processing Menu, we will create a patient admission in a clinically
inactive ward. If your site has active wards, we’ll go ahead and look at the first
portion of this since it involves a full registration which is done regardless of the
wards being active or not. Full Registration may also be done via the PAD ROM
Menu.
Let’s access the training database to see how an admission is created in PAD.




                                                                                        22
                              Demonstration:

              Accessing the ADT Processing Menu
              Creating a patient admission




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Instructor Notes:
Sign onto the CHCS training database using the access/verify codes of
JABBER/WOCKY. Continue with sample data and text on the next slide.
Text:
This is the menu path from the System Manager Menu to the ADT Processing
Menu.
Type CA and press <Enter>. Type PAD and press <Enter>.
Type ADT and press <Enter>. You have now accessed the ADT Processing Menu.
To create a patient admission for an inactive ward, type ADM and press <Enter>.
You are prompted to enter the patient’s name.
Let’s stop here to emphasize how very important the patient lookup is. If names are
not entered or looked up correctly, huge data problems result with duplicate
patients. The best method for looking up a patient already registered is to enter their
Social Security Number (SSN). As you know from CHCS Orientation, you can also
enter the first letter of the last name, followed by the last four digits of the SSN. Last
name, followed by the first (with a comma, no space) is a convenient method but
not the best (we use it in the demos simply for convenience). For inpatients, you
can also enter a register number to access a patient’s record.




                                                                                             23
                             Demo: (cont.)

             Admissions




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Instructor Notes:
Continue with the demo of the admission action; continue with sample data.
Text:
We’ll access a patient who has not yet been registered. Type BELLAMY,JAMES
and enter Y, for YES, to verify that you are entering a new patient.
Most patients in CHCS are entered through mini-registration. The system requires
Full Registration, however, if the patient is being admitted.
<Full Registration> SPONSOR NAME: BELLAMY,JAMES (If the patient is their
own sponsor, once again enter their name identically or <Spacebar> then <Enter>
for quick entry.)
The system will now do a DEERS Eligibility Check on the patient. (Note: For
training purposes, the DEERS interface is not turned on. The next screen will have
“Patient – Initial Information” at the top right.)




                                                                                     24
                             Demo: (cont.)

          Patient Name: BELLAMY,JAMES
                        FMP:
                        Sex:
                        DOB:
                        SSN:
                    PATCAT:




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Acronyms:
FMP = Family Member Prefix
DOB = Date of Birth
SSN = Social Security Number
Instructor Notes:
Continue with the demo of the admission action on this and the next screen.
Discuss the entries; enter a double question mark at each field, and explain the
options as found in the text below. The asterisk (*) denotes required fields.
Text:
You now see the Patient Information screen.
FMP: 20 *Enter the appropriate FMP (Family Member Prefix) for the patient. 20, if
they are their own sponsor, 30 if they are a spouse etc.
Sex: M *Enter the appropriate Gender, M for male or F for female.
DOB: 22JAN57 *Enter the patient’s DOB (Date of Birth). For example: JAN 22 2001
or 22 JAN 01 or 1/22/01 or 012201. You may enter “??” for more examples.
SSN: 876-96-9867 *Enter the Social Security Number (SSN) of the sponsor. The
system will ask for the user to re-enter the SSN for verification. There are cases
where a person has no SSN or it is unknown. If you enter an 8 or 9 here, the system
will prompt you and ask if this is a foreign or temporary I.D. DEERS tracks these
people and issues a military I.D. with a a foreign or temporary number which looks
similar to an SSN. In this way, you can do a DEERS check even for people without
SSNs.



                                                                                      25
                              Demo: (cont.)

             Admissions




          August 2006           PAD ADT and ADT Reports, v2               26




Acronyms:
PATCAT = Patient Category
Instructor Notes:
Continue with the demo of the admission action on this and the next screen.
Continue to double question mark at each field that requires additional information.
Text:
PATCAT: M11 *Enter a valid Patient Category (PATCAT) for the patient. For
example: N11 or M11, etc. Enter “??” for more help.
Next, you are prompted for the patient identifier information.
You are prompted, ‘Does this patient have a DEERS Person Identifier code,
shown on their ID card? Yes//’
Press <Enter> to accept the default. We’ll make entries in the next two prompts, but
first let’s do a double question mark and see the options on the first prompt.
Person Identifier Type Code: You can see that there are several possibilities and
you would choose the appropriate one for the patient. We’ll enter “S” for the social
security number (SSN).
Person Identifier: If this were a newborn, you would enter “D,” or “F” in the case of
a foreigner. We’ll enter the SSN with no dashes (and confirm it at the next prompt).
File and exit.




                                                                                        26
                              Demo: (cont.)

             Admissions




          August 2006           PAD ADT and ADT Reports, v2                27




Acronyms:
DEERS = Defense Enrollment Eligibility Reporting System
Instructor Notes:
Continue with the demo of the admission action on this and the next screen.
Continue to double question mark at each field that requires additional information.
Text:
The HCP identification screen appears next. We’ll skip this since the patient does
not have one assigned.
The system will now perform a DEERS Eligibility Check on the patient. (Note: For
training purposes, the DEERS interface is not turned on so we’ll exit from these
screens.)
The system now returns to the Full Registration screen. Note that there are three
screens in Full Registration:
1. Patient Information
2. Sponsor Information
3. Emergency Contact/Next of Kin Information




                                                                                       27
                                Demo: (cont.)

              Admissions




          August 2006             PAD ADT and ADT Reports, v2                 28



Instructor Notes:
Continue with the demo of the admission action on this and the next screen. The “*”
denotes a required field. Continue with text on next slide. Type in a “??”
 and discuss the fields as shown in the text.
Text:
This is the first screen for full registration, the patient information screen.
The ‘Patient,’ ‘DOB,’ ‘ PATCAT,’ ‘FMP,’ ‘SSN’ and ‘Sex’ field entries have
defaulted from the initial patient screen prior to the DEERS Check.
Religion: This is not a required field. You may enter the patient’s religious
preference at this time. One reason would be a reference if the patient requests a
visit from a clergy member, etc.
Ethnic Origin: OTHER *This is a required field. Enter a valid Ethnic Origin code.
For more information or a list of options, enter "??."
Race: OTHER *This is a required field. Enter a valid Race code. For more
information or a list of options, enter "??." (Note: Race and Ethnic Origin
information may be used to collect statistics on genetically related diseases.)
MARITAL STATUS: MARRIED *This is a required field. Enter a valid Marital
Status code. Note that this may be important for an emergency contact.
Civ Occup: This is not a required field. The information in this field is for statistical
purposes in higher commands.
Command Interest: This is not a required field. CMD Interest is used to identify
special categories of patients that may be of special interest to the command such
as a foreign dignitary (or another category of patients that may require follow up
care).


                                                                                            28
                               Demo: (cont.)

              Admissions




          August 2006             PAD ADT and ADT Reports, v2                 29




Instructor Notes:
Continue with the demo of the admission action on this and the next screen.
Text:
Patient Addr:, St/Cntry:, Zip:, Home Phone:, Work Phone:
These are not required fields but should be filled in if possible. This information is
necessary for billing purposes.
O/P Rec Loc:, O/S Rec Loc:
These are not required fields. These fields are used to enter the Location with in
the MTF where the patient’s Outpatient record resides. The O/S field is to allow
free text entry of the patient’s record is located Off Site or not within the MTF.
Though not required, it is very important that this information is entered to track the
record and so that some automated printouts, such as telephone consults, can be
sent to the patient’s record room.
Primary Phy: This is not a required field. This allows the entry of the patient’s
primary HCP.
Reg Comment: You may enter an optional “free text” comment here.

Now you will see the Sponsor Information screen.




                                                                                          29
                              Demo: (cont.)

             Admissions




          August 2006           PAD ADT and ADT Reports, v2                30




Instructor Notes:
Continue with the demo of the admission action on this and the next screen.
Text:
The patient name and initial information through date of birth defaults from the
information already entered for this patient since he is his own sponsor.
Command Sec: This is not a required field. This field is used for the sponsor’s
Command Security, PRP, PSP or SCI. There are only three Command Security
types, whereas there may be site-defined Command Interest types used for both
dependents and sponsors. (This is the field we discussed earlier in the screen.)
Rank: (enter 1141) *Enter the sponsor’s rank. Although the system allows the field
to be by-passed, it will not allow the patient to be filed without an entry.
Mil Occup Code: *This field is for the Sponsor’s Military Occupation. Enter “??” for
more info or for a list of valid codes and select one.
DEERS UIC: This defaults from DEERS after the DEERS eligibility response.
Remember, on the training database, we are not truly connected with DEERS.




                                                                                       30
                              Demo: (cont.)

            Admissions




         August 2006            PAD ADT and ADT Reports, v2                 31



Instructor Notes:
Continue with the demo of the admission action on this and the next screen.
Text:
Local UIC: (enter 11340121) *This is a required field and very important. This field
impacts No-Show and statistical reports, as well as Medical Record Tracking and
Managed Care Program, to mention a few impacts. Enter the sponsor’s Station or
Unit. There are around 80,000 entries, but you can narrow the selection. To pull up
a picklist of Primary UICs (Unit Ship ID codes), you could enter a zip code for the
unit. There is another method to pull up a pick list. Enter “??”, and then press
<Enter>. Press <Enter> to accept the default of L (List), then again for the “P//”
default. This displays a list of all Primary UICs used in this region. Scroll to the
correct UIC and select the correct one. This will allow notification of the unit. If the
unit is unknown, as a last resort, type 55555 for “UNKNOWN.” Note: in some
cases, an active duty sponsor moves from one unit to another and the DEERS data
will not be up to date. In this situation, it’s important to enter the patient’s current
UIC. In most cases, however, the UIC will match the DEERS record.
Unit Loc: (Enter DC) This information in this field will default from the Station/Unit.
Lgth Service: 12Y *This is a required field. Enter the length of service this patient
has served. Enter "??" for more info or formatting.
Flying Status: Enter “yes” or “no” based on their current military flying status.
Duty Address:, St/Cntry:, Zip:, Duty Phone:, DSN:
This information may be entered but is not required. These fields contain the
Sponsor’s Duty address and phone information.




                                                                                           31
                                Demo: (cont.)

              Admissions




          August 2006             PAD ADT and ADT Reports, v2                     32




Acronyms:
EC/NOK = Emergency Contact/Next of Kin
Instructor Notes:
Complete the full registration. Next, you’ll continue with an admission for students
who use the PAD method (inactive wards). For students using the CLN method, see
text on the next screen.
Text:
Emergency contact information is displayed next.
This is the “EC/NOK” Information screen. EC stands for emergency contact. NOK
is next of kin.
EMERGENCY CONTACT INFO:
Name:, Relationship:, Address:, City:, St/Cntry:, Zip:
These are not required fields. These fields allow emergency contact information for
this patient in the case of an emergency. Next of Kin (NOK) may or may not be the
same as the emergency contact so fill it in accordingly.
Finally, you get a question about whether or not the patient wants to be an organ
donor. Follow your site’s business rules on how to respond to this question if it is
not already answered.
The final step on this screen is to press <Enter> to file the full registration
information.



                                                                                       32
                               Demo: (cont.)

              Admissions




           August 2006           PAD ADT and ADT Reports, v2               33



Instructor Notes:
Continue with the demo of the admission action for PAD-centered users only.
Students using activated wards at their site would continue with the CLN section at
the end of this topic.
Text:
You are prompted for a Data Error Report. Press <Enter> for NO. Next, you’re
prompted to enter an admission. The error report is important. You should look at
the issues flagged and resolve them, if possible, as part of your job. These
problems, if handled up front, improve the overall data quality.
If you are using active wards at your site, you would not be entering an admission
via this method so we will skip this PAD instruction and move to the CLN order entry
section of this topic. You have seen how to complete a full registration via the ADM
option but you could also use the Full Registration option on the ROM menu if you
were working at a site with active wards.
Now, let’s continue with the PAD admission method. Type YES at the prompt to add
a new admission for this patient.




                                                                                       33
                                Demo: (cont.)

               Admissions




           August 2006            PAD ADT and ADT Reports, v2                34



Acronyms:
ER = Emergency Room
APU = Ambulatory Procedure Unit
Instructor Notes:
Continue with the demo of the admission action for PAD-centered users only. Text:
You are prompted for the admission date/time. Press <Enter> to accept the default
of NOW.
At the ‘Source of Admission’ field, a double question mark shows the various
choices. (Note: Discuss the choices.)
Type DIR for “Direct to Military MTF” (Military Treatment Facility) from other than
Emergency Room (ER) or Ambulatory Procedure Unit (APU) and press <Enter>.
A double question mark can also be used at the ‘Admitting Ward’ field to see the
options available. We’ll type 9B and press <Enter>.
The ‘Room-Bed’ field is next, and again a double question mark will provide the
options of room numbers, gender, and bed availability.
Type 909-A and press <Enter> for room-bed selection.




                                                                                      34
                                Demo: (cont.)

               Admissions




           August 2006             PAD ADT and ADT Reports, v2                 35



Acronyms:
MEPRS = Medical Expense and Performance Reporting System
ICD-9 = International Code of Diseases
Instructor Notes:
Continue with the demo of the admission action.
Text:
Next we have the ‘MEPRS (Medical Expense and Performance Reporting System
)/Service’ field. This field refers to the workload tracking tool used to give credit to
the ward or clinic that sees the patient. Type ABAA for General Surgery and press
<Enter>.
Next type Y for Yes and press <Enter> at the ‘Meal Card Required’ field.
Then type CALD and press <Enter> twice to verify Doctor Lorraine Caldwell as the
admitting physician.
Also press <Enter> to verify Dr Caldwell as the attending physician.
At the ‘Admitting Diagnosis’ field, you would enter the ICD-9 (International Code of
Diseases) code. Type 429.4 and press <Enter>. Note that the diagnosis text
appears.




                                                                                           35
                                Demo: (cont.)

              Admissions




          August 2006             PAD ADT and ADT Reports, v2                  36




Text:
In the next field, you can enter free text of a description of the patient’s admitting
diagnosis as necessary. We’ll type post-cardiac surgery.
The next two fields are for the first and second scheduled procedures. At the first
‘Procedure’ field type 37.71 for a pacemaker procedure and continue by pressing
<Enter> twice. We won’t enter a second procedure at this point.
At the Admissions Comment, you can add any pertinent comments pertaining to the
patient’s admission. Type Admit overnight for observation and press <Enter> to
continue.
At Type/Case, a double question mark will show your choices. This field indicates
the type of case for this admission such as injury or disease. If you enter “Disease,”
you will continue filing the admission. On the other hand, if you enter Injury, you will
be required to enter additional information. Type INJ and press <Enter> to go to the
new screen.
At ‘Trauma,’ there are multiple choices for the injury. (Note: discuss the choices.)
Select “5-occurring while off duty” and press <Enter>.
Now you need to enter the cause of the injury. The double question mark shows
multiple causes. Select 299 and a date/time for the injury at the next prompt. Enter
the injury date/time as 20 JUN 2001@1100 and press <Enter>.




                                                                                           36
                              Demo: (cont.)

             Admissions




          August 2006           PAD ADT and ADT Reports, v2                37




Text:
Note that the geographic location is populated. In our demonstration, the District of
Columbia is the site location. Press <Enter>.
The injury comment is populated by the Cause of Injury code you entered. Press
<Enter> to continue.
The register number has to be a unique number for each admission. This number
is incremented automatically by the system since the parameter is set for the auto-
register number option. The system uses the next available number without user
intervention.
Note: If you have downtime at your site, for a software upgrade or another reason,
you must change your process for register numbers. Your PAD supervisor must turn
auto-registration off via the PAD parameters. The last number should be used as a
reference and you would start with the next number manually, in a paper log. The
record of register numbers for admissions during downtime should be logged, then
these numbers back loaded into the system when it comes up again (prior to
returning the system to users). When auto-reg is turned back on, your PAD
supervisor would enter the number following the last downtime register number.
To continue with our admission demo, we’ll press <Enter> to continue.




                                                                                        37
                             Demo: (cont.)

             Admissions




         August 2006           PAD ADT and ADT Reports, v2               38




Text:
You now see several screens referencing data discrepancies, patient status, and
printing prompts. Enter the appropriate status. The print prompts are:
     PRINT WORK COVER SHEET? NO// (NO)
     PRINT EMBOSS CARD? NO// (NO)
     PRINT INDEX CARD? NO// (NO)
     PRINT A MRT LABEL? NO// (NO)
     PRINT MITRC? NO// (NO)
     PRINT TPC WORKSHEET? NO// (NO)
     PRINT ADMISSION NOTICE? NO// (NO)
You will need to check your local business rules on how to respond to these items.
Any of the print prompts that appear can be customized based on site parameters
for admissions, transfers and dispositions. Customizing the set of questions can
improve workflow.
This completes a PAD admission. Now I have a couple of questions for you.




                                                                                     38
                                     Question
                             Case’
               At the ‘Type Case’ field, which of the following choices
               will require additional information?
                    a)   Disease
                    b)   Injury
                    c)   Both a and b
                    d)   Neither a nor b




          August 2006              PAD ADT and ADT Reports, v2            39




Instructor Notes:
Read the question and possible answers.
Correct answer: b
Text:
(Note: Read the slide.)
The correct answer is b - injury. Extra information such as the location and
date/time of the injury are required.
Now let’s move on to Topic 2.




                                                                               39
                                 Question
           True/False:
           A patient must have already gone through a full registration
           before the ADT admission option may be accessed.




          August 2006             PAD ADT and ADT Reports, v2                 40




Instructor Notes:
If you are teaching students using inactive wards (PAD method), the topic ends
here. Skip the CLN slides that follow on this topic and go to Topic 3.
Read the question and explain the answer.
Correct answer: False
Text:
The correct answer is False. If a patient is not fully registered is entered in the
admission option (ADM), the system will display the screens needed for a full
registration. This information is completed during the admission process.
Now let’s move on to Topic 3.




                                                                                      40
                         CLN Admissions




          August 2006            PAD ADT and ADT Reports, v2                41




Instructor Notes:
This slide begins the CLN method section of this topic for students at sites with
activated wards.
Text:
As we’ve already discussed, if you are at a site where the wards are activated,
inpatient orders, including admissions, are entered by the providers, normally
physicians.
This means that instead of PAD initiating the admission on CHCS, the physician
enters it via an order in the order entry option (ORE) located on the physician’s
menu. We’ll demonstrate this in a moment, but first let’s look at a slide giving you an
overview of the two-step process involved when providers enter admissions.




                                                                                          41
                 Clinical admission: Two Steps

             Admission Order is entered in ORE
                           activated” (ACT’
              The order is “activated” (ACT’ed)




          August 2006           PAD ADT and ADT Reports, v2                42




Instructor Notes:
This slide continues the CLN method section of this topic for students at sites with
activated wards. A demo in the training database is next.
Text:
As we’ve mentioned previously, when the clinical method is used on active wards,
there are two steps involved for Clinical users in order to fully activate the
admission. What do we mean by “activate?” This is not referring to activation of
orders such as a lab or pharmacy order in order entry. Activation of an admission
means that the patient is seen on the order entry page as having already entered
the ward. This is very important since inpatient orders cannot be actively processed
by the ancillaries (LAB, PHR, etc.) until the admission is activated. We’ll talk in
more detail about the impact on orders later in the lesson.
Let’s talk about the two steps for a Clinical admission. First, the admission order is
entered by the provider (physician, normally). Next, the order is
 “A-C-T’ed.” This ACT action, entered in order entry, should be done at the time the
patient actually physically enters the ward. The ACT action activates the admission
and the patient is now seen as occupying the ward (as indicated on the order entry
page display). This may make more sense when you see it on the system, so we’ll
take a look at it on the training database next.




                                                                                         42
                             Demo: (cont.)

             Entry of Admission from CLN option




          August 2006           PAD ADT and ADT Reports, v2                43




Instructor Notes:
Log onto the TDB as Dr. Lamp (Access/Verify codes: DRLAMP/DRLAMPV). Go to
the ORE option.
Text:
I am logged in as a doctor. To enter an admission order, I use the ORE option on
the physician’s menu.
Type Picard,B and press <Enter> twice to accept the patient name and default
requesting location. At ‘ACTION’ type N for New and press <Enter>. At ‘ORDER
TYPE’ type ADT and press <Enter>. At ‘ADT Procedure’ type ?? and press
<Enter> to see your choices. We want to enter an Admission order, so type A and
press <Enter> twice. That brings you to the Admission Order screen. At the
‘Admitting Ward’ field, type 10A and press <Enter>. In the training database, Ward
10A is a clinically active ward. Notice that the current census displays. The order
date/time defaults to the current time but you may change this to a future date. We’ll
accept the default. Type AAAA and press <Enter> at the MEPRS field. The
inpatient MEPRS code always begins with an “A” and should correspond to the
appropriate inpatient code for the admission. Note that the attending physician
defaults to your name as the provider entering the order. The ‘Diagnosis’ field is
free text. Type Pain in lower abdominal area. The ‘Admission Comment’ and
‘Transportation’ fields are not required, but data may be entered. Type ?? to see the
types of admissions at the next field and select the one for “direct from MTF.” File
the order.




                                                                                         43
                              Demo: (cont.)

             Entry of Admission from CLN option




          August 2006           PAD ADT and ADT Reports, v2                44




Instructor Notes:
Continue demonstrating the CLN admission order in the training database. Log on
as a nurse at the appropriate time in the discussion using A/V code:
NURSELAMP/NURESLAMPV.
Text:
Note that the order is displayed in the Patient Order List (POL). Notice the two
highlight boxed in the middle left of the screen. These are what we call “pages” and
indicate the history and location of the patient. The pages are where outpatient and
ward orders display. Wherever the asterisks are displayed indicates where the
patient is currently located on the system. For this patient, the asterisks are on the
outpatient page. [I-Note: use left arrow to go to the outpatient page and demo
switching between pages.]
As you can see, we can switch between pages to display the orders for the episode.
Watch what happens if I enter an order on the inpatient page. [I-Note: Enter a
glucose order on the ward page.] You see that the order is flagged “Future.” This
means it is not yet active since the admission is not yet activated. To make the
order current and active, we must do step two of the CLN admission process – ACT
the order. The ACT action is what we do when the patient has arrived on the ward.
Usually the nurse does this, but in some cases it could be a ward clerk. First, let’s
demonstrate the nurse entering this action. I’ll enter “Q” to quit from this POL and
log on as a nurse.




                                                                                         44
                              Demo: (cont.)

             Entry of Admission from CLN option




          August 2006           PAD ADT and ADT Reports, v2                45




Instructor Notes:
Demo the ACT action using the same patient (Picard,B); you are logged on as a
nurse. Return to your slides after this demonstration.
Text:
I’m now a nurse user and my patient has arrived at the ward. I log the patient in at
the ORE prompt and enter my patient name. If the orders are not displaying, type
DPOL to display them. You see the admission order. Now, type ACT at the action
prompt to activate the admission. We entered the ACT action from the outpatient
page, but this could also be done from the inpatient page. You are prompted with a
question asking if you want to activate the admission. Press <Enter> to accept the
default of “Y” for yes. The admission order information is redisplayed with an added
field for the bed. You can enter the bed information if you have it (a double question
mark in this field shows available beds to select from). Enter bed 1006-B. You can
also confirm or edit the admission information in this screen and then file it.
Note that the Lab order is now active and no longer flagged “future.” Any orders
entered prior to the ACT action (i.e., activation of the admission) will automatically
become active once the admission is activated. You can see why the timing of this
ACT action is important. If the nurse forgot to ACT the admission, any orders for the
patient would not be available to the ancillaries for processing. Now you’ve seen a
demonstration of the two step process involved for Clinical users in entering an
admission. One other thing to note is that there is an option that can be assigned to
a clerk which allows them to only ACT admissions so they do not have access to
the ordering option. This could be utilized if ward clerks were checking in patients.




                                                                                         45
                        PAD RPA Processing

             PAD users must process clinically activated admissions
             RPA option is where pending orders are accessed
             Menu Path: PAD  ADT  RPA




          August 2006           PAD ADT and ADT Reports, v2               46




Instructor Notes:
You have exited the TDB and are back to your slides now.
Text:
Now that the Clinical admission is completed, there is an action you as a PAD user
must take. Remember, to complete an admission, the Clinical users must do the
two step process of: 1) entering the admission order, and 2) ACTing (activating) the
admission. When this occurs, the order will appear on the PAD RPA option, ready
for the PAD user to process. Let’s take a look at what displays when you access
RPA.




                                                                                       46
                           PAD RPA Processing

                                                 PAD ACTIONS


                  =========================================================================
                         ADMISSIONS                        (135)
                         INTERWARD TRANSFERS               ( 24)
                         DISPOSITIONS                      ( 16)
                         ABSENCE STATUS                    ( 0)
                         FUTURE DATED ADMISSIONS           (104)

                  ==========================================================================
                      =




          August 2006                   PAD ADT and ADT Reports, v2                            47




Instructor Notes:
Point to item on screen as discussed (or circle, if possible).
Text:
This is a sample of what you would see when you access the RPA option. Each
item listed represents ADT orders that are pending processing by the PAD user.
The numbers in the parentheses tell you how many are pending. This option should
be checked frequently throughout the day to keep up with incoming clinical orders.
The first item, “ADMISSIONS” is where you would find activated (ACT’ed) Clinical
admission orders. If the order had been entered, but not ACT’ed, it would not
appear on this list.
This RPA option should only be used to process admissions at sites where wards
are clinically activated. Obviously, if your Clinical users are not activating the
admissions because wards are set up as inactive, there will be nothing pending on
the list.
To process the admission, you would first select the category “ADMISSIONS,” and
then select the individual orders. They are listed in chronological order, with the
oldest orders listed first. By processing an admission on RPA, you are assigning the
admission number, a very important step for PAD records. Keep in mind, this is not
related to the clinical paging or ability to enter inpatient orders such as labs and
medications. Orders for the patient can be entered before PAD processes this via
RPA. However, it is crucial to the PAD records. Now let’s look at the RPA process
in the training database.




                                                                                                    47
                                      Demo

             RPA option: Admission processing




          August 2006           PAD ADT and ADT Reports, v2                48




Instructor Notes:
Enter the TDB and log on as JABBER/WOCKY. Access the PAD subsystem.
Text:
Now let’s look at the RPA option by logging into the PAD menu. I enter the ADT
option, then RPA. You can see the pending orders to be processed. I select
ADMISSIONS. Here, there is a long list of patients with admissions pending. Notice
that the dates start with the oldest to the most recent at the bottom of the list as I
scroll through them.
You can see our patient, Picard, at the bottom of the list since our provider just
entered it. Let’s select this one to process it. The sponsor name is listed first for
your confirmation (press <Enter>). The Patient Information screen is displayed
next. The required information was input in registration, but you can add or change
information here if necessary. We’ll add “Nurse” as the civilian occupation and go to
the next screen. Now you see the sponsor information which again may be edited if
necessary. Lastly, the EC/NOK screen is displayed for edit and/or confirmation.
After pressing <Enter> through these fields you are prompted for organ donor
information (follow your site policy on how to answer this). Now we’ll file the
admission information. The PCM Assignment Information screen displays after
filing. Press <Enter> and then you’ll see if any data discrepancies are listed (none
for this patient). Press <Enter>. The next screen redisplays the admission order
data and confirms that it’s been clinically activated. Press <Enter> to accept the
YES default at the next prompt for processing the admission.




                                                                                         48
                              Demo (cont.)

             RPA option: Admission processing




          August 2006           PAD ADT and ADT Reports, v2               49




Instructor Notes:
You are logged into RPA and processing an admission for Picard,Bernadette.
Continue with the demo using the data/text listed.
Text:
A DEERS interactive request is presented next. Since we are on a TDB that’s not
interfaced with DEERS, we’ll exit the DEERS screens. Now you see the Admission
screen. The information displayed comes from data entered previously in
registration and on the Clinical admission order. You may edit it or add to it if you
have more information available. For example, if you had information from the
physician on the admitting diagnosis or procedures you could enter these. We’ll
enter an admitting diagnosis (562.13). Now, let’s press <Enter> until we come to the
‘Type Case’ field, which requires an entry. Type D for disease cases. Now press
<Enter> until the file action is highlighted. Notice that a register number for the
admission is assigned. After filing, you are prompted for administrative status and
print options. These would be answered in accordance with your site policy. Let’s
take a look at them.
This completes the RPA processing of the admission.
Remember, it is important to process these orders on RPA throughout the day. You
would also be processing transfers and dispositions, as well as any future dated
admissions.




                                                                                        49
                                Demo (cont.)

              RPA option: Admission processing




          August 2006            PAD ADT and ADT Reports, v2                 50




Instructor Notes:
You are logged into RPA and processing an admission for Picard,Bernadette.
Continue with the demo using the data/text listed. You are finishing now with the
final fields displayed after filing an admission on RPA.
Text:
The first field, ‘Administrative Status,’ would be entered based on the patient’s
status and your site policy. If none apply, you may skip this field as we’ll do. Next, a
series of print options are listed. These are all answered “YES” or “NO” depending
on what your site requires for hard copies and labels on an admission. Follow your
PAD department’s site policy.
     PRINT WORK COVER SHEET? NO// (NO)
     PRINT EMBOSS CARD? NO// (NO)
     PRINT INDEX CARD? NO// (NO)
     PRINT A MRT LABEL? NO// (NO)
     PRINT MITRC? NO// (NO)
     PRINT TPC WORKSHEET? NO// (NO)
     PRINT ADMISSION NOTICE? NO// (NO)
This completes the RPA processing of the admission. The patients remaining on the
pending list are redisplayed for selection.




                                                                                           50
                        PAD RPA Processing

             Process RPA orders throughout the day to keep current
             Admissions, transfers, dispositions on RPA
             Future dated Admissions




          August 2006           PAD ADT and ADT Reports, v2                51




Instructor Notes:
You have exited the TDB and are back to your slides now.
Text:
Remember: It is important to process these orders on RPA throughout the day.
Check your RPA option frequently to keep current with your processing.
You would also be processing transfers and dispositions, as well as any future
dated admissions and absence status orders. We’ll demonstrate transfers and
dispositions are RPA later when these topics are discussed. Right now, though, let’s
look at how future dated admissions and absence transfers are processed.
We’ll return to the TDB to demonstrate. As part of this demonstration, we’ll discuss
preadmission pages in order entry as well.




                                                                                       51
                                      Demo

             RPA option: Future Admission processing




          August 2006           PAD ADT and ADT Reports, v2                52




Instructor Notes:
Enter the TDB and log on as JABBER/WOCKY. You will access the PAD RPA
option. At the appropriate time in the discussion, log on as Dr. Lamp again
(DRLAMP/DRLAMPV) and enter a future dated admission (use the patient
Picard,Jessica).
Text:
Let’s look again at the RPA option. I enter the ADT option, then RPA. You can see
the pending orders to be processed and the last category “Future Dated
Admissions.”
Future dated admissions are placed into the system in advance of the patient’s
actual admission. These admissions will be clinically activated by a provider,
through Order Entry, when the patient is actually admitted. In other words, the future
dated admission order will be “ACTed” once the patient arrives, but the admission
order may be entered hours or any date in advance of the patient’s arrival. The
patient appears on the RPA “Future Dated Admissions” list when an admission
order is placed for a future date or time, before it is activated (ACTed).
I’ll log on as a doctor now and enter a future dated admission for Jessica Picard. I
enter a future date of T+1@1200, for tomorrow at noon. I’ll file and leave the POL,
then log back in as a PAD user to look at RPA.




                                                                                         52
                                      Demo

             RPA option: Future Admission processing




          August 2006           PAD ADT and ADT Reports, v2                53




Instructor Notes:
You’re logged on as JABBER/WOCKY. Access the PAD RPA option.
Text:
I select the future admissions category. As I scroll through, notice again that
patients are listed in order of the admission date placed on the order. We find our
patient midway down the list.
These future dated admissions are displayed separately to allow the preprocessing
of registration information by PAD personnel. After the admission is clinically
activated, the record will be moved from the “Future Dated Admissions” category
and will require PAD processing in order to receive a register number.
When we select the patient from this “Future Dated Admissions” list, we would have
the chance to edit and confirm information as we demonstrated on the “Admissions”
category previously. The difference, again, is that a register number is not
assigned. We will not go through this on the demo.
Another thing to mention in regard to future admissions is a clinical function called
the “Preadmit” page. This does not require processing by PAD, but it is of benefit for
you to see how it works so you can understand the process on the Clinical side. Not
all sites use the preadmit page, but it is available. Some sites have assigned the
order entry option to PAD users for preadmission processing. Let’s take a look.




                                                                                         53
                                       Demo

              Preadmissions on Clinical software




          August 2006            PAD ADT and ADT Reports, v2                54



Instructor Notes:
Log in now as a doctor (Dr. Lamp). You will enter a pre-admission page.
Text:
I am logging in as a doctor again. The scenario is that I have placed a future
admission order for my patient and now I want to create a pre-admission page so
that I can place orders for my patient that should be done prior to admittance to the
ward. These orders could be placed on the outpatient page. However, there are
advantages to placing them on a pre-admit page. First, you have them categorized
as pre-admit orders rather than added to a long list of outpatient orders. Secondly, if
any order had not been completed (i.e., resulted) prior to the date of admission, the
order will automatically be copied to the ward page when the admission is
completed. The advantage is that these preadmission orders will be associated with
the inpatient stay which would not happen if orders were entered on the outpatient
page. This flags the inpatient personnel that orders are still pending.




                                                                                          54
                               Demo (cont.)

              Preadmissions on Clinical software




          August 2006            PAD ADT and ADT Reports, v2                55



Instructor Notes:
You are logged in now as a doctor (Dr. Lamp), continuing the demo of the pre-
admission page.
Text:
Now, let’s enter a preadmit page. We’ll access ORE and enter our patient Jessica
Picard for whom the doctor entered a future admission order. You can see that the
patient is still in outpatient status on the system, indicated by the asterisks on this
page. There is a future ward page, not yet activated since the patient’s admission is
for the next day. We will create a preadmit page. At the ‘ACTION’ prompt, type
PRE. Now you see the preadmit page appear between the outpatient and ward
page. Pre-admit orders can be entered for the patient now. I will enter a lab and a
radiology order. [I-Note: enter a CBC lab order and a RAD order for CHEST].
You can see that the preadmission orders are displayed on this page. Now watch
what happens when I “ACT” this order. The incomplete pre-admit orders have
moved to the activated ward page.
Okay, this concludes our discussion of the Clinical admission process. Before we
conclude this topic, though, I have a question for you.




                                                                                          55
                                        Question
          The following is TRUE of Future dated admission orders on
                                 Admissions”
          the RPA “Future Dated Admissions” category. They −

                        a)   Appear on RPA after activation (ACTed)
                        b)   Are assigned a register number in RPA
                        c)   Both a and b
                        d)   Neither a nor b




          August 2006                 PAD ADT and ADT Reports, v2          56




Instructor Notes:
Read the question and possible answers.
Correct answer: d
Text:
The correct answer is d – neither a nor b. A is not true – the future dated admission
orders appear on this category only prior to activation of the admission order. When
selected off this category, the admission order is preprocessed by PAD but not
assigned a register number.
Now let’s move on to Topic 3.




                                                                                        56
                        Topic 3: Create a Transfer

           Objective: At the end of this topic, you will be able to
           process a patient transfer.




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Instructor Notes:
In this topic, tailor your instruction to the students you are teaching. If they are at a
site using inactive wards, start with the PAD transfer process in the beginning of this
topic and skip the CLN method covered at the end. If they use the CLN method
(i.e., there are active wards at their site), skip the PAD instruction after this slide and
go to the latter portion of this topic where CLN transfers are discussed.
Go to the TDB next.
Text:
In this topic, we will discuss how ward transfers are created and processed. We
will cover the method relevant to the way your site does business – whether through
the PAD-centered or CLN-centered method.
Let’s get started.




                                                                                              57
                            Demo: Transfer

             Transfer




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Instructor Notes:
This starts the PAD method instruction. Skip to the CLN section if wards are
activated. Log in as JABBER/WOCKY.
Text:
Since you are at a site with inactivated wards, you must do the transfer through the
PAD options. We are going to first look at a clinically inactive ward with a sample
patient.
In this scenario, you are a PAD user who has received transfer paperwork for a
patient on ward 9A to go to ward 6A.
We begin again with the ADT Processing Menu. Type TRA and press <Enter>.
At the patient name prompt, type Clark,Anne and press <Enter>. The patient’s
inpatient episode information is displayed.
At the ‘New Transfer’ field press <Enter> to accept the default of “Yes.”
Press <Enter> to accept the date/time of NOW.
Note that you are on the Interward Transfer screen.
Note that the transfer date includes the exact time.
At the ‘Transfer to’ field, do a double question mark to see available wards. Type
6A and press <Enter>.




                                                                                       58
                                Demo: (cont.)

              Transfer




          August 2006             PAD ADT and ADT Reports, v2                 59




Instructor Notes:
Continue with the transfer topic on this screen.
Text:
At the ‘Room/Bed’ field type 602-A and press <Enter>.
Press <Enter> to accept the MEPRS code for Ward 6A.
At the ‘Transferring Physician’ field, type Caldwell and press <Enter> twice to
accept Dr. Lorraine Caldwell. The system enters the provider’s taxonomy
information automatically. Press <Enter> to accept the MEPRS code for the
transfer.
At ‘Diagnosis’ type 124 and press <Enter>. Note how the text appears. You may
edit or add to the description in this field. After I press <Enter> I can enter another
diagnosis if necessary in this screen.
Now press <Enter> until the transfer is filed.
It is very important that the transfer is done in a timely manner. If the transfer is not
entered on the system, the ancillary users for pharmacy, laboratory and radiology
orders will not have the correct ward page available to place orders. We’ll demo this
later in the lesson. For now, this concludes the PAD demo for transfers.
Here’s a question for you.




                                                                                            59
                                     Question
           Which of the following is not displayed patient information
           when creating a patient transfer?
                          a)   The admitting ward
                          b)   The date/time
                          c)       on-
                               The on-duty nurse
                          d)   The attending physician




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Instructor Notes:
This concludes the PAD-centered instruction for this topic. Skip the rest of this topic
if students have inactive wards at their site.
Read the question and possible answers.
Correct answer: c
Text:
(Note: Read the question.)
The correct answer is c, the on-duty nurse. The admitting ward, date/time, and
attending physician are all required fields. There is no field for the on-duty nurse.
Now let’s move on to Lesson 2.




                                                                                          60
                            CLN Transfers




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Instructor Notes:
This slide begins the CLN method section of this topic for students at sites with
activated wards.
Text:
As we’ve already discussed, if you are at a site where the wards are activated,
inpatient orders, including transfers, are entered by the providers, normally a
physician.
This means that PAD users have no ability to enter a transfer on CHCS when wards
are activated. The physician enters it via an order in the order entry option (ORE)
located on the physician’s menu. We’ll demonstrate this in a moment, but first let’s
look at a slide giving you an overview of the two-step process involved when
providers enter transfers.




                                                                                       61
                    Clinical Transfer: Two Steps

              Transfer Order is entered in ORE
                            activated” (ACT’
               The order is “activated” (ACT’ed)




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Instructor Notes:
This slide continues the CLN method section of this topic for students at sites with
activated wards. A demo in the training database is next.
Text:
As we’ve discussed previously on admissions, when the clinical method is used on
active wards, there are two steps involved for Clinical users in order to fully activate
a transfer. Again, activation of a transfer means that the patient is seen on the
order entry page as having already entered the transfer ward. This is very
important since inpatient orders cannot be actively processed on the correct ward
page (the transfer ward) until the transfer is activated. We’ll talk in more detail
about the impact on orders later in the topic.
Let’s review the two steps required for a clinical transfer. First, the transfer order is
entered by the provider (physician, normally). Next, the order is “ACT’ed.” This
ACT action, entered in order entry, should be done at the time the patient actually
physically transfers to the ward. The ACT action activates the transfer and the
patient is now seen as occupying the ward (as indicated in the order entry page
display).
Let’s take a look at it on the training database next.




                                                                                            62
                                     Demo:

             Entry of Transfer from CLN option




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Instructor Notes:
Log onto the TDB as Dr. Lamp (Access/Verify codes: DRLAMP/DRLAMPV). Go to
the ORE option.
Text:
I am logged in as a doctor. To enter a transfer order, I use the ORE option on the
physician’s menu.
Type Marshall,A and press <Enter> twice to accept the patient name and default
requesting location. At ‘Action’ type N for New and press <Enter>. At ‘Order Type’
type ADT and press <Enter>. At ‘ADT Procedure’ type ?? and press <Enter> to
see your choices. We want to enter an interward transfer order, so type I and press
<Enter> twice. That brings you to the Transfer Order screen. At the ‘Requested
Ward’ field, type 10A and press <Enter>. in the training database, Ward 10A is a
clinically active ward. Notice that the current census displays. Enter T@[time later
in the day] for the date/time of the transfer. Note that this date/time field may be
skipped. Type AAAA and press <Enter> at the MEPRS field. Note that the
attending physician defaults from the admission information entered previously. The
‘Comment’ and ‘Transportation’ fields are optional. We’ll skip these and file the
order.




                                                                                       63
                             Demo: (cont.)

             Transfer from CLN option




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Instructor Notes:
You are on the training database as Dr. Lamp (Access/Verify codes:
DRLAMP/DRLAMPV).

Text:
Note that the new ward page is displayed but there are no asterisks so the system
records this patient as not yet on this ward. This means that orders entered for this
new ward page would be flagged as “future” orders and not active, just as we
demonstrated for admissions.
Let’s talk about orders in relation to transfers for a moment. A provider could enter
orders on this future transfer page and they would be flagged future, but activated
once the transfer order is activated (ACTed). All orders from the “losing ward”
would be cancelled automatically at the time the transfer is activated. There is a
way around this, however, if there are orders the physician wanted to continue on
the transfer ward. They could be what we call “scratch-padded.” Notice the
message on the screen regarding scratch pad actions. These are actions Clinical
users can use to move orders to the new ward once it is activated. We won’t go into
detail since you as a PAD user would not have to do this, but this is an overview for
your understanding of the process. The scratchpad actions could even be used for
orders cancelled on the losing ward to transfer them to the new ward. This function
is sometimes used by ancillary users such as pharmacists to avoid re-entering
orders.




                                                                                        64
                              Demo: (cont.)

              Transfer from CLN option: ACT action




          August 2006            PAD ADT and ADT Reports, v2                 65




Instructor Notes:
You are on the training database as Dr. Lamp (Access/Verify codes:
DRLAMP/DRLAMPV). Change to a nurse user when indicated in the text
(NURSELAMP/NURSELAMPV)
Text:
The next step, when the patient arrives at the ward, is to activate the transfer. I will
now sign in as a nurse and do that. I access the same patient, then type in DPOL to
display the orders. Now, to activate the transfer, I type ACT at the ‘ACTION’
prompt. In the next screen the original transfer information from the order is
defaulted. There is an added field for room/bed that may be filled in (this is
optional). The attending physician defaults from the admission information. We file
the screen.
Notice that now the asterisks have moved to the new ward page, indicating that the
system recognizes the patient as being on this ward. Let’s look back that the old
“losing ward” page. You can see that all the orders were automatically cancelled.
Again, this could have been prevented for any orders if they were scratch padded
over by the CLN user.
Next, let’s look at an order for an absence status transfer.




                                                                                           65
                              Demo: (cont.)

              Transfer to Absence Status from CLN option




          August 2006            PAD ADT and ADT Reports, v2                66




Instructor Notes:
Log on as Dr. Lamp (Access/Verify codes: DRLAMP/DRLAMPV).
Text:
I’m on the system as a physician again. I have a patient who is on a ward and must
be transferred to absence status. This is a status assigned to a patient when they
are no longer physically on the ward but will return in a number of days. The patient
is still counted as an inpatient on that ward. The absence transfer is usually used for
a leave greater than 100 hours (but you should check with your site’s policy).
The use of the absence status may vary per branch of the military service. For
example, “convalescent leave” is commonly assigned for an absence for 30 days in
the Army and Air Force. In the Navy, however, the patient is dispositioned rather
than put on con leave.
If an absence status is required and you have active wards, this is how it is done. I
enter a new ADT order as we did for admissions and transfers. This time, I will enter
the patient Allen Kagan for this demo. At the “Select ADT Procedure prompt, I enter
“AB” for Absence Transfer. Let’s enter ?? at the first field in the Absence Transfer
Order screen to see the options. We’ll select Convalescent Leave. The remaining
fields are not required. You may enter the duration of the leave, a yes/no to reserve
the bed, and comments as desired. File the order.




                                                                                          66
                              Demo: (cont.)

              Transfer to Absence Status from CLN option




          August 2006            PAD ADT and ADT Reports, v2                 67




Instructor Notes:
You are logged on as Dr. Lamp (Access/Verify codes: DRLAMP/DRLAMPV). Text:
The existing orders are displayed and I may select any I would like to retain.
Otherwise, other than an outpatient prescription (RX), the orders will be put on hold
when the absence transfer order is activated. I press <Enter> until the POL is again
displayed. There is no change to the patient’s status on the system since the
absence transfer order has not yet been activated.
To clinically activate an admission, the user would type ABS this time, not ACT at
the ‘ACTION’ prompt. We’ll do this now. I am presented with the absence transfer
screen again to confirm information and fill in the optional fields, then File. Notice
that orders are put on hold unless we had selected them in the previous screen.
Next, the order is processed by a PAD user on the RPA menu.




                                                                                         67
                                Demo (cont.)

              RPA option: Transfer processing




          August 2006             PAD ADT and ADT Reports, v2                 68




Instructor Notes:
Enter the TDB and log on as JABBER/WOCKY. You will access the PAD RPA
option.
Text:
Let’s look again at the RPA option. I am logged in as a PAD user. I enter the ADT
option, then RPA. You can see the pending orders to be processed and the
categories “Interward Transfers” and “Absence Status.” We’ll process the
interward transfer first.
I select the transfer category and I’m prompted to display all wards or I can enter
the ward my patient is on – 10A. I will enter this here. My patient is listed for
selection. Now I am prompted to process the transfer so I press <Enter> for “Yes.”
I press <Enter> through the fields redisplaying the transfer information from the
original clinical order. In the next screen, I may enter a diagnosis, but I will assume I
don’t have this information and leave it blank. I file to complete the transfer
processing. Next, I’m prompted for administrative status as you saw with
admissions. This does not apply to my patient so I leave it blank and then press
<Enter> through the print prompts. Now I’m back to my RPA screen. I will process
the Absence Status transfer order next.




                                                                                            68
                               Demo (cont.)

              RPA option: Absence Status Transfer processing




          August 2006            PAD ADT and ADT Reports, v2                69




Instructor Notes:
You’re logged in as JABBER/WOCKY. You have accessed the PAD RPA option.
Text:
I select the “Absence Status” category and I’m prompted to display all wards or I
can enter the ward my patient is on – 10A. I will enter this here. My patient is listed
for selection. Now there’s a screen showing the patient’s previous admission. This
admission is listed for processing since it had not yet been processed by PAD in the
RPA menu. This must be done first before the Absence Transfer can be processed.
This would be the case with other orders, including transfers and dispositions, that
you try to process through RPA if the admission was incomplete. We will quickly
process this admission using the <page down> key to go through the screens and
activate the admission. We’ll bypass the DEERS check screens (press <Exit>) and
in the admission screen fill in the ‘Type Case’ field with DIS. Press <Enter> through
the remaining admission prompts and now you’re ready to do the absence transfer
processing.




                                                                                          69
                              Demo (cont.)

             RPA option: Absence Status Transfer processing




          August 2006           PAD ADT and ADT Reports, v2               70




Instructor Notes:
Enter the TDB and log on as JABBER/WOCKY. You will access the PAD RPA
option. Make entries in fields listed if desired for demo, or leave them blank.
Text:
Once you start processing it, the following fields appear:
    Date Left for Absence: 21 Jun 2001@1708
    Absence Status: CL
    Anticipated Return Date:
    Convalescent Leave Duration:
    Reserve Bed: YES
    Absence Facility: [do a ?? Here]
Then:
    Civilian Physician:
    Provider:
    Select Diagnosis:
And finally:
    Military Service Notified Date:
The blank fields are not required but may be filled in if you have the information.
File and you’ve completed the transfer to absence status. This concludes our
instruction on the processing of CLN transfers. Let’s review what we covered in this
topic.


                                                                                       70
                        Clinical Transfers: Review

             Interward transfer:
                     Order is entered in ORE
                     Order is activated (ACT action) in ORE

                     Activated order is processed through RPA by PAD

             Absence Status transfer:
                     Order is enter in ORE
                     Select existing clinical orders to remain active

                     Order is activated in ORE (ABS action)

                     Activated order is processed on RPA by PAD

          August 2006             PAD ADT and ADT Reports, v2              71




Instructor Notes:
You have exited the TDB. Review the bulleted items.
Text:
Let’s review the steps required for a clinical interward and absence status transfer.
First, the interward transfer order is entered by the provider (physician, normally).
Next, the order is “ACT’ed.” This ACT action, entered in order entry, should be
done at the time the patient actually physically transfers to the ward. The ACT
action activates the transfer and the patient is now seen as occupying the ward (as
indicated in the order entry page display). The next step is for you, the PAD user.
You will select the transfer off the RPA option and process it.
The absence status transfer follows similar steps. One difference, however, is the
action for activation is ABS, not ACT. The user is also required to select orders for
retention which would otherwise be put on hold while the patient is on absence
status. One exception is RXs which would be automatically kept active. The final
step is the processing on RPA by you, the PAD user.
This concludes our topic. I have a question for you to test your knowledge.




                                                                                        71
                                         Question
           Which of the following steps is NOT the responsibility of the
           PAD user in transfers at sites where the wards are active?

                        a)   Processing the activated order through RPA
                        b)   Initiating the transfer
                        c)   Verifying the transfer information
                        d)   Doing the transfer processing in a timely manner




          August 2006                  PAD ADT and ADT Reports, v2              72




Instructor Notes:
Read the question and possible answers.
Correct answer: b
Text:
The correct answer is b – initiating the transfer. This cannot be done by a PAD user
when the wards are activated. The clinician must enter and initiate the transfer
order. The PAD user will process the activated order on RPA and verify the
information at that time. It is important that this is done in a timely manner, so check
the RPA option throughout the day for pending transfers.

Now let’s move on to our next topic.




                                                                                           72
                  Topic 4: Create a Disposition

           Objective: At the end of this topic, you will be able to
           process a patient disposition.




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Instructor Notes:
In this topic, tailor your instruction to the students you are teaching. If they are at a
site using inactive wards, start with the PAD disposition process in the beginning of
this topic and skip the CLN method covered at the end. If they use the CLN method
(i.e., there are active wards at their site), skip the PAD instruction after this slide and
go to the latter portion of this topic where CLN dispositions are discussed.
Go to the TDB next.
Text:
In this topic, we will discuss how dispositions are created and processed. We will
cover the method relevant to the way your site does business – whether through the
PAD-centered or CLN-centered method.
Let’s get started. We’ll begin with a demonstration on the training database.




                                                                                              73
                                      Demo:

              Disposition




          August 2006            PAD ADT and ADT Reports, v2               74




Instructor Notes:
Return to the TDB, logged on as JABBER/WOCKY and continue with the demo of
the disposition action. Access the PAD ADT Processing Menu.
Text:
 We’ll once again start at the ADT Processing Menu. You can see that the
disposition option is the second one on the menu. Type in D.
We’ll work with a patient who has been admitted to a clinically inactive ward,
Florence Cook. I’m prompted to process the disposition so type in a “Y” for Yes.
Next is the date prompt. I will accept the default of NOW but you could change this
to a past time if necessary to make it accurate. The Dispositions screen displays
next.
Note that the disposition date includes both the date and time of the disposition.
At ‘Type of Disposition’ type a double question mark. [I-Note: review the options
listed.]
Type Duty, for this patient’s ‘Type of Disposition’ entry.




                                                                                      74
                              Demo: (cont.)

             Disposition




          August 2006           PAD ADT and ADT Reports, v2                75




Instructor Notes:
Continue with the demo of the disposition action on this and the next screen.
Text:
The ‘Disposition Comments’ field is free text and allows you to enter any data
pertinent to this disposition. Leave it blank by pressing <Enter>.
The name of the attending physician is entered in the next field (Note that the
taxonomy information is automatically defaulted).
The name of the dispositioning physician is entered next.
Any convalescent leave days would be entered in the final field on the screen and
then press <Enter>.
You are now at the Disposition Diagnosis and Procedure screen.
Note each field of information at the top of the screen.
The diagnosis and procedure are already defaulted based on the admission
information. This may be edited but we’ll accept it. Note that both the diagnosis and
procedure fields will accept multiple entries.
Press <Enter> twice to file the disposition. The screen that informs you that you
have no data discrepancies displays. You have returned to the ADT Processing
Menu.
You have now completed the topic on creating a patient disposition. Let’s take a
look at a question to see how much you remember.




                                                                                        75
                                    Question
           True/False:

           An admitting diagnosis may not be changed in a disposition.




          August 2006            PAD ADT and ADT Reports, v2            76




Instructor Notes:
Read the statement.
Correct answer: False
Text:
The correct answer is False. You may add a diagnosis or edit an existing one in the
disposition when it is processed.
Now let’s take a look at the final topic of Lesson 1.




                                                                                      76
                        CLN Dispositions




          August 2006            PAD ADT and ADT Reports, v2               77




Instructor Notes:
This slides begins the CLN method section of this topic for students at sites with
activated wards.
Text:
As we’ve already discussed, if you are at a site where the wards are activated,
inpatient orders, including dispositions, are entered by the providers, normally a
physician.
This means that PAD users have no ability to enter a disposition on CHCS when
wards are activated. The physician enters it via an order in the order entry option
(ORE) located on the physician’s menu. We’ll demonstrate this in a moment, but
first let’s look at a slide giving you an overview of the two-step process involved
when providers enter dispositions.




                                                                                      77
                Clinical Disposition: Two Steps

              Disposition Order is entered in ORE
                            activated” (ACT’
               The order is “activated” (ACT’ed)




          August 2006            PAD ADT and ADT Reports, v2                 78




Instructor Notes:
This slide continues the CLN method section of this topic for students at sites with
activated wards. A demo in the training database is next.
Text:
As we’ve discussed previously on admissions and transfers, when the clinical
method is used on active wards, there are two steps involved for Clinical users in
order to fully activate a disposition. Again, activation of a disposition means that the
patient is seen on the order entry page as having left the ward and is now in
outpatient status.
Let’s review the two steps required for a clinical disposition. First, the disposition
order is entered by the provider (physician, normally). Next, the order is “ACT’ed.”
This ACT action, entered in order entry, should be done at the time the patient is
actually leaving the ward. The ACT action activates the disposition and the patient
is now seen as no longer occupying the ward (as indicated in the order entry page
display).
Let’s take a look at it on the training database next.




                                                                                           78
                                      Demo:

              Entry of Disposition from CLN option




          August 2006            PAD ADT and ADT Reports, v2                79




Instructor Notes:
Log onto the TDB as Dr. Lamp (Access/Verify codes: DRLAMP/DRLAMPV). Go to
the ORE option.
Text:
I am logged in as a doctor. To enter a disposition order, I use the ORE option on the
physician’s menu.
Type Kagan,Earl and press <Enter> twice to accept the patient name and default
requesting location. At ‘Action’ type N for New and press <Enter>. At ‘Order Type’
type ADT and press <Enter>. At ‘ADT Procedure’ type ?? and press <Enter> to
see your choices. We want to enter a disposition, so type D and press <Enter>
twice. That brings you to the Disposition Order screen.
Type a ?? in the ‘Type of Disposition’ field to review the choices. We’ll choose
“Return to Duty.” The date/time defaults to the current time so we’ll press <Enter>
to accept this. The census is incremented as you can see. The disposition
physician defaults to me since I am entering the order, but this could be changed.
The comment and transportation field are optional; we’ll file the order. Now let’s talk
about what happens to orders. The message tells us that any disposition
medications (RXs) will remain active. They will move to the outpatient page after
activation of the disposition. Other orders display so the doctor may select them to
be retained on the outpatient page after disposition. We’ll select two orders.




                                                                                          79
                               Demo: (cont.)

              Disposition from CLN option




          August 2006             PAD ADT and ADT Reports, v2                 80




Instructor Notes:
You are on the training database as Dr. Lamp (Access/Verify codes:
DRLAMP/DRLAMPV). Text:
Note that the current ward page is displayed with asterisks so the system records
this patient as not yet dispositioned and still on this ward. The orders are retained
until the disposition is activated. At that time, only those selected to remain active,
along with any outpatient disposition prescriptions will be moved to the outpatient
page.




                                                                                          80
                               Demo: (cont.)

              Disposition from CLN option: ACT action




          August 2006            PAD ADT and ADT Reports, v2                81




Instructor Notes:
You are on the training database as Dr. Lamp (Access/Verify codes:
DRLAMP/DRLAMPV). Change to a nurse user when indicated in the text:
NURSELAMP/NURSELAMPV.
Text:
The next step, when the patient leaves the ward, is to activate the disposition. I will now
sign in as a nurse and do that. I access the same patient, then type in DPOL to display
the orders. Now, to activate the disposition I type ACT at the ‘ACTION’ prompt. Press
<Enter> at the next prompt to accept the “Y” for yes. In the next screen the original
disposition information from the order is defaulted. We file the screen.
Notice that now the asterisks have moved to the outpatient page, indicating that the
system recognizes the patient as being dispositioned from the ward. Let’s look back
that the old ward page. You can see that all the orders not selected for retention were
automatically cancelled.
Now that you’ve seen the clinical user’s input on the disposition, let’s look at the PAD
side.




                                                                                              81
                                Demo (cont.)

              RPA option: Disposition processing




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Instructor Notes:
Enter the TDB and log on as JABBER/WOCKY. You will access the PAD RPA
option.
Text:
Let’s look again at the RPA option. I am logged in as a PAD user. I enter the ADT
option, then RPA. You can see the pending orders to be processed and the
category “Dispositions.”
I select the category and I’m prompted to display all wards or I can enter the ward
my patient is on – 10A. I will enter this here. My patient is listed for selection so I
select Earl. You’re prompted to process the disposition. Press <Enter> for “Yes.”
Information entered on the disposition order is redisplayed. I will accept the first two
fields and add a comment, “Will need wheelchair.” The next field is skipped since
the patient was not on medical hold. I accept the provider information and enter a
“3” for recommended convalescent days. The next screen gives me an opportunity
to enter a diagnosis. I will assume I have this information from the physician and
enter 711.06 for arthritis. I enter 93.39 for the procedure and press <Enter> through
the procedure fields. Now I can file the disposition.
This concludes the instruction on processing clinical dispositions. Let’s review the
main points and finish up our topic with a question.




                                                                                           82
                   Clinical Dispositions: Review

              Disposition (CLN user):
                     Order is entered in ORE
                     Select Orders for retention

                     Order is activated (ACT action) in ORE

              Disposition (PAD user):
                       Activated order is processed on RPA by PAD




          August 2006              PAD ADT and ADT Reports, v2                 83




Instructor Notes:
You have exited the TDB. Review the bulleted items.
Text:
Let’s review the steps required for a clinical disposition. First, the disposition order is
entered by the provider (physician, normally). The physician has a chance to select
orders to be retained rather than cancelled at disposition. Next, the order is
“ACT’ed.” This ACT action, entered in order entry, should be done at the time the
patient actually leaves the ward. The ACT action activates the disposition and the
patient is now seen as an outpatient on the system (as indicated in the order entry
page display). The next step is for you, the PAD user. You will select the transfer off
the RPA option and process it.
This concludes our topic. I have a question for you to test your knowledge.




                                                                                              83
                                        Question
          A written disposition order arrives in PAD but the order has
          not yet been entered into CHCS by the physician. What
          can you do?
                    a)                        Dispositions”
                         Process it from the “Dispositions” category through RPA
                    b)   Enter the Order and activate it
                    c)   Use the disposition option on the ADT Menu
                    d)   Call and ask the physician to enter the order




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Instructor Notes:
Read the question and possible answers.
Correct answer: d
Text:
The correct answer is d – call and ask the physician to enter the order. A disposition
order cannot be entered by a PAD user when the wards are activated. The clinician
must enter and initiate the disposition order. It won’t appear on RPA until the
Clinical user enters and activates the disposition order. The PAD user could call the
physician and remind him to enter the order on CHCS.
Now let’s move on to our next topic.




                                                                                         84
           Topic 5: Impact of ADT Processing
                       on Orders
           Objective: At the end of this topic, you will be able to
           describe the impact of ADT processes on patient orders.




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Instructor Notes:
This topic applies to both the PAD and CLN methods, though the specific
differences will be addressed in the discussion. Teach the entire topic to both types
of students.
Text:
In this topic, we will discuss how clinical orders for patients are impacted by ADT
processing. Though there are differences in how clinical orders are entered when
the PAD or CLN ADT methods are used, there are similarities in the impact a
patient’s PAD movements have on their orders. We’ll discuss the common problems
that can occur and address any specifics in clinical order processing between the
PAD and CLN methods when relevant.
Let’s get started.




                                                                                        85
               What do Orders have to do with
                        PAD ADT?
              Why PAD actions impact clinical orders
              How Order Entry Paging works
              It’
               It’s all about timing




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Text:
You may be asking what PAD actions have to do with orders for patients. If you’ve
been following the instruction for the CLN active ward method, you probably have
some idea by now, but this is relevant to PAD users no matter which method is
used. Let me explain.
Orders are entered on “Pages” in the system that are associated with a patient’s
episode – outpatient, inpatient, transfer, or disposition. Each of these pages contain
orders. Orders are restricted on some pages based on where the system “sees” the
patient located. For example, if the system shows a patient on an outpatient page
because they’re not admitted, the inpatient orders cannot be entered as active
orders. Therefore, the timing of the ADT movement (admission, transfer,
disposition) is crucial to the ordering process. If, for example, a patient is admitted in
the morning, but the PAD user does not enter this on the system until the afternoon,
the user entering orders for the patient will be unable to enter inpatient medications,
labs or other orders crucial to that patient’s care. Other problems include orders
entered on the wrong page or automatic canceling of orders in error due to bad
timing of the ADT movement. I hope this gives you an idea of the impact, but we’ll
discuss and demonstrate this in more detail to give you a better understanding.
Let’s talk about timing first.




                                                                                             86
                        Timing is Everything

             If ADT timing is off, orders are off
             Orders are totally dependent on timing of ADT actions
             Patient safety may be impacted




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Instructor Notes:
Point to items as they are discussed.
Text:
If an ADT processing step is delayed or entered in error, it does not just mean that
there are inaccuracies on PAD reports. Because CHCS is an integrated system,
what one subsystem such as PAD does has a direct link to other subsystems. For
example, let’s look at a scenario involving an admission. A patient comes into the
Emergency Room and a doctor writes an order to have the patient admitted. The
patient is taken to the ward and some urgent medications are needed. We’ll assume
this is a site where wards are inactive so the PAD department has the responsibility
to enter the admission on the system. The PAD user doesn’t get around to entering
it until the next day. Meanwhile, the pharmacy user is trying to enter a critical
inpatient medication but there is no “page” on the system in Order Entry except an
outpatient page which does not accept inpatient medication orders. This is because
the page is only created after the PAD department enters the admission.
Let’s look at the same scenario at a site with active wards where the provider must
enter the admission. The patient is admitted to the ward but the physician forgets to
enter the admission order on CHCS. Meanwhile, a nurse is asked to order several
lab tests at a doctor’s request. The orders cannot be entered on the patient’s
inpatient episode or end up on the outpatient page, causing inaccuracies in the
record. Let’s look at this on the training database.




                                                                                        87
                                      Demo:

              Admission Impact on Clinical Orders




          August 2006            PAD ADT and ADT Reports, v2                 88



Instructor Notes:
Log on as Dr. Lamp (DRLAMP/DRLAMPV). Later in the discussion, log on as
JABBER/WOCKY. Go to the pharmacy subsystem. Menu Path: PHR  UDM
(inpatient pharmacy)  IOE  EMI
Text:
I am logged in as a doctor and access the ORE option where orders are entered.
Recall our first scenario. The patient’s written order was to be admitted to a ward.
However, the PAD user has not yet entered the admission. Let’s look at what I, as a
pharmacy user, see when I go to enter an inpatient medication order. The patient’s
name is entered: PICARD,E. When I access the order list, it is showing the patient
as an outpatient. There is no inpatient “page” on which to enter inpatient orders.
The pharmacist must call PAD to have the admission entered.
Let’s say there are active wards where the admitting doctor has entered an
admission, but never activated, or “ACTed” it. Let’s see what I as a doctor see when
I access this patient in order entry. The patient name entered is: NATHAN,A.
Order Entry displays the patient as an outpatient. There is a ward page, but there
are no asterisks on it, indicating that the patient is not yet located there. The system
treats this as a “future page,” meaning that any orders entered there will not be
active, but flagged as “future.” The is why it is so critical that the ADT steps
involved be entered in a timely manner. Watch how the future orders work [I-Note:
enter a lab (glucose) and medication (MED) order]. Note the orders are flagged
“future.” This means the lab and pharmacy do not see these orders and cannot
process them until the ward is activated. The order must be “ACTed” (activated)
before any action can be taken on this order.
You can see that timing is crucial. Let’s look at transfers next.



                                                                                           88
                               Demo (cont.):

              Transfer Impact on Clinical Orders




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Instructor Notes:
Remain logged in as Dr. Lamp (DRLAMP/DRLAMPV) to demonstrate until the text
discusses the pharmacy user (then log on as JABBER WOCKY and go to: PHR 
UDM (inpatient pharmacy)  IOE  EMI
Text:
I am logged in as a doctor. Let’s go to the ORE option and look at an inpatient who
requires a transfer. The doctor put in a request for transfer to a new ward several
hours ago and the patient is there. The patient we will enter is George Cassidy.
This patient is on ward 9B (an inactive ward), but should have been transferred to
ward 9A. I cannot enter orders for this patient. If an ancillary user enters orders for
this patient, they may end up on the current (wrong) page. When the patient is
transferred by PAD later, the orders would be automatically cancelled because
PAD’s timing was off. You can see how critical this is. Watch what I mean. I log into
the pharmacy order entry option and place a medication order [I-Note: Enter
Demerol order (50mg tab, code: T1 tab tid)]. Now I go to the PAD menu and
transfer the patient (remember, the patient really went to this ward hours ago, but I
am behind). Now look in order entry at what happened to the order the pharmacist
placed. It was automatically cancelled due to the transfer when it should still be
active. If you look at the original ward page you’ll see the cancelled order. This
could be a patient safety issue.




                                                                                          89
               Disposition Processing: Impact on
                            Orders
              If Disposition timing is off, orders are left as active
              Orders are automatically cancelled when patient is
               dispositioned (unless wards are active and orders have
               been selected for retention)
              Accuracy of timing is critical




          August 2006            PAD ADT and ADT Reports, v2                90




Instructor Notes:
You have exited the TDB.
Text:
For dispositions, timing is critical as with the admissions and transfers we
demonstrated. What happens to orders on the system when a disposition is
processed (either via PAD or the CLN entry method)? If PAD enters the disposition,
all orders are automatically cancelled. This will prevent the pharmacy from
continuing to send meds to a ward where a patient has been dispositioned. If the
disposition is delayed, the pharmacy and other ancillaries, still see the orders as
active and action needed. One exception to mention is disposition prescriptions
which are not cancelled but moved to the outpatient page when the disposition is
activated.
In the a case of active wards, the same is true – that is orders are automatically
cancelled. However, the clinical user does have a chance to select orders for
retention if desired.
We will not take the time to demonstrate the disposition, but you should have a
good understanding of the importance of getting the disposition action done in a
timely manner. If the disposition does not take place on the system, the pharmacy
will continue to send medications to the ward.
Let’s end our topic with a question.




                                                                                      90
                                              Question
           A patient who transferred from a medical ward to the ICU
           (inactive wards) has an important medication that never
           arrived. Later, it is discovered that it was cancelled, though
           the pharmacist entered the order. What likely happened?
                    a)   The pharmacist cancelled the order and is not being truthful
                    b)   The physician cancelled it in CHCS
                    c)                  didn’
                         The PAD user didn’t transfer the patient until hours after the
                         transfer order
                    d)   None of the above




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Instructor Notes:
Read the statement.
Correct answer: c
Text:
The correct answer is c. If a PAD user does not enter a transfer for a patient in a
timely manner, the ancillary orders could end up on the “old ward” page. When the
PAD user finally enters the transfer, all the orders are cancelled. It is not possible
for a CLN user to enter or cancel inpatient orders on inactive wards so this is not a
possibility. It’s unlikely a pharmacist would lie about this; however, it could be
researched in the system if he/she did cancel the medication. The most likely
problem is the PAD user action.
Now let’s move on to Lesson 2.




                                                                                               91
                        Lesson 2: Perform Special
                             ADT Functions
              Topic 1: Special Admissions and Statuses
              Topic 2: Remaining Overnight (RON) Admissions and
               Projected Dispositions
              Topic 3: Cancel ADT Transactions and
               Corrections/ADT View




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Instructor Notes:
If possible, use drawing tools, such as a pointer, to emphasize each bullet as it is
mentioned.

Text:
Our second lesson in this course centers on performing special ADT functions.
(Note: Read the bulleted items).
Let‘s begin with Topic 1.




                                                                                       92
        Topic 1: Special Admissions and Statuses

           Objective: At the completion of this topic, you will be able
           to describe the CHCS processes for special patient
           admissions and statuses.




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Instructor Notes:
If possible, use drawing tools, such as a pointer, to emphasize the item as it is
mentioned. Read the objective on the slide.
Text:
In this topic, we’ll learn how to process various special patient admissions and
statuses. We’ll cover the admission of newborns which requires some special
processing. Future dated admissions, Absence Status transfers, patients on
Medical Hold, and Casualty Status will be discussed as well. In addition, we’ll look
at how to do a ward pass. The process will be different for this, depending if wards
are active or not.
Let’s get started. Along with some discussion, I’ll be demonstrating some of these
functions in the training database.




                                                                                       93
                        Newborn Admissions

              Mother is admitted first
              Baby receives a pseudo SSN
                                           Birth”
               Source of Admission is “Live Birth”
              Always disposition baby before mother




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Acronyms:
L&D = Labor and Delivery
A&D = Admissions and Dispositions
Instructor Notes:
Point to items as discussed
Text:
For newborn admission, Labor and Delivery (L&D) or the Newborn Nursery
personnel must call the PAD Admissions and Disposition (A&D) department to
register and admit the patient. These patients should have high priority for A&D.
Let’s look at some important points on processing newborn admissions. First, be
sure that the mother is admitted first. You will see in our demo that you cannot
process a newborn admission until this is done. When you enter the newborn, use a
pseudo SSN and make sure the source of admission is entered as a live birth.
Lastly, and very importantly, be sure to disposition the baby before the mother!!! If
mothers are dispositioned prior to their babies, there is the chance that an inpatient
billing account may be set up for the baby.
Whether or not wards are active, the newborn admission and disposition should be
entered using the points mentioned here. Either way, PAD would be able to fill in
this essential admission information. I’ll demonstrate admitting the newborn via the
PAD options.




                                                                                         94
                                     Demo:

             Newborn admission




          August 2006           PAD ADT and ADT Reports, v2               95




Instructor Notes:
Log into the TDB as JABBER/WOCKY. Access the ADT  ADM menu to demo
admission of a newborn. IMPORTANT: Pre-position admission for mother prior to
demo as follows:
     Mother’s Names: MARSHALL,MOM; FMP: 30; SSN: 777-77-7777;
     PATCAT: A41; register as married and accept default screens prior to
     admission screen. For admission screen: Source of Admission: DIR;
     Ward: 9D; Admitting Dx: V30.00 (Birth); attending physician and other
     fields may be ad-libbed.
Text:
I’m going to demonstrate what a PAD user would do to admit a newborn. I’ve
accessed the PAD Admission option. Now I will enter a name: BABY,JANE. You
would of course enter the real name of the newborn on the live system. The
sponsor is entered: Marshall,Charles. The FMP is entered as 01 for this example
(the oldest dependent child). I enter the DOB as “T” for today. Let’s enter a “??” as
the ‘SSN’ field. The explanation on pseudo SSNs tells us that the system will assign
a pseudo number is I type in a “P.” Let’s do that for the SSN. Remember, a
newborn should always be assigned a pseudo SSN. We’ll enter A41 as a patient
category (family member of Active Duty). Enter “N” for the next I.D. card prompt
and file. Press <Enter> to get past the PCM information screen and exit the
DEERS check screens. Next, you’re prompted to select the sponsor name to move
demographic information from him to the registration information. We’ll select the
name.




                                                                                        95
                              Demo (cont.):

             Newborn admission




          August 2006           PAD ADT and ADT Reports, v2                96




Instructor Notes:
You are logged into the TDB as JABBER/WOCKY. Access the ADT  ADM menu
to demo admission of a newborn. Text and data are continued from the previous
slide.
Text:
Now fill in the remaining fields as necessary. Remember that the ‘Ethnic Origin,’
‘Race,’ and ‘Marital Status’ fields are required, even for a newborn. We’ll press
<Enter> through the remaining fields but fill in an outpatient record location since
this is important in tracking medical records. Accept the defaults in the next two
screens for sponsor and EC/NOK. Answer yes or no to organ donor prompt based
on your site policy and file the screen.
The PCM info screen redisplays next. Press <Enter> twice and you are prompted
next for insurance information since this is a dependent. We will not cover insurance
entry in this lesson, but we have another class on this if you’re interested. Now
you’re ready to enter the admission data. Type Y to process the admission. Press
<Enter> to accept the admission time of NOW. The admission screen displays.
Keep in mind, this example is for users with inactive wards where PAD initiates the
admission. However, on active wards the processing is similar, but the original order
would be entered by the physician, then processed by the PAD user on RPA.




                                                                                        96
                               Demo (cont.):

              Newborn admission




          August 2006            PAD ADT and ADT Reports, v2              97




Instructor Notes:
You are logged into the TDB as JABBER/WOCKY. Access the ADT  ADM menu
to demo admission of a newborn. Text and data are continued from the previous
slide.
Text:
Okay, let’s finish this admission screen. Press <Enter> to accept the date default.
Enter LIVE for the source of admission (Live Birth). Now a new screen displays with
fields required for the mother’s name and register number. This is why it’s important
that the mother is admitted first.
Enter MARSHALL,MOM in the ‘Mother’s Name’ field, then press <Enter> to accept
the register number. Enter 9D for the ward number in the next field. We’ll enter
ADBA for the MEPRS number and go down to admitting physician. Enter
HARTMAN,CHRIS. Skip down to the admitting diagnosis and enter BIRTH to see
the choices. Let’s select V30.00 for a birth without C-Section. You would of course
enter whatever the diagnosis was from the physician for the birth. We’ll skip down to
the ‘Type Case’ field and enter DIS, then accept the register number and file. We’ll
stop our demonstration here. Do you have any questions?
Let’s talk about future admissions briefly next.




                                                                                        97
                        Future Dated Admissions

             PAD user CANNOT enter a future dated admission
             Must be entered by CLN user (usually, from active ward)




          August 2006           PAD ADT and ADT Reports, v2                  98




Instructor Notes:
You are no longer in the training database. Point to bullets as discussed.
Text:
The first important point we need to make is that future dated admissions are not
possible from the PAD software. This is only possible when entered by a provider,
usually a physician, from the Clinical Order Entry (ORE) option. This would usually
be done at sites where wards are activated.
Just a note: It is possible on the software for an admission order to be entered (and
future dated) from the outpatient page where wards are inactive. However, it is very
unlikely that this would be done and would be a rare exception in the workflow. If
this were the case the PAD user could pull if off the RPA option for processing. We
won’t cover that here since it is not a common practice.
Next, we’ll talk about the various statuses that an inpatient may be put on while
admitted, such as absence status. That’s what we’ll talk about next.




                                                                                        98
                            Absence Status

             CLN Method – via and order, then PAD RPA
             PAD Method – via the




          August 2006           PAD ADT and ADT Reports, v2                99




Instructor Notes:
Point to bullets as discussed.
Text:
If your site is using the CLN method for active wards, we’ve already discussed how
to do an absence status transfer. The provider would enter an order, then PAD
would process it via the RPA option.
In the scenario where wards are inactivated, this method via a clinical order is not
possible so the patient would be put on absence status via the PAD options. Before
we give details on this, though, let’s talk about some commonalities and what
absence status is. It includes, but is not limited to, patients who are inpatients at
your MTF but are sent to another facility for tests or treatment. Other examples are
patients who have gone AWOL, in custody of civilian or military authorities, are on
pass, or on a temporary/special assignment.
Here are some tips to remember:
a) This status may or may not affect the inpatient’s daily chargeable rate so
    it’s important that it’s recorded.
a) Patient absence status must be provided on a daily basis so that a patient
   is not dispositioned prior to the absence status entered.
Let’s look at what it may include on the next slide.




                                                                                        99
                           Absences Include:

           AC ABSENT IN CUSTODY OF CIVILIAN AUTHORITIES
           AG AWOL (MORE THAN 10 DAYS) DFR
           AM ABSENT IN CUSTODY OF MILITARY
              AUTHORITIES
           AW AWOL (LESS THAN 10 DAYS)
           BO BED OCCUPANT THIS MTF
           CC COOPERATIVE CARE
           CL CONVALESCENT LEAVE
           EL EMERGENCY LEAVE

          August 2006            PAD ADT and ADT Reports, v2              100




Instructor Notes:
Point to bullets items on this and the next slide where list continues.
Text:
Take a look at the list of absence statuses on this slide and the next.




                                                                                100
                        Absences Include (cont.):

           OL      ORDINARY LEAVE
           PH      PCS HOME PENDING SEPARATION/RETIREMENT
           PV      PCS VA HOSPITAL PENDING
                   SEPARATION/RETIREMENT
            SC     SUPPLEMENTAL CARE
            SE     SUBSISTING ELSEWHERE/OUT
            TD     TEMPORARY DUTY/SPECIAL DUTY
            WA     WARD ABSENCE



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Instructor Notes:
Point to bullets items on this and the next slide where list is continued from the
previous slide. You will log into the TDB next.
Text:
Now that you’re familiar with the status choices, let’s do a demo of entering a
patient’s Absence Status through the PAD software.




                                                                                     101
                                       Demo:

              Absence Status Transfer via PAD option
              Menu Path: PAD  PAM  AST




          August 2006             PAD ADT and ADT Reports, v2                 102




Instructor Notes:
Log into the TDB as JABBER/WOCKY. Access the PAD  PAM  AST option.
Text:
The option we want is under the Patient Affairs/Administrative Menu (PAM). Enter
AST. We enter George Crockett. Note that if you tried to enter a patient on an
active ward the system would prevent it. Enter Y at the prompt to change status and
press <Enter> for the default time of NOW. You can enter a different past date if
necessary. Enter the next field with AWOL and select the item for less than 19
days. You don’t know the return date so leave this field blank. The next
convalescent field is skipped since it doesn’t apply here. You can choose to reserve
the bed or not. If the patient had gone to another facility, this could be filled in from
the picklist in the last field, ‘Absence Facility.’
In the next screen, you would fill in the civilian physician if the patient were going to
another facility for treatment. The current provider may be entered in the next field.
We’ll enter HARTMAN,CHRIS and 275.42 for the ‘Diagnosis’ field. The last field is
‘Military Service Notified Date’ and we’ll enter it as T for today’s date. We file the
screen and the absence transfer is completed.
Let’s talk about Medical Convalescent Leaves and Medical Hold status next.




                                                                                            102
                        Medical Hold and Medical
                          Convalescent Leave
              Put patient on convalescent leave first
                    Via an Absence Transfer order (CLN Method)

                    Via PAM  AST (PAD Method)



              Disposition the patient for Medical Hold
                                                     Holding”
                    Type of disposition is “Medical Holding”




          August 2006             PAD ADT and ADT Reports, v2                 103




Instructor Notes:
Text:
Before going on a “Medical Hold” status, a patient would be put on convalescent
leave. This would be done through an absence transfer, either from the PAD option
as we just saw (for inactive wards) or through a clinical order absence transfer when
the site is using active wards. The absence status on the absence transfer would be
entered as “Convalescent Leave.”
For active duty personnel, Medical Hold means that the patient is on hold as far as
being transferred to another site, going TDY or going to war. On the system, this
must be done as a disposition with the ‘Type of Disposition’ field entered as
Medical Holding. This would be done through a clinical order or through the PAD
disposition option, depending on the method used at your site.
When the disposition is processed through PAD, a field appears on the last screen:
‘Released From Medical Hold Date.’ It’s very important that this be left blank until
the patient is released from Medical Hold.
To release an inpatient from Medical Hold, return to the DIS option in PAD to enter
the date in this field. The ‘Type of Disposition’ field at that time should not be edited
but remain at HOLD (to indicate Medical Holding).




                                                                                            103
                        Medical Hold and Medical
                          Convalescent Leave
             Outpatients put on Med Hold from PAM  MEB
             Tracking Medical Holding from POUT
                   Via PAM  POUT

                   Option 8 - Medical Holding/Patient Squadron
                    Tracking Report




          August 2006          PAD ADT and ADT Reports, v2             104




Instructor Notes:
Point to items as discussed.
Text:
Outpatients are put on Medical Hold using the PAM option MEB. This option should
not be used for inpatients. Both inpatients and outpatients on Medical Hold may be
tracked using the report shown on this slide.




                                                                                     104
                            Ward Absence

             For patients leaving the ward less than 24 hours
             Two Methods: CLN vs. PAD (inactive/ wards)
                   Via CLN Order Entry (ADT  Ward Absence)

                   Via PAD – from PAM  AST




         August 2006           PAD ADT and ADT Reports, v2              105




Instructor Notes:
Point to items as discussed. Go to the TDB next.
Text:
The Ward Absence applies to patients leaving the ward temporarily, for less than 24
hours. To put a patient on Ward Absence status, there are two methods, depending
on the method used at your site (i.e., inactive or active wards).
For active wards, the clinical user enters the Ward Absence from the ORE option. It
is an ADT order called “Ward Absence.” Type ABS to activate it. When the patient
returns, the provider would type ABS again to take the patient off ward absence.
For PAD users with inactive wards, you would go to the PAM menu and enter an
absence transfer from the AST option. The absence status would be entered as WA
for Ward Absence.
Let’s go back to the TDB and look at the PAM menu once more to discuss two more
statuses.




                                                                                      105
                                       Demo:

              PAM option – entry of other statuses




          August 2006             PAD ADT and ADT Reports, v2                106



Instructor Notes:
Log onto the TDB as JABBER/WOCKY. Go to the pharmacy subsystem. Menu
Path: PAD  PAM
Text:
We are looking at the PAM menu. We’ve already seen how to enter an Absence
Status transfer here which could be used to enter convalescent leave. Notice the
MEB option and remember that this is for outpatients only, to place them on Medical
Hold. Let’s look at what else you can do here. We’ll type a triple question mark
(???) to see some information on the options.
Let’s look at the Casualty Status option first. [I-Note: Read info listed.] This option
is where you can enter a casualty status. Let’s look at Command Interest Status
also [read information listed].
In addition to these statuses that can be entered on the PAM menu, you may also
pull up the Medical Hold Tracking Report via the POUT option as we mentioned.
Let’s look at it [pull up report POUT  8]. We’ll exit back to the PAM menu. You
also have options to look up information on patients from the IDD and VRG options.
Let’s finish up our topic with a question.




                                                                                          106
                                    Question
            A patient must go on Convalescent Leave. What must be
            entered in CHCS?
                       a)   A Ward Absence
                       b)   A Disposition
                       c)   An Absence Transfer
                       d)   Medical Hold status




         August 2006              PAD ADT and ADT Reports, v2          107




Instructor Notes:
Read the question and possible answers.
Correct answer: c
Text:
The correct answer is c – Absence Transfer. The absence transfer would be
entered (either via PAD or CLN, depending on active or inactive wards). Then you
would enter the field for status as “Convalescent Leave.”
Now let’s move on to Topic 2.




                                                                                   107
                  Topic 2: RON Admission and
                     Projected Dispositions
           Objective: Upon completion of this topic, you will be able to
           create remaining overnight (RON) admissions and
           projected dispositions.




          August 2006            PAD ADT and ADT Reports, v2               108




Acronyms:
RON = Remaining Overnight
Instructor Notes:
If possible, use drawing tools, such as a pointer, to emphasize the item as it is
mentioned.
Read the slide.
Text:
In this topic, we’ll learn how to create a remaining overnight (RON) admission and
projected dispositions.
Let’s get started. I’ll be demonstrating these functions once again in the training
database.




                                                                                      108
                    Demo: RON and Projected
                          Dispositions
             RON and Projected Dispositions




          August 2006           PAD ADT and ADT Reports, v2               109




Instructor Notes:
Return to the TDB and demo RON and projected dispositions.
Text:
We’ll start once again from the ADT Processing Menu and access the RON option.
This option allows the user to enter or edit admission information pertaining to the
status of a patient remaining overnight (RON). Required data to admit a RON
patient include: admission date/time (future dated admission not allowed),
UCA/Service, Admitting Physician, and admission ward.
This option is used for patients who are not admitted as inpatients.
At the select patient prompt type Martin,Benjamin and press <Enter>.
Note the information at the top of the screen. Note also that the patient has never
been admitted to this facility. An inpatient, with a regular admission, could not be
entered in this option. This option is for patients who are just remaining one night
and not fully admitted. This could affect billing, depending on the type of patient
(active duty versus a chargeable patient).
Accept the default of YES to add a new RON admission.
Accept the default of NOW to enter the admission date and time.
Bypass the DEERS eligibility screens as done previously during this course.
Note the patient data at the top of the RON admission screen.
At the MEPRS/Service prompt type AAAA and press <Enter>.




                                                                                       109
                              Demo: (cont.)

             RON and Projected Dispositions




          August 2006           PAD ADT and ADT Reports, v2             110




Instructor Notes:
Demo of RON and projected dispositions.
Text:
At ward location type 10G and press <Enter>.
Type a double question mark at the ‘Room-Bed’ prompt to check availability.
Type 117-B and press <Enter>.
At the ‘Admitting Physician’ field, type Hartman and press <Enter> twice to accept
Dr. Chris Hartman.
At the ‘Attending Physician’ field, type Hartman and press <Enter> twice again to
accept Dr. Chris Hartman.
At the ‘Meal Card Required’ field, type Y for Yes and press <Enter>.
At the ‘Admission Comment’ field, type Admitting overnight to monitor vitals.
Press <Enter> to file and return to the ADT Processing Menu.




                                                                                     110
                              Demo: (cont.)

             RON and Projected Dispositions




          August 2006           PAD ADT and ADT Reports, v2              111




Instructor Notes:
Continue with the demo of RON and projected dispositions.
Text:
At the ADT Processing Menu type PRD for projected dispositions and press
<Enter>.
Note the information at the top of the screen. Type Y for Yes at the Projected
Disposition prompt and press <Enter>.
At the ‘Disposition Date’ prompt, type T+1 for tomorrow’s date and press <Enter>.
At the ‘Disposition Type’ prompt, type Home for dispositioned to home and press
<Enter>.
Press <Enter> to file the projected disposition and return to the ADT Processing
Menu.
That concludes the topic on RON and projected dispositions. Let’s take a look at
another question.




                                                                                    111
                                    Question
          RON admissions are limited to patients who are:
                       a) on outpatient Status
                       b) readmitted
                       c) requesting a new provider
                       d) named RON




         August 2006              PAD ADT and ADT Reports, v2           112




Instructor Notes:
Read the question and possible answers.
Correct answer: a
Text:
The correct answer is a. The patient cannot already be admitted to a ward with a
regular admission.
Now let’s move on to Topic 3.




                                                                                   112
           Topic 3: Cancel ADT Transactions
               and Corrections ADT View
           Objective: Upon completion of this topic, you will be able to
           cancel ADT transactions and correct an ADT view.




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Instructor Notes:
If possible, use drawing tools, such as a pointer, to emphasize the item as it is
mentioned.
Read the slide.
Text:
In this topic, we’ll learn how to cancel ADT transactions and correct an ADT view.
Let’s get started. I’ll be demonstrating these functions once again in the training
database.




                                                                                      113
                                     Demo:

             Cancel ADT Transactions – CAT option




          August 2006           PAD ADT and ADT Reports, v2              114




Instructor Notes:
Log onto the TDB as JABBER/WOCKY. Enter ADT  CAT to demo cancellation of
an admission via the PAD options.
Text:
If you are at a site with inactive wards, you would use the CAT option to cancel an
admission if necessary. If you were using the Clinical method the provider would
have to cancel the admission order.
I’ll now demonstrate a sample ADT cancellation using the PAD method.
At the ADT Processing Menu type CAT for cancel ADT transactions and press
<Enter>.
At the Patient Name prompt type Caper,Florence (on an inactive ward) and press
<Enter>. Note the data at the top of the screen. At the Select prompt type A for
admission and press <Enter>. Press <Enter> at the next prompt for “Yes” to
indicate you want to cancel the admission.




                                                                                      114
                               Demo: (cont.)

              Cancel ADT Transactions – CAT option




          August 2006            PAD ADT and ADT Reports, v2           115




Instructor Notes:
Continue with a demo of the CAT option.
Text:
Type a double question mark at the ‘Cancel Reason’ prompt and press <Enter>.
Note the various cancellation reasons. Select the “03 Unable to process record—
patient not admitted” cancellation reason.
Press <Enter> to file the cancellation.
Note the message on patient admission.
Note that canceling dispositions and transfers work in the same way.
Press <Enter> to return to the ADT Processing Menu.




                                                                                  115
                              Demo: (cont.)

             ADT Transactions and Corrections – COR option




          August 2006           PAD ADT and ADT Reports, v2               116




Instructor Notes:
Continue with a demo of the COR option.
Text:
To correct an admission, transfer or disposition which is in the past, use the COR
option. Let me explain. If there is a CURRENT admission, transfer or disposition
(i.e., the patient has not moved on to a new ADT movement) you can use the ADT
options to edit it – ADM, TRA or DIS. If, however, you have transferred your
patient, for example, then realize that there is admission information that needs
correcting, you would use the COR option.
In our scenario, we want to edit the admission of our patient George Crockett who
we entered an absence transfer for earlier to put him on Medical Hold. Type
Crockett,George and press <Enter> twice. Select the first admission listed. Note
the options at the bottom of the screen. If this information would be in error, you
could delete it. You could view the information. You could also insert a special
admission, such as a RON admission. You want to change the admitting physician.
Type E to edit the admission.
Press <Enter> three times until you are in the ‘Admitting Physician’ field. Change to
physician name to HARTMAN,CHRIS. Press <Enter> until you file.
That concludes our training of Topic 3. Now let’s look at another question.




                                                                                        116
                                   Question
          True/False:
          You’
          You’ve just transferred your patient to the wrong ward
          number. You would use the COR option to correct this.




         August 2006             PAD ADT and ADT Reports, v2           117




Instructor Notes:
Read the question and possible answers.
Correct answer: False
Text:
The correct answer is False. This option can only be used on ADT actions that are
past, not current. You could use the ADT  TRA option to edit.
Now let’s move on to Lesson 3.




                                                                                    117
                        Lesson 3: ADT Reports

              Topic 1: Access and View Admission and Disposition
               Summary Reports
              Topic 2: Access and View Miscellaneous ADT Reports




          August 2006            PAD ADT and ADT Reports, v2               118




Instructor Notes:
If possible, use drawing tools, such as a pointer, to emphasize each bullet as it is
mentioned.

Text:
The third lesson in this course centers on accessing and viewing ADT Reports.
(Note: Read the bulleted items).
Let us begin with Topic 1.




                                                                                       118
                        Topic 1: Access and View
                        Admission and Disposition
                           Summary Reports
           Objective: Upon completion of this topic, you will be able to
           access and view admission and disposition summary
           reports.




          August 2006            PAD ADT and ADT Reports, v2               119




Instructor Notes:
If possible, use drawing tools, such as a pointer, to emphasize the item as it is
mentioned.
Read the slide.
Text:
In this topic, we’ll learn how to access and view admission and disposition reports.
Let’s get started. I’ll be demonstrating these functions once again in the training
database.




                                                                                       119
                        Demo: Access and View
                        Admission and Disposition
                           Summary Report
              Upon completion of this topic you will be able to access
               and view admission and disposition summary reports.




          August 2006            PAD ADT and ADT Reports, v2               120




Instructor Notes:
Return to the TDB logged on as JABBER/WOCKY to demo access and view of
admission and disposition summary reports. Type a triple question mark to show an
overview of each report Enter a spool report, then display it to the screen from the
spooler menu. If it runs by the screen too fast, use the following slide to display a
sample report.
Text:
There are numerous ADT related reports, but the most common, that should be run
every day are the Admissions and Dispositions (A&D) Report that we’ll cover here,
as well as the Alpha Roster that will be discussed with other miscellaneous reports
in the next topic. Let’s look at the A&D Report now.
At the ADT Processing Menu type AOUT for ADT reports. Type 1 for the Admission
and Disposition Recap by PATCAT Report and press <Enter>.
Note that you will have to spool this report for display. This report is not CPU
intensive, so can be run at any time. This report summarizes admissions and
dispositions for a specified date. When we pull this report up from the spooler menu,
it may race by and be difficult to read on the screen. The next slide shows a printout
of the report.
Let’s review the details of this report. Review the details of the report. Note the
patient categories, previous date admission totals, the day’s increase, any
absences, and bed totals for each patient category. The report will also list any
admissions by live birth for the date. Press <Enter> twice until you exit the report
and return to the menu of reports.

                                                                                         120
                        TRAINING HOSPITAL                                   21 Jun 2001 1007   Page 1
                                        Personal Data - Privacy Act of 1974 (PL 93-579)
                            * * * ADMISSION AND DISPOSITION RECAPITULATION BY PATIENT CATEGORY * * *
                                              PERIOD ENDING 2400 HOURS 20 Jun 2001
                        Patient Category
                                  PREV GAIN LOSS CURR      SUB   ABS SUPL OTHER TOTAL    NEW   BED
                                   DAY               DAY ELSE SICK CARE      ABS   ABS BORN TOTAL
                        -------------------------------------------------------------------------------
                        -
                        A11   USA ACTIVE DUTY ENLISTED
                                    13   135     0   148     0     0     0     0     0     0   148
                        A11   USA ACTIVE DUTY OFFICER
                                    27   158     0   185     0     0     0     0     0     0   185
                        A11   USA AD ENLISTED
                                    21    24    21    24     0     0     0     0     0     0    24
                        A11   USA AD OFFICER
                                    12   133     7   138     0     0     0     0     0     0   138
                        A41   USA DEP AD, EXC FORM SPOUSE
                                     0     1     0     1     0     0     0     0     0     0     1
                        A41   USA FAM MBR AD
                                     0     1     0     1     0     0     0     0     0     0     1
                        F11   USAF ACTIVE DUTY
                                    32   250     3   279     0     0     0     0     0     0   279
                        F12   USAF RES-30 DAYS OR LESS,NOT IN LOD
                                    22     0     0    22     0     0     0     0     0     0    22
                        F31   USAF RET LOS OFFICER
                                     1     0     0     1     0     0     0     0     0     0     1
                        F41   USAF DEP AD, EXC FORM SPOUSE
                                     0    10     0    10     0     0     0     0     0     0    10
                        F43   USAF FAM MBR RET
                                     1     0     0     1     0     0     0     0     0     0     1
                        F48   USAF UNREMARRIED FRM SPOUSE
                                     9     0     0     9     0     0     0     0     0     0     9
                        M11   USMC ACTIVE DUTY
                                     1     5     0     6     0     0     0     0     0     0     6
                        N11   USN ACTIVE DUTY
                                    35   249     3   281     0     0     0     0     0     0   281
                        TOTAL
                                   174   966    34 1106      0     0     0     0     0     0 1106




          August 2006                       PAD ADT and ADT Reports, v2                                   121




Instructor Notes:
Show this slide of a sample report if the printout on the screen in unreadable.
Text:
Here is a sample report.




                                                                                                                121
                        Demo: Access and View
                        Admission and Disposition
                           Summary Report
              Upon completion of this topic you will be able to access
               and view admission and disposition summary reports.




          August 2006             PAD ADT and ADT Reports, v2              122




Instructor Notes:
Return to the TDB to demo access and view of admission and disposition summary
reports. Type a triple question mark to show an overview of each report.
Text:
Type 2 for the Admission and Disposition Report and press <Enter>. This report
lists all admissions and dispositions for a designated 24-hour period. We’ll type T for
today’s date in the date field and display the report to the screen. Let’s review the
details of the report. It shows patient category, register number, duty address, type
case (disease or injury), flying status, rank, time of transaction and ward
assignment. The admissions are listed first, categorized by PATCAT. The
dispositions are shown last on the report.
Press <Enter> until you exit the report.
Here’s a question for you next.




                                                                                          122
                                   Question
          What period of time is covered by the Admission and
          Disposition Report?

                        a)   24 hours
                        b)   One week
                        c)   One month
                        d)   One year




          August 2006            PAD ADT and ADT Reports, v2            123




Instructor Notes:
Read the question and responses.
Correct answer: a
Text:
The correct answer is a, 24 hours. The report covers a defined 24 hour period.
Now let’s look at some more reports in Topic 2. We have summarized all the rest of
the reports as miscellaneous.




                                                                                     123
                    Topic 2: Access and View
                    Miscellaneous ADT Reports
           Objective: Upon completion of this topic, you will be able to
           access and view miscellaneous ADT reports.




          August 2006            PAD ADT and ADT Reports, v2               124




Instructor Notes:
If possible, use drawing tools, such as a pointer, to emphasize the item as it is
mentioned.
Read the slide.
Text:
In this topic, we’ll learn how to access and view miscellaneous reports. Let’s get
started. I’ll be demonstrating these functions once again in the training database.




                                                                                      124
                     Demo: Access and View
                    Miscellaneous ADT Reports
              Access and View Miscellaneous ADT Reports




          August 2006            PAD ADT and ADT Reports, v2               125




Instructor Notes:
Demo of access and view miscellaneous ADT reports.
Text:
At the ADT Processing Menu type AOUT and press <Enter>.
Type 3 for the Admission by Diagnosis Report and press <Enter.
This report enables you to obtain a list of patients sorted by date and time of
admission and includes a listing of the admitting diagnosis if entered on the
admission.
Note the details of the report including patient name, rank, patient category,
command interest, admission date, register number, admitting MEPRS code,
admitting ward and room/bed, admitting diagnosis, and unit ship I.D.
Press <Enter> until you exit the report.
Type 4 for the Admission Cover Sheet Report and press <Enter>.
This report displays an admission cover work sheet for any patient episode. This
would be used often for the admission folder.
Note the details of the report including patient and sponsor identifying data,
emergency contact information, and ADT information.
Press <Enter> until you exit the report.




                                                                                   125
                              Demo: (cont.)

              Access and View Miscellaneous ADT Reports




          August 2006            PAD ADT and ADT Reports, v2                126




Instructor Notes:
Demo of access and view miscellaneous ADT reports.
Text:
Type 5 for Admission Notification to Unit Report and press <Enter>.
This option generates a letter notifying an Active Duty patient’s commanding officer
of an admission to the facility.
Note the details of the letter including the name of the commanding officer, the
patient’s name, the grade/rank of the patient, and applicable admission information.
Press <Enter> until you exit the option.
Type 6 for the Alpha Roster Report and press <Enter>. This is one of the most
commonly run reports. It is typically run several times a day. This report is a list of
all patients’ currently admitted to the facility. Inpatients are listed in alphabetical
order. Note the details of the report including admission date/time, register number,
current ward and room/bed, and patient category.
Press <Enter> until you exit the report.




                                                                                          126
                               Demo: (cont.)

              Access and View Miscellaneous ADT Reports




          August 2006             PAD ADT and ADT Reports, v2                127




Instructor Notes:
Demo of access and view miscellaneous ADT reports.
Text:
Type 7 for the Batch Consolidated Edits Report and press <Enter>.
This report enables you to print a list of patients with unresolved data edits. Note the
details of the report and the addendum displaying the edit problems. For example,
a patient’s rank doesn’t agree with the patient’s pay grade.
Press <Enter> until you exit the report.
Note that report number 8 is just like number 5, except that the notification letter to
the commander is for a disposition instead of an admission.
Type 9 for Emboss card and press <Enter>.
Type Haversham,G for the patient name and press <Enter>.
Type I for Inpatient format and press <Enter>.
Press <Enter> at the display prompt to view a sample of the emboss card.
Press <Enter> to exit the card.




                                                                                           127
                              Demo: (cont.)

              Access and View Miscellaneous ADT Reports




          August 2006            PAD ADT and ADT Reports, v2              128




Instructor Notes:
Demo of access and view miscellaneous ADT reports.
Text:
Type 10 for the Future Dated Admissions Report and press <Enter>.
This report displays a list of patients which have future dated admissions.
Note that the report can be for a single date or a range of dates. This report would
be run only at sites where wards are active and physicians are entering the
admission orders.
Press <Enter> until you exit the report.
Type 11 for the Inpatient Index Card and press <Enter>.
Press Spacebar/Return to bring up patient Haversham, and then press <Enter>
three times to see a copy of the index card.
Note the details on the card including patient name, ward, room/bed, address,
admission date, and provider.
Press <Enter> until you exit the card.




                                                                                       128
                               Demo: (cont.)

              Access and View Miscellaneous ADT Reports




          August 2006             PAD ADT and ADT Reports, v2                129




Instructor Notes:
Demo of access and view miscellaneous ADT reports.
Text:
Note that 12, the Medical Inpatient Treatment Recording Card, is generated just like
the Inpatient Index Card. This card may be generated at admission or on demand.
Note that 13 will print the patient an identification label for wrist bands and bed
cards.
Type 14 for the RON Roster Report and press <Enter>.
This report is a summary report of all inpatients with the admission type of
Remaining Overnight. Note the details of the report, including patient name,
grade/rank, current ward, and room/bed.




                                                                                       129
                              Demo: (cont.)

             Access and View Miscellaneous ADT Reports




          August 2006           PAD ADT and ADT Reports, v2               130




Instructor Notes:
Demo of access and view miscellaneous ADT reports.
Text:
Type 15 for the TPC Insurance Worksheet and press <Enter>.
This option allows you to produce one or more copies of the standardized DoD
Form DD2569 containing detailed insurance policy information for a patient.
Note that the patient should update and sign a new worksheet if he/she has not
been admitted previously, or if a previous admission was over a year prior.
Press <Enter> until you exit the worksheet.
Note that number 16 is a Transfer Notice to Unit, and it works just like number 5,
Admission Notice to Unit.
Type 17 for the Ward Nursing Report and press <Enter>.
This report covers ADT activity and bed status information for a specified 24 hour
period.
Note the details of the report including number of patients admitted, dispositioned,
and transferred. The report also includes bed counts, number of beds reserved,
evacuated, or unavailable for a 24 hour period.




                                                                                       130
                                Demo: (cont.)

              Access and View Miscellaneous ADT Reports




           August 2006             PAD ADT and ADT Reports, v2                  131




Instructor Notes:
Demo of access and view miscellaneous ADT reports.
Text:
Type 18 for Ward Roster and press <Enter>.
This report displays a list of all inpatients currently admitted to the facility.
Note that the report can be generated for one or all wards. The data is displayed in
alphabetical order by patient last name or by room/bed in each ward.
Press <Enter> until you exit the report.
Type 19 for Admission Verification Worksheet and press <Enter>.
This option generates a patient worksheet with demographic information and
signature blocks. Note that the purpose of the worksheet is to acknowledge
hospitalization charges, insurance billing, and valuable safekeeping statements.




                                                                                       131
                              Demo: (cont.)

             Access and View Miscellaneous ADT Reports




          August 2006            PAD ADT and ADT Reports, v2               132




Instructor Notes:
Demo of access and view miscellaneous ADT reports.
Text:
Type 20, for Consolidated Clinical Records Report, and press <Enter>.
This option prints Consolidated Clinical Records sorted by clinical record status.
Note that the report can be run for one or all statuses.
This completes our accessing and viewing of ADT reports. Now let’s take a look at
one final question.




                                                                                     132
                                       Question
               Which items in the reports would generate a letter to the
               commander?

                           a)   Admission Notice to Unit
                           b)   Disposition Notice to Unit
                           c)   Transfer Notice to Unit
                           d)   All of the above




          August 2006               PAD ADT and ADT Reports, v2          133




Instructor Notes:
Read the question and responses.
The correct answer is d.
Text:
The correct answer is d - All of the above. Each notice would generate a letter to
the unit commander.
Now let’s take a look at our class summary.




                                                                                     133
                                      Summary
           In this course, you have learned how to:
            Access the ADT Processing Menu to process admissions,
                                                                              your
               dispositions, and transfers. The method you use is specific to your
               site, depending on which scenario exists – active vs. inactive wards.
                      Active Wards require that providers enter the ADT orders.

                      Inactive Wards require that ADT actions are initiated by PAD
                       users.
            Perform special ADT functions, including processing special
               admissions and statuses, performing RON admissions and
               projected dispositions, cancel ADT transactions, and view
               corrections.
            Access and view ADT admission and disposition summary reports,
               as well as miscellaneous ADT reports.

          August 2006               PAD ADT and ADT Reports, v2                    134




Instructor Notes:
Read the course summary as shown in the slide.
Text:
[Read bulleted list.]




                                                                                         134
                               References

           The following document will be available upon request from
           your instructor:

              ADT and ADT Reports Student Guide




          August 2006          PAD ADT and ADT Reports, v2          135




Instructor Notes:
Read the course reference as shown in the slide.
Text:
[Read the slide.]




                                                                          135
                                Questions




         August 2006           PAD ADT and ADT Reports, v2           136




Instructor Notes:
Give the students the opportunity to ask any remaining questions.
Text:
Are there any final questions or comments before we end the class?




                                                                           136