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SMHC SNF/ED Transfers Pilot

Greetings Cross-Continuum Team!

The forms on this page are to be used for the SMHC SNF/ED Transfers Pilot. SMHC's Emergency Department, local EMS and nursing homes are partnering to improve the communication process.

 

Contact Information

 

Pilot Participants
SMHC Emergency Department
Biddeford Campus: Lauren Vickerson  LEVickerson@smhc.org
Sanford Campus: Lillian Watterson  jimandlil2002@yahoo.com
EMS Companies
John Brady  jbrady@kennebunkmaine.org
Kevin Duross  kevin.duross@BPD.net
Marc Minkler  mminkler@mobilehealthmedics.com
Operational Excellence
Mary Page
mepage@smhc.org
 Homes
Greenwood Center
Anna Rabassa
ARabassa@greenwoodcenter.com
Newton Center
Roger Caron  RJCaron@smhc.org
Kathy Fernberg  KEFernberg@smhc.org
Varney Crossing
Barbara Rentz-Champagne
brcvcross@maine.rr.com

 

MaineHealth Contact:
Sharon Foerster, 207-661-7595
FOERSS@mainehealth.org

As you use the forms, feel free to provide feedback to Sharon Foerster in between meetings.

** In the course of your pilot, immediate communication is expected if the pilot process adversely affects patient care in any way. **


DOCUMENTS
Pilot Process Map
This is an overview of the current process, with flagged areas for improvement/change.
Under Development

 FORMS
To be used by the SNF/NH, ED, OneCall and/or EMS.

Transfer to ED Document Checklist
This form is placed on the outside of the manila envelope.
Checklist_Transfer_to_ED_July%202015.jpg

 Resident Transfer Form
This form is placed inside the manila envelope and includes most important resident information.

RESIDENT_TRANSFER_FORM_SMHC_July_2015.jpg

SBAR Forms

(1) One-Page SBAR Document

SBAR_onepage_PB_2014.jpg

 

(2) INTERACT® SBAR Form This form is also available on the INTERACT® website. Please note that you must go to the INTERACT® website and agree to use the INTERACT® Licensed Materials as described in the terms of agreement. You may want to use this form for training staff but not to send to the ED.

Homes might use their own type of form to document the SBAR communication.

Transfer Form - ED Discharge to Nursing Home
This form was created with SMHC ED input.
 Transfer_Form_ED_Discharge_to_SNF_June_2015_SMHC.jpg
Face Sheet
This form will be specific to each SNF/NH but contains standard information.
 
Current MAR
This form will be specific to each SNF/NH documentation.
 
Advance Directives and Code Status Documentation
Will be what the SNF/NH has on record for the resident. The POLST form will be a state form if the resident has previously filled one out.
 

 Data Tracking Form
This form is to be used by the SMHC ED and the SNFs in the pilot. Staff from any location (SNF, ED, EMS and MaineHealth) can use this form to track data and document comments. Please send the form to Sharon Foerster foerss@mainehealth.org each Friday after the beginning of the pilot. The sub-group will review results periodically.

 Data_Tracking_Form_SMHC_July_2015.jpg

 

 

 

 

 

Phase 1 and Phase 2 Pilots with Maine Medical Center

 

Phase 3 Pilot with Pen Bay


110 Free Street | Portland, Maine 04101 | (207) 661-7001