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SNF/NH Transfer to MMC ED

Greetings!

The forms on this page are to be used for the SNF/NH to MMC ED patient transfer process. Maine Medical Center's Emergency Department and North East Mobile Health Services are partnering with the participating homes listed below. 

Participants
MMC ED
Pam Jordan
JORDAP@mmc.org
North East Mobile Health Services
Polly Miller
PMiller@mobilehealthmedics.pro
Homes (Phase 1)
Barron Center
Ed Latham
EAL@portlandmaine.gov
Gorham House
Gail Hauser
Gail.Hauser@continuummaine.com
Seaside Rehabilitation and Healthcare Center
Danielle Sullivan
donseaside@firstatlantic.com 
Homes (Phase 2)
The Cedars    
Sue Dionne-Jones     
sdionne-jones@thecedarsportland.org
Falmouth by the Sea    
Lindsay Brown  
donfbts@firstatlantic.com
St. Joseph's Rehabilitation and Residence    
Bonnie Smith   
bsmith@sjm-me.org

 

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.

** Immediate communication is expected if the 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.

 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.

SNF_to_ED_Checklist_Aug2015.jpg

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

SNF_to_ED_Pilot_RESIDENT_TRANSFER_FORM_Aug2015.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. Seaside uses their own SBAR format which comes out of their electronic record.

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

OneCall Form

This form includes the bullets of what the SNF/NH clinician will tell the OneCall staff and/or what the OneCall person will ask during the call.
SNF_to_ED_OneCall_FORM_Aug2015.jpg
Transfer Form - ED Discharge to Nursing Home
This form was created by the MMC ED.
 ED_Transfer_Form_to_SNF_Aug2015.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 MMC ED and the SNFs. Staff from any location (SNF, ED, OneCall, EMS and MaineHealth) can use this form to track data and document comments.

 SNF_to_ED_Process_Data_Tracking_Form_Aug2015.jpg

 

 

 

 


Phase 3 Pilot with Pen Bay


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