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SNF/NH Resident Transfer to MMC ED Communication Process

Greetings!

The forms on this page are to be used for the SNF/NH to MMC Emergency Department patient transfer process for communication. Maine Medical Center's Emergency Department and North East Mobile Health Services are partnering with the nursing homes in the MMC area. Below are contacts should you have any questions.

Participants
MMC Emergency Department
Pam Jordan
JORDAP@mmc.org
North East Mobile Health Services
Sarah Scott
SScott@nemhs.com
 
Falmouth by the Sea     
donfbts@firstatlantic.com
Gorham House
Kathy Walker-Leighton
Kathy.Walker-Leighton@gorhamhouse.com
Seaside Rehabilitation and Healthcare Center
Danielle Sullivan
donseaside@firstatlantic.com 
South Portland Nursing Home
Gail Hauser
St. Joseph's Rehabilitation and Residence    
Bonnie Smith   
bsmith@sjm-me.org
The Cedars    
Sue Dionne-Jones     
sdionne-jones@thecedarsportland.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_Sept_2016_MMC.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 Maine state form if the resident has previously filled one out. (POLST stands for Physician Orders for Life-Sustaining Treatment.)
 

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

If you do not want to use the form above, you may consider:

  • Monitoring that the process was done during the INTERACT Quality Improvement Tool analysis.
  • Designate one person to review use of the process.
 


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