How do I manage orders for Long-Term Care/Supportive Living patients on dialysis?

Question: How do I manage orders in Connect Care for Long-Term Care (LTC) and Supportive Living (SL) residents requiring hemodialysis (HD), peritoneal dialysis (PD), or an Alberta Kidney Care (AKC) clinic appointment?

Context: If an LTC/SL resident requires HD/PD or an AKC clinic appointment, there is a specific workflow that needs to be followed so that information flows appropriately through Connect Care. This will allow medication orders to work correctly and help to mitigate patient safety concerns. The specific workflow is dependent on whether the facility is on Connect Care, and, if it is, whether the facility has an on-site pharmacy (e.g., CareWest or Capital Care facilities) or uses a contracted/community pharmacy.

Answer: For HD, PD, or AKC clinic appointments, the LTC/DSL Prescriber and Nephrologist must follow the workflow specific to the whether the facility is on Connect Care (as this will determine whether the resident is considered an outpatient or an inpatient) and whether the facility has an onsite vs. contracted/community pharmacy, with the following considerations in mind: 

• Connect Care facilities with on-site pharmacy: Medications are ordered in the inpatient "Orders" activity.
• Connect Care facilities with a contracted/community pharmacy: Medications are ordered in the "External Orders Community" tab.
• For HD: Ordered via the Hemodialysis Therapy Plan, with any changes to be made by the Nephrologist. The "Dialysis Treatment Orders", "Hemodialysis-Anemia Management Protocol" and "Hemodialysis-Intradialytic Anticoagulation Protocol" medications are already included in the Hemodialysis Therapy Plan. It is important for the LTC/DSL Prescriber to ensure there are not duplicative orders for medications, as duplicative orders may lead to patient safety concerns. 
• For PD: Ordered via the Adult Peritoneal Dialysis Order Sets, with any changes to be made by the Nephrologist.  

Please see the memo and tip sheet for further details. 

• Memo: Managing Orders for Continuing Care/Designated Supportive Living Patients on Dialysis [updated Oct 31, 2024]
• Tip: LTC Residents Requiring Dialysis or Renal Clinic Appointment
• Manual: Workflows - Long-Term Care

How do I manage orders for admitted patients on dialysis?

Question: How do I manage orders in Connect Care for admitted patients on hemodialysis (HD) or peritoneal dialysis (PD)?

Context: If an admitted patient requires HD/PD, there is a specific workflow that needs to be followed so that information flows appropriately through Connect Care. This will allow medication orders to work correctly and help to mitigate patient safety concerns. (Note: There is a separate blog post for managing orders for Long-Term Care/Supportive Living patients on dialysis.)

Patients receiving dialysis have their dialysis treatment and associated intradialytic medications ordered via the Hemodialysis Therapy Plan or Peritoneal Dialysis Therapy Plan. When a patient with a Hemodialysis/Peritoneal Dialysis Therapy Plan is admitted to the hospital, the Therapy Plan is automatically placed on hold so that the Nephrology team can adjust the prescription and intradialytic medication orders. Once the prescription and orders have been adjusted, the Therapy Plan is available for the duration of the admission.

Answer: For HD and PD, to ensure information flows correctly and medication and blood product orders function properly in Connect Care, a non-nephrologist admitting prescriber should first place a consult order to Nephrology. Then there are specific workflows for medication and blood product ordering, including (but not limited to) the below: 

• For HD: The dialysis treatment prescription, anemia and intradialytic medications are already included in the Hemodialysis Therapy Plan, and changes are to be made by the Nephrologist. It is important to ensure there are not duplicative orders for medications, as duplicative orders may lead to patient safety concerns. 
• For PD: All PD treatments and medication orders are ordered via the Peritoneal Dialysis Adult Order set and inpatient orders by the Nephrologist. 

Please see the memo and tip sheet for further details. 

• Memo: Managing Orders for Admitted Patients on Dialysis
• Tip: Admitted Patients Requiring Hemodialysis

What happens when a Restricted Medication Therapy Plan has a date change?

Question: Why do I need to re-sign a Restricted Medication Therapy Plan when only the date has been changed?

Context: Therapy Plans can be entered in advance and expected dates may change. While nursing can make changes to Therapy Plans, plans with Restricted Medications cannot be signed by nurses. Therefore, if there is a date change to a Restricted Medication Therapy Plan, the plan will then have to be re-signed by the prescriber. (Note that Connect Care is continuing to look at options to reduce this workload on prescribers.)

Answer: If a date has been changed in a Restricted Medication Therapy Plan, you will receive a notice in your In Basket indicating that review and re-sign is required.

1. In the "Recurring Treatments" folder of your In Basket, select the relevant patient.
2. Click on the 3 dots icon above the message and select "Open Plan" from the dropdown menu that appears.
3. Review and edit, if necessary. 
4. Sign the plan.

For more information:

• Guide: Therapy Plan – Date Change for Restricted Medications
• Guide: Therapy Plans with Restricted Medications – Started Outside of Connect Care
• Manual: Therapy Plans

What are Therapy Plan expiration messages?

Question: Connect Care prescribers increasingly receive In Basket messages to the effect that a Therapy Plan is about to expire. What does this mean?

Context: Therapy Plans help organize the delivery of tests and therapies across multiple encounters for a specific health condition. They are used for a wide range of interventions (e.g., dialysis, iron sucrose treatments) and are increasingly encountered by Connect Care users. 

By default, all Therapy Plan orders (usually for repeating interventions) expire after 12 months, with the exception of antimicrobial plans (which expire at 7 days). The lead prescriber assigned to a plan will receive an In Basket notice at the 11-month mark. This prompts to either renew or discontinue the plan.

Answer: Such messages are not received if a Therapy Plan is set to discontinue once a treatment program is complete. Open ended plans need to be reconsidered at least once a year because there are limits to the number of such plans that can be managed at any one time, and it is important to confirm that ongoing plans are still needed.

• Tip: Expired Therapy Plans
• Manual: Therapy Plans

How can Therapy Plans be scheduled in Emergency Departments?

Question: How can Therapy Plan treatments be scheduled for actions to take place in Emergency Departments (EDs)?

Context: Therapy Plans help organize the delivery of tests and therapies for a specific health condition. They are most commonly used in medical outpatient units and outpatient clinics. Examples include IV Iron Therapy, Transfusions and some Antimicrobial therapies.

Sometimes a Therapy Plan is initiated or continued in an ED setting. EDs on Connect Care are able to book Therapy Plans in-system.

Answer: A tip summarizes how to schedule therapy plan activities in a Connect Care ED.

• Tip: Therapy Plan Treatments in Emergency Departments
• Manual: Therapy Plans