SPH Hospitalist Wiki

SNF Discharge Checklist

Properties2
tagssnf, discharge, workflow, checklist, skilled-nursing, med-rec, insulin, orders
aliasesSNF discharge checklist, skilled nursing discharge, SNF discharge orders, snf checklist

2 min read

1. Discharge Order Set for Skilled Nursing Facility

TIP

Use the Discharge to Skilled Nursing Facility order set for all SNF discharges. This is where you can order PT, OT, ST, oxygen, and other orders. Make sure to order a diet and weight bearing status.

The orders from this order set will later populate the .HOSPITALISTSNF dot phrase discussed below.

Diet orders: If regular diet, type “Regular Diet” in the comment section instead of only checking the No Restrictions diet.

2. Medication Reconciliation

WARNING

All controlled substances need new prescriptions sent to the SNF pharmacy, even if continuing from home!

New Prescriptions

  • Any new prescriptions started during admission that are continued at discharge need 30 days supply (unless a set number of days for antibiotics).
    • ⚠️ This includes narcotics
  • Any scheduled medications, even if continued from home, need a new 30-day prescription for:
    • Narcotics
    • Ambien and other sleep aids
    • Benzodiazepines
    • Some anti-seizure medications
    • Lyrica
    • Tramadol
    • Lomotil

Continue Without New Script

Continue medications from home and do NOT write a new prescription for them if:

  • There are no changes in dose, and
  • They are not scheduled meds

SNF Pharmacy Routing

Send electronic scripts to:

  • Elkhorn: Continued Care, Boise, Idaho
  • Cooney: Continued Care, South Dakota
  • Mt. Ascension: Omnicare, Billings
  • Full list for other SNFs and some ALFs → check with Shelly Boyd or Care Managers

INFO

See SNF pharmacy for the full pharmacy directory.

3. Insulin Orders

  • It is OK to continue sliding scale insulin if the patient was on that at home prior to admission
  • ❌ Avoid starting new sliding scales on patients discharging to SNFs
  • ⚠️ Carb counting with insulin correction is NOT available at SNFs
  • If discharging with a sliding scale, indicate Low, Medium, or High on the insulin order — SNFs have protocols for each tier
    • This includes continuing home sliding scales (the instructions do not flow to the SNF from the patient’s home Rx’s)

4. Text Instructions Area (Discharge Tab)

AFTER completing your discharge orders, type .hospitalistsnf into the “Text Instructions” area of the “Discharge” tab to pull your discharge orders into the AVS instructions that go with the patient to the SNF. These have an electronic signature.

5. Coordinate with Surgery

If ortho or general surgery is also following the patient, coordinate to make sure someone is sending 30 days of medications to the SNF at discharge for mutual patients.

Graph View

Backlinks