Access to eDN from the Hospital Intranet. Select Clinical Systems Select eDN

Type in username and password Select Ward

Patient List View – on Admission

Patient List View – on Transfer to another Ward

To access the patient’s Discharge Notification click on the underlined ID number

From this view you can also go into Ward Handover and Handover Summary

Responsibility for completion of the eDN sections splits into 3 staff groups :

Only doctors (or prescribing nurses) can complete Clinical and Medicine on Discharge

Ward Clerks and Nurses can complete Notes and Management, BUT doctors can also complete those sections

Clinical, Medicine on Discharge, Notes and Management sections are accessed by clicking on Edit Details for each section

The blue buttons along the top of the eDN screen display information and extra screens

The front screen of eDN Opening for the first time it displays the admission information brought through from iPM and any patient allergies recorded previously in eDN

The Draft view in the Preview screen shows how the eDN will look in its final version.

The Journal is the eDN Audit Trail recording who is entering information at the various stages of the eDN. Of necessity, the eDN will be accessed and added to by a number of clinical staff during the patient’s stay on the Ward.

The ADT screen is essentially the messaging screen displaying locations of the patient’s eDN from Admission to eventual discharge

Extra data provides extra information screens which can be added to the eDN as appropriate.

Extra data splits into two sections :

Extra Clinical Data which adds extra screens providing relevant clinical information for the GP

Extra Management Data which adds an extra screen for paediatric patients only

NB Notification of Death should only be used when there is a death on the Ward. Its layout is similar to the Death Certificate and after completion the notification is sent electronically to the GP for their information.

The Dementia screen is added automatically for any patients aged 75 and over

Having chosen the required extra screens, clicking Update adds them to the Discharge Notification

Clinical Section

• Responsibility of the Junior Doctor

• Should be completed in stages, not intended to be left until the patient is ready to be discharged

• Medication on Discharge cannot be finalised until the Clinical Section has been completed

• Pharmacy require both sections to validate TTO

The Clinical Section should be commenced after taking the Patient’s History. It is intended to be completed in stages

Fields marked with an arrowhead are mandatory

It is important to search for, and select, a Primary Diagnosis using the search facility in eDN Click in the field and type in the first 4 letters and click on the Find button to the right of the field. Select the coded item from the list.

If the patient has had a previous eDN at NGH the co-morbidities section will display information added at that time. If this is their first eDN, any co-morbidities should be added in the appropriate field

eDN commenced – basic information completed. Click on Hold to save.

If the patient has had a previous eDN at NGH the co-morbidities section will display information added at that time. If this is their first eDN, any co-morbidities should be added in the appropriate field

This part of Clinical Details records any Hospital Acquired Infections and treatment given, Investigations/Results and Interventions and any complications and problems arising during the patient’s stay on the Ward. Click on Hold to save.

This final part of the Clinical Details screen is information giving for the GP (and the patient) Click Complete to save and mark this section as ready for discharge

Medication on Discharge Section

• Responsibility of the Junior Doctor

• Medication on Discharge must be a complete record of medication to be taken after discharge. As well as newly prescribed drugs, it must reflect the position with regard to any drugs the patient was already taking prior to Admission – POS (Patient’s own supply)

• Any POS drugs to be stopped, or replaced, on discharge need to be added and clearly marked as stopped with appropriate explanation

• The Drug chart to Pharmacy or Ward Pharmacist (if applicable) for validation

Medication on discharge allows for prescribing on eDN and transfer of the eDN to Pharmacy for dispensing. Clinical details MUST be completed before this can happen.

If the patient has had an eDN before, Drug Treatment History displays previously prescribed drugs. It is possible to copy drugs from that screen into today’s prescription. Edit Drug Treatment goes through into the Allergy confirmation and prescribing screens.

To select a previously prescribed drug or drugs select Click to Copy to add them to today’s prescription Click on Back to return to the previous screen

Confirm allergies as recorded and add any new allergies Confirm as correct

Add drugs one by one, entering dose, frequency, route and duration to be taken home. If drugs are to be dispensed in Pharmacy, select Supply from Pharmacy, if packs are held on the Ward select Supply from Ward. If the patient was previously taking the drug select POS (Patient’s Own Supply. Advise whether GP to continue with drug Click on Add Drug Repeat for each Drug (including those Patient Own Supply drugs to be continued by the patient)

Drugs to be Discontinued : Add drugs one by one, entering dose, frequency, route and duration as before. Click on Stop Drug and type in reason for stopping When the prescription is complete, click on Complete to send the eDN to Pharmacy

Complete the planned Discharge date and time and Discharge from fields. Click on Next

eDN in Pharmacy

• The patient’s Drug Chart must be delivered to Pharmacy, unless a Ward Pharmacist has validated the prescription

• Pharmacy will contact by telephone if discussion needed on any of the drugs

• If need for drug to be altered, eDN will be rejected by Pharmacy and returned to the Ward screen for amendment and subsequent return

• Once drugs are dispensed, status of Prescription in Patient List will show as Dispensed

Management Section

• Can be completed by any member of staff

• The Management screen details where the patient is going on discharge, any care arrangements made, e.g. physiotherapy, occupational therapy, specialist nurse etc., information given to the patient/relative.

• There are a number of mandatory questions to record NGH compliance with targets, e.g. smoking cessation, VTE assessment.

• The final section concerns outpatient follow up plans, appointment date if known, outstanding tests.

The Management Section can be completed by any member of staff. It must be completed to enable the Discharge Notification to be finalised.

The top half of the screen details where the patient is to go on discharge, care arrangements made, information given and various mandatory fields indicating NGH compliance with national targets.

The bottom half of the screen details outpatient arrangements (if known), sickness certificate given, any further reports the GP should look out for on ICE. The Patient should always be given a copy of the Discharge Notification on discharge. Click on Complete

When Clinical, Medication on Discharge and Management have all been completed another blue button is displayed at the top of the screen to allow finalisation of the Discharge Notification

The GP’s copy has been sent electronically – unless it is an out of area GP, in which case it is printed out in IT and posted. The Patient’s copy, a copy for the notes and a copy for the Clinical Coders are printed.

Patient Deceased on the Ward

• Notification of Death is available in the Extra Data Section

• Responsibility of the Junior Doctor

• Death Notification must be completed in the Evelyn Centre (Bereavement Office) where there are computers available to doctors for this purpose

• It is important that Death Notification is completed in a timely manner to ensure the GP is informed as quickly as possible of the death of his/her patient

Select Notification of Death and click on Update

Complete the screen as fully as possible and click on Update to send to the GP