Psychiatry Epic Workflows

Update once evaluation is complete. Mark the principal problem.

Confirm with patient and make necessary additions. Mark as Reviewed.

Complete on admission if the patient is prescribed buprenorphine or methadone. Search "MOUD" (bup, methadone). The Psychotropic Medications Consent ("Psychotropic Medications Consent") is only required if the patient is on antipsychotic medication AND has abnormal movements.

Review PDMP. Mark as Reviewed.

Must be documented for any patient on antipsychotic medication — whether we are continuing it, stopping it, or starting it. Complete the AIMS exam within the Admission activity, under the Screenings and Scales section.

Review nursing entries. Document Family Psych History.

Document thoroughly. For patients with extensive treatment histories, it's acceptable to consolidate multiple treatments into a single entry as long as pertinent information is captured.

Review nursing screening documentation and update as needed. Drug section: make a selection (yes/not currently/never) for "Drug use" and skip subsequent subsections. Class section MUST be completed for Primary, Secondary, and Tertiary substance of choice — this is a Federal requirement. Complete [Drug] Details for each current and historic substance.

Complete. Ensure Gender Identity is accurate for gender minorities.

Record categories of traumas and approximate age. Avoid documenting sensitive details here (reserve those for the evaluation note if clinically appropriate).

Every home medication must be addressed: continue, don't continue, or order and hold.

• Admission orders

  If primary care hasn't completed the admission order set first:

  • ACU: JFK ADATC Admission - ACU (Anna L Dill,MD - JFK Pref ACU Admission Order Set)
  • ARS: JFK ADATC Admission - ARS (Anna L Dill,MD - JFK Pref ARS Admission Order Set)

  If the order set doesn't appear by default, search Pref ACU Admission or Pref ARS Admission. Mark it as a favorite so it shows up automatically next time. If other admission order sets are appearing as defaults, right-click them and unmark them as favorites.

• SUD/Detox orders
  • SUD Monitoring and Treatment Order Set — contains all detox protocols, MOUD, and MAUD

Select Add Care Plan (unless one already exists). Add a plan for each problem requiring active management. IP Substance Use should apply to every patient.

• Add at least one Long-term goal — choose from list or use .JFKPSYLTG. End date: "t+365"
• Add at least one Short-term goal — choose from list or use .JFKPSYSTG. End date: "t+7" (ACU) or "t+14" (ARS)
• Add at least one Intervention per STG — choose from list or use .JFKPSYINT. Select a measurable frequency (not "as needed"). ACU frequency: Daily. ARS frequency: Weekly.
• Set the effective date 30 days out so the care plan does not expire
• Select Plans → Start a New Plan → Multidisciplinary Treatment Plan

Also accessible via: Notes tab → New Note → Comp Psych Eval. SmartPhrase: .JFKACUADMISSIONPSYCHIATRY or .JFKARSADMISSIONPSYCHIATRY

Update Handoff and Hospital Course (both in Sidebar). SmartPhrases: .JFKHANDOFF and .JFKHOSPITALCOURSE

Notes tab → New Note → Progress Note. SmartPhrase: .JFKACUPROGRESSNOTEPSYCHIATRY or .JFKARSPROGRESSNOTEPSYCHIATRY

Always update Handoff and Hospital Course (Sidebar). SmartPhrases: .JFKHANDOFF and .JFKHOSPITALCOURSE

Transfer tab → Transfer Orders: Click "Transfer Patient to new unit" order

• Service: ADATC
• Level of care: ACU → ARS is residential. For ARS → ACU diversion, select whichever LOC best applies
• Review current orders for accuracy. Continue/DC/Modify as indicated
• Activity level 3 for ARS; level 1 for ACU
• Safety Check for ARS: q60m daytime, q30m nighttime
• Order an Inpatient Recreational Therapy Consult. In the comment field, enter "ARS transfer."
• No detox protocols, CIWA/COWS, or frequent PRNs for ARS patients. Exceptions must be confirmed with attending. In these cases, always inform the nurse supervisor and provide a warm handoff (verbal report) to the ARS psych provider.

Transfer Note — Notes tab → New Note → Progress Note. SmartPhrase: .JFKTRANSFERSUMMARY

Treatment Plan tab → Manage Plan & Document Progress

• → Document Progress: Update goals (Progressing, Adequate for Transfer, Completed)
• → Manage Plan: Add additional STG + Intervention if needed (ensure at least one of each applies to rehab). Create a new plan (can carry forward the first one) → Plans → Start a New Plan → Multidisciplinary Treatment Plan

Update the Handoff to clearly convey upcoming plans, recommendations, and action items.

Complete CSSRS Discharge Screener.

Update Problem List — ensure all SUDs have severity specifiers.

• Discharge Med Rec (done by primary care, except for unplanned after-hours discharges)
• Bridge prescription buprenorphine (when applicable). Moonlighters and trainees do not have eRX privileges and must reach out to the attending or backup provider for this.
• Click Discharge Patient order → Select Routine Discharge → Enter anticipated discharge date
• Order Sets → Psychiatry Discharge Order Set
• Personalize Psychiatry Discharge Instructions (can delete "Monitoring" section if primary care is contributing to the discharge; for after-hours, complete as best you can)
• Add "How to Use Naloxone" discharge instructions, if applicable

Create Note. SmartPhrase: .JFKDISCHARGESUMMARY. Pro tip: reference the psych eval for Psychosocial Stressors, Suicide Risk, and Violence Risk sections. Make updates as applicable.

Treatment Plan tab → Document Progress → Resolve Plan. Goal closure guidance:

• "Adequate for Discharge" — the patient has achieved the goal (e.g., detox complete or symptoms minimal)
• "Completed" — we are no longer managing that goal because they are leaving our care. The treatment episode is complete. This does not imply the goal was fully achieved.
• If a patient is leaving with minimal progress and the problem remains tenuous (e.g., leaving against advice at the peak of withdrawal), document a brief note describing the situation. That note type is found in Treatment Plan tab → Summary and Note.

Discharge tab → Admission Denial subtab: Complete basic navigator sections (allergies, SUD history, medical history)

Notes tab → New Note → SmartPhrase: .JFKMEDICALSCREENINGEXAMFOREMTALA

Consents → search "EMTALA Transfer" → complete consent with the patient

Order a Nursing Communication for naloxone (NOT a prescription to our pharmacy). Search orders for "Nursing Communication" and add the comment: "Please dispense OTC naloxone rescue kit with patient education"

Discharge tab → Admission Denial → Instructions for AVS → add SmartPhrase: JFKCRISISRESOURCELIST. At the top of that section, include personalized follow-up recommendations.

Do NOT place a discharge order — the patient was never admitted. Nursing removes the patient from the facility in Bed Manager.

Notes tab → New Note → Progress Note → SmartPhrase: .JFKONCALLADMISSION

Admission tab → Admission Navigator → Place admission orders (refer to the standard Admission workflow above)

Notes tab → New Note → Significant Event → SmartPhrase: .JFKSIGNIFICANTEVENT