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The provincial Alternate Level of Care (ALC) designation project provides resources to support healthcare staff and physicians with the implementation of a standardized ALC designation process for all acute care settings within Nova Scotia Health (NSH).
The ALC Designation Project includes the following key components:
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To standardize the ALC designation process in all acute care settings within Nova Scotia Health.
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Alternate level of care (ALC) is used to identify patients who no longer require inpatient acute care services provided at their current facility.
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Once the patient fulfills above criteria, the patient must be designated as ALC by their care team within 24 hours.
The STAR ADT (Admissions, Discharge, Transfer) system is used to capture all ALC information for patients in Central Zone. Entering this information into STAR in a consistent and timely way makes it possible to track and report on the ALC patient population within Central Zone.
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Once a patient has been designated as ALC as per the ALC Designation Policy, a data entry clerk/nurse enters the ALC designation in STAR (on the applicable Admission Revision screen) on the same date as the designation using one of the following processes:
1.1 In STAR where physicians wish to have ALC patients remain on their worklist:
1.1.1 Enter Date of ALC Designation identified on the ALC Status Form.
1.1.2 Enter ALC Support Required identified on the ALC Status Form using the dropdown list.
1.2 In STAR where physicians do not wish for ALC patients to remain on their worklist:
1.2.1 Change the patient’s CUT Code/Service to ALC using the Transfer Patient function, as you would for any CUT Code/Service change for an Inpatient.
1.2.2 Enter Date of ALC Designation identified on the ALC Status Form (Appendix A).
1.2.3 Enter ALC Support Required identified on the ALC Status Form (Appendix A) using the dropdown list.
1.2.4 The date field will only be changed when a patient is medically discharged or moved back into an acute care status.
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If a patient no longer meets the Nova Scotia Health definition of ALC and all criteria and has been re-designated as acute as per the ALC designation Policy, a data entry clerk/nurse removes the ALC designation in STAR (on the applicable Admission Revision screen) on the same date as the re-designation using one of the following processes:
2.1 In STAR for ALC specific fields:
2.1.1 Remove Date of ALC Designation
2.1.2 Remove ALC Support Required
2.2 In STAR for ALC CUT Codes:
2.2.1 Using the Transfer Patient function, replace the ALC CUT code with the new most appropriate CUT code that reflects the acute care admission.
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If a patient has been re-designated as ALC as per the ALC Designation Policy, a data entry clerk/nurse enters the ALC designation in STAR (on the applicable Admission Revision screen) on the same date as the re-designation using the procedure in Step 1 of the Entering information into STAR once ALC designation has been established section above.
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If the ALC Support Required is changed, a data entry clerk/nurse updates the ALC Support Required (on the applicable Admission Revision screen) using the following process:
4.1 Enter the updated ALC Support Required identified on the ALC Status Form (Appendix A) using the dropdown list.
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| Role | Action(s) |
|---|---|
| Data Entry/Ward Clerks |
|
How does the new ALC designation process change the way we work?
The new ALC designation process provides clarity on the classification of ALC patients and recommended supports for discharge from the acute care setting.
All ALC designation information will be documented on the ALC Status Form. All information on the form must be entered into the appropriate Admission Revision Screen within STAR on the same day the ALC designation/status change takes place. Where physicians do not wish for ALC patients to remain on their worklist, the patient’s CUT code must be changed to ALC using the Transfer Patient function.
What if a Data Entry/Ward Clerk is not available on my unit to enter ALC Status Change information into STAR?
If a Data Entry/Ward Clerk is not available to enter ALC Designation/status change information into STAR, any care team member with the appropriate systems access may enter the information.
Units should follow their own internal processes for determining who is responsible for entering admission/transfer information into STAR. Changes in a patient’s ALC status must be communicated to the individual responsible for entering the data into STAR, using the ALC Status Form, in a timely manner after a decision is made.
Where can I find detailed instructions on how to enter ALC information into STAR?
Detailed information on how to enter ALC status information into STAR can be found in the Work Instructions: Tracking of Alternate Level of Care in STAR document.
Integrated Access and Flow Network, 2024
The Meditech ADT (Admissions, Discharge, Transfer) system is used to capture ALC information for patients in Eastern Zone (EZ), Northern Zone (NZ) and Western Zone (WZ). Entering this information into Meditech in a consistent and timely way makes it possible to track and report on the ALC patient populations in these zones.
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Once a patient has been designated as ALC as per the ALC Designation Policy, a data entry clerk/nurse enters the ALC designation in Meditech (on the applicable Admission Revision screen) on the same date as the designation using the following process:
1.1 A transfer notice is entered in the Meditech Order Entry module containing the following information:
1.1.1 Enter Reason for transfer as Change Service.
1.1.2 Add Service Type of ALC- Alternate Level of Care.
1.1.3 Enter ALC Support Required identified on the ALC Status Form (Appendix A) using the dropdown list.
1.1.4 Enter Date of ALC Designation identified on the ALC Status Form
(Appendix A).
1.2 Once the transfer notice is received by Admitting/Access and Flow, a clerk will update the patient’s service in the ADM module.
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If a patient no longer meets the Nova Scotia Health definition of ALC and all criteria and has been re-designated as acute as per the ALC designation Policy, a data entry clerk/nurse removes the ALC designation in Meditech using the following process:
2.1 A transfer notice is entered in the Meditech Order Entry module containing the following information:
2.1.1 Enter Reason for transfer as Change Service
2.1.2 Add Service Type as new most appropriate service that reflects the acute care admission.
2.2 Once the transfer notice is received by Admitting/ Access and Flow, a clerk will update the patient’s service in the ADM module.
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If a patient has been re-designated as ALC as per the ALC Designation Policy, a data entry clerk/nurse enters the ALC designation in Meditech using the procedure in Step 1 of the Entering information into Meditech once ALC designation has been established section above.
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If the ALC Support Required is changed, a data entry clerk/nurse updates the ALC Support Required using the following process:
4.1 A Change of ALC Support procedure is entered in the Meditech Order Entry module containing the following information:
4.1.1 Enter updated ALC Support Required identified on the ALC Status Form (Appendix A) using the dropdown list.
Click through the tabs for more information.
Click through the tabs for more information.
Click through the tabs for more information.
| Role | Action(s) |
|---|---|
| Data Entry/Ward Clerks |
|
How does the new ALC designation process change the way we work?
The new ALC designation process provides clarity on the classification of ALC patients and recommended supports for discharge from the acute care setting.
All ALC designation information will be documented on the Nova Scotia Health ALC Status Form. All information on the form must be entered into the Meditech Order Entry module on the same day the ALC designation/status change takes place.
What if a Data Entry/Ward Clerk is not available on my unit to enter ALC Status Change information into Meditech?
If a Data Entry/Ward Clerk is not available to enter ALC Designation/status change information into Meditech, any care team member with the appropriate systems access may enter the information.
Units should follow their own internal processes for determining who is responsible for entering Order Entry procedures into Meditech. Changes in a patient’s ALC status must be communicated to the individual responsible for entering the data into Meditech, using the ALC Status Form, in a timely manner after a decision is made.
Where can I find detailed instructions on how to enter ALC information into Meditech?
Detailed information on how to enter ALC status information into Meditech can be found in the Work Instructions: Tracking of Alternate Level of Care in Meditech document.
Integrated Access and Flow Network, 2024