enhanced maternal & child health referral

September 2016

MCH CDIS EMCH REFERRAL PROCESS

MAV MCH CDIS EMCH Referral Process: Sept 2016 Page 1 of 16

Contents

Making an Enhanced Maternal & Child Health Referral from Primary Caregiver History ................................................................................................................................ 2

Internal Referral to Enhanced Maternal & Child Health via Primary Caregiver History - by Universal MCH Nurse ................................................................................................... 3

Internal Referral to Enhanced Maternal & Child Health in Primary Caregiver Referrals – Editing & Completing ...................................................................................................... 4

Example of Completed Internal Referral to Enhanced Maternal & Child Health in Primary Caregiver Notes – Editing Internal Referral Notes ....................................................... 5

Example of Completed Internal Referral to Enhanced Maternal & Child Health Notes Edited in Primary Caregiver History/Notes ......................................................................... 6

Adding ‘Referral Follow-up’ Blue Alert Flag for Internal Referral to EMCH ..................................................................................................................................................... 7

Viewing, Accepting, Assigning & Declining Internal Referrals to Enhanced Maternal & Child Health – by EMCH Program ............................................................................... 8

Example of when Internal Referral to Enhanced Maternal & Child Health has been declined – by EMCH Program ............................................................................................... 10

Status of Internal Referrals to Enhanced Maternal & Child Health - Pending, Active, Assigned, Completed or Declined ....................................................................................... 11

Adding ‘Enhanced MCH’ Purple Alert Flag for Internal Referrals to Enhanced Maternal & Child Health – by EMCH Program ......................................................................... 12

Closing Enhanced Maternal & Child Health Episode of Care- by EMCH Program ........................................................................................................................................... 13

Example of Completed Closed Enhanced Maternal & Child Health Episode of Care in Client Summary - by EMCH Program ................................................................................. 14

Removing ‘Enhanced MCH’ Purple Alert Flag for Internal Referrals to Enhanced Maternal & Child Health – by EMCH Program ..................................................................... 15

Removing ‘Referral Follow-up’ Blue Alert Flag for Internal Referral to Enhanced Maternal & Child Health – by Universal MCHN .................................................................. 16

MAV MCH CDIS EMCH Referral Process: Sept 2016 Making an Enhanced Maternal & Child Health Referral from Primary Caregiver History Page 2 of 16

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Making an Enhanced Maternal & Child Health Referral from Primary Caregiver History

1. In Primary Caregiver History, hover

cursor over Clinical Activity Move curser down and left click:

Referrals

2. Click on Internal

Referrals to Enhanced Maternal & Child Health are recorded from the PRIMARY CAREGIVER HISTORY

Ensure Primary Caregiver is Open

After making an Enhanced Maternal & Child Health referral in the Primary Caregiver History: 1. Document in the Child Notes:

a. “Primary Caregiver referred to Enhanced Maternal & Child Health” b. Date referral made c. Brief referral reason

2. Add Referral Follow-up Blue Alert Flag to: a. Primary Caregiver History b. Child History

3. Follow-up status of client’s referral and document any relevant information in: a. Primary Caregiver History b. Child History

4. On closure of the referral, remove Referral Follow-up Blue Alert Flag from: a. Primary Caregiver History b. Child History

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Internal Referral to Enhanced Maternal & Child Health via Primary Caregiver History - by Universal MCH Nurse

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1. Select Program: Enhanced Maternal and Child Health from look-up list This is a mandatory field marked with *

2. Select Referral Reason(s) from look-up list

This is a mandatory field marked with * More than one Reason can be selected Select one Reason at a time and click for each

3. Enter Referral Information

This is a mandatory field marked with *

4. Enter Additional comments if relevant

5. Enter Other agencies/professionals involved if relevant

6. Gain informed consent to referral Select by clicking Yes or No accordingly

7. Click Save

Save and continue later will allow editing

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Internal Referral to Enhanced Maternal & Child Health in Primary Caregiver Referrals – Editing & Completing

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1. In Primary Caregiver History, hover cursor over Clinical Activity Move curser down and left click: Referrals

2. Click Open on relevant Referral to be edited/saved Incomplete Pending Referrals lists incomplete referrals Referral Status lists all complete referrals with their status as

either pending, active, completed or declined

3. Ensure Program: Enhanced Maternal and Child Health is selected from look-up list This is a mandatory field marked with *

4. Edit Reason from look-up list This is a mandatory field marked with * More than one Reason can be selected Select one Reason at a time and click for each Reason can be deleted by clicking

5. Edit Referral Information This is a mandatory field marked with *

6. Enter/edit Additional comments if relevant

7. Enter/edit Other agencies/professionals involved if relevant

8. Ensure informed consent to referral is received Select by clicking Yes or No accordingly

9. Click Save No further editing

10. Completed referral displayed in Client Activity – Referrals Referral Status lists completed referrals with their status as

either pending, active, completed or declined


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Example of Completed Internal Referral to Enhanced Maternal & Child Health in Primary Caregiver Notes – Editing Internal Referral Notes

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1. In Primary Caregiver History, hover cursor over History/Notes Move curser down and left click: Notes

2. Click Edit

This will ONLY edit what is documented in the Client/Primary Caregiver Notes and NOT the Internal Referral

3. Add or edit Note

4. Select Edit reason

Click either Incorrect Entry or Incomplete Entry from look-up list

5. Click Save

Whilst there is the option to edit Internal Referral when in Client/Primary Caregiver Notes – it ONLY edits the Notes

and NOT the actual Internal Referral itself

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Example of Completed Internal Referral to Enhanced Maternal & Child Health Notes Edited in Primary Caregiver History/Notes

If Internal Referral Notes have been edited from Primary Caregiver Notes (as per previous page): The Primary Caregiver Notes will then display the edited entry with the heading: Supersedes Progress note previous entered on [date of original] Additionally, the original Internal Referral Note will have the heading: Superseded by note entered on [date of edited version]

MAV MCH CDIS EMCH Referral Process: Sept 2016 Adding ‘Referral Follow-up’ Blue Alert Flag for Internal Referral to EMCH Page 7 of 16

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Adding ‘Referral Follow-up’ Blue Alert Flag for Internal Referral to EMCH

A ‘Referral Follow-up’ Blue Alert Flag must be added to Primary Caregiver AND Child History when there has been an Internal Referral to Enhanced Maternal & Child Health

A ‘Referral Follow-up’ Blue Alert Flag alerts the Universal MCH Nurse to follow-up the referral (from both Primary Caregiver AND Child History) – especially if the referral is pending for an extended period of time and is not yet documented as active/assigned/declined

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1. In Primary Caregiver History, hover cursor over Clinical Activity Move curser down and left click: Flags/Alerts

2. Click Add to add Flag/Alert for referral follow-up

3. Select Category, by clicking on General from look-up list

4. Select Details, by clicking on referral follow-up required from look-up list

5. Enter Start Date by using digits or calendar box Defaults to today’s date

6. Enter Comments: “Referred to Enhanced MCH”

7. Click Confirm

8. Blue Alert Flag is displayed in Primary Caregiver History

**Repeat steps for CHILD in Child History**

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MAV MCH CDIS EMCH Referral Process: Sept 2016 Viewing, Accepting, Assigning & Declining Internal Referrals to EMCH Page 8 of 16

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Viewing, Accepting, Assigning & Declining Internal Referrals to Enhanced Maternal & Child Health – by EMCH Program

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Hint: To view the referral (including referral reasons, referral information, additional comments, other agencies involved) in Client notes, click on Client Identifier hyperlink. The referral &/or notes can be viewed in the Progress Notes tab via this Client details pop-up box.


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Viewing Accepting, Assigning & Declining Internal Referrals to Enhanced Maternal & Child Health – by EMCH Program

1. In Home Screen, hover cursor over General Move curser down and left click: Programs Active List

2. Select Program: by clicking Enhanced Maternal and Child Health from look-up list

3. Select Site from look-up list This will display all those referred to Enhanced Maternal & Child Health from that Site Site: All – displays all those referred to Enhanced Maternal & Child Health from all Sites

4. Select View by clicking on radio button Displays those referred to Enhanced Maternal & Child Health

5. Click Search

6. Select relevant Primary Caregiver(s) by clicking on tick-box

7. Select Accept Referral by clicking on radio button

8. Click Accept Referral(s)

9. Click OK to accept referral to Enhanced Maternal & Child Health

10. Select Assign Referral by clicking on radio button

11. Select Clinician from look-up list

12. Click Assign Referral(s)

13. Click OK to assign referral to Enhanced Maternal & Child Health OR

14. Select Decline Referral by clicking on radio button

15. Select Decline Reason from look-up list

16. Click Decline Referral(s)

17. Click OK to decline referral to Enhanced Maternal & Child Health


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Example of when Internal Referral to Enhanced Maternal & Child Health has been declined – by EMCH Program

After Primary Caregiver Internal Referral to Enhanced Maternal & Child Health has been declined by Enhanced MCH Program, it is automatically documented in Primary Caregiver Notes

Enhanced MCH Program need to document in Child Notes: “Referral to Enhanced Maternal and Child Health has been declined, for (reason)”

On advisement that the Internal Referral to Enhanced Maternal & Child Health has been declined, the Universal MCH Nurse should contact the family to

advise of the referral decline and to offer a review/follow-up if appropriate

Remove ‘Referral Follow-up’ Blue Flag Alert for the Internal Referral to Enhanced Maternal & Child Health from both: Primary Caregiver History, AND Child History


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Status of Internal Referrals to Enhanced Maternal & Child Health - Pending, Active, Assigned, Completed or Declined

Client Referrals Screen / Referral Status: Pending – referred but not yet accepted/declined Active – being currently actioned/receiving service Completed – episode of care has ended/been closed Declined – referral declined

Programs Active List & Client Notes: Active – accepted but not assigned to worker Assigned – assigned to worker Declined – referral declined

Client Summary Page: Program Name – referral has been accepted Start Date – date referral was accepted End Date – date program closed/ended

MAV MCH CDIS EMCH Referral Process: Sept 2016 Adding ‘Enhanced MCH’ Purple Alert Flag for Internal Referrals to EMCH Page 12 of 16

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Adding ‘Enhanced MCH’ Purple Alert Flag for Internal Referrals to Enhanced Maternal & Child Health – by EMCH Program

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2. Click Add to add Flag/Alert for Enhanced MCH

3. Select Category from look-up list, by clicking on Enhanced MCH

4. Select Details from look-up list, by clicking on Client

5. Enter Start Date by using digits or calendar box Defaults to today’s date

6. Enter Comments if relevant

7. Click Confirm

8. Purple Alert Flag is displayed in Primary Caregiver History


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MAV MCH CDIS EMCH Referral Process: Sept 2016 Closing EMCH Episode of Care Page 13 of 16

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Closing Enhanced Maternal & Child Health Episode of Care- by EMCH Program

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1. In Primary Caregiver History, hover cursor over Clinical Activity Move curser down and left click: Programs

2. Click Edit

3. Ensure Program Name is Enhanced Maternal and Child Health

4. Enter End / Exit Date, by using digits or calendar box

NB: Start Date cannot be edited

5. Click Save

6. End Date will be displayed in Client Programs and also in Client Summary (page 11)

7. Status: Completed will be displayed in Client Referrals Screen

**Document in Primary Caregiver Notes AND Child Notes**

“Enhanced Maternal and Child Health Closed” NB: NOT automatically updated in Client Notes

**Remove MCH Enhanced Purple Flag Alert**

From both Primary Caregiver AND Child History

*Client will be removed from Programs Active List*

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MAV MCH CDIS EMCH Referral Process: Sept 2016 Closing EMCH Episode of Care Page 14 of 16

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Example of Completed Closed Enhanced Maternal & Child Health Episode of Care in Client Summary - by EMCH Program

MAV MCH CDIS EMCH Referral Process: Sept 2016 Removing ‘Enhanced MCH’ Purple Alert Flag for Internal Referrals to EMCH Page 15 of 16

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Removing ‘Enhanced MCH’ Purple Alert Flag for Internal Referrals to Enhanced Maternal & Child Health – by EMCH Program

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2. Click Edit on Enhanced MCH Flag/Alert

3. Ensure Category is correct: Enhanced MCH, or EMCH - Referral criteria This is auto filled

4. Enter End Date by using digits or calendar box Calendar box displays red square around today’s date

5. Enter Comments if relevant For example, outcome and recommendations

6. Click Confirm

7. New display in Client History: i. Purple Alert Flag Box replaced with Light Purple Triangle

ii. Status: Inactive displayed in Client Flags / Alerts iii. End Date displayed in Client Flags / Alerts


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MAV MCH CDIS EMCH Referral Process: Sept 2016 Removing ‘Referral Follow-up’ Blue Alert Flag for Internal Referrals to EMCH Page 16 of 16

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Removing ‘Referral Follow-up’ Blue Alert Flag for Internal Referral to Enhanced Maternal & Child Health – by Universal MCHN

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2. Click Edit on relevant General: referral follow-up required Flag/Alert

3. Ensure Category & Details are correct: General: referral follow-up required This is auto filled

4. Enter End Date by using digits or calendar box Calendar box displays red square around today’s date

5. Enter Comments if relevant For example, “episode of care closed by Enhanced MCH”

6. Click Confirm

7. New display in Client History:

i. Blue Alert Flag Box with 1 less number or replaced with Light Blue Triangle ii. Status: Inactive displayed in Client Flags / Alerts

iii. End Date displayed in Client Flags / Alerts


‘Referral Follow-up’ Blue Alert Flag is to be removed only after re-engagement with Universal MCH Service and the relevant Universal MCH Nurse has reviewed the Internal Referral to Enhanced Maternal and Child Health and the Enhanced MCH episode of care

‘Referral Follow-up’ Blue Alert Flags will then need to be removed from both the Primary Caregiver AND Child History

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enhanced maternal & child health referral

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