Updating Problem Lists

From Guide to YKHC Medical Practices

Enter any new problem that will need ongoing follow up and care management ie seizures /status epilepticus; VSD; respiratory failure; Chronic Kidney Disease etc, Congenital Adrenal Hyperplasia etc

Only add problems that require ongoing management or might impact future health status…Do not add non-serious issues like strep throat/chronic Otitis media/mild anemia or other issues that do not require ongoing evaluation and management

Update problem lists regularly with new or additional information noted on chart reviews, specialty notes reviews, and patient encounters in ER, OP clinic, village clinic and NW. Put in things that another provider would want to know if they were providing acute care, doing a care management review or in an emergency.

Consolidate like problems and comments into as few problems as possible. Try to combine issues into one problem where it makes sense. (e.g.: When we get a ‘simple’ discharge from NICU, A summary problem could look like 36 week premie: transient hypoglycemia, hyperbli treated with lights and poor feeding that resolved. This makes it so you don’t’ have three separate problems to put on the list.)

Cancel old problems (this lines them out) that are no longer important and resolve problems that are not active but would be good to know about --this leaves them visible on regular RAVEN and removes them from RMT problem lists.

You can modify the name of the problem list to add limited information… ie Premature Infant can be changed to read ‘33 6/7 week Premie’ and no further comments are needed if they are uncomplicated

Alert Notes are created for longer and evolving individual care plans. Make a note in the comments of a problem with the date of the latest note/s. Make sure your filters are set to see all alert notes

Put a date in the body of your problem list comments. The date of a comment is seen on regular RAVEN, but not in the RMT problem list comments. On RMT comments there is no time frame reference. EX: Put date the specialist was seen and the month and year the follow up is due

Add brief pertinent information in the problem list comments if needed.

Examples of Problem List Communications Notes that might be helpful

  • Seen on 2/15/13. Start Pulmocort. PMD recheck in 2 months. pulm f/u 6 months. Needs chest CT in one year with pulm f/u
  • Atypical febrile seizures. EEG referral made. Diastat prescribed. No anti-epileptics for now
  • Weight check q week in village and monthly with Bethel peds until patient reaches 10th percentile
  • Work with and allow family to make decisions about treatment and coming to Bethel by regular plane or medevac.
  • A specific plan for emergencies like SVT or recurrent difficult-to-control seizures
  • Made CPP until FTT issue resolved and may then graduate from registry if gaining weight well

Keep Problem Lists updated with

  • Specialty visits and f/u or management changes and when next appointment is due
  • Therapeutic pearls for really sick and difficult patients
  • Meds and lab result with therapeutic goals and plans
  • Important things that might affect future care
  • The date of last/most updated alert note detailing longer and more complex individual care plans

If you make a patient CPP (should only be done by a Pediatrician), please put a problem in for why this patient is made CPP. Example: Patient is made CPP for Severe Breath Holding with seizure like movements. Referred for an EEG etc. Note the EEG referral has been made so the next person can check on the status of the EEG. Also note that the patient was made CPP for this issue.

Put procedures in histories section. PE tubes, T&As, appys etc are easy to enter there.


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