Admission Day Done Right: A 24-48 Hour Checklist for New Residents

Sep 30

Did you know one study found that 36% of patients had errors in their admission medication orders? It’s why the first 24–48 hours matter so much—and why a tight, repeatable checklist pays off.

In the next section, we’ll cover the first 24–48 hours that matter most: immediate orders, med reconciliation, day-one safety checks, clear family updates, clean handoffs, and quick physician follow-up. Get these right and you’ll cut errors, avoid unnecessary transfers, pass surveys with less stress, and save staff hours.

1) Immediate Orders (Day 0)

Baseline & safety: vitals with parameters, weight, fall precautions, skin check order, pain plan.
Standing PRNs with clear indications & max doses: pain, nausea, bowel regimen, rescue inhaler.
If clinically indicated: basic labs (BMP/CBC), fingersticks/insulin plan, wound orders, oxygen parameters.

2) Medication Reconciliation (within 24h)

Tri-match: hospital discharge list ↔ pharmacy profile ↔ facility MAR (dose, route, timing).
Confirm allergies, indications, start/stop dates; eliminate duplications/interactions (e.g., overlapping sedatives, anticholinergics).
Verify timing of the next dose for time-sensitive meds (anticoagulants, antibiotics, insulin).

3) Core Assessments (within 24h)

Falls & mobility: gait device, transfer assist level, PT/OT eval if needed.
Skin & nutrition: pressure-injury risk, turning schedule, supplements.
Cognition & swallowing: baseline orientation, aspiration risk, texture/liquid orders.

4) Communication That Prevents Callbacks

Family touchpoint: who to contact, preferred hours, expectations for updates.
Goals of care: confirm POLST/advance directives; document code status clearly.
Shift brief: what’s urgent today vs. what can wait until rounds.

5) Care Coordination (within 24–48h)

Therapy & DME: PT/OT/SLP orders; walkers, cushions, bedside commode, etc.
External partners: pharmacy sync, hospice/home health if indicated, specialty follow-ups booked.
Transport & appointments: align dates/times with your staffing realities.

6) Documentation & Handoffs

Admission note with change-in-condition, assessment, and plan; orders sign-off.
Handoff summary for night/weekend: parameters, who to call, what to watch.
Keep an audit-ready trail (orders, med rec, family contact).

7) 24–48 Hour Physician Follow-Up

Review response to treatments, lab results, vitals trends.
Close any open loops (missing signatures, unclear PRNs, pending referrals).
Simplify where possible (once-daily dosing, deprescribe low-value meds).

How On-Site Internal Medicine Makes This Easy

Direct access: quick clarifications so care isn’t waiting on signatures.
Treat-in-place mindset: same-day plan updates reduce avoidable send-outs.
Clean documentation: survey-ready notes and a clear plan across shifts.

📍 Mana Medical supports senior facilities across Greater Los Angeles (Pasadena, Glendale, San Fernando Valley, Santa Monica, Torrance, and more).
💌 Contact us if you’re looking for dependable physician support for your facility.

Henry Cheung