Transcript ED Nursing: How to Use Med List Tool - MLT Replacement for Med List in Triage Form) Education - 6.2014

Medication List Tool
Emergency Department
Implementation
Medication List Tool Changes
Objectives:
1. State the rationale for replacing PAML/Med List with
the new Medication List Tool (MLT) in the ED Triage
Form and Inpatient Nursing Admission History (Peds
& Adult)
2. Describe features of the Medication List Tool (MLT)
and associated workflow
3. Understand implementation and support plans for
VUH and VCH
Medication List Tool Implementation
June 10 MCJCHV
( except NICU/ NBN)
Inpatient Nursing
June 17 VUH
Medication List Tool
(MLT) embedded in Adult
& Peds Nursing Admission
History Starform (replacing
PAML)
June 24 VUH & VCH ED
Emergency Department
 Medication List Tool (MLT)
Embedded in Nurse Triage
 MLT embedded in provider
workflow (tentative)
Why Change?
• Patient Dissatisfaction
– Patients are asked multiple times to
supply the same information about
medications taken at home
• Wasted Time
– Redundant work being done due to lack
of integration of current tools
Why Change?
• SAFETY - There is not one source of truth for home medications
– Numerous members of the team collect medication lists yet
these lists are not shared and there is lack of confidence in
the list.
For example, RN collects medication list in triage form yet
this information doesn’t display in the provider workflow
when completing the H&P. The provider collects yet
another list.
– Failure to reconcile medications during transitions (home to
hospital, hospital to home) results in medication errors
Up to 67% inpatients have at least 1 discrepancy
between the prescription medication list obtained by
the admitting provider and the patient’s actual preadmission medication regimen (Tam)
IMPLICATIONS
Adverse drug events, ED visits,
hospital admissions and
readmissions, prolonged length
of stay, patient and provider
dissatisfaction
59% of admission medication
discrepancies could result in
patient harm if they persist
beyond discharge (Gleason)
On average, each patient on a
general medicine service has
more than 1 discrepancy with
potential for harm in the
admission or discharge orders
(Pippins)
Medication Errors at Vanderbilt
In a randomized study of cardiac patients:
• ~50% of patients experienced a clinically
important medication error within 30
days post-discharge (Kripalani)
• ~42% of patients had at least 1 error in
pre-admission medication list (Salanitro)
• ~39% had at least 1 error in discharge
medication list (Salanitro)
In a quality improvement study of general
medicine patients:
• ~90% of patients had an error in their MDobtained admission med list during night shift
Background
Replacing PAML and other medication list tools with the new
Medication List Tool (MLT) in the Nursing Admission History
and ED Triage form is phase 1 of the One Medication List
project
Goals of the One Medication List project:
1) One source of truth for medications
2) All members of the team access and edit the same list
3) Processes, tools and expectations for the medication list
management are standardized across VUMC
One Medication List Project
Implementation
• VPH completed a successful pilot
in March
 Medication List Tool (MLT) in VPH
Nursing Admission History (replace
PAML)
 MLT embedded in the VPH
provider H&P
• Perioperative workflow analysis
and adoption of MLT is in progress
• OB is on hold until system updates
occur later this year
One Medication List Project
Implementation – continued • Embed MLT in the Adult and Pediatric
ED Triage form and Nursing
Admission History
 Replace PAML with MLT
• Provider workflow will be part of
future phases
 Embedded in provider admission
process, i.e., documenting H&P
 Exit check during the discharge process
 Long term goal is for the providers to
have the ability to enter orders for
medications from the list
Current Medication Reconciliation Tools
PAML
The Med List Tool
New Medication List Tool
MLT
NEW
Last completed list visible
with date, time and collector
included
The MLT Summary page display
in the Admission History &
Triage Note
Embedded in Admission History
Embedded in Triage Note
Click Edit or Pencil icon to
open the tool and make
changes
The Med List Tool
• MLT will
open a new
window
when
clicked from
the triage
screen
Left column pulls previous
VUMC medication list from
Patient Summary (PSS)–
such as from clinic visit,
last hospitalization.
NON EDITABLE
Right column is “SCRATCH
PAD” which is an EDITABLE
version of the previous
VUMC medication list.
EDIT list to reflect
medications patient is
currently taking prior to
admission
How to DELETE a medication
DELETE icon
Click “X” to delete a med
that is no longer being taken
Med appears with
strikethrough
Make a mistake? Use the UNDO icon
Click EDIT icon to edit
medication information
How to EDIT a medication
Edit Icon ->
Denote edits to dose, route,
frequency, indication, start date
(OPTIONAL), comments. Specify
date/time last dose taken if
appropriate.
Click SAVE when
revisions completed
Changes are highlighted
for easy review
Click Add Medication
How to ADD a medication
Type Medication Name. Select
from list if appropriate
Denote dose, route, frequency,
start date, indication,
comments. Specify date/time
last dose taken if appropriate
Click Save
New Med highlighted for
easy review
Incomplete medication information
Type medication information that is
known, i.e. “little blue pill for BP”
Select “Unable to Obtain” and denote
reason, if obtaining medication history is
not possible.
Select “Submit” and then “No Current
Medications” if the patient does not have any
home medications.
• This button will only be available when the
scratch pad has no meds listed or all meds
have been deleted.
How to Save MLT
Preview- Displays the list without
the strikethroughs and highlights.
Click a second time return to display
with strikethroughs and highlights
Submit for Review- saves the list
and prompts the provider that the
medication list collection by
nursing is complete and ready for
the provider to review/edit/ send
to Patient Summary
Icons & Displays
Delete
Edit
View
Click to display icons to
print, show/hide comments
or display list of edits by visit
The View icon
displays detailed medication
information including;
history, creation date, and
editor
Click to display all
comments. Click again to
hide comments
Accessing the
Med List Tool (MLT) in Star Panel
Click Actions
to open
Click Med List
Tool to open
• Click
Actions to
open
• Click Med
List Tool
to open
• May have
to
customize
menu to
have Med
List Tool
available
as an
option
MLT and the Provider
Integration of MLT into ED provider workflow is tentatively planned for
June 24
• A column will be added to the ED Whiteboard “M” that will link to the MLT and will
flash if not completed by the provider within an hour of the patient being placed in a
room
• MLT will be embedded in the ED H&Ps
• Medication lists from the MLT will be presented in the ED Discharge Med
Reconciliation process
Once the Nurse Submits for Review, the Provider will review the list
obtained in the Triage Form and will have the option to:
• Edit the list and/or to Save to Pt. Summary if there is a high confidence that the list is
accurate
OR
• Document that the list has been Reviewed but Don’t Save to Pt. Summary if the
confidence level in the accuracy of the list is low (i.e. patient is poor historian or
unable to give a complete home medication list). A reason will be required.
OR
• Document Unable to Obtain a medication list
Implementation & Support
IMPACT TO PATIENTS IN THE ED WHO ARE ADMITTED AND AWAITING BEDS
• June 10: VCH PAML link in the Peds Nursing Admission History will be replaced
with MLT
• June 17: VUH PAML link in the Adult Nursing Admission History will be
replaced with MLT
Support: System Support Services staff will be rounding in the ED. Contact the help
desk (343-4357) for assistance.
IMPACT TO ALL ED PATIENTS (VCH & VUH)
• June 24: Medication List Tool will be embedded into the Triage form
Support: System Support Services will provide 24h support onsite in the ED X 4
days then via call to help desk (343-4357).