Transcript One of America`s Best Hospitals

Electronic Medication Reconciliation
Nursing Discharge Process
“One of America’s Best Hospitals”
– U.S. News & World Report
Regulation on Joint Commission
Requirements
Requirement: There is a process for comparing
the patient’s current medications with those
ordered for the patient while under the care of
the organization.
The Joint Commission, 2008
“One of America’s Best Hospitals”
– U.S. News & World Report
Regulation on Joint Commission
Requirements
Goal: Accurately and completely reconcile
medications across the continuum of care
Joint Commission, 2008
“One of America’s Best Hospitals”
– U.S. News & World Report
Critical Importance for Nursing
• Complete and accurate home medication list in
the Admission Profile.
• Keep admission profile home medications
updated and as complete as possible.
• Physicians are reconciling from this list.
• Accuracy of the home medication list = patient
safety.
“One of America’s Best Hospitals”
– U.S. News & World Report
Patient Workflow Scenario
At time of Admission
• Mr. Smith admitted to the hospital for
pneumonia.
• Mr. Smith/family provides his home
medication list to the admitting nurse.
• Medications are entered into the admission
database. Patients list may not be accurate (mgs
may be missing, medications are misspelled
which might be an entirely different drug, etc.).
“One of America’s Best Hospitals”
– U.S. News & World Report
MEDICATION SAFETY
• Don’t guess:
Spellings – get the proper name
Milligrams (Micrograms, units, etc.)
• If the patient does not know meds or is unsure
of dosage – record that and report to peer at
change of shift and/or MD for accuracy.
• Review what you have entered BEFORE saving
database (error of transcription for frequency,
etc.)
“One of America’s Best Hospitals”
– U.S. News & World Report
Patient Workflow Scenario
At time of discharge
• Mr. Smith has responded well to treatment and
is now ready for discharge.
• There are 3 MDs on the case that need to
complete their discharge orders for this patient.
• The primary MD (Captain of the Ship) and 2
consultants.
• Electronic medication reconciliation begins:
“One of America’s Best Hospitals”
– U.S. News & World Report
Patient Workflow Scenario
At time of discharge
• Responsibility of the Primary physician
(Captain of the Ship):
– Complete the electronic medication
reconciliation for an accurate discharge.
The following slide is what the primary
physician will see.
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– U.S. News & World Report
“Captain of the Ship”
checkbox.
List of Home
Medications
List of active inpatient
Medications
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– U.S. News & World Report
Select medications
from the ‘Home Meds’
list and the ‘Inpatient
Medication’ list that
you want the patient
to take at home.
*Do not select the same medications
from both lists.
“One of America’s Best Hospitals”
– U.S. News & World Report
Consultants
Medication Reconciliation not completed
Consultant arrives before the captain of the ship
reconciles:
The consultant may add medications through the
discharge process which will populate onto the
electronic medication reconciliation form. This will
also generate a prescription(s) that will require a
physician signature.
“One of America’s Best Hospitals”
– U.S. News & World Report
Consultant
Medication Reconciliation Completed
Consultant arrives after the captain of the ship
reconciles:
Any consultant that orders medication after
reconciliation will not populate on the electronic form
for other physicians to see.
However, the added discharge medications will display
in the final med reconciliation report that the nurses
give to the patient.
“One of America’s Best Hospitals”
– U.S. News & World Report
If med rec has not been completed by the ‘captain
of ship’, the order form will display active and home
medications. Review and click Close.
Open order entry worksheet to enter prescriptions.
If med rec has been completed by the ‘captain of ship’, You
will see the details of what medications have been reconciled
already, but you cannot add or edit form. Review and click
Close.
Open order entry worksheet to enter prescriptions.
“One of America’s Best Hospitals”
– U.S. News & World Report
Nursing Nugget
• All medications written in the discharge process
will populate the report that the nurse gives to
the patient.
• This process eliminates the need for Nursing to
transcribe discharge medications onto the
discharge form.
“One of America’s Best Hospitals”
– U.S. News & World Report
How do I Know Reconciliation is
Complete?
• Go to orders tab
• Build a filter for Medication Reconciliation or
look for the current active orders.
“One of America’s Best Hospitals”
– U.S. News & World Report
Go to orders tab
Under the Orders Tab, the summary
line specifies that Med Reconciliation
was completed electronically.
“One of America’s Best Hospitals”
– U.S. News & World Report
Nursing Discharge Process
• Print medication reconciliation form.
• Review form for duplicates or orders needing
clarification. (patient advocacy/safety concern)
• Use Patient Discharge Home Care sheet to
provide patient with activity, wound care, diet,
education, follow up appoints, etc.
• For now, this part of the process will not
change.
“One of America’s Best Hospitals”
– U.S. News & World Report
Click on Printer Icon
“One of America’s Best Hospitals”
– U.S. News & World Report
Order Management
NEW
“Medication Reconciliation@
Discharge electronic InstructionsPrint for patient to sign”.
Medication Reconciliation-Print Home Meds Only
“One of America’s Best Hospitals”
– U.S. News & World Report
Under Order management you
will see 3 Med Rec reports
•“Medication Reconciliation at
discharge report (old process)
Print only if MD to complete Med
Rec on paper”.
Nursing will print discharge
instructions for the patient after
all medication reconciliation is
completed by captain of the ship
and consultants.
•Two copies will print.
•The patient and the nurse signs
both forms.
“One of America’s Best Hospitals”
•One of the forms will be
scanned back into electronic
record and available to view in
documents tab after discharge.
– U.S. News & World Report
• Continue to use patient discharge
Home Care sheet to provide patient
with activity, wound care, diet,
education, follow up appoints, etc.
“One of America’s Best Hospitals”
– U.S. News & World Report
This printed form is still available for discharge.
From the orders tab in SCM, click on the printer icon
and choose Medication Reconciliation Report
discharge report (old process)
“One of America’s Best Hospitals”
– U.S. News & World Report
If there are more than 30 active medications the electronic
form will not be able to be used. The physician will receive
the above message; ‘Maximum inpatient medication
exceeded’.
If the physician would like to reconcile, they can click on the ‘I
am Captain of the Ship’ box and a paper medication
reconciliation form will automatically print. The paper form
needs to be reconciled and signed.
“One of America’s Best Hospitals”
– U.S. News & World Report
Super Users
Each area will have staff that have learned the
physician process and the nursing process. The
names of the super users will be posted on the
unit to help assist physicians and nurses on the
process of medication reconciliation. Please
direct your questions to your super users for
clarification.
“One of America’s Best Hospitals”
– U.S. News & World Report
Thank you for your time, you have
completed the nursing education on
medication reconciliation
Please print the certificate and hand in to
your Manager/Educator
Medication Reconciliation Committee
“One of America’s Best Hospitals”
– U.S. News & World Report
Nursing Discharge
Process for Electronic
Medication Reconciliation
Doctor
discharges
patient &
med rec is
completed.
Check in
SCM for
discharge
orders ( ex.
Activity, diet,
consults)
Nurses go to
printer Icon
Fill out
Home Care
Instructions
Click order
Management
Click on
Medication
reconciliation
@ Discharge
electronic
instructions a
Document
education given
to patient and
review meds,
follow up appts
and discharge
orders
Have patient
sign
discharge
instructions
and a copy
of med rec
***Med Rec – Medication
Reconciliation
“One of America’s Best Hospitals”
– U.S. News & World Report
Print for
Patient to
sign
Give patient a
copy of Patient
discharge (Home
Care) instructions
and signed copy
of the med rec.
Review
Medications
Pull paper
copy of patient
Discharge
(Home Care)
instructions
Place copy of
signed Med
rec in chart to
be scanned
back into
SCM
Certificate of Completion
__________________________________
Name
to certify that he/she has reviewed to satisfaction
2008
Electronic Medication
Reconciliation
Nursing Discharge Process
“One of America’s Best Hospitals”
– U.S. News & World Report