Transcript Select “Medication List,”

Tiffany Montoya, PharmD, PhC
Lead Cardiology Pharmacist
October 25, 2012
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The average hospitalized patient is subject to
at least one medication error per day
Medication errors are the most common
patient safety error
>40% of med errors are believed to result
from inadequate reconciliation in handoffs
during admission, transfer, and discharge of
patients.
 Of these errors, ~20% result in harm
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National Patient Safety Goal #3: Improving the safety
of using medications
 Requires that organizations “maintain and communicate
accurate medication information” and “compare the
medication information the patient brought to the
hospital with the meds ordered for the patient by the
hospital in order to identify and resolve discrepancies.”
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Core Measures for Heart Failure
 HF1: Written discharge instructions
▪ Patient must be discharge with a compete med rec list
▪ The discharge med list must match the discharge summary med list
EXACTLY
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The process of comparing a patient’s medication
orders to all of the medications that the patient
has been taking. (The Joint Commission)
This process comprises 5 steps:
1.
2.
3.
4.
5.
Develop a list of current meds
Develop a list of meds to be prescribed
Compare the meds on the two lists
Make clinical decisions based on the comparison
Communicate the new list to appropriate caregivers
and to the patient
1. Select
“Medication List” tab on left Menu
2. Select “Customize View”
3. Move “Available Columns” to “Selected
Columns”
4. Move “Type” up to top
5. “Group orders by:” VENUE
6. “Then by:” ACTIVE/INACTIVE
7. “Sort orders:” ORDER NAME
8. Ascending or descending---either one
1. Select “Medication list”
2. Select “Customize View”
Select everything from “available columns”
and move it to “selected columns” by
selecting “Add”
Move “Type” up to top
(just below “Quick Discontinue”)
“Group Orders By:”
Active/Inactive
“Then By:” Venue
“Sort orders by:” Details
“Ascending” or
“Descending,”
then “OK”
For in-house use,
keep display set to
“All Active Medications”
Meds are now
sorted by
Active or Inactive
and by
Venue (IP/OP/Hx)
Note disclaimer statement- this function contains Rxs that have been escribed and filled by patient.
Please be aware this is not all inclusive and info may be missing
It is intended as an additional source of info and should not be used alone.
Select “Medication List”
Select “Document Medication By Hx”
Select Add
Type the drug name in the “Find:” box
Select the desired drug from the list below
Select from the quick order sentences for dose,
rout, and frequency
7. Select “OK”
8. Select “Done,” if no other meds need to be added
9. To view lower screen larger: Hover your mouse
pointer over the bar, left click and move the bar up.
10.Fill out “Order details” under “Detail values”
11.Select “Document History” to complete order
1.
2.
3.
4.
5.
6.
Select “Medication List”
then select “Document Medication by Hx”
Select “Add”
Type the drug name in the “Find:” box
Then, select the desired drug from the list below
1. Select from the quick
order sentences
for dose, route, and frequency
2. Select “OK”
Select “Done,” if no other meds need to be added
To view lower screen larger:
Hover your mouse pointer over the bar,
left click and move the bar up.
Fill out “Order details” under “Detail values”
then select “Document History” to complete order.
Should be done when/if you discover that a patient is NOT
taking a med previously free-texted into the list by another
person.
1. Select
“Medication List”
2. Select “Document Medication By Hx”
3. Hx meds will have a scroll icon
4. Right click on med to D/C
5. Select “Cancel/DC”
6. Select discontinue reason below
7. Finish by clicking “Sign”
Select “Medication List,”
Then, Select
“Document Med by Hx” above
Right Click on the med to D/C
Select “Cancel/DC”
2. Then select D/C reason
under “Detail values”
1. Select “Cancel Reason”
3. Finish by selecting “Sign”
Select Medication List
Click on “Reconciliation”
Select “Admission” from the drop down menu
Review all meds on this screen
Select the circle to identify which meds to continued on this
admit and which should be d/c’d
NOTE: Meds may be added & Power Plans may be managed
from this view
6. The meds that have been selected to continue on this
admission will be listed on the right
7. Make sure there are NO duplicate meds on this list
8. Select “Reconcile And Sign” to complete Admission Med Rec
9. “Admission Meds Rec” is now complete
1.
2.
3.
4.
5.
Admission Med Rec needs to be completed
2. Click on “Reconciliation”
Then select “Admission”
1. Select Medication List
Meds may be added
& Power Plans may be managed
from this view
Review all meds
Select the circle
to identify which meds to continued on this admit
and which should be d/c’d
=Hospital med
=Historic med
=Outpt Rx med
=Part of a power plan
=Med that needs to be reviewed
The meds that have been selected to continue on this admission
will be listed on the right
Make sure there are NO duplicate meds on this list
Select “Reconcile And Sign” to complete Admission Med Rec
“Admission Meds Rec” is now complete
Select “Chart”
Click on “Depart Process”
3. Select “ Med Rec/DC Prescriptions”
4. Review all meds: Select the circle to identify which meds to: “Continue
after discharge”, “Create New Rx”, or “Do not continue after Discharge”
5. Meds that have been selected to “continue after discharge” or “create
new Rx” will be listed on the right
6. Make sure there are NO duplicate meds on this list; It should not include
any pharmacy abbreviations; All meds should have name, dose, route,
and frequency; It should include all meds that the patient should be
discharged on (eg., home medications that were not changed, new
medications…)
7. Any medication that has a blue circle with an “X” means information for
that medication needs to be completed
8. Left click on the medication
9. Fill in any missing information for the prescription to be complete
10. Select “Reconcile And Sign”
11. Select “Sign” to complete med rec and to create a note in Powerchart
with all the patients discharge information
1.
2.
Shortcut to “Depart Process”
Discharge Med Rec needs to be completed
Select “Chart” then
Select “Depart Process”
Select “Med Rec/DC Prescriptions
Meds may be added
& Power Plans may be managed
from this view
Review all meds
Select the circle to identify which meds to
“Continue After Discharge”
“Create New Rx”
Or “Do Not Continue After Discharge”
=Hospital med
=Historic med
=Outpt Rx med
=Part of a power plan
•Meds are listed in groups if there are multiple orders for the same med
•Home meds are automatically checked to “Continue After Discharge”
•Hospital meds are automatically checked “Do Not Continue After Discharge”
•Adjust all meds as appropriate
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If there are meds on the “Meds prior to discharge reconciliation” list that
are SUSPENDED, they will have a bolded comment to the right (see
above).
As long as these meds are “suspended”, they will not populate the final
depart med list that is given to the patient.
You must address each of the suspended meds (usually by right
clicking, resuming the order, then selecting the appropriate final action)
The meds that have been selected to continue after discharge
will be listed on the right
• Make sure there are NO duplicate meds on this list
• It should not include any pharmacy abbreviations
• All medications should have name, dose, route, and frequency
• It should include all medications that the patient should be discharged on
(eg., home medications that were not changed, new medications…)
Any medication that has a blue circle with an “X” means
information for that medication needs to be completed
2nd : Left click on the medication
1st : Select a printer or
pharmacy to e-scribe
3rd: Fill in any
missing information
for the prescription
to be completed
Select “Reconcile And Sign”
This should be the medication list
that the patient is expected to be discharged with
Select “Sign” to create a note in Powerchart
with all the patients discharge information
The medication list can be found under
Clinical Notes
Inpatient Discharge Documents
Inpt Depart Summary
The depart medication list that was finalized
should be the second note
in the group of most recently signed documents
Percent
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Advancing Excellence in Health Care. Medication
Reconciliation. Retrieved October 24, 2012, from
http://www.psnet.ahrq.gov/primer.aspx?primerID=1.
Jane H. Barnsteiner. Chapter 38Medication Reconciliation.
Patient Safety and Quality: An Evidence-Based Handbook
for Nurses;(2):495-472.