Transcript Reconciling The List - TIGER Leadership Development

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Building and Reporting for
Medication Reconciliation
The Multi-Template Navigator
Objectives
• Review the key elements of the National Patient
Safety Standard for Medication Reconciliation
• Can describe Medication Reconciliation
workflows using the EMR to a third party
• Describe how Epic tools were enhanced to
enable electronic Medication Reconciliation
• Verbalize how Clarity Reports were used to track
compliance
How it all began….
JCAHO - Mandated the review and
reconciliation of all medication orders so
that “a complete list of the patient’s
medications is communicated to the next
provider of service when a patient is
referred or transferred to another setting,
service, practitioner or level of care within
or outside the organization”.
NPSG # 8
Accurately and completely reconcile
medications across the continuum of care.
• 8A There is a process for comparing the
patient’s current medications with those
ordered for the patient while under the care
of the organization.
[Ambulatory, Assisted Living, Behavioral Health Care,
Critical Access Hospital, Disease-Specific Care, Home
Care, Hospital, Long Term Care, Office-Based Surgery]
NSPG # 8
• 8B A complete list of the patient’s medications is
communicated to the next provider of service
when a patient is referred or transferred to
another setting, service, practitioner or level of
care within or outside the organization. The
complete list of medications is also provided
to the patient on discharge from the facility.
[Ambulatory, Assisted Living, Behavioral Health Care, Critical Access
Hospital, Disease-Specific Care, Home Care, Hospital, Long Term
Care, Office-Based Surgery]
FAQ Document for Goal # 8
• The document is long – 17 pages!
• Safe to say that this is the one goal that is
probably keeping most Quality VP’s awake
at night!
• However, out of the 17 pages we are going
to focus on 3 key questions
Key Questions
• Is documentation of the reconciliation required
and if yes, what type of documentation is
required?
• What is the expectation under 8B, for
communicating information to the next provider
of service?
• So, if the discharging physician doesn’t have to
reorder the patient’s home medications, can we
just instruct the patient to “resume previous
home medications?” Isn’t this a violation of the
standards?
Last Year we walked you
through……..
• A Patient got sick and called an ambulance
• He went to the ED where one team did lots of
tests and wrote some orders
• He was admitted to ICU and another team
rewrote his orders
• He got better and was transferred to the floor
where another team rewrote his orders again
• Eventually, he went home with prescriptions in
hand and information on what to do, and not to do
…..a.k.a The Transfer Navigator
Now ……
• How we get the list
• Re-ordering from the list
• Reconciling the list on discharge
• Monitoring compliance
The Workflows
Obtaining the Outpatient
Medication List
Patient enters
hospital
Point of entry RN
obtains outpatient
medications list,
including OTC and
herbals
Open Epic
Outpatient
Medication List
OML populated
Yes
A physician has
reviewed The OML
for this admission
There are
additional
medications not
listed
No
No
Yes
RN enters outpatient
medications into OML
(The medications are
automatically check
marked as taking)
RN adds any
medication not on
the OML
RN adds
additional
medications and
notifies physician
of additions
RN check marks
all medications
patient says they
are taking
Documents date &
time of call in
OML Comments
field
For meds with
unknown name
please enter in
OML comments
field using
.omlmeds
RN clicks review
button to indicate
that they have
completed the
OML
Physician Med
Reconciliation
Workflow
Approved For Distribution: 2-22-07
Yes
No
No further action
Reconciling the “List” for
Inpatients
Direct Admission
The admitting physician
reconciles inpatient medications
with the outpatient medications
by completing the orders
section of the “Admission”
Navigator
Outpatient
Medications List
workflow completed
(including “reviewed”)
within the current
encounter dates
Discharging Physician will
reconcile Inpatient medications
with PTA medications by
completing the orders section in
the “Discharge” Navigator
No
Complete
Outpatient
Medications List
workflow
Level Of Care
Transfer
Approved For Distribution: 2-22-07
Updated: 3-7-07
Sending physician reconciles
current inpatient medications
between levels of care by
completing the orders section in
the “Transfer” Navigator
OML updated
.meddischarge puts
updated Outpatient
Medication List into any
subsequent note/
instructions
Reconciling the “List” for HOV
OR
Procedure physician Reviews
Outpatient medication list and
allergies prior to procedure in
“HOV Pre” or “Specialty”
Navigator
Recovery in
procedure aea
No
Cath Lab/EP
Yes
Outpatient
Medications List
workflow completed
(including “reviewed”)
within the current
encounter dates
Discharging Physician will
reconcile HOV medications with
discharge medications by
completing the orders section in
the “HOV DC” Navigator
GI Lab
Which HOV
Department?
No
Complete
Outpatient
Medications List
workflow
L&D
undelivered
OML updated
IR
ED
Approved For Distribution: 2-22-07
Updated: 3-7-07
.meddischarge puts
updated Outpatient
Medication List into any
subsequent note/
instructions
Discharging Physician will
reconcile ED medications with
discharge medications by using
the “ED Discharge” functionality
Procedure physician
reviews current active
procedure related
orders; D/Cing,
modifying or
continuing them in the
orders section of the
“HOV Post” Navigator.
Recovery orders are
also written here and
Sign&Held
Obtaining the Outpatient
Medication List
© 2007 Epic Systems Corporation Confidential
Admission Navigator
© 2007 Epic Systems Corporation Confidential
Reconciling The List
© 2007 Epic Systems Corporation Confidential
© 2007 Epic Systems Corporation Confidential
© 2007 Epic Systems Corporation Confidential
On Transfer
© 2007 Epic Systems Corporation Confidential
Rounding Navigator
© 2007 Epic Systems Corporation Confidential
Arrival Navigator
© 2007 Epic Systems Corporation Confidential
Discharge Navigator
© 2007 Epic Systems Corporation Confidential
© 2007 Epic Systems Corporation Confidential
Reconciling The List
© 2007 Epic Systems Corporation Confidential
The Reconciled List
© 2007 Epic Systems Corporation Confidential
Giving the Patient the List
© 2007 Epic Systems Corporation Confidential
And in the HOV World….
© 2007 Epic Systems Corporation Confidential
© 2007 Epic Systems Corporation Confidential
Compliance Reporting
If you can answer the question, “How do I
know the comparison process is
consistently happening in my
organization?” then you will be prepared to
answer any surveyor’s question in this
regard.
IP - Outpatient Medication Review Utilization Report
03-17-07 thru 04-17-07
Location
Total
Encounters
Reviewed
By Nurse
in 24 hrs
%
Reviewed
By Nurse
Reviewed
By
Physician in
24 hrs
%
Reviewed
By
Physician
Not
Reviewed or
Reviewed
after
24hours
% Not
Reviewed or
Reviewed after
24hours
HOSPITAL A
2145
1456
67.88
66
3.08
788
36.74
HOSPITAL B
1005
668
66.47
24
2.39
375
37.31
HOSPITAL C
735
531
72.24
31
4.22
211
28.71
HOSPITAL D
74
12
16.22
0
0.00
62
83.78
HOSPITAL A
2058
1420
69.00
65
3.16
812
39.46
HOSPITAL B
989
670
67.75
17
1.72
355
35.89
HOSPITAL C
792
559
70.58
17
2.15
242
30.56
HOSPITAL D
66
6
9.09
0
0.00
61
92.42
04-17-07 thru 05-17-07
Discharge Navigator Utilization Report
03/17/2007 - 04/17/2007
PTA Medication List
Reconciliation
Location
# Encounter where the PTA
list was touched (option of
“Resume, “D/C”, or “Modify”
was selected for a medication)
in the Discharge Navigator
# Encounters with
populated Prior to
Admission (PTA)
Medication list
% of encounters
where a populated
PTA list was
reconciled at
Discharge
% Encounters
with a
populated PTA
medication list
Total
Encounter
s
HOSPITAL A
267
686
39%
31%
2145
HOSPITAL B
112
342
33%
34%
1005
HOSPITAL C
54
230
23%
31%
735
HOSPITAL D
10
22
45%
30%
74
Total Distinct Encounters:
443
# encounters where active
medications were touched
(option of “Prescribe” or
“Don’t prescribe” was
selected for a medication) in
the discharge Navigator
# of encounters
with inpatient
medications list
that has active
medications at
time of discharge
% encounters
whose active
medication list was
reconciled at
Discharge
% encounters
that had an
active
medication list
Total
Encounter
s
HOSPITAL A
77
1886
4%
88%
2145
HOSPITAL B
33
966
3%
96%
1005
HOSPITAL C
11
616
2%
84%
735
HOSPITAL D
2
73
3%
99%
74
Inpatient Medication
Reconciliation
Location
Total Distinct Encounters:
123
Admission Navigator Utilization Report
03/17/2007 - 04/17/2007
Location
# Encounter where the PTA
list was touched in the Adm
Navigator
# Encounters with
populated Prior to
Admission (PTA)
Medication list
% of encounters
where a populated
PTA list was
reconciled at
Admission
% Encounters
with a populated
PTA medication
list
Total
Encounters
HOSPITAL A
364
1895
19%
88%
2145
HOSPITAL B
251
957
26%
95%
1005
HOSPITAL C
74
633
12%
86%
735
HOSPITAL D
15
74
20%
100%
74
Total Distinct Encounters:
680
04/18/2007 - 05/17/2007
HOSPITAL A
404
1787
23%
90%
1994
HOSPITAL B
337
899
37%
94%
958
HOSPITAL C
112
665
17%
86%
771
HOSPITAL D
22
60
37%
97%
62
Total Distinct Encounters:
844
Issues
• The technical issues fall into 4 board
categories
> Outpatient Medication List
> Admission
> Discharge
> D/C Instructions
• The Operational issues fall into 2
categories
> Educational
> Cultural
Questions?
Contact Information
• Dan Exley
[email protected]
• Kate Reynolds, RN
[email protected]
• Janet Ryan, BS, RN
[email protected]