Transcript Medication Reconciliation

Physician Admission and Discharge
Medication Reconciliation
Training Guide
June 2015
2
ADMISSION MEDICATION RECONCILIATION
Accessing the Admission Medication Reconciliation
From the Inpatient Rounding List, select your patient and select Order
Accessing the Admission Medication Reconciliation
From POM Orders screen, select Reconcile Meds
Before reconciling meds, note that the Medication Review column
should reflect the admission date.
If not, contact Nursing and ask them to review the patient’s medications.
Reconciliation Buttons
Function
DC (Discontinue)
Completely stopping med for Inpatient
and home settings. The Med will still
appear on Discharge Med list unless
the DC reason selected is wrong
medication or wrong patient.
Cont (Continue)
Continue home medication as an
inpatient.
Hold
Select the appropriate action
Will not continue med as an inpatient,
but the medication will show on
for each
medication
by selecting a radio bubble.
Discharge
Med Rec
Actions may need to taken for some first dose medications.
This is similar to the current process in POM.
Home Medications not on Formulary Requiring Substitution
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After Selecting the Continue (CONT) button, use this workflow for medication substitutions.
1. Enter home med on POM orders screen
2. Note substitute medication
3. Select the Route
4. Select Done to continue the ordering process
ORDERING ADDITIONAL
INPATIENT MEDICATIONS
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Ordering a new inpatient medication that is not a home medication
1. Select Inpatient Meds
2. Start typing desired medication
3. Continue POM medication ordering process
REVIEW AND SUBMISSION OF
MEDICATION RECONCILIATION
Submitting the Completed Medication Reconciliation
Select Submit to review the reconciled list of Inpatient and Home Medications.
Prior to finishing medication reconciliation the lists of medication are displayed for review.
1. Enter Password and Select OK to complete medication reconciliation
2. Select Cancel to return to medication reconciliation to make any necessary changes
Completed Admission Medication Reconciliation
Discharge Medication Reconciliation
From the Inpatient Rounding List select Discharge to navigate to the Discharge Desktop
To begin Discharge medication reconciliation select the red Edit button next to Medications.
Inpatient
Home
New Inpt.
On the previous paper medication reconciliation process, Home Meds and
Inpatient Meds were displayed side by side on the Discharge Med Rec document.
The updated electronic format will display as follows:
• Inpatient Medication will display first in blue
• Home Meds will display under the Inpatient Medication in black
Medications ordered after the admission medication reconciliation appear only
once in blue during the discharge medication reconciliation process.
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1. Choose Continue (CONT) or Stop on the Home Medications (black entries)
2. If continuing an Inpatient medication (blue entries):
a) Stop the home medication
b) Select Convert (CONV) to continue the medication at home
3. Select Submit to save the medication reconciliation
Converting an Inpatient Medication to a Home Medication
Converted Inpatient Medications require the following entries:
Line 1 - Dose, Units, Route, Frequency, and Reason for Use
Line 2 – Quantity or Days
Select Done
Multiple physicians can act on a patient’s medication reconciliation.
Submitting a partial completed medication reconciliation will trigger this message.
Select “Yes” to leave some medications unreconciled.
a) unsure of the home status of a medication at this time
b) waiting for another physician to act on medication
c) will complete reconciliation at a later time
Select “No” to return to the medication reconciliation screen.
ALL Home Medications must be addressed prior to discharge.
Completed Discharge Medication Reconciliation
Medications EDIT button changes from Red to Blue , signifying all Home Medications
have been acted upon.
Medications are listed by actions taken: New Prescriptions, Continued, and Stopped.