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NEW Med Rec Module• What is the PURPOSE?

o A tool to reconcile meds on admission and discharge to SFGHo Replace the LCR Outpt Med List

• What will it DO?o Look up meds dispensed from retail pharmacies (mostly)o Allow electronic prescribing of meds upon dischargeo Facilitate easier creation of discharge list in anticipation of actual

discharge

• Where will it LIVE?o In LCR (and listed in EML)

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Why the New System?• REQUIRED on admit/discharge by the ACA, Joint

Commission

• Incorporates med list into new electronic discharge summary/ePDP

• A med list for SFGH hospitalization only….not a clinic med lists

New Process

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Step 1: Collect Home Med List• May be done in ED by support staff• ADMITTING provider’s

responsibility to verify any list by Re-collecting

Step 2: Order Inpatient Meds

• Use “Order Home Meds” in CPOE

Step 3: Create a DISCHARGE MED LIST• “Push” meds from either home

or inpt med lists to discharge• Start anytime during admission• MD, student, NP, Pharmacist

can perform

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Step 1:Collection of

Home Meds on Admission 3 WAYS to Collect a Med1. Existing Home Meds2. Meds From Retail

Pharmacy3. Add a New Med

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Select the unit.

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Select the patient.

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Select Medication Reconciliation.

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Display Home Meds displays

medications previously

collected in the system

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Notice two places for messages in

system to alert you for any

errors/status during Med Rec

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Status displays the last time Home Meds were collected (if

at all).

** Home Meds must be collected FOR EACH

ADMISSION**

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Next, Select Enterprise Med list to open a new window displaying meds prescribed

from all DPH facilities.

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Use the Enterprise Medication List

(EML) as a unified reference when

reconciling medications.

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Select Collect Home Meds.

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Review the Current Home

Med list as follows:

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Address Existing Meds Will be populated if:• The system was used on a

previous discharge OR • If Home Meds were ‘collected’

earlier in this admission

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Use > to continue or X to stop each medication

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OR use All button to STOP or CONTINUE all meds in one

click.

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TIP: To change directions of a med: click med name, adjust sig in the details panel, then click

Add to Current

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Next, Use the Prescription History

tab to display meds filled at retail pharmacy

(if data available).

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Note: this Retail Pharmacy data may not be complete and must be verified with this

patient

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First, select a med to see retail rx details

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Complete med instructions manually.

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The click the Add to Current Meds button.

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To add a new med, use the Search for New Medications

tab.

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Type the drug name, then Search

• Minimum of three characters• Including dose narrows down results• Select “Brand” if searching by brand

name

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Select the correct med, paying attention to dose

and form.

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Enter the medication

details.

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TIP: Use Alt Dose for sigs like “1 to 2 puffs”

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Click the Add to Current Meds button.

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Drug is then added to the

Current Home

Medication list.

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Repeat as needed. Finally, click Complete

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TIP: To save a list in-progress, Hit complete button before navigating away from this page. List can be updated later.

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Caution: the Cancel button will delete the entire

home med collection…at ANY

point in the process

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To enter a free-text med: first use “search

for new med”(required), then proceed to free text

medication & directions

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Remember**Final verification of Home Meds is the responsibility of

the admitting provider**

Two Additional Steps during admission process….1. Enable Eligibility Check

2. Identify a Retail Pharmacy

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1. Request the system to look up the patient’s

insurance

Regardless of insurance (no coverage, selecting yes or no) hit Complete

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2. Select a Retail

Pharmacy

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Enter the zip or city/state + name

to find the patient’s pharmacy

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Click the Pharmacy name, then COMPLETE

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Step 2:Order Home Meds

Using CPOE Advantages• Start home meds quickly thorough CPOE during

admission• Reconcile home meds with inpatient meds (helps

reduce unintentional omissions)

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AFTER Home Meds are collected, go to CPOE and

Write Orders

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Click here to access the list of Home Meds to order via

CPOE

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Select a Home Med to order upon admission

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All potentially corresponding meds in CPOE will be pulled up

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Then select the medication to order

*Make sure to select the correct strength, since

system shows ALL strengths*

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Repeat as needed with other home meds, THEN hit OK to

complete ordering via CPOE.

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TIP: click here to view home meds details during ordering within CPOE

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It looks like this!

You can reference this dropdown when you complete orders in CPOE

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Step 3: Medication

Reconciliation Before

Discharge

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Best practice: select eligibility to re-enable e-prescribing

functions

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Select Reconcile Discharge.

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First: Address all Home Meds

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Tip: Any Home Medication stopped (X), will be automatically noted in the Patient Discharge Instructions

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Tip: Med with a GREEN arrow cannot be e-prescribed later. (telling the patient “take your home supply”)

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Next, address all Inpatient Meds

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Click X to stop any medication

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Add any new meds

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This creates your discharge med

list. Meds listed here = ALL meds the patient should

take upon discharge

(this list is imported to ePDP)

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To Prescribe a med, Select the

med name

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Some med info auto-populates

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You must fill out any additional required

prescription information

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Be mindful of tablet strength (325mg) vs.

Dose (650mg)

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Select Extended Meds radio button to add more

directions

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Then you should Always….Always…Always

***HIT THE E-RX BUTTON*** when

available

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Failure to hit eRX button will prevent you from e-

prescribing a prescription !!!

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Finally, select a destination. You can assign each row a

different destination.

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SFGH Discharge Pharmacy

(Can be chosen by Interns, NP, DEA

license)

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Retail Pharmacy(by DEA licensed providers

only)

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If you do not have a DEA license, you cannot send to Retail Pharmacy. (ask

Attending/R3 to send prescriptions)

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Paper RxFor any controlled

medication or Supplies (e.g. ‘test strips’)

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TIP: schedule II meds (e.g. oxycodone) still require a secure script in addition to entering on the discharge med list

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To remove a med from Discharge List, select the

med, then the Remove button

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To Save work before addressing all Home & Inpt

Meds, use this button

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If you have addressed every med on each list, you may

Complete the Discharge List

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Clinical Checking will identify potential

interactions

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Click here to address the issue

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Select appropriate choice or free-text reply, then hit

Update

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Green Triangle indicates issue is resolved.

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****WARNING: hit COMPLETE or WORK WILL

BE LOST**

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The GRAY screen indicates your work is saved.

(If you navigated away without saving/completing, you do NOT see this

screen)

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Electronic Prescribing &

Printing Prescriptions

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The next step is to Send the

e-prescriptions

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Prescriptions ready to send will have both an icon and a quantity

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You can change quantity/destination by

selecting the medication then adjusting in Med Detail pane

below

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Always Update the Prescription if you

adjust any part of an Rx

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Or just hit Clear to de-select the medication

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Red Triangle indicates a problem with rx

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Here, problem is Rx #2 has no destination.

Note: Retail Pharmacy grayed out. Why?

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Because no Retail Pharmacy was selected.

Use the Change button to select one.

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No problems are present, (note Retail pharmacy

selected).Ready to send Rx!

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Icons indicate meds queued up to prescribed

Electronically

Or

Printed

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Hit Complete

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This is your final acknowledgement

window. Click OK to send the

prescriptions.

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1) Pagerbox window opens. Use this to send D/C info to discharge pharmacy. ***very useful to reduce calls for clarifications** (e.g. – changed lasix dose

2) Notice Gray screen indicates successful completion

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WAIT!!!

How do I know e-Rx was actually sent?

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Return to Display Home Meds. Icons indicate Rx was sent. You can

review prescription details including last prescription date and

destination(s).

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ePrescribing is complete!

Prescription(s) will then be electronically transmitted

to the dispensing pharmacy or printer.

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PEARLS

Some Common Problems/issues.

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Problem #1:Trying to start discharge meds before Home Med were collected.

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Problem #2:“I couldn’t select a destination (they were grayed out) so I did paper rx’s for all my meds”

WHAT HAPPENED?

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One of two things happened:• Provider did not select Eligibility

Benefits prior to starting discharge meds.

You can see no destination nor eRx button is available

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Or….• Provider did NOT hit eRx button

when adding medication to discharge list.

Note only Paper rx and eRx are available to select

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Problem #3: “I spent 30 minutes making this list and when I came back, I lost all my

work!! (and almost had a heart attack)

You MUST hit ‘complete’ or “save in progress” before leaving.

The GRAY screen indicates your work is saved. It is your friend!