NEW Med Rec Module What is the PURPOSE? o A tool to reconcile meds on admission and discharge to...

Last updated: 04/23/2014 1

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)


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


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

4Last updated: 04/23/2014

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


Select the unit.


Select the patient.


Select Medication Reconciliation.


Display Home Meds displays

medications previously

collected in the system


Notice two places for messages in

system to alert you for any

errors/status during Med Rec


Status displays the last time Home Meds were collected (if

at all).

** Home Meds must be collected FOR EACH

ADMISSION**


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

from all DPH facilities.


Use the Enterprise Medication List

(EML) as a unified reference when

reconciling medications.


Select Collect Home Meds.


Review the Current Home

Med list as follows:


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


Use > to continue or X to stop each medication


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

click.


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

Add to Current


Next, Use the Prescription History

tab to display meds filled at retail pharmacy

(if data available).


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

patient


First, select a med to see retail rx details


Complete med instructions manually.


The click the Add to Current Meds button.


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

tab.


Type the drug name, then Search

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

name


Select the correct med, paying attention to dose

and form.


Enter the medication

details.


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


Click the Add to Current Meds button.


Drug is then added to the

Current Home

Medication list.


Repeat as needed. Finally, click Complete


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


Caution: the Cancel button will delete the entire

home med collection…at ANY

point in the process


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

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

medication & directions


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


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

insurance

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


2. Select a Retail

Pharmacy


Enter the zip or city/state + name

to find the patient’s pharmacy


Click the Pharmacy name, then COMPLETE


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)


AFTER Home Meds are collected, go to CPOE and

Write Orders


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

CPOE


Select a Home Med to order upon admission


All potentially corresponding meds in CPOE will be pulled up


Then select the medication to order

*Make sure to select the correct strength, since

system shows ALL strengths*


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

complete ordering via CPOE.


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


It looks like this!

You can reference this dropdown when you complete orders in CPOE


Step 3: Medication

Reconciliation Before

Discharge


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

functions


Select Reconcile Discharge.


First: Address all Home Meds


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


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


Next, address all Inpatient Meds


Click X to stop any medication


Add any new meds


This creates your discharge med

list. Meds listed here = ALL meds the patient should

take upon discharge

(this list is imported to ePDP)


To Prescribe a med, Select the

med name


Some med info auto-populates


You must fill out any additional required

prescription information


Be mindful of tablet strength (325mg) vs.

Dose (650mg)


Select Extended Meds radio button to add more

directions


Then you should Always….Always…Always

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

available


Failure to hit eRX button will prevent you from e-

prescribing a prescription !!!


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

different destination.


SFGH Discharge Pharmacy

(Can be chosen by Interns, NP, DEA

license)


Retail Pharmacy(by DEA licensed providers

only)


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

Attending/R3 to send prescriptions)


Paper RxFor any controlled

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


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


To remove a med from Discharge List, select the

med, then the Remove button


To Save work before addressing all Home & Inpt

Meds, use this button


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

Complete the Discharge List


Clinical Checking will identify potential

interactions


Click here to address the issue


Select appropriate choice or free-text reply, then hit

Update


Green Triangle indicates issue is resolved.


****WARNING: hit COMPLETE or WORK WILL

BE LOST**


The GRAY screen indicates your work is saved.

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

screen)


Electronic Prescribing &

Printing Prescriptions


The next step is to Send the

e-prescriptions


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


You can change quantity/destination by

selecting the medication then adjusting in Med Detail pane

below


Always Update the Prescription if you

adjust any part of an Rx


Or just hit Clear to de-select the medication


Red Triangle indicates a problem with rx


Here, problem is Rx #2 has no destination.

Note: Retail Pharmacy grayed out. Why?


Because no Retail Pharmacy was selected.

Use the Change button to select one.


No problems are present, (note Retail pharmacy

selected).Ready to send Rx!


Icons indicate meds queued up to prescribed

Electronically

Or

Printed


Hit Complete


This is your final acknowledgement

window. Click OK to send the

prescriptions.


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


WAIT!!!

How do I know e-Rx was actually sent?


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

review prescription details including last prescription date and

destination(s).


ePrescribing is complete!

Prescription(s) will then be electronically transmitted

to the dispensing pharmacy or printer.


PEARLS

Some Common Problems/issues.

Last updated: 04/23/2014 100

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

Last updated: 04/23/2014 101

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

WHAT HAPPENED?

Last updated: 04/23/2014 102

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

Last updated: 04/23/2014 103

Or….• Provider did NOT hit eRx button

when adding medication to discharge list.

Note only Paper rx and eRx are available to select

Last updated: 04/23/2014 104

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!

NEW Med Rec Module What is the PURPOSE? o A tool to reconcile meds on admission and discharge to...

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