new med rec module what is the purpose? o a tool to reconcile meds on admission and discharge to...
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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)
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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!
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