Medication Reconciliation

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Alice Gaines
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Medication Reconciliation Admission and Transfer Med Reconciliations Click the CPOE tab, then Medication Reconciliation. Click the green start button for the Admission Med Rec.

1 Medication Reconciliation Admission and Transfer Med Reconciliations Click the CPOE tab, then Medication Reconciliation. Click the green start button for the Admission Med Rec. A list of the patient s meds displays. The green house icon, preceding the name indicates a home medication. ***NOTE*** If you complete the admission med reconciliation before ordering IP meds, the med list will be shorter. IP med orders are created automatically when you continue or modify a home med. Once you have addressed the home meds you want to continue, use the Defer remaining home meds button to defer the remaining meds. Use the add order button to order any additional IP meds. The complete button will be grayed out until all meds have been addressed.

2 Address each medication by clicking the Continue, Defer, or Modify buttons. Continue Defer Modify DC Defer Remaining Home Meds Creates an inpatient order for the medication (same dose, route, frequency) Defers any action until discharge med rec Creates an inpatient order and allows for modifications Discontinue the medication (applies to IP meds only) Defers the rest of the home meds that have not yet been addressed ***NOTE - if the button is grayed out, scroll the ribbon bar all the way to the bottom so that all meds have been viewed To Modify a home med to for an IP order, make the desired changes and click the Save button. LINKING MEDS A home med that is given during the inpatient stay can be linked to the IP med on the reconciliation. Linking the home med with the corresponding IP med simplifies the medication reconciliation process. Fewer clicks are needed when home and IP meds are joined. In addition, the likelihood of duplicate orders is also decreased. Select the home med and the applicable IP med to link within drug class Linked meds display here

3 Linking the meds when the pop-up box appears is not mandatory, but will help with subsequent reconciliations. Create the desired links and click LINK to save, or click CLOSE to bypass. ***NOTE*** The physician has no way of unlinking the meds once saved. Only nursing can unlink. McKesson is working on this. COMPLETING THE RECONCILIATION Once you have addressed all medications, the complete button will appear at the bottom of the med rec display. Click the complete button to submit your orders. All continued and modified medication orders will be sent to pharmacy. If you save as draft, no orders will be submitted. At some point you must go back in and complete the draft for any of the med orders to be submitted. *****NOTE - The Med Rec complete button will be grayed out until all medications have been addressed!

Discharge Med Reconciliation The discharge med reconciliation accomplishes several tasks: Generates discharge instructions for the patient, Provides a means for writing new prescriptions which can be

4 Discharge Med Reconciliation The discharge med reconciliation accomplishes several tasks: Generates discharge instructions for the patient, Provides a means for writing new prescriptions which can be printed or electronically sent to the patient s preferred pharmacy, Updates the patient s home meds section of the Paragon Patient Profile. Click the CPOE tab, then the Medication Reconciliation sub-tab. Click the green start button for the Discharge Med Rec. A list of the patient s meds displays. The green house icon, preceding the name indicates a home medication.

5 ***NOTE*** First address the meds you would like to continue, and add home meds and/or prescribe new meds. Then scroll to the bottom of the page to highlight the buttons, DC Remaining Inpatient Orders and Aware Remaining Home Meds. The complete button will be grayed out until all meds have been addressed. Address each medication by clicking an action button: Action Description IP Med Continue Continue taking the med at home * * Cancel Cancel IP med (available only if it is in a pending status) * Prescribe Home Med Launch the prescription writer to create a new prescription * * Modify Modify the dose or frequency of a med * DC Discontinue use of the med * Replace Replace the home med with a new medication * Aware Acknowledges that the patient is on the home med * DC Remaining Discontinue all unaddressed IP meds Inpatient Orders * Aware Remaining Acknowledges that the patient is taking the unaddressed Home Meds home meds * If you modify a medication a pop-up appears. Change the dose, or frequency and click save. After saving, it appears the medication did not change. Click the information icon to view your changes.

6 ADDRESSSING LINKED MEDS A home med that is also given during the inpatient stay will be linked to the IP med on the reconciliation. The link is automatically created when a home med is continued on a previous med reconciliation. Like meds may also have been linked manually either by nursing or by the physician during a prior med rec. When addressing linked meds on the discharge med rec, you must first address the IP med. The action you take for the IP med will determine which buttons are available for the home med. For example, continuing or prescribing the IP med will automatically DC or continue the home med. To modify a home med, cancel the IP med to activate the buttons for the home med. COMPLETING THE RECONCILIATION Once you have addressed all medication, the complete button will appear at the bottom of the med rec display. Click the complete button to finalize the discharge med rec. If you save as draft, at some point you must go back in and complete the draft. (You can amend a completed med rec after it has been completed if needed.) *****NOTE - The Med Rec complete button will be grayed out until all medications have been addressed!

eprescribe Training for Nurses and Pharmacy Techs Net Access Home Medication Pathway Clinical Informatics - Oct 2015

eprescribe Training for Nurses and Pharmacy Techs Net Access Home Medication Pathway Clinical Informatics - Oct 2015 Click Home Medications on the Navigator Home Medications Pathway Click on Select Default