Excela Health STAR Medication Reconciliation Workgroup
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1 Date: December 20, 2010 To: From: Excela Health Medical Staff Excela Health STAR Medication Reconciliation Workgroup Subject: Medication Reconciliation Electronic Conversion Recent Excela Health audits on the accuracy of medication reconciliation have revealed a 12% potential Admission Medication Reconciliation error rate. It was estimated that 61% of the errors could have been avoided by a smarter electronic system since most errors involved the inability to link medication name to dose and route. Thus, the Excela Health Hospital Physician Advisory Councils, Nursing Executive Council and Administration recommended a conversion from Care Manager to STAR Pharmacy as an interim electronic solution to improve Medication Reconciliation by linking of medication name to appropriate dose and route. STAR Pharmacy will be utilized until the installation of Cerner. The go-live for conversion to STAR Pharmacy for Medication Reconciliation is scheduled on Tuesday, January 18, All areas currently using Care Manager for electronic medication reconciliation recording and printing of physician Admission and Discharge Medication Reconciliation order forms, with the exception of the Emergency Departments, will convert to STAR Pharmacy at that time. To avoid transcription errors, for current inpatients, the existing Care Manager Discharge Medication Reconciliation order form will continue to be utilized until Tuesday, February 8, The Emergency Departments will continue to use Care Manager for Medication Reconciliation until January 25, 2011 when EPOWERdoc will go-live. If you are admitting a patient in the Emergency Department and wish to order the admission medications, the EPOWERdoc Medication Reconciliation order form may be utilized. Workflow and physician order forms will remain similar to the current process. Home medications will continue to be accessible via eportal. Reaudits will be performed after STAR implementation to evaluate the effectiveness of the conversion. Please review the attached EPOWERdoc and STAR physician order forms. If you have any questions or would like to review the forms, please attend one of the open sessions listed on the next page at your convenience. Thank you for your participation in improving the medication safety of our Excela Health patients. Please contact the following individuals for further information: Amy Kriss, WH Pharmacy ( ) or AnneMarie Scekeres, LH Quality ( )
2 2 STAR Medication Reconciliation Question and Answer Open Sessions: Location Date Time FH Conference Room B Wednesday, January 5, and FH Conference Room B Thursday, January 6, and LH Office of Medical Affairs Thursday, January 6, and LH Office of Medical Affairs Friday, January 7, and WH MCC Alcove Monday, January 10, and WH MCC Alcove Wednesday, January 12, and WH MCC Alcove Friday, January 14, and Medication Reconciliation Reminders: STAR Go-Live for new patients: Tuesday, January 18, 2011 EPOWERdoc Go-Live for all ED patients: Tuesday, January 25, 2011 STAR Conversion for all inpatients: Tuesday, February 8, 2011
3 EPOWERdoc Test Facility Emergency Department Medication Reconciliation PATIENT: MEDREC, EXCELA MRN: PROVIDER 12/7/10 11:15:1 Acct. No Page 1 of 1 DOB: 02/03/45 Wt. 180 lb (81.65 kg) Ht. 70 in (178 cm) Allergy History Bee allergens cause(s) flushing. This section is NOT seen for patients who are being ADMITTED. This section ONLY applies to those patients being discharged from the ED. New Medication Orders Medication Dose Route Frequency Comment RX Given Cipro 500 mg Tab 1 Tablets Twice a Day Medications Administered in the Emergency Dept. Medication Time Given Comment (DO NOT WRITE Admission Orders in this section) Phenergen 12.5 mg IM 12/7/ :37 Demerol 25 mg IM 12/7/ :37 For Information Only! Reported Home Medications Medication Frequency Route Last Dose Taken Continue Discontinue Please Clarify Norvasc 5mg Tab Every day Orally Today Singular 10 mg Tab At Night Orally Yesterday Evening Emergency Department Medication Reconciliation Order Form If ADMITTING physician sees patient in ED, and wants to write medication orders, use this as a HANDWRITTEN ORDER FORM for Home Meds and write in any new meds in the white blank spaces at bottom of form. ADMITTING physician can also use as an ORDER FORM on the nursing unit PRIOR to the admitting nurse entering the patient s home medications into the STAR Med Reconciliation electronic system. We reviewed and listed the information you provided about the medications you currently take. If you notice any regular home medications that we did not discuss with you or if there is confusion about your medications please contact your primary care doctor as soon as possible for discussion. Discard old medication list and update record with all medications providers. Take this list with you to all healthcare visits! NOT TO BE USED AS A PRESCRIPTION! Provider Signature: Date: / / Time: :
4 Excela Health FRICK HOSPITAL Admission Medication Reconciliation Form Page 1 12/7/ (Last Page) Medications Taken Prior To Admission (The information contained in this list is based on patient-provided information.) 1. ACETAMINOPHEN 325 MG TABLET Freq: EVERY 4 HOURS AS NEEDED (TYLENOL) Comment: FOR ARTHRITIS PAIN 2. ALBUTEROL SULFATE 90 MCG AEROSOL Freq: EVERY 4 HRS PRN SOB (PROVENTIL HFA) INHALATION Comment: USES AEROCHAMBER HOME meds DEVICE in: 3. DIGOXIN MG TABLET EH Acute Care (LANOXIN) Barclay Inpatient Rehab 4. FUROSEMIDE 40 MG TABLET (LASIX) 5. METFORMIN HCL 500 MG TABLET (GLUCOPHAGE) STAR Med Rec ADMISSION Form will be used to reconcile Comment: TAKES WITH BREAKFAST 6. WARFARIN SODIUM 2.5 MG TABLET (COUMADIN) Physician MUST: Last Dose Taken 10 PM 12/7/10 6 AM 12/7/10 8 AM 6 PM Continue Discontinue Please Clarify NOTE: If more than 9 medications are listed, this creates the 2 nd page: 1 st page will say (Continued) under the Page 1 2 nd page will say (Last Page) Under Page 2. Physician Signature, Date & Time will MOVE to the 2 nd page ALLERGIES: Aspirin Sign Date Time Order form Physician Name Printed: Account # MR # DOB 02/03/45 Patient Name: FRICK, RELIGION Room 2S 2142-B Physician Signature: Date: Time:
5 Excela Health FRICK HOSPITAL Discharge Medication Reconciliation Page 1 12/7/ (Last Page) Medications Taken Prior To Admission (The information contained in this list is based on patient-provided information.) 1. ACETAMINOPHEN 325 MG TABLET Freq: EVERY 4 HOURS AS NEEDED (TYLENOL) Comment: FOR ARTHRITIS PAIN 2. ALBUTEROL SULFATE 90 MCG AEROSOL Freq: EVERY 4 HRS PRN SOB (PROVENTIL HFA) INHALATION Comment: USES AEROCHAMBER DEVICE 3. DIGOXIN MG TABLET (LANOXIN) 4. FUROSEMIDE 40 MG TABLET (LASIX) 5. METFORMIN HCL 500 MG TABLET (GLUCOPHAGE) Comment: TAKES WITH BREAKFAST 6. WARFARIN SODIUM 2.5 MG TABLET (COUMADIN) Last Dose Taken 10 PM 12/7/10 6 AM 12/7/10 8 AM 6 PM Continue Discontinue Physician MUST: Sign Date Time Order form ALLERGIES: Aspirin Account # MR # DOB 02/03/45 Patient Name: FRICK, RELIGION Room 2S 2142-B Physician Name Printed: Physician Signature: Date: Time:
6 Excela Health Discharge Medication Reconciliation Page 1 Active Orders Date: 9/24/10 Time: 11:34 No. Name Sex Age Room Doctor Service Status Frick, Religion M 65Y 2142-B Lynn, Richard IP Medic FIP 788 ********************************************************************************** Height Weight IBW BSA MR# DOB KG /03/45 Current Diagnosis: TEST Allergy/ Aspirin Additional Medications: Physician MUST: Sign Date Time Order form Order new home medications after reconciling the reported home medications (listed on the Discharge Medication Reconciliation Order Form) with the current hospital medications (listed on the Medication Administration Record). Date/Time Physician Signature *** This is not a prescription***
7 TRANSITION: Patients Leaving FH/LH To WH CCVM Excela Health FRICK HOSPITAL Discharge Medication Reconciliation Page 1 12/7/ (Last Page) Medications Taken Prior To Admission (The information contained in this list is based on patient-provided information.) 1. *WARFARIN SODIUM 2.5 MG TABLET (COUMADIN) 2. DIGOXIN MG TABLET (LANOXIN) 3. FUROSEMIDE 40 MG TABLET (LASIX) Last Dose Taken Continue Discontinue 6 PM PER CARDIOLOGIST" REMINDER: STAR Med Rec Discharge Form is new, but PHYSICIAN RESPONSIBILITIES (listed below) ARE UNCHANGED FOR PATIENTS WHO WILL EITHER BE DISCHARGED TO HOME POST CATH or WILL HAVE A CARDIAC INTERVENTION AND BE ADMITTED TO Westmoreland Hospital: Frick Hospital and Latrobe Hospital Discharging Physicians: 1. Complete this Discharge Medication Reconciliation Order Form (reconcile the listed home medications with the MAR current hospital medications) to the best of your ability based on the patient s condition at the time you are discharging. 2. Write PER CARDIOLOGIST in last column for medications such as Coumadin, Glucophage, etc. that would require a different start date based on having had the cath.* 3. Write any Rx that is new for the patient based on medications on the discharge order form. 4. Complete a Discharge Instruction Sheet that includes when you want to see the patient post-discharge and any other orders you may have for post-discharge lab studies. FOR PATIENTS ADMITTED TO Westmoreland Hospital POST CARDIAC INTERVENTION: Westmoreland Hospital Admitting Physicians: 1. Complete the WH Admission Medication Reconciliation Order Form to order the patient s HOME medications. 2. Handwrite NEW medication orders on the Progress & Order Form using the Acute Care MAR to reconcile Current medications.
8 REMINDER: Post Op Transfer Renew Form Appearance is UNCHANGED. However, the USE of the form HAS CHANGED. This order form will continue to be used for Post-Op Patients Patients transferred from a Higher Level of Care to a Lower Level of Care ************************************ As of January 18 th, 2011: This form will NO LONGER be used in WH Barclay Rehab In-Patient Dept (located at LH) for patients COMING from EH Acute Care. ************************************ ACUTE CARE DISCHARGING PHYSICIAN: o No order form needs completed! To standardize the process for patients admitted to Rehab regardless of portal of entry: PHYSICIAN ADMITTING Patient to Rehab: 1. Complete STAR Med Rec Admission Form (from Rehab) to order the patient s HOME medications. 2. Handwrite NEW medication orders on the Progress & Order Form (using the Acute Care MAR to reconcile current medications).
9 EXCELA HEALTH Education Med Reconciliation History Found in eportal CM Meds Prior 1/18/11 tab contains: Name, MR # Visit Date, Physician Name Medications from the previous Care Manager system for patients who have NOT YET been admitted to STAR. Meds tab contains: 1. IN-PATIENT PROFILE (Listed at Top) 2. STAR HOME MEDS LIST (Listed Below)
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Any questions can be addressed by Dr. Breakey
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