Objectives of the Pharmacy Forum Page To become familiar with EPIC functionalities used in prior to admission (PTA) medication reconciliation (Section 1) 2 7 To understand the pharmacy technicians role in the Medication Reconciliation process o To become familiar with the Med Rec technicians workflow, including their multi pronged approach (Section 2) 8 18 o To understand the role of the ED pharmacist in reviewing and verifying the medication history 19 To be able to identify if a patient has been interviewed by the Med Rec Team (Section 3) 20 22 To be able to add Med List Status to your patient list (Section 4) 23 24 General Information The initiative is based in The Emergency Department Hours 9:00am 10:00pm Currently three technician shifts daily 4 hours overlap 9:00am 5:30pm x 1 technician 1:30 10:00pm x 2 technicians Contact Details Med Rec ED referral Pgr 25323 Vince Pgr 25287 Tonya Pgr 25153 Wahu Pgr 25281 Stephen Pgr 25310 1
Section 1: EPIC Functionalities used in Prior to Admission (PTA) Medication Reconciliation Double arrow symbol to access the ED Track Board Most frequently used tabs PTA Meds Review (Pharmacy only tab) and Ready for Admit Similar patient information in both tabs 2
Sort information in each column by clicking on the header Emergency Severity Index (ESI) numbers refer to acuity 1 = most severe, 5 = least severe Med List Status can be Complete, Incomplete, Pharmacist review pending or blank (default mode on admission, as shown) 3
Shows if anyone has reviewed the Med List does not account for accuracy of the list Highlight a patient and click on the notes tab to open the reports section 4
Reports generated under PTA Meds Review tab (no Admit Med Rec in Ready for Admit screen, see page 6 for instructions on how to add this report) Printable Admit Med Rec report generates; Patient Demographics Preferred Pharmacy Outpatient Meds (patient reported and outpatient clinics) Recently Dispensed Meds (Surescripts) 5
No Admit Med Rec report in the Ready for Admit screen must be wrenched in 6
After clicking on the wrench, search for SHC ED Med Reconciliation Report as shown, and accept 7
Section 2: Medication Reconciliation Technician Workflow and Role 1. Prioritizing a Patient Patients are reviewed according to the prioritization criteria: o All patients with ES1 & 2 scores and patients on the Ready for Admit board o ESI 3 patients Age > 65 years > 4 medications Co morbidities >3 o ESI 4 & 5 patients 2. Print Admit Med Rec report & Complete an initial work up for the patient Check reason for admission & diagnosis (if present on the Track Board) Check Rx Snapshot Check Rx Dispenses (page 10) Check Care Everywhere (page 11) Check Reconcile Outside Medications (page 12 13) 8
Double clicking on the patients name from the Track Board brings you to ED Navigator Most frequently used in ED Navigator: Rx Dispenses PTA Med document Add to Meds function can be used to add medications to the PTA Med Document List. All fields have to be manually completed e.g. dose/ strength, frequency etc. 9
Rx Dispenses shows dispensing from the Surescripts database Clicking on a drug brings up a dispense report Quantity supplied Dispensing Pharmacy 10
Care Everywhere tab (if available) reports a medication list from Sutter Health affiliates Medication lists can be found under the Summary tab 11
Reconcile outside medications list, (if available) reports a medication list from external sources e.g. external pharmacies, Sutter Health affiliates Click on blue font to access the list 12
Outside of local medical records lists medications by source in this case Sutter Health and an External Pharmacy source Each medication should be added or discarded. The add function adds to the local list (as below) the discard function greys out the medication and it Current medications in Local Medical Record is a duplicate view of the PTA Med Document list 13
3. Pharmacy Technician interviews the patient in the following way: Checks two patient identifiers Checks patients preferred pharmacy Asks the patient what regular medications they are taking includes oral medications, topicals, drops, inhalers, injections, sprays Asks patient specific questions e.g. HRT, Contraceptives Asks about OTC medications including PRN, seasonal meds, vitamins, herbals & dietary supplements Is able to obtain name, strength of medication, dosage form, administration instructions and route Additional instructions e.g. duration, tapering dose Confirmed last doses & if the patient is still taking 4. Verifying and Clarifying: Clarify and confirm any medication discrepancies Knowledgeable in obtaining contact numbers for alternative sources Uses the most appropriate sources o Caregivers o Outpatient pharmacies o Primary Care Providers o Drug Dependency Services o Senior Care Facilities o Outpatient Clinics Annotates Admit Med Rec report clearly o Preferred pharmacy o Meds patient is taking o Meds patient is not taking o Name, strength, dosage form, administration instructions and route o Reasons for unusual dosing o Additional instructions or pertinent information Highlights simple discrepancies o Incorrect doses, frequencies, duration o Unusual duplicate meds in the same class o Refers potentially serious situations to the pharmacist 14
Pharmacy Technician updates PTA Med Document list (ED Navigator): Preferred Pharmacy Each drug name, dosage form and strength must be listed Specific admin instructions with dose and frequency Last taken (if known) 15
= taking No check = not taking Delete erroneous entries (removes from all records) Never uses Discontinue 16
Order notes can be utilized to add extra information Opens this window to add text Once accepted, the note appears highlighted in yellow 17
Once the data entry is complete, the Med List Status is changed to Pharmacist review pending A comment is added via + Add Note to show that the med list has been reviewed by a technician and the sources used time and date of this entry is automatically recorded 18
Pharmacist reviews the EPIC entry against an annotated copy of the Admit Med Rec report that was printed (see page 5) Pharmacist clinically checks the list; doses, interactions, duplicate therapies, etc. Once the pharmacist s check is done, they change the Med List Status to Complete and click Mark as Reviewed 19
Section 3: How to check if a Prior to Admission medication history has been completed by the Med Rec Team Under More Activities access the Admission Navigator 20
PTA Med Document List can be accessed from here 21
Scroll down the list to review the Med List Status Can review previous notes by clicking on + Add Note (Reconciliation Comment shown in the open window) Click on History to view previous users who have reviewed the list 22
Section 4: How to Add Med List Status to your Patient List Select a patient list e.g. B2 and select Properties to open the window Scroll down the list to select Med List Status and click Add Once added the order of the Selected Columns may be adjusted using the up or down arrows Click Accept when finished 23
Med List Status now appears in the patient list Fields can be: Complete Incomplete Pharmacist review pending Blank (default mode) To check if the Med List Status has been completed by Pharmacy Look in the Admission Navigator under the patients admission records (pages 19 21) 24