“one of america’s best hospitals” – u.s. news & world report electronic medication...

“One of America’s Best Hospitals” – U.S. News & World Report

Electronic Medication Reconciliation

Nursing Discharge Process


Regulation on Joint Commission Requirements

Requirement: There is a process for comparing the patient’s current medications with those ordered for the patient while under the care of the organization.

The Joint Commission, 2008


Regulation on Joint Commission Requirements

Goal: Accurately and completely reconcile medications across the continuum of care

Joint Commission, 2008


Critical Importance for Nursing

• Complete and accurate home medication list in the Admission Profile.

• Keep admission profile home medications updated and as complete as possible.

• Physicians are reconciling from this list.• Accuracy of the home medication list =

patient safety.


Patient Workflow ScenarioAt time of Admission

• Mr. Smith admitted to the hospital for pneumonia.

• Mr. Smith/family provides his home medication list to the admitting nurse.

• Medications are entered into the admission database. Patients list may not be accurate (mgs may be missing, medications are misspelled which might be an entirely different drug, etc.).


MEDICATION SAFETY

• Don’t guess: Spellings – get the proper name Milligrams (Micrograms, units, etc.)• If the patient does not know meds or is

unsure of dosage – record that and report to peer at change of shift and/or MD for accuracy.

• Review what you have entered BEFORE saving database (error of transcription for frequency, etc.)


Patient Workflow ScenarioAt time of discharge

• Mr. Smith has responded well to treatment and is now ready for discharge.

• There are 3 MDs on the case that need to complete their discharge orders for this patient.

• The primary MD (Captain of the Ship) and 2 consultants.

• Electronic medication reconciliation begins:


Patient Workflow ScenarioAt time of discharge

• Responsibility of the Primary physician (Captain of the Ship):– Complete the electronic medication

reconciliation for an accurate discharge.

The following slide is what the primary physician will see.


“Captain of the Ship” checkbox.

List of active inpatient Medications

List of Home Medications


Select medications from the ‘Home Meds’ list and the ‘Inpatient Medication’ list that you want the patient

to take at home.

*Do not select the same medications from both lists.


ConsultantsMedication Reconciliation not completed

Consultant arrives before the captain of the ship reconciles:The consultant may add medications through the discharge process which will populate onto the electronic medication reconciliation form. This will also generate a prescription(s) that will require a physician signature.


ConsultantMedication Reconciliation Completed

Consultant arrives after the captain of the ship reconciles:

Any consultant that orders medication after reconciliation will not populate on the electronic form for other physicians to see.

However, the added discharge medications will display in the final med reconciliation report that the nurses give to the patient.


If med rec has been completed by the ‘captain of ship’, You will see the details of what medications have been reconciled

already, but you cannot add or edit form. Review and click Close.

Open order entry worksheet to enter prescriptions.

If med rec has not been completed by the ‘captain of ship’, the order form will display active and home

medications. Review and click Close.Open order entry worksheet to enter prescriptions.


Nursing Nugget

• All medications written in the discharge process will populate the report that the nurse gives to the patient.

• This process eliminates the need for Nursing to transcribe discharge medications onto the discharge form.


How do I Know Reconciliation is Complete?

• Go to orders tab• Build a filter for Medication

Reconciliation or look for the current active orders.


Under the Orders Tab, the summary line specifies that Med Reconciliation

was completed electronically.

Go to orders tab



• Print medication reconciliation form.• Review form for duplicates or orders

needing clarification. (patient advocacy/safety concern)

• Use Patient Discharge Home Care sheet to provide patient with activity, wound care, diet, education, follow up appoints, etc.

• For now, this part of the process will not change.


Click on Printer Icon


Medication Reconciliation-Print Home Meds Only

Order Management

Under Order management you will see 3 Med Rec reports •“Medication Reconciliation at discharge report (old process) Print only if MD to complete Med Rec on paper”.

NEW“Medication Reconciliation@

Discharge electronic Instructions-Print for patient to

sign”.


Nursing will print discharge instructions for the patient after all medication reconciliation is completed by captain of the ship and consultants.

•Two copies will print.

•The patient and the nurse signs both forms.

•One of the forms will be scanned back into electronic record and available to view in documents tab after discharge.


• Continue to use patient discharge Home Care sheet to provide patient with activity, wound care, diet, education, follow up appoints, etc.


This printed form is still available for discharge. From the orders tab in SCM,

click on the printer icon and choose Medication Reconciliation Report discharge

report (old process)


If there are more than 30 active medications the electronic form will not be able to be used. The physician will receive

the above message; ‘Maximum inpatient medication exceeded’.

If the physician would like to reconcile, they can click on the ‘I am Captain of the Ship’ box and a paper medication

reconciliation form will automatically print. The paper form needs to be reconciled and signed.


Super Users

Each area will have staff that have learned the physician process and the nursing process. The names of the super users will be posted on the unit to help assist physicians and nurses on the process of medication reconciliation. Please direct your questions to your super users for clarification.


Thank you for your time, you have completed the nursing education on

medication reconciliation

Please print the certificate and hand in to your Manager/Educator

Medication Reconciliation Committee


Doctor discharges patient &

med rec is completed.

Nurses go to printer Icon

Click order Management

Click on Medication

reconciliation @ Discharge

electronic instructions a

Print for Patient to

sign

Pull paper copy of patient

Discharge (Home Care) instructions

Check in SCM for

discharge orders ( ex. Activity, diet,

consults)

Fill out Home Care Instructions

Document education given to patient and review meds,

follow up appts and discharge

orders

Have patient sign

discharge instructions and a copy of med rec

Give patient a copy of Patient

discharge (Home Care) instructions and signed copy of the med rec.

Place copy of signed Med

rec in chart to be scanned

back into SCM

***Med Rec – Medication Reconciliation

Nursing Discharge Process for Electronic

Medication Reconciliation

Review Medications


Certificate of Completion

__________________________________

Name

to certify that he/she has reviewed to satisfaction2008

Electronic Medication Reconciliation


“one of america’s best hospitals” – u.s. news & world report electronic medication...

Documents

americas best hospitals

news world report captain

news world report regulation

accurate home medication

inpatient medication

following slide

home meds list

patients list