Medication Reconciliation Training Packet. Legacy Health System

Transcription

1 Medication Reconciliation Training Packet Legacy Health System 1

2 Objectives To identify the key elements of the medication reconciliation process To describe the role of the nurse in the medication reconciliation process To identify all of the medication information needed to build an accurate list To demonstrate the input of the patient s medication list into E-Chart and the printing of the RxPad Home Medications list for Licensed Independent Practitioners (LIPs) 2

3 Medication Reconciliation Joint Commission s National Patient Safety Goal #8 Accurately and completely reconcile medications across the continuum of care. This is the process of identifying the most accurate list of all medications a patient is taking at home and using the list to provide correct medications for patients anywhere within the healthcare system. 3

4 What does completely reconcile mean? Reconciliation is the process of comparing the meds that the patient has been taking prior to the time of admission (or entry) into Legacy with the meds that Legacy is about to provide. Any discrepancies must be resolved or clarified. Why? To avoid errors of: omission transcription duplication drug interactions To facilitate communication between providers 4

5 The Joint Commission s Patient Safety Goal Healthcare organizations must implement a process for obtaining and documenting a complete list of the patient s home medications upon entry into the system. Medication orders must be compared and reconciled at admission/entry, transfer and discharge. Once the complete discharge medication list is compiled and reconciled, it will be communicated to the patient and the next provider of service. 5

6 What is the expectation of communication to the next provider of service? When referring or handing over responsibility for the patient s care to another setting, service, practitioner, or level of care within or outside the organization, it is expected that each organization has a process to communicate to the next provider (or setting) all of the patient s current medications. 6

7 What is the definition of a medication? Medications include any of the following: prescription drugs, sample medications, herbal remedies, vitamins, nutriceuticals, over-the-counter drugs, vaccines, diagnostic and/or contrast agents such as radioactive agents, respiratory therapy treatments, parenteral nutrition, blood derivatives, intravenous solutions (plain, or with electrolytes and/or drugs), and any product designated by the Food and Drug Administration (FDA) as a drug. 7

8 Physician s s role in the medication reconciliation process Physicians will review and act upon each medication on the list. (This will include a comparison of the home medications to the prescribed admission medications. The physician will resolve any discrepancies). For Inpatients, physicians have 24 hours from the time of admission to reconcile the patient s s medications. 8

9 E-Chart Medication Reconciliation Process 9

10 Medication information to be collected on admission On admission, gather data to create an accurate list of the patient's home medications. (This includes documentation of what the patient is actually taking versus what is prescribed.) Medication details to capture include: *dose *route *frequency *indication, if known (basic terms) *date/time of last dose *where medications are being stored (home, hospital or other) 10

11 You can access RxPad from the base screen Activate a patient. Go to the Clinical chart tab and select Med profile/rxpad (or you can type rx into the command field). 11

12 or from the Admit History Go to Admit History screen. You can access the Med Profile/RxPad from the Clinical chart tab. 12

13 When you select Med Profile/RxPad, this screen will appear. Just double click on the current account (usually at the top). 13

14 This takes you to RxPad where the patient s s active med list is displayed **Note that there are different statuses in front of each medication start date. For the purpose of creating a home medication list, medications must have an O status. 14

15 RxPad Status Definitions O= Outside (Meds taken outside the hospital or prior to admission) N= New (new prescription) R= Reorder (old prescription) I= Inactive X= Discontinued For the purpose of collecting the patient s home medication list, the nurse building the list must ensure each medication s status is O. 15

16 Steps to create a home medication list in RxPad Review the existing list with the patient or designee. You need to: 1) update the current meds, 2) delete discontinued meds, and 3) add any new meds. 16

17 1. Update medications already on the list All current medications must be updated with the date/time of last dose taken and location. To do this, click on each current med (may click on more than one) and a red checkmark will appear. Then click on the 17 Reorder button.

18 You might see this conflict window with information about a medication conflict If this conflict screen appears when you are entering medications, click on Continue Order Process (or press 18 the Enter key).

19 Welcome to RxPad! This brings you to RxPad. Required fields appear in red. Update and complete as appropriate (see next pages to know what is appropriate). 19

20 Make changes to dose, route, and frequency as appropriate. Right click the mouse (or use F1 on the keyboard) when the cursor is in the units, route, or freq box to see more information. If the dose is unknown, use the number 9999 to indicate unknown dose. This information must be clarified and updated prior to the patient s discharge. 20

21 For # of Refills put in N or 0 DAW (dispense as written) should be N If medication is PRN, put in Y (otherwise leave blank) 21

22 Fill in last taken/location Fill in Last Taken/Location with the last date/time medication was taken and current location of medication (home, hospital or other). 22

23 To add comments Place comments in Comment box (such as skips doses ). If you need more space for additional narrative information, click on the Edit Window button and type comments in the white box titled Additional Instructions. When comments are complete, click on the OK button this will only exit you from the comment box so you may continue to complete RxPad. 23

24 Put in provider s s name Your name will appear in the Provider box. You must type a provider s name in the box to be able to continue. If you know the MD who prescribed the medication, type his/her name in the box. If you don t know the spelling, begin typing the first few letters of the last name & hit F1 (on the keyboard) or right click the mouse. 24

25 Put in provider s s name If MD is unknown, type in misc,d (for miscellaneous doctor). To copy and paste for subsequent medications, highlight the provider name with the mouse and use ctrl C to copy and ctrl V to paste. Copy = ctrl c Paste = ctrl v 25

26 When done with all of the information, click on the Outside button Click on Outside (meds taken outside the hospital) 26

27 RxPad can also generate prescriptions MDs will use the Print Rx and Fax buttons to generate prescriptions for discharge. 27

28 2. Delete any medications the patient is no longer taking If the patient is no longer taking a medication, click on the med and click the D/C button. You can click on more than one med & then D/C each one. 28

29 Discontinue Reason You have the OPTION to type in a Discontinue Reason (if known) or select one from the drop down menu. Click on Discontinue Rx to finish. 29

30 3. Add new medications to the list To add a medication, click on the Alpha button. This will 30 give you an alphabetical listing of meds.

31 On the keyboard, type in the first few letters of the medication using either the generic or brand name (e.g. LAS for LASIX and it will show up in the gray bar), then double click on the correct medication from the list. 31

32 Complete RxPad by filling in the r by filling in the required fields in red and then click on the Outside button. 32

33 If the medication you want to enter is not on the Alpha list (see slide 31), select Medications S-Z S and type in UNLISTED.. Type the actual drug or herbal name in the Comment box. 33

34 If the patient denies taking any medications, select Medications M-R M from the Alpha list (see slide 31) and type in NONE 34

35 Continue this process until all of your patient s medications have been added to the list and have an O status. 35

36 Am I done with the list? When you are done creating the patient s home medication list, it should only include the patient s medications as taken at home and the meds should all be O status. If the list is not complete (e.g. patient s family is bringing in medication to clarify dose), the admitting nurse must place a medication communication order on the plan of care with the following comment: Med list incomplete, see progress note. Document details for follow up in a progress note. Now you need to print the RxPad Home Medication List report for the MD to review and reconcile. The medication list should still be printed for the MD even if you are waiting for additional info. 36

37 4. Print the RxPad Home Medications list Go to the Clinic Record chart tab and select Med Reconciliation Reports.. Enter Report #1 and then select the printer using the drop down box. Leave all other boxes blank. **You can only print this report if allergies have been entered into E-Chart** E 37

38 If the printed list is not complete Write any comments in the blank space at the bottom of the printed page of the Home Medication List. Examples include: comments about abnormal doses or information still awaiting clarification. Place the list in the Physicians Orders section of the patient s chart. 38

39 To complete the process Now that the RxPad Home Medication list is printed and placed in the Physician Orders section of the chart, complete the Pharmacy Consult Criteria along with your admission assessment. 39

40 Admit History The admission assessment now includes Pharmacy Consult Criteria as part of the admit history. 40

41 Pharmacy Consult Criteria When you choose one or more of the pharmacy consult criteria, pharmacy will be notified. Criteria include: Patient age => 75 years Routine prescription meds => 10 Unfamiliar medication names or doses (If the patient reports a dose outside of normal range). Digoxin level < 0.5 or > 2 ng/ml (If available at time of admission.) Phenytoin level < 5 or > 20 mcg/ml (If available at time of admission.) Warfarin with INR > 5 (If available at time of admission.) Benzodiazepines in patients > 70 years Nurse/MD request for pharmacy review (If you think pharmacy needs to review or clarify patient medications.) Previous admit (within 3 days) with a medicationrelated problem 41

42 To complete the Pharmacy Consult Criteria Review criteria and check only those that apply. Add to the Comment box if appropriate. Once complete, click the Save and Next button. See next page for full description of Pharmacy Consult Criteria. 42

43 Transfer Process The transferring unit prints the Medication Admin Guide report (this is a list of the inpatient meds for the transferring patient) and places it in the Physician Orders section of the chart See the next slide The transferring physician has the option to review the Medication Admin Guide (inpatient medications) and cross out any that are not appropriate for transfer this option replaces the need to hand write medication orders 43

44 Transfer Process From the E-Chart base screen go to the Worklists tab and select MAR Routine Select the current account 44

45 Transfer Process Choose Print a Med Guide 2. Select report number 6 (double click) 3. Select your printer 4. Choose Print Report 45

46 Transfer Process The receiving unit copies the Medication Admin Guide (if completed by the physician) and sends the copy to pharmacy. The receiving unit must print out the RxPad Home Medications List (report #1) from E-Chart and place it in the Physicians Orders section of the chart (This can also be done by the transferring unit if there is no change in the physician providing care). The receiving MD must reconcile the home medications with the transfer orders. The completed list must be copied and sent to pharmacy (same as at admission). 46

47 Patient teaching upon discharge After the physician updates RxPad and generates discharge prescriptions, 2 lists/reports need to be printed (see slide 37) and reviewed with the patient by the nurse. This is in addition to the patient discharge instructions. 1. Discharge Medication Handout (report #11) Home meds and new meds that the patient should take after discharge 2. Recently Discontinued Medication Handout (report #12) RxPad meds discontinued by the MD in the last 2 days Home medications that the patient should stop taking 47

48 If you want to see more information about a prescription entered by the MD (status will be N for new) you can click on the History button on the base screen of RxPad. 48

49 The History screen shows if the prescription was printed or electronically faxed ( Out means it was entered as an Outside med). It also shows the brand name of the medication. 49

50 From the base screen of RxPad, you can also click on the Detail button to see further details about a new prescription or an O status med 50

51 The Detail screen shows where the prescription was faxed (it will be blank if it was not faxed), any comments, and the quantity ordered. 51

52 Share the list Give the patient or caregiver the two patient medication handouts for discharge (reports #11 and #12) This is required by the Joint Commission Upon discharge from the hospital, a unit designee must forward the list to the patient's primary care physician or next provider of service Fax or send the complete list of the patient's medications (report #11) to the next provider of service when transferring a patient to another setting, service, practitioner or level of care outside of the organization Encourage patients to share the list with their pharmacy 52

53 Incident Documentation Use Report It! (the incident reporting system) to document near misses or errors associated with the medication reconciliation process Go to the Legacy intranet, click on Clinical Resources and then Report It! Fill out as usual & under the Contributing Factors section (last section before submitting report) select System and then Medication Reconciliation Error This will track problems and lead to appropriate follow up This should also be used to document a medical staff specific conduct issue 53

54 Practice Patients If you want to practice in the training environment prior to the go-live date: Click on the Windows Start button (lower left corner of the computer monitor) Scroll to Programs then Lastword Client for Windows and then E-Chart (Training) Log in with User Number 1CLIN or 2CLIN or 3CLIN The password will always be BEGIN Select any patient from the Hotlist or MyCensus Practice as often as you wish 54

55 Creating a list of frequently used meds in RxPad You can create a list of the meds you enter most often into RxPad (e.g. aspirin, NTG SL). They will then be listed under the My Meds button. 55

56 Creating your My Meds list... After you finish entering a medication that you want to add to your My Meds list, simply click on Add to My Meds 56

57 Once you have created your list, you can click on the My Meds button and quickly select from the medications in your personal list. You cannot remove meds from this list (IR must do it). 57

58 Congratulations, you made it through the process! Contact your unit s Super user if you need assistance with medication reconciliation with your next admission, transfer, or discharge. 58