Overview. On June 23 rd , several separate but related changes will take place impacting MD’s PA’s and ARNP’s. These changes are being implemented at hospitals throughout the US due to Meaningful Use requirements.
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On June 23rd, several separate but related changes will take place impacting MD’s PA’s and ARNP’s.
These changes are being implemented at hospitals throughout the US due to Meaningful Use requirements.
The following presentation communicates these changes and provides additional detail.
The new Med Rec at Admission, using the Order Reconciliation Manager (Scale Icon) was introduced hospital-wide in February. Education material is located in the MD lounge, or on SMH.com, Physician Resources.
Effective June 23, 2014, the process of completing a Medication Reconciliation within SCM is continuing with the addition of Medication Reconciliation at Discharge. You will complete your discharge reconciliation via the “SCALE ICON”.
If Med Rec @ DC has not been completed, a link will display for the new DC Rec. If Med Rec has been completed the link will appear greyed out.
Click on the Discharge(New) link to open the Discharge Rec session.
Med Rec @ DC indicates where a medication order came from. Medications continued from Home will be listed with “Home” beside them. If the Home Medication was reconciled on Admission and continued you will see “Inpatient” next to the medication. You will see both versions of the medication available to you at Discharge.
To continue a medication on discharge as a Home Medication, you will click on the green arrow next to the medication (either Home or Inpatient).
Once selected via the green arrow, the Medication will be added to the right pane as a Home Medication at Discharge.
Within Med Rec @ DC, if you would like to create a printed prescription; you would click the Rx button next to the med for which you wish to create a printed prescription. Once you have selected the Rx option, the Modify Prescription window will open to allow you to configure the prescription for that medication.
You would then check that all info is entered correctly, click done and the Modify Prescription window will close.
The medication will be added to the Home Medications at Discharge side with the Rx icon showing that it is a Home Medication generated from a printed prescription.
When satisfied with Home Medications at Discharge, you will need to “Mark All Remaining as Reviewed” to reconcile all remaining medications.
Click the “Save as Complete” button at the bottom.
You will then be taken to the Review Prescription screen where you can take one final look at the medication prescriptions being printed. The selection for “Print” has been pre-selected. Select the “Submit” button. Your prescription will then print to the default printer for your location. Sign the prescription and give to patient as you would with a written prescription today.
The medications that were submitted as Home Medications during this Med Rec @ Discharge session will be available in the Home Medications List during the patient’s next hospital admission.
Effective 6/23, the Discharge / Approved By Order will be modified.
The following screen shot shows the modified order session:
Note that the new order session has two mandatory fields, the Discharge to (no change from current order), and Discharge Diagnosis (new field). Meaningful Use requirements now make a Discharge Diagnosis mandatory.
NOTE: The Discharge Diagnosis can be established from this order session, or at any time through SCM using the Health Issues icon.
Clicking on the Discharge Diagnosis button in your order screen brings you directly to the following screen within the SCM Health Issues Manager:
If you do not wish to copy an existing Working Diagnosis as your Discharge Diagnosis, then:
Go to the bottom left of the screen, click on ‘Discharge Dx’, and then search for the appropriate diagnosis. (Similar to ‘IMO’ in entering the Working DX). Use the applicable shortcuts in the box, if not use the ‘Full Catalog Search’ tab.
Once the appropriate diagnosis is found, click the ‘Add’ button
3) This will establish the Discharge Diagnosis
4) Then click on ‘Save to Order’
This will add the selected Discharge Diagnosis to the order.
When you click on ‘OK’ to submit your order, the following Alert will fire so that a detailed instruction note can be prepared:
While you have to respond to this alert, please note that this complicated process for meaningful use preparation of a discharge note is automated and you will only have to click “save” and acknowledge the alert before submitting the order. See below.
You must click on ‘Add Document’ to complete your Discharge order. You will be brought to the new, mandatory Discharge Instructions note. This note will be placed on the Patient Portal.
After clicking on the ‘Add Document’ button, you’re brought to the following screen:
All fields required by Meaningful Use to create a minimum plan are pre-populated, therefore it’s only necessary to click ‘Save’ and all the pre-filled fields will become the Discharge Instructions note. You may add more detail or change the default selections, however, because the Discharge Instructions note will be going to the Patient Portal. MD’s, PA’s and ARNP’s are encouraged to fill out here what they have always filled out in the DC order previously. Once done click ‘Save’. The password box should not come up.
This returns you to the alert. Acknowledge the alert and move on to submitting the order.
Now the order is placed for Discharge, and the Discharge Instructions note is in the Documents tab.