Medication Reconciliation Training Packet

Medication Reconciliation Training Packet PowerPoint PPT Presentation


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2. Objectives. To identify the key elements of the medication reconciliation processTo describe the role of the nurse in the medication reconciliation processTo identify all of the medication information needed to build an accurate listTo demonstrate the input of the patient's medication list into E-Chart and the printing of the

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Medication Reconciliation Training Packet

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1. 1 Medication Reconciliation Training Packet Legacy Health System

2. 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) Other goals include: Reduce the risk of patient harm resulting from falls. Other goals include: Reduce the risk of patient harm resulting from falls.

3. 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.  

4. 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 Losec-lasix Losec 20mg po od ordered but written as lasix- got this 4 3 days Levothyroxine and lanoxin- got thyroid meds instead of digoxin because of transcription error for 4 days Didn’t get potassium supplement only on ED list very depleted as on high does of lasix GI bleed on coumadin for 2 days Losec-lasix Losec 20mg po od ordered but written as lasix- got this 4 3 days Levothyroxine and lanoxin- got thyroid meds instead of digoxin because of transcription error for 4 days Didn’t get potassium supplement only on ED list very depleted as on high does of lasix GI bleed on coumadin for 2 days

5. 5 The Joint Commission’s Patient Safety Goal With the patient and family involvement in this process. Talk about Milton…Give examples of patient list, with past hospital list, with MD list form previuos hospitalizations…. 3. When a patient is transferred to another setting, service, practitioner or level of care within or outside the organization With the patient and family involvement in this process. Talk about Milton…Give examples of patient list, with past hospital list, with MD list form previuos hospitalizations…. 3. When a patient is transferred to another setting, service, practitioner or level of care within or outside the organization

6. 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.

7. 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.

8. 8 Physician’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 medications.

9. 9 E-Chart Medication Reconciliation Process

10. 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) This includes assessment of patient compliance with drug therapy and a visual inspection of the medications brought into the facility). This includes assessment of patient compliance with drug therapy and a visual inspection of the medications brought into the facility).

11. 11 You can access RxPad from the base screen…

12. 12 …or from the Admit History

13. 13

14. 14 This takes you to RxPad where the patient’s active med list is displayed

15. 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”.

16. 16 Steps to create a home medication list in RxPad

17. 17 1. Update medications already on the list Physicians also use the Reorder button to generate a new prescription for an existing medication.Physicians also use the Reorder button to generate a new prescription for an existing medication.

18. 18 You might see this conflict window with information about a medication conflict

19. 19 Welcome to RxPad!

20. 20

21. 21

22. 22 Fill in last taken/location…

23. 23 To add comments…

24. 24 Put in provider’s name…

25. 25 Put in provider’s name…

26. 26 When done with all of the information, click on the “Outside” button

27. 27 RxPad can also generate prescriptions

28. 28 2. Delete any medications the patient is no longer taking

29. 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.

30. 30 3. Add new medications to the list

31. 31

32. 32

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

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

35. 35

36. 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.

37. 37 4. Print the “RxPad Home Medications” list…

38. 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.

39. 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.

40. 40 Admit History

41. 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 medication-related problem ***indicate if information is not available on admission not applicable***indicate if information is not available on admission not applicable

42. 42 To complete the Pharmacy Consult Criteria…

43. 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

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

45. 45 Transfer Process 1. Choose “Print a Med Guide” 2. Select report number 6 (double click) 3. Select your printer 4. Choose “Print Report”

46. 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).

47. 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 Both lists should be reviewed with patients and family members at the time of discharge Patient teaching should include: A review of those medications that were taken before admission (list to be given to patient) Teaching about the new medications from the discharge prescription The complete medication list will be generated and reviewed with the patient and family at discharge. Both lists should be reviewed with patients and family members at the time of discharge Patient teaching should include: A review of those medications that were taken before admission (list to be given to patient) Teaching about the new medications from the discharge prescription The complete medication list will be generated and reviewed with the patient and family at discharge.

48. 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.

49. 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.

50. 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

51. 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.

52. 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

53. 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”

54. 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

55. 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.

56. 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”

57. 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).

58. 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.

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