Electronic Medication Reconciliation Nursing Discharge Process 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
Nursing Discharge Process
Joint Commission, 2008Regulation on Joint Commission Requirements
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.Critical Importance for Nursing
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.).Patient Workflow ScenarioAt time of Admission
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.)MEDICATION SAFETY
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
Complete the electronic medication
reconciliation for an accurate discharge.
The following slide is what the primary physician will see.Patient Workflow ScenarioAt time of discharge
List of Home Medications
List of active inpatient Medications
Select medications from the ‘Home Meds’ list and the ‘Inpatient Medication’ list that you want the patient to take at home.
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.Consultants Medication Reconciliation not completed
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.ConsultantMedication Reconciliation Completed
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 notbeen 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.
This process eliminates the need for Nursing to transcribe discharge medications onto the discharge form.Nursing Nugget
Under the Orders Tab, the summary line specifies that Med Reconciliation was completed electronically.
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.Nursing Discharge Process
“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.
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.
Thank you for your time, you have completed the nursing education on medication reconciliationPlease print the certificate and hand in to your Manager/EducatorMedication Reconciliation Committee
Certificate of Completion__________________________________Nameto certify that he/she has reviewed to satisfaction2008Electronic Medication ReconciliationNursing Discharge Process