Medication Reconciliation using Web OMR Ambulatory Services September 2007

Table of Contents The Steps to Medication Reconciliation………………………………………………….4 Patient Profile……………………………………………………………………………….5 Active Medication List ……………………………………………………………………..6 Definitions of Med List Actions …………………………………………………………...7-8 Verify………………………………………………………………………………………....9-10 Not Taking…………………………………………………………………………………..11-13 Inactivate…………………………………………………………………………………….14-15 New Medications……………………………………………………………………………16 Record Only/Not Prescribing………………………………………………………….17 Dosage Uncertain……………………………………………………………………...18 Modify………………………………………………………………………………………..19-20 Print Web OMR Med List…………………………………………………………………...21 Discharge Med Tab…………………………………………………………………………22-26 No Medications on File/Verify No Meds…………………………………………………..27-29 Notifying the Next Provider…………………………………………………………………30 Automation/Setting defaults……………………………………………………………31-32 Adding Medications to Notes & Letters……………………………………………….33 CCC Scheduling Tools……………………………………………………………………...34 OMR Med List Report…………………………………………………………………..35 OMRI Med List Report………………………………………………………………….36 Print OMR Med List at Check In……………………………………………………….37 Sample OMR Med List………………………………………………………………….38

Agenda Introduction Goals and Background Web OMR Medication List Functionality Real Estate Scenarios/Actions Communicate to Next Provider CCC Scheduling Tools Questions

The Steps of Medication Reconciliation Obtaining/Documenting the most complete and accurate list possible of all current medications. Comparing the listed medications with any new orders to reconcile discrepancies. Updating the list as orders change during the visit/stay and making necessary and appropriate medication changes based on the patient’s clinical condition. Communicating updated list to the next provider of service when the patient is transferred to another setting, service, practitioner or level of care within or outside the organization. An updated list of the patient’s medications is provided to the patient and to the next giver of care at discharge or transfer.

Patient Profile Click on Medication tab to access the patient med list Patient information Tabs including med tab Outpatient Medications including med, last action and by Appointments Allergies

Active Medication List Tabs: Active, Inactive, discharge Med Name Sort First Latest- date with action BY ACTION Check All History of meds Allergies Interaction Alert Geriatric Alerts Print Labs/Print Grid View Labs Micromedex Show EPISODIC Meds

Active Medication List – Actions Definitions and Guidelines New Medication Adds a new medication to the active med list. May also be used to free text a med (unknown med) or add a supply item. Should be used when the ordering provider adds a new medication to the patient routine Can also be used to record medications that the patient reports taking, although is not already on the active med list or has not been prescribed by the recording provider. The clinician may select: “Recording Medication Only/Not Prescribing” to differentiate between ordering the med and documenting the med. The documenting provider can indicate that the medication was prescribed by another provider, is over the counter or provide an “other reason”. In addition, the documenting provider may select “dosage uncertain” if the patient can not provide the necessary dosage/instruction information. Inactivate Removes a med from the active med list and places it on the “Inactive” (previously known as “D/C”) med list. Medications on the inactive med list can be ‘reactivated’ and added back to the active med list Used when a provider decides to cease a medication Can be used when a patient reports that they are no longer taking or have been taken off a medication Verify Used to document that a patient confirms that they are taking the med as prescribed. Can be used to document that a patient reports that they are NOT taking a medication listed on the active med list (see “Not Taking” Action). This should be used by providers who wish to document that the patient is not taking the medication but do not want to inactivate the med/remove it from the active med list. Intended to be a notification to the ordering or next provider as “Not Taking” appears next to medication name on the active med list.

Active Medication List – Actions Definitions and Guidelines Modify Allows the clinician to alter dosage, instructions, duration, frequency, quantity, refills, etc. Should be used when the provider changes or updates the prescription OR a patient indicates that dosage or instructions have changed Renew- Used to quickly review and renew an active medication of the same dose and instructions. Not Taking/Not Taking As Prescribed- The user is brought to the VERIFY Screen Can be used to identify medications that the patient has reported that they are not taking or are not taking according to the instructions documented on the active med list This should be used by providers who wish to document that the patient is not taking the medication as prescribed but do not want to inactivate the med/remove it from the active med list. Intended to be a notification to the ordering or next provider as “Not Taking” appears next to medication name on the active med list.

Verify Screen

Verify Screen Shows last action & date of last action

“Not Taking” Action

Not Taking Action/Verify Screen Free text entered here will appear on the active med list

Not Taking Action/Verify Screen

Inactivate Screen User may select a reason why the med is being inactivated. Reason will appear on the inactive med list Physician Doing Medication Reconciliation

Restarting an Inactive Med Click on “restart” to move the med back to the active med list

New Medication Reminder: Set the duration to reflect how long the patient will be taking the medication. If episodic, the medication will automatically be moved to the inactive list when the course is complete Reminder: Medications can easily be saved to the providers quick pick list

Record Only/ Not Prescribing The clinician may select: “Recording Medication Only/Not Prescribing” to differentiate between ordering the med and documenting the med

Dosage Uncertain “Dosage Uncertain” will appear next to the medication name on the active med list. Strength & Dosage information may not be available but is required to ensure interaction checking

Modify Screen Allows the user to edit dosage, instructions, duration, frequency, quantity, refills, etc

Modify Screen Allows the user to edit dosage, instructions, duration, frequency, quantity, refills, etc

Print OMR Med List

Discharge Med Tab ***remains in TEST pending User Group approval This tab lists all inpatient discharge meds entered via POE.

Discharge Med Tab ***remains in TEST pending User Group approval Prior admissions are listed at the bottom of the discharge tab med list. Clicking on the link displays the meds from the admission. Discharge Med Tab ***remains in TEST pending User Group approval

Discharge Med Tab ***remains in TEST pending User Group approval Discharge meds NOT on the “Active Meds” list can be moved to the active list by clicking on the “Move to Active” link. Discharge meds that match the drug name (generic) and dose of meds already on the “Active Meds” list are shown here. Discharge Med Tab ***remains in TEST pending User Group approval Pop up box of active med list

Discharge Med Tab ***remains in TEST pending User Group approval automatic Standard order screen for webOMR meds is populated with date from POE. User enters Dispense # and refills. Interaction checking with Active med list is turned on automatically. Discharge Med Tab ***remains in TEST pending User Group approval

Discharge Med Tab ***remains in TEST pending User Group approval Transferred from discharge to active med list.

No Medications on File Click on the medication tab to enter new meds or verify that the patient is not taking medications

Verify No Medications

Verify No Medications

Notifying the Next Provider Inserting Meds into Notes and Letters If the next provider is Internal- Web OMR If the next provider is external- medication information can be added to the progress note or letter. Currently the provider has defaults that can help in adding the medications 1 - MEDICATIONS PRIOR TO THE VISIT 2 - DC'D ON THE DAY OF THE VISIT       3 - PRESCRIBED ON THE DAY OF THE VISIT 4 - NO MEDICATIONS AT ALL IN THE NOTE  Dictated Notes: When dictated notes are uploaded to Web OMR the meds will automatically appear according to the default settings. If no defaults are set, it pulls defaults 1,2 and 3 Medications- when the provider is writing, reviewing or editing notes and letters, medications can be inserted by clicking the Medication button.

Setting User Defaults

Setting User Defaults

Adding Medications To Notes/Letters Click on Medications button to insert medications into notes and letters (dependant on default settings)

CCC Appointment Scheduling Tools OMR Med Lists Based on Schedule OMR Med Lists for an Individual Patient OMR Med List Printing at Check-In

OMR Med Lists Based on Schedule Within Appointment Scheduling, users have the ability to print OMR Med Lists for scheduled appointments. The user may specify an individual provider or provider set (group of providers) within a specified date range (can be 1 day or several). The OMR med lists will print in alphabetical order for the patients scheduled within that date range. Patients with no documented medications will also print with the following message: No Medication Sheet Online. Medications appearing on this report are medications that appear on the patients active med list in web OMR. Inactive meds will not appear on this report. To Access This Report:

OMRI: Med Lists for an Individual Patient Within Appointment Scheduling, users have the ability to print OMR Med Lists for individual patients. This tool can be helpful to print med lists (during chart prep) for last minute add patients.

OMR Med List Printing at Check-In Print OMR Medication list ? This option appears for all patients and must be answered “Y”es or “N”o. Check with the department manager to determine when or whether to print a medication list at check in.

Sample OMR Med List FROG,KERMIT 0901910 M73 09/21/33 MEDICATION SHEET 1. CATAPRES 0.1 mg Oral 08/22/2007 (Prescribed by Other Provider: Sands) 1 Tablet by mouth 2. KEFLEX 250 mg Oral 07/24/2007 2 Capsule(s) by mouth twice a day 3. LASIX 20 mg Oral 08/22/2007 1 Tablet(s) by mouth three times a day 4. NEXIUM 40 mg Oral 08/22/2007 1 Capsule(s) by mouth once a day 5. Oxycodone-Acetamin 5 mg-325 m Oral 04/04/2007 1 Tablet by mouth every four (4) hours 6. PREDNISONE 1 mg Oral 08/23/2007 Prednisone 20 mg Tablet 4 Tablet(s) by mouth daily for 3 days Then reduce to: 3 tabs daily (60 mg) x 3 days, 2 tabs daily (40 mg) x 7 days, 1 1/2 tab daily (30 mg) x 7 days, 1 tab daily (20 mg) x 7 days, 1/2 tab daily (10 mg) x 7 days Your medication list has been updated to the best of our ability based on the information provided to us during your visit. IF YOU HAVE ANY QUESTIONS OR FEEL THIS LIST MAY BE INCORRECT,  CALL YOUR DOCTOR BEFORE MAKING ANY CHANGES TO YOUR MEDICATION ROUTINE. Printed on Aug 27, 2007 11:34AM