Discharge Orders/Medication Reconciliation Medication Education Module 4 Discharge Orders/Medication Reconciliation Trainer Preparation Copies of: -PowerPoint handouts -Print p. 2 “Objectives” to test staff knowledge before & after the training. (Use as your training documentation.) -Discharge Orders/Medication Reconciliation Checklist -Responsibilities in Action (RIA) pages 53-54; curriculum can be downloaded at www.mass.gov/dph/map scroll down to "what would you like to do" and select View MAP training resources and curriculum, then select DDS MAP training resources; once there you will see MAP Curriculum and Adjunct Materials -Corresponding MAP Policy 13-6

Objectives 1. When do I use discharge orders? 2. What is medication reconciliation? 3. What is a transition of care? What I know about discharge orders before the training: 1. 2. 3. 4. What I learned about discharge orders after the training: 4. What do I tell the PCP?

Discharge Orders Discharge (new) orders from a Health Care Facility take the place of prior existing orders Examples of a Health Care Facility are a hospital, nursing home, crisis stabilization unit, rehabilitation center, etc. An Emergency room visit is not considered an admission therefore orders obtained during an emergency room visit are in addition to the current HCP orders in the residence.

Medication Reconciliation Comparing an individual’s new medication orders to all of the medication orders that were in place prior to the new orders Must be done during every transition of care Examples of transition of care include transfer to/from a hospital, nursing home, crisis stabilization unit, rehabilitation center.

Before Discharge Obtain PCP orders from individual’s home before admission HCP discharge (new) orders

Before Discharge Compare the meds on the two sets of orders New and Prior Pay attention to possible dose and/or frequency changes for meds that appear on both sets of orders

Before Discharge Review any discrepancies between the two sets of orders with the HCP

Before Discharge Obtain signed, dated HCP orders If more than 1 page, HCP must sign and date each page Electronic signatures are acceptable

Before Discharge Obtain new prescriptions or ensure the pharmacy has been notified by HCP of new medication prescriptions

After Discharge Notify PCP and any other prescribing HCP that the individual had a transfer of care

After Discharge Notify PCP and any other prescribing HCP of New or changed medication/treatment orders Previously ordered medications omitted from HCP discharge orders Document

After Discharge Obtain from PCP and any other prescribing HCP New orders for any previously ordered medications [omitted from HCP discharge orders] that they want reordered Orders must be re-written Statements such as resume all meds as previously ordered are not acceptable.

After Discharge Obtain newly prescribed medications from pharmacy Transcribe new orders (previous transcriptions may not be used) Post and Verify all orders Communicate changes Map Policy 10-10 When a medication had been previously transferred (such as a hospital), the medication may be returned and used as long as: -there is a current order for the medication -the label agrees with the order (there are no hand printed changes on the label) -the directions have not changed -the medication is in a tamper resistant package -a dated medication release form has been signed (hospital licensed staff/MAP Certified staff) Make sure other coworkers, supervisor, day program staff, family members, etc. involved in supporting the individual are aware of changes.

Discharge Checklist The Discharge Checklist may be used as a resource tool in the medication reconciliation process. To locate the Discharge Checklist page 54 in RIA or page 144 in the MAP Policy Manual.

Questions

Resources MAP Curriculum- Responsibilities in Action www.mass.gov/dph/map https://shriver.umassmed.edu/programs/cdder/webinars/map-training-resources/dds-map-training-resources MAP Policy Manual