E-DISCHARGE MEDICATION MODULE Last updated: 7/25/2017

GETTING ORIENTED Shows most recent Home Med List Displays all med lists within San Francisco Health Network (SFHN) e.g. eCW, Jail Health Services, Laguna Honda Create a complete Discharge Med List using Home & Inpatient med lists Send electronic or print paper rx’s Find formulary & insurance info 2

CREATE HOME MEDICATION LIST STEPS SEND PRESCRIPTIONS To Retail or Discharge Pharm. DISCHARGE MED LIST Imported to Discharge docs CREATE HOME MEDICATION LIST Required For Every Admit 3

STEP 1: Collect Home Meds SEND PRESCRIPTIONS To Retail or Discharge Pharm. DISCHARGE MED LIST Imported to Discharge docs HOME MEDICATION LIST Required For Every Admit Done By Provider or Med Rec Techs Cannot start any discharge process until home meds are collected

STEP 1: Collect Home Meds SEND PRESCRIPTIONS To Retail or Discharge Pharm. DISCHARGE MED LIST Imported to Discharge docs HOME MEDICATION LIST Required For Every Admit To Request Home Med collection from Med Rec Techs Select “Home Med Request” under Collect Home Meds Expect 24 hr turnaround time

Patient’s Instructions STEP 2 SEND PRESCRIPTIONS To Retail or Discharge Pharm. DISCHARGE MED LIST Imported to Discharge docs HOME MEDICATION LIST Required For Every Admit Accuracy Counts! Used by all KEY STAKEHOLDERS Discharge Meds Patient’s Instructions Outpatient Providers Home Health Worker Discharge Summary

STEP 2: Create Discharge Med List Step 1: MUST select Eligibility Benefits to enable e-prescribing. You cannot e-rx later if this step is missed. [choose any available option and then click complete] 1. 2. Step 2: Select Reconcile Discharge.

Step 3: Address all Home Meds Tips Any Home Medication stopped (X), will be automatically noted in the Patient Discharge Instructions A BLUE arrow appears when a provider: Clicks the gray arrow to push the home med over to the discharge medication list. This med cannot be e-prescribed later – e.g. telling the patient “take your home supply” Changes the home med’s directions OR prescribes a new medication. To prescribe a home med, click on the med. Complete the Rx fields and “add to discharge meds.” Each medication needs to either have: red X [do not take], green arrow [home medication, continue to take home supply upon discharge], blue arrow [new medication or home medication with changes to instructions]

Step 4: Address all In-house Meds Click X to stop any medication

This creates your discharge med list. Meds listed here = ALL meds the patient should take upon discharge This list is imported to the ePDP and patient discharge instructions

Add any new meds

To Prescribe a med, Select the med name Then fill out additional Rx information Be mindful of tablet strength (325mg) vs. Dose (650mg)

***HIT THE E-RX BUTTON*** when available Always….Always…Always ***HIT THE E-RX BUTTON*** when available Failure to hit eRX button will prevent you from e-prescribing a prescription !!!

Each row is an Rx with unique destination. Select Rx destination. Each row is an Rx with unique destination. TIP SFGH Discharge Pharmacy can be chosen by MDs without DEA license, i.e. interns Retail Pharmacy Only DEA licensed providers can send eRX to Retail pharmacy. (ask Attending or R3 to send prescriptions)

Any controlled medication Select Paper Rx for: Any controlled medication TIP: schedule II meds, e.g. oxycodone, requires a secure script in addition to entering in discharge med list All Supplies (e.g. ‘test strips’) TIP: supplies to any RETAIL (non-discharge) pharmacy must also be called in OR paper faxed 3. To hand a physical prescription to patient

To remove a med from Discharge List, select the med, then the Remove button

Save all work if navigating away from this page **or it will be lost**

Complete the Discharge List after all meds are addressed

Clinical Checking will identify potential interactions Click here to address the issue

Select appropriate choice or free-text reply, then hit Update

Green Triangle indicates issue is resolved.

****WARNING: hit COMPLETE or WORK WILL BE LOST**

The GRAY screen indicates your work is saved. (If you navigated away without saving/completing, you do NOT see this screen)

STEP 3 SEND PRESCRIPTIONS To Retail and/or Discharge Pharm. DISCHARGE MED LIST Imported to Discharge docs HOME MEDICATION LIST Required For Every Admit Final step Remember: interns cannot e-Rx to Retail Pharmacy (get attending/R3) Even if not Rx’ing, discharge list should contain ALL meds patient takes upon discharge

Select send e-prescriptions

Prescriptions ready to send will have both an icon and a quantity

**then hit UPDATE PRESCRIPTION* You can change quantity/destination by selecting the medication then adjusting in Med Detail pane below **then hit UPDATE PRESCRIPTION* Or just hit Clear to de-select the medication

Red Triangle indicates a problem with rx

Here, problem is Rx #2 has no destination. Note: Retail Pharmacy grayed out. Why?

Because no Retail Pharmacy was selected Because no Retail Pharmacy was selected. Use the Change button to select one.

No problems are present, (note Retail pharmacy selected). Ready to send Rx!

Icons indicate meds queued up to prescribed  Electronically Or Printed

Hit Complete

LCR discharge medication reconciliation communication pop-up This pop-up will appear at the end of the medication reconciliation process. NO POP-UP = NO Rx SENT This is ONLY sent to the ZSFG Discharge Pharmacy. Community pharmacies do NOT receive this information. Free text message to pharmacy Click OK!

LCR Discharge Med Rec Pop-up: This is only to be used for communication with the ZSFG Discharge Pharmacy and will not transmit to any community pharmacies. Anticipated DC time helps the pharmacy prioritize the filling of the prescription. Check boxes if the answer is YES! Is a secure script en route for Schedule 2 (e.g. morphine)? Is it OK to dispense 10-day supply of meds if limited by insurance? Is patient being discharged to Medical Respite? Will this patient benefit from more in-depth discharge medication education by a pharmacist? Msg to Pharmacy: Free text message to pharmacy. (e.g. If this is a repeat e-Rx, use the free text box to summarize the changes that you are sending to the Pharmacy.)

Issues That Arise ISSUE RESOLUTION I can’t select a destination to send my Rx! Did you (or person who entered med) hit gray e-Rx button and do an Eligibility Request? Perform those functions, remove med in question, re-add it My med says “free-text medication” and I can’t prescribe it Try removing medication from discharge list, then using the “Search for New Med” tab rather than using Home or In-House med list Pagerbox Superuser to make aware of issue: 443-5794?? Last resort: keep free-text medication on DC med list, call in rx to pharmacy verbally I can’t add a med due to invalid frequency Use a frequency from the drop-down list OR Use the ‘alt dose’ field to write out sig free-hand I’m an intern/resident but not enrolled to e-Rx to Discharge Pharmacy Email dph.helpdesk@sfdph.org with the following: name, CHN #, NPI #, department and DEA (if you have it). Call the IT Help Desk 628-206-7378

Problems? Ask your Clinical Pharmacist (if available) Ask your Chief Resident Discharge Pharmacy If discharge pharmacy unable to help resolve the issue, ask for Med Rec Support pager # 327-0673 (business hours only) All help info and powerpoints available at: http://tiny.ucsf.edu/edischarge Last updated: 7/25/2017