Medication List Tool Changes Objectives: 1.State the rationale for replacing PAML with the new Medication List Tool (MLT). 2.Describe features of the Medication List Tool (MLT) and associated workflow. 3.Understand implementation and support plans VUH and VCH

Medication List Tool Changes June 17 VUH June 10 MCJCHV

Background Replacing PAML with the new Medication List Tool (MLT) in the Nursing Admission History is phase 1 of the One Medication List project. Goals of the One Medication List Project: 1)One source of truth for medications 2)All members of the team access and edit the same list 3)Processes, tools and expectations for the medication list management are standardized across the medical center

One Medication List Project Implementation VPH completed a successful pilot in March Medication List Tool ( MLT) in VPH Nursing Admission History (replace PAML) MLT embedded in the VPH provider H&P. ED and Perioperative workflow analysis and adoption of MLT is in progress OB is on hold until system updates occur later this year

One Medication List Project Adult and Pediatric Nursing Admission History is the next step. Replace PAML with MLT Provider workflow will be part of future phases Embedded in provider admission process ie documenting H&P Exit check during the discharge process Long term goal is for the providers to have the ability to enter orders for medications from the list.

Med List Tool (MLT) will replace PAML in the Admission History Current New Last completed list visible with date, time and collector included The MLT Summary page will be displayed in the Admission History. Click Edit to open the tool and make changes

I’ve already told someone the medications I’m taking and they typed it in the computer. Why are you asking again?

Why Change? Patient Dissatisfaction – Patients are asked multiple times to supply the same information about medications taken at home Wasted Time – Redundant work being done due to lack of integration of current tools.

Why Change? Safety - There is not one source of truth for home medications – Numerous members of the team collect medication lists yet these lists are not shared and there is lack of confidence in the list. For example, RN collects medication list in PAML yet this information doesn’t display in the provider workflow when completing the H&P. The provider collects yet another list. – Failure to reconcile medications during transitions (home to hospital, hospital to home) result in medication errors

IMPLICATIONS Adverse drug events, ED visits, hospital admissions and readmissions, prolonged length of stay, patient and provider dissatisfaction Up to 67% inpatients have at least 1 discrepancy between the prescription medication list obtained by the admitting provider and the patient’s actual pre- admission medication regimen (Tam) On average, each patient on a general medicine service has more than 1 discrepancy with potential for harm in the admission or discharge orders (Pippins) 59% of admission medication discrepancies could result in patient harm if they persist beyond discharge (Gleason)

Medication Errors at Vanderbilt In a quality improvement study of general medicine patients: – ~90% of patients had an error in their MD- obtained admission med list during night shift In a study of cardiac patients: 50% of patients experienced a clinically important medication error within 30 days post-discharge (Kripalani) 42% of patients had at least 1 error in pre-admission medication list (Salanitro) 39% had at least 1 error in discharge medication list (Salanitro)

The problem(s)  Too many different lists and difficult to know which one to use/update  Existing tools do not meet provider and patient needs (too slow, systems don’t link, displays not user friendly, inadequate decision support, inconsistent use of lay language, lack of standardization)  No standard approach to collection, documentation, and communication of med lists across sites of care Inefficient use of resources, potential for patient harm

How to use the MLT We have established the reasons for taking a home medication list We have defined the best way to collect a medication history (associated educational module) The next several slides will discuss details of how to use the new Med List Tool step by step

Ways to access the Med List Tool (MLT) MLT will be embedded in the Nursing Admission History To initiate MLT click on “edit” in the upper right corner of the list If the MLT needs editing after the admission history is completed, it can be accessed from the actions menu (more detail in upcoming slide)

Current Medication Reconciliation Tool PAML Left column pulls previous VUMC medication list from Patient Summary (PSS)– such as from clinic visit, last hospitalization. NON EDITABLE Right column is “SCRATCH PAD” which is an EDITABLE version of the previous VUMC medication list. EDIT list to reflect medications patient is currently taking prior to admission NEW New Medication List Tool MLT The Med List Tool

Med appears with strikethrough Click “X” to delete a med that is no longer being taken Make a mistake? Note the undo icon How to delete a medication Delete Icon ->

Click Edit icon to edit medication information Denote edits to dose, route, frequency, start date (OPTIONAL), comments. Specify date/time last dose taken if appropriate. Changes are highlighted for easy review. Click Save when revisions completed. How to edit a medication Edit Icon ->

Type Medication Name. Select from list if appropriate Denote dose, route, frequency, start date, comments. Specify date/time last dose taken if appropriate Click Save Click Add Medication New Med highlighted for easy review How to add a medication

Type Medication Information that is known ie Little blue pill for BP Incomplete medication information Select “submit” and then “ No Current Medications” if the patient does not have any home medications. This button will only be available when the scratch pad has no meds listed or all meds have been deleted. Select “Unable to Obtain” and denote reason, if obtaining medication history is not possible.

How to Save Preview- Displays the list without the strikethroughs and highlights. Click a second time return to display with strikethroughs and highlights Submit for Review- saves the list and prompts the provider that the medication list collection by nursing is complete and ready for the provider to review/edit/ finalize

Icons & Displays Click to display all comments. Click again to hide comments The View icon displays detailed medication information including hi Edit Click to display icons to print, show/hide comments or display list of edits by visit Delete View

Accessing Med List Tool from StarPanel Click Actions Click Med List Tool If the MLT needs editing after the admission history is completed, it can be accessed from the actions menu

Implementation & Support June 10 MCJCHV – June 17 VUH  Medication List Tool will replace PAML in the Nursing Admission History  Medication List tool will be available from the Actions Menu & OPC in Star panel Implementation Support System Support Services will provide 24h Support onsite X 4 days then via call to help desk System Support Staff will round on each of the units Debriefing meetings will be held the first week Time to identify and quickly address issues