NEW Med Rec Module What is the PURPOSE? o A tool to reconcile meds on admission and discharge to SFGH o Replace the LCR Outpt Med List What will it DO? o Look up meds dispensed from retail pharmacies (mostly) o Allow electronic prescribing of meds upon discharge o Facilitate easier creation of discharge list in anticipation of actual discharge Where will it LIVE? o In LCR (and listed in EML) Last updated: 04/23/20141

Why the New System? REQUIRED on admit/discharge by the ACA, Joint Commission Incorporates med list into new electronic discharge summary/ePDP A med list for SFGH hospitalization only….not a clinic med lists Last updated: 04/23/20142

New Process New Process Last updated: 04/23/ Step 1: Collect Home Med List May be done in ED by support staff ADMITTING provider’s responsibility to verify any list by Re-collecting Step 2: Order Inpatient Meds Use “Order Home Meds” in CPOE Step 3: Create a DISCHARGE MED LIST “Push” meds from either home or inpt med lists to discharge Start anytime during admission MD, student, NP, Pharmacist can perform

Step 1: Collection of Home Meds on Admission 3 WAYS to Collect a Med 1.Existing Home Meds 2.Meds From Retail Pharmacy 3.Add a New Med 4Last updated: 04/23/2014

Select the unit. Last updated: 04/23/20145

Select the patient. Last updated: 04/23/20146

Select Medication Reconciliation. Last updated: 04/23/20147

8 Display Home Meds displays medications previously collected in the system

Last updated: 04/23/20149 Notice two places for messages in system to alert you for any errors/status during Med Rec

Status displays the last time Home Meds were collected (if at all). ** Home Meds must be collected FOR EACH ADMISSION** Last updated: 04/23/201410

Last updated: 04/23/ Next, Select Enterprise Med list to open a new window displaying meds prescribed from all DPH facilities.

Last updated: 04/23/ Use the Enterprise Medication List (EML) as a unified reference when reconciling medications.

Last updated: 04/23/ Select Collect Home Meds.

Last updated: 04/23/ Review the Current Home Med list as follows:

Last updated: 04/23/ Address Existing Meds Will be populated if: The system was used on a previous discharge OR If Home Meds were ‘collected’ earlier in this admission

Last updated: 04/23/ Use > to continue or X to stop each medication

Last updated: 04/23/ OR use All button to STOP or CONTINUE all meds in one click.

Last updated: 04/23/ TIP: To change directions of a med: click med name, adjust sig in the details panel, then click Add to Current

Last updated: 04/23/ Next, Use the Prescription History tab to display meds filled at retail pharmacy (if data available).

Last updated: 04/23/ Note: this Retail Pharmacy data may not be complete and must be verified with this patient

Last updated: 04/23/ First, select a med to see retail rx details

Last updated: 04/23/ Complete med instructions manually.

Last updated: 04/23/ The click the Add to Current Meds button.

Last updated: 04/23/ To add a new med, use the Search for New Medications tab.

Last updated: 04/23/ Type the drug name, then Search Minimum of three characters Including dose narrows down results Select “Brand” if searching by brand name

Last updated: 04/23/ Select the correct med, paying attention to dose and form.

Last updated: 04/23/ Enter the medication details.

Last updated: 04/23/ TIP: Use Alt Dose for sigs like “1 to 2 puffs”

Last updated: 04/23/ Click the Add to Current Meds button.

Last updated: 04/23/ Drug is then added to the Current Home Medication list.

Last updated: 04/23/ Repeat as needed. Finally, click Complete

Last updated: 04/23/ TIP: To save a list in-progress, Hit complete button before navigating away from this page. List can be updated later.

Last updated: 04/23/ Caution: the Cancel button will delete the entire home med collection…at ANY point in the process

Last updated: 04/23/ To enter a free-text med: first use “search for new med”(required), then proceed to free text medication & directions

Remember Last updated: 04/23/ **Final verification of Home Meds is the responsibility of the admitting provider** Two Additional Steps during admission process…. 1.Enable Eligibility Check 2.Identify a Retail Pharmacy

Last updated: 04/23/ Request the system to look up the patient’s insurance

Regardless of insurance (no coverage, selecting yes or no) hit Complete

Last updated: 04/23/ Select a Retail Pharmacy

Last updated: 04/23/ Enter the zip or city/state + name to find the patient’s pharmacy

Last updated: 04/23/ Click the Pharmacy name, then COMPLETE

Step 2: Order Home Meds Using CPOE Last updated: 04/23/ Advantages Start home meds quickly thorough CPOE during admission Reconcile home meds with inpatient meds (helps reduce unintentional omissions)

Last updated: 04/23/ AFTER Home Meds are collected, go to CPOE and Write Orders

Last updated: 04/23/ Click here to access the list of Home Meds to order via CPOE

Last updated: 04/23/ Select a Home Med to order upon admission

Last updated: 04/23/ All potentially corresponding meds in CPOE will be pulled up

Last updated: 04/23/ Then select the medication to order *Make sure to select the correct strength, since system shows ALL strengths*

Last updated: 04/23/ Repeat as needed with other home meds, THEN hit OK to complete ordering via CPOE.

Last updated: 04/23/ TIP: click here to view home meds details during ordering within CPOE

Last updated: 04/23/ It looks like this! You can reference this dropdown when you complete orders in CPOE

Step 3: Medication Reconciliation Before Discharge Last updated: 04/23/201450

Last updated: 04/23/ Best practice: select eligibility to re- enable e-prescribing functions

Last updated: 04/23/ Select Reconcile Discharge.

Last updated: 04/23/ First: Address all Home Meds

Last updated: 04/23/ Tip: Any Home Medication stopped (X), will be automatically noted in the Patient Discharge Instructions

Last updated: 04/23/ Tip: Med with a GREEN arrow cannot be e-prescribed later. (telling the patient “take your home supply”)

Last updated: 04/23/ Next, address all Inpatient Meds

Last updated: 04/23/ Click X to stop any medication

Last updated: 04/23/ Add any new meds

Last updated: 04/23/ This creates your discharge med list. Meds listed here = ALL meds the patient should take upon discharge (this list is imported to ePDP)

Last updated: 04/23/ To Prescribe a med, Select the med name

Last updated: 04/23/ Some med info auto-populates

Last updated: 04/23/ You must fill out any additional required prescription information

Last updated: 04/23/ Be mindful of tablet strength (325mg) vs. Dose (650mg)

Last updated: 04/23/ Select Extended Meds radio button to add more directions

Last updated: 04/23/ Then you should Always….Always…Always ***HIT THE E-RX BUTTON*** when available

Last updated: 04/23/ Failure to hit eRX button will prevent you from e-prescribing a prescription !!!

Last updated: 04/23/ Finally, select a destination. You can assign each row a different destination.

Last updated: 04/23/ SFGH Discharge Pharmacy (Can be chosen by Interns, NP, DEA license)

Last updated: 04/23/ Retail Pharmacy (by DEA licensed providers only)

Last updated: 04/23/ If you do not have a DEA license, you cannot send to Retail Pharmacy. (ask Attending/R3 to send prescriptions)

Last updated: 04/23/ Paper Rx For any controlled medication or Supplies (e.g. ‘test strips’)

Last updated: 04/23/ TIP: schedule II meds (e.g. oxycodone) still require a secure script in addition to entering on the discharge med list

Last updated: 04/23/ To remove a med from Discharge List, select the med, then the Remove button

Last updated: 04/23/ To Save work before addressing all Home & Inpt Meds, use this button

Last updated: 04/23/ If you have addressed every med on each list, you may Complete the Discharge List

Last updated: 04/23/ Clinical Checking will identify potential interactions

Last updated: 04/23/ Click here to address the issue

Last updated: 04/23/ Select appropriate choice or free- text reply, then hit Update

Last updated: 04/23/ Green Triangle indicates issue is resolved.

Last updated: 04/23/ ****WARNING: hit COMPLETE or WORK WILL BE LOST**

Last updated: 04/23/ The GRAY screen indicates your work is saved. (If you navigated away without saving/completing, you do NOT see this screen)

Electronic Prescribing & Printing Prescriptions Last updated: 04/23/201482

Last updated: 04/23/ The next step is to Send the e- prescriptions

Last updated: 04/23/ Prescriptions ready to send will have both an icon and a quantity

Last updated: 04/23/ You can change quantity/destination by selecting the medication then adjusting in Med Detail pane below

Last updated: 04/23/ Always Update the Prescription if you adjust any part of an Rx

Last updated: 04/23/ Or just hit Clear to de- select the medication

Last updated: 04/23/ Red Triangle indicates a problem with rx

Last updated: 04/23/ Here, problem is Rx #2 has no destination. Note: Retail Pharmacy grayed out. Why?

Last updated: 04/23/ Because no Retail Pharmacy was selected. Use the Change button to select one.

Last updated: 04/23/ No problems are present, (note Retail pharmacy selected). Ready to send Rx!

Last updated: 04/23/ Icons indicate meds queued up to prescribed  Electronically Or  Printed

Last updated: 04/23/ Hit Complete

Last updated: 04/23/ This is your final acknowledgement window. Click OK to send the prescriptions.

Last updated: 04/23/ )Pagerbox window opens. Use this to send D/C info to discharge pharmacy. ***very useful to reduce calls for clarifications** (e.g. – changed lasix dose 2)Notice Gray screen indicates successful completion

WAIT!!! How do I know e-Rx was actually sent? Last updated: 04/23/201496

Last updated: 04/23/ Return to Display Home Meds. Icons indicate Rx was sent. You can review prescription details including last prescription date and destination(s).

ePrescribing is complete! Prescription(s) will then be electronically transmitted to the dispensing pharmacy or printer. Last updated: 04/23/201498

PEARLS Some Common Problems/issues. Last updated: 04/23/201499

Last updated: 04/23/ Problem #1: Trying to start discharge meds before Home Med were collected.

Last updated: 04/23/ Problem #2: “I couldn’t select a destination (they were grayed out) so I did paper rx’s for all my meds” WHAT HAPPENED?

Last updated: 04/23/ One of two things happened: Provider did not select Eligibility Benefits prior to starting discharge meds.  You can see no destination nor eRx button is available

Last updated: 04/23/ Or…. Provider did NOT hit eRx button when adding medication to discharge list.  Note only Paper rx and eRx are available to select

Last updated: 04/23/ Problem #3: “I spent 30 minutes making this list and when I came back, I lost all my work!! (and almost had a heart attack) You MUST hit ‘complete’ or “save in progress” before leaving. The GRAY screen indicates your work is saved. It is your friend!