1. Electronic Medication Reconciliation Nursing Discharge Process

2. Regulation on Joint Commission Requirements
Requirement: There is a process for comparing the patient’s current medications with those ordered for the patient while under the care of the organization.
The Joint Commission, 2008

3. Regulation on Joint Commission Requirements
Goal: Accurately and completely reconcile medications across the continuum of care
Joint Commission, 2008

4. Critical Importance for Nursing
Complete and accurate home medication list in the Admission Profile.
Keep admission profile home medications updated and as complete as possible.
Physicians are reconciling from this list.
Accuracy of the home medication list = patient safety.

5. Patient Workflow Scenario At time of Admission
Mr. Smith admitted to the hospital for pneumonia.
Mr. Smith/family provides his home medication list to the admitting nurse.
Medications are entered into the admission database. Patients list may not be accurate (mgs may be missing, medications are misspelled which might be an entirely different drug, etc.).

6. MEDICATION SAFETY Don’t guess: Spellings – get the proper name
Milligrams (Micrograms, units, etc.)
If the patient does not know meds or is unsure of dosage – record that and report to peer at change of shift and/or MD for accuracy.
Review what you have entered BEFORE saving database (error of transcription for frequency, etc.)

7. Patient Workflow Scenario At time of discharge
Mr. Smith has responded well to treatment and is now ready for discharge.
There are 3 MDs on the case that need to complete their discharge orders for this patient.
The primary MD (Captain of the Ship) and 2 consultants.
Electronic medication reconciliation begins:

8. Patient Workflow Scenario At time of discharge
Responsibility of the Primary physician (Captain of the Ship):
Complete the electronic medication
reconciliation for an accurate discharge.
The following slide is what the primary physician will see.

9. List of Home Medications List of active inpatient Medications
“Captain of the Ship” checkbox.
List of Home Medications
List of active inpatient Medications

10. *Do not select the same medications from both lists.
Select medications from the ‘Home Meds’ list and the ‘Inpatient Medication’ list that you want the patient to take at home.

11. Consultants Medication Reconciliation not completed
Consultant arrives before the captain of the ship reconciles:
The consultant may add medications through the discharge process which will populate onto the electronic medication reconciliation form. This will also generate a prescription(s) that will require a physician signature.

12. Consultant Medication Reconciliation Completed
Consultant arrives after the captain of the ship reconciles:
Any consultant that orders medication after reconciliation will not populate on the electronic form for other physicians to see.
However, the added discharge medications will display in the final med reconciliation report that the nurses give to the patient.

13. If med rec has not been completed by the ‘captain of ship’, the order form will display active and home medications. Review and click Close. Open order entry worksheet to enter prescriptions.
If med rec has been completed by the ‘captain of ship’, You will see the details of what medications have been reconciled already, but you cannot add or edit form. Review and click Close. Open order entry worksheet to enter prescriptions.

14. Nursing Nugget
All medications written in the discharge process will populate the report that the nurse gives to the patient.
This process eliminates the need for Nursing to transcribe discharge medications onto the discharge form.

15. How do I Know Reconciliation is Complete?
Go to orders tab
Build a filter for Medication Reconciliation or look for the current active orders.

16. Go to orders tab
Under the Orders Tab, the summary line specifies that Med Reconciliation was completed electronically.

17. Nursing Discharge Process
Print medication reconciliation form.
Review form for duplicates or orders needing clarification. (patient advocacy/safety concern)
Use Patient Discharge Home Care sheet to provide patient with activity, wound care, diet, education, follow up appoints, etc.
For now, this part of the process will not change.

18. Click on Printer Icon

19. Order Management
NEW
“Medication Discharge electronic Instructions-Print for patient to sign”.
Under Order management you will see 3 Med Rec reports
“Medication Reconciliation at discharge report (old process) Print only if MD to complete Med Rec on paper”.
Medication Reconciliation-Print Home Meds Only

20. Nursing will print discharge instructions for the patient after all medication reconciliation is completed by captain of the ship and consultants.
Two copies will print.
The patient and the nurse signs both forms.
One of the forms will be scanned back into electronic record and available to view in documents tab after discharge.

21. Continue to use patient discharge Home Care sheet to provide patient with activity, wound care, diet, education, follow up appoints, etc.

22. This printed form is still available for discharge
This printed form is still available for discharge. From the orders tab in SCM, click on the printer icon and choose Medication Reconciliation Report discharge report (old process)

23. If there are more than 30 active medications the electronic form will not be able to be used. The physician will receive the above message; ‘Maximum inpatient medication exceeded’.
If the physician would like to reconcile, they can click on the ‘I am Captain of the Ship’ box and a paper medication reconciliation form will automatically print. The paper form needs to be reconciled and signed.

24. Super Users
Each area will have staff that have learned the physician process and the nursing process. The names of the super users will be posted on the unit to help assist physicians and nurses on the process of medication reconciliation. Please direct your questions to your super users for clarification.

25. Thank you for your time, you have completed the nursing education on medication reconciliation Please print the certificate and hand in to your Manager/Educator Medication Reconciliation Committee

27. Certificate of Completion __________________________________ Name to certify that he/she has reviewed to satisfaction Electronic Medication Reconciliation Nursing Discharge Process