1. E-DISCHARGE MEDICATION MODULE Last updated: 2/9/151

2. 2 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

3. Last updated: 2/9/153 SEND PRESCRIPTIONS To Retail or Discharge Pharm. DISCHARGE MED LIST Imported to Discharge docs CREATE HOME MEDICATION LIST Required For Every AdmitSTEPS

4. Last updated: 2/9/15 4 SEND PRESCRIPTIONS To Retail or Discharge Pharm. DISCHARGE MED LIST Imported to Discharge docs HOME MEDICATION LIST Required For Every Admit STEP 1: Collect Home Meds Done By Provider or Med Rec Techs Cannot start any discharge process until home meds are collected

5. Last updated: 2/9/15 5 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  Allow 24 hr turnaround time STEP 1: Collect Home Meds

6. Last updated: 2/9/15 6 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 STEP 2 Discharge Meds Patient’s Instructions Outpatient Providers Home Health Worker ePDP

7. Last updated: 2/9/157 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] Step 2: Select Reconcile Discharge. STEP 2: Create Discharge Med List 1. 2.

8. Last updated: 2/9/158 Step 3: Address all Home Meds Tips Any Home Medication stopped (X), will be automatically noted in the Patient Discharge Instructions Med with a GREEN arrow cannot be e-prescribed later. (telling the patient “take your home supply”)

9. Last updated: 2/9/15 9 Step 4: Address all In-house Meds Click X to stop any medication Tip Med with a BLUE arrow indicates either a home med with changes to directions OR a new medication. [quantity to dispense and refills should be filled in]

10. Last updated: 2/9/1510 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

11. Last updated: 2/9/15 11 Add any new meds

12. Last updated: 2/9/1512 Be mindful of tablet strength (325mg) vs. Dose (650mg) To Prescribe a med, Select the med name Then fill out additional Rx information

13. Last updated: 2/9/1513 Always….Always…Always ***HIT THE E-RX BUTTON*** when available Failure to hit eRX button will prevent you from e-prescribing a prescription !!!

14. Last updated: 2/9/1514 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)

15. Last updated: 2/9/1515 Select Paper Rx for: 1.Any controlled medication TIP: schedule II meds, e.g. oxycodone, requires a secure script in addition to entering in discharge med list 2.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

16. Last updated: 2/9/1516 To remove a med from Discharge List, select the med, then the Remove button

17. Last updated: 2/9/1517 Save all work if navigating away from this page **or it will be lost**

18. Last updated: 2/9/1518 Complete the Discharge List after all meds are addressed

19. Last updated: 2/9/1519 Clinical Checking will identify potential interactions Click here to address the issue

20. Last updated: 2/9/1520 Select appropriate choice or free- text reply, then hit Update

21. Last updated: 2/9/1521 Green Triangle indicates issue is resolved.

22. Last updated: 2/9/1522 ****WARNING: hit COMPLETE or WORK WILL BE LOST**

23. Last updated: 2/9/1523 The GRAY screen indicates your work is saved. (If you navigated away without saving/completing, you do NOT see this screen)

24. Last updated: 2/9/1524 SEND PRESCRIPTIONS To Retail and/or Discharge Pharm. DISCHARGE MED LIST Imported to Discharge docs HOME MEDICATION LIST Required For Every Admit STEP 3 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

25. Last updated: 2/9/1525 Select send e- prescriptions

26. Last updated: 2/9/1526 Prescriptions ready to send will have both an icon and a quantity

27. Last updated: 2/9/1527 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

28. Last updated: 2/9/1528 Red Triangle indicates a problem with rx

29. Last updated: 2/9/1529 Here, problem is Rx #2 has no destination. Note: Retail Pharmacy grayed out. Why?

30. Last updated: 2/9/1530 Because no Retail Pharmacy was selected. Use the Change button to select one.

31. Last updated: 2/9/1531 No problems are present, (note Retail pharmacy selected). Ready to send Rx!

32. Last updated: 2/9/1532 Icons indicate meds queued up to prescribed  Electronically Or  Printed

33. Last updated: 2/9/1533 Hit Complete

34. Last updated: 2/9/1534 Acknowledgement Pop-up. Click OK. No acknowledgement = No Rx sent

35. Last updated: 2/9/1535 1)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

36. Last updated: 2/9/1536 Issues That Arise ISSUERESOLUTION 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 1. Text Page 443-5794 (superuser) or page 327-0739 OR 2. Email: david.e.smith@sfdph.org with the following: name, year CHN #, NPI# department, and DEA (if you have it)david.e.smith@sfdph.org

37. Last updated: 2/9/1537 Problems? 1.Ask your Chief Resident 2.Discharge Pharmacy has the Med Rec Support pager/phone # 3.Last line: Superuser 443-5794 (business hours only All help info and powerpoints available at: http://tiny.ucsf.edu/edischarge