1. 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

2. 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

3. New Process New Process Last updated: 04/23/2014 3 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

4. 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

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

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

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

8. 8 Display Home Meds displays medications previously collected in the system

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

10. 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

11. Last updated: 04/23/201411 Next, Select Enterprise Med list to open a new window displaying meds prescribed from all DPH facilities.

12. Last updated: 04/23/201412 Use the Enterprise Medication List (EML) as a unified reference when reconciling medications.

13. Last updated: 04/23/201413 Select Collect Home Meds.

14. Last updated: 04/23/201414 Review the Current Home Med list as follows:

15. Last updated: 04/23/201415 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

16. Last updated: 04/23/201416 Use > to continue or X to stop each medication

17. Last updated: 04/23/201417 OR use All button to STOP or CONTINUE all meds in one click.

18. Last updated: 04/23/201418 TIP: To change directions of a med: click med name, adjust sig in the details panel, then click Add to Current

19. Last updated: 04/23/201419 Next, Use the Prescription History tab to display meds filled at retail pharmacy (if data available).

20. Last updated: 04/23/201420 Note: this Retail Pharmacy data may not be complete and must be verified with this patient

21. Last updated: 04/23/201421 First, select a med to see retail rx details

22. Last updated: 04/23/201422 Complete med instructions manually.

23. Last updated: 04/23/201423 The click the Add to Current Meds button.

24. Last updated: 04/23/201424 To add a new med, use the Search for New Medications tab.

25. Last updated: 04/23/201425 Type the drug name, then Search Minimum of three characters Including dose narrows down results Select “Brand” if searching by brand name

26. Last updated: 04/23/201426 Select the correct med, paying attention to dose and form.

27. Last updated: 04/23/201427 Enter the medication details.

28. Last updated: 04/23/201428 TIP: Use Alt Dose for sigs like “1 to 2 puffs”

29. Last updated: 04/23/201429 Click the Add to Current Meds button.

30. Last updated: 04/23/201430 Drug is then added to the Current Home Medication list.

31. Last updated: 04/23/201431 Repeat as needed. Finally, click Complete

32. Last updated: 04/23/201432 TIP: To save a list in-progress, Hit complete button before navigating away from this page. List can be updated later.

33. Last updated: 04/23/201433 Caution: the Cancel button will delete the entire home med collection…at ANY point in the process

34. Last updated: 04/23/2014 34 To enter a free-text med: first use “search for new med”(required), then proceed to free text medication & directions

35. Remember Last updated: 04/23/201435 **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

36. Last updated: 04/23/201436 1. Request the system to look up the patient’s insurance

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

38. Last updated: 04/23/201438 2. Select a Retail Pharmacy

39. Last updated: 04/23/201439 Enter the zip or city/state + name to find the patient’s pharmacy

40. Last updated: 04/23/201440 Click the Pharmacy name, then COMPLETE

41. Step 2: Order Home Meds Using CPOE Last updated: 04/23/201441 Advantages Start home meds quickly thorough CPOE during admission Reconcile home meds with inpatient meds (helps reduce unintentional omissions)

42. Last updated: 04/23/201442 AFTER Home Meds are collected, go to CPOE and Write Orders

43. Last updated: 04/23/201443 Click here to access the list of Home Meds to order via CPOE

44. Last updated: 04/23/201444 Select a Home Med to order upon admission

45. Last updated: 04/23/201445 All potentially corresponding meds in CPOE will be pulled up

46. Last updated: 04/23/201446 Then select the medication to order *Make sure to select the correct strength, since system shows ALL strengths*

47. Last updated: 04/23/201447 Repeat as needed with other home meds, THEN hit OK to complete ordering via CPOE.

48. Last updated: 04/23/201448 TIP: click here to view home meds details during ordering within CPOE

49. Last updated: 04/23/201449 It looks like this! You can reference this dropdown when you complete orders in CPOE

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

51. Last updated: 04/23/201451 Best practice: select eligibility to re- enable e-prescribing functions

52. Last updated: 04/23/201452 Select Reconcile Discharge.

53. Last updated: 04/23/2014 53 First: Address all Home Meds

54. Last updated: 04/23/201454 Tip: Any Home Medication stopped (X), will be automatically noted in the Patient Discharge Instructions

55. Last updated: 04/23/201455 Tip: Med with a GREEN arrow cannot be e-prescribed later. (telling the patient “take your home supply”)

56. Last updated: 04/23/2014 56 Next, address all Inpatient Meds

57. Last updated: 04/23/201457 Click X to stop any medication

58. Last updated: 04/23/2014 58 Add any new meds

59. Last updated: 04/23/201459 This creates your discharge med list. Meds listed here = ALL meds the patient should take upon discharge (this list is imported to ePDP)

60. Last updated: 04/23/201460 To Prescribe a med, Select the med name

61. Last updated: 04/23/201461 Some med info auto-populates

62. Last updated: 04/23/201462 You must fill out any additional required prescription information

63. Last updated: 04/23/201463 Be mindful of tablet strength (325mg) vs. Dose (650mg)

64. Last updated: 04/23/201464 Select Extended Meds radio button to add more directions

65. Last updated: 04/23/201465 Then you should Always….Always…Always ***HIT THE E-RX BUTTON*** when available

66. Last updated: 04/23/201466 Failure to hit eRX button will prevent you from e-prescribing a prescription !!!

67. Last updated: 04/23/201467 Finally, select a destination. You can assign each row a different destination.

68. Last updated: 04/23/201468 SFGH Discharge Pharmacy (Can be chosen by Interns, NP, DEA license)

69. Last updated: 04/23/201469 Retail Pharmacy (by DEA licensed providers only)

70. Last updated: 04/23/201470 If you do not have a DEA license, you cannot send to Retail Pharmacy. (ask Attending/R3 to send prescriptions)

71. Last updated: 04/23/201471 Paper Rx For any controlled medication or Supplies (e.g. ‘test strips’)

72. Last updated: 04/23/201472 TIP: schedule II meds (e.g. oxycodone) still require a secure script in addition to entering on the discharge med list

73. Last updated: 04/23/201473 To remove a med from Discharge List, select the med, then the Remove button

74. Last updated: 04/23/201474 To Save work before addressing all Home & Inpt Meds, use this button

75. Last updated: 04/23/201475 If you have addressed every med on each list, you may Complete the Discharge List

76. Last updated: 04/23/201476 Clinical Checking will identify potential interactions

77. Last updated: 04/23/201477 Click here to address the issue

78. Last updated: 04/23/201478 Select appropriate choice or free- text reply, then hit Update

79. Last updated: 04/23/201479 Green Triangle indicates issue is resolved.

80. Last updated: 04/23/201480 ****WARNING: hit COMPLETE or WORK WILL BE LOST**

81. Last updated: 04/23/201481 The GRAY screen indicates your work is saved. (If you navigated away without saving/completing, you do NOT see this screen)

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

83. Last updated: 04/23/201483 The next step is to Send the e- prescriptions

84. Last updated: 04/23/201484 Prescriptions ready to send will have both an icon and a quantity

85. Last updated: 04/23/201485 You can change quantity/destination by selecting the medication then adjusting in Med Detail pane below

86. Last updated: 04/23/201486 Always Update the Prescription if you adjust any part of an Rx

87. Last updated: 04/23/201487 Or just hit Clear to de- select the medication

88. Last updated: 04/23/201488 Red Triangle indicates a problem with rx

89. Last updated: 04/23/201489 Here, problem is Rx #2 has no destination. Note: Retail Pharmacy grayed out. Why?

90. Last updated: 04/23/201490 Because no Retail Pharmacy was selected. Use the Change button to select one.

91. Last updated: 04/23/201491 No problems are present, (note Retail pharmacy selected). Ready to send Rx!

92. Last updated: 04/23/201492 Icons indicate meds queued up to prescribed  Electronically Or  Printed

93. Last updated: 04/23/201493 Hit Complete

94. Last updated: 04/23/201494 This is your final acknowledgement window. Click OK to send the prescriptions.

95. Last updated: 04/23/201495 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

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

97. Last updated: 04/23/201497 Return to Display Home Meds. Icons indicate Rx was sent. You can review prescription details including last prescription date and destination(s).

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

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

100. Last updated: 04/23/2014100 Problem #1: Trying to start discharge meds before Home Med were collected.

101. Last updated: 04/23/2014101 Problem #2: “I couldn’t select a destination (they were grayed out) so I did paper rx’s for all my meds” WHAT HAPPENED?

102. Last updated: 04/23/2014102 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

103. Last updated: 04/23/2014103 Or…. Provider did NOT hit eRx button when adding medication to discharge list.  Note only Paper rx and eRx are available to select

104. Last updated: 04/23/2014104 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!