Enhancing Patient Safety Through Effective Medication Reconciliation

1. Outpatient Pharmacy Version 7Medication ReconciliationPatient Wellness Handout (PWH) Outside Medication CDR Wil Darwin, PharmD, CDE, NCPS June 2011

2. Foot Worthy Disclaimer • EHR/RPMS optimization is essential • EHR GUI template may/may not be configured • RPMS PDM may/may not be configured • CAC and Pharmacist CAC may need to configure components • Chronic Meds vs Acute Meds: A Difference • EHR/RPMS is a moving target • Meeting Meaningful Use measures

3. Objectives • Review Medication Reconciliation Documentation (Patient Education Codes) • Review Outside Medication processes • Use the Patient Wellness Handout to assist with Medication Reconciliation Process

4. MEDICATION RECONCILIATION

5. Medication Reconciliation • Improve patient safety • Assist in identification of chronic medications across the continuum of care • Encourage patients to become more involved with their healthcare • Improve compliance with Joint Commission standards regarding medication reconciliation

6. Medication Reconciliation • Everyone’s responsibility including the RPh • Train > Train > Train • Consistency is key • Many ways to slice & dice Med Rec processes but only one way it will be counted • PWH Med Rec “print outs” to be counted • Document M-MR Pt Education in EHR

7. Process - Outpatient Staff • Nurse/Nursing Assistant • Call patient into exam room • Screen patient • Enter chief complaint and vitals via EHR • Document health screenings (tobacco, alcohol, depression, domestic violence) • Print PWH Med Rec • Patient • Review PWH Med Rec while awaiting for provider • Assist in record update • Provider • Examine patient • Review PWH Med Rec with patient to determine required updates (new meds / outside Rx, discontinued meds, OTC products, vitamins, herbal remedies) • Identify medications that need to be ordered today • Document updated med list in EHR progress note • Send new revised PWH Med Rec home with patient to compare with home meds

8. Process – Pharmacist Screening • Roll-n-Scroll Med Management • Chronic Med designation • Med Profile screen of Chronic Med

9. Process – Pharmacist Screening • EHR GUI Med Management • Managed in the MED tab • Chronic Only, >6mo, Alphabetized med list • Review Med List • Re-designate “discontinued” meds and duplicate meds as non-Chronic • Med Rec specialist

10. Process – Pharmacist Screening • EHR GUI Med Management • Document M-MR Pt Education in EHR • Managed in the PT ED tab

11. Practice Activities • Med Rec pharmacist processes in database

12. PATIENT WELLNESS HANDOUT

13. Patient Wellness Handout (PWH)Med Reconciliation • Developed by National IHS OIT team • Letter format - patient friendly • PWH Med Rec Contains: • Patient Demographics • Current documented food / drug allergies and adverse reactions • Outpatient Medication profile • Active Med • Outside Med • Unknown Med

14. Patient Wellness Handout(Med Rec)

15. Practice Activities • PWH Med Rec button and print in database

16. OUTSIDE MEDICATION

17. Outside Medication • It is a Med Rec Measure • End-user documents in EHR • Facilitates with communication • Medical Provider/Nurse driven • No executable for RPh to finish order • Each Meds need to be defined in PDM

18. Outside Medication • One Methodology • Managed in the ORDERS tab

20. Outside Medication

21. Outside Medication • “Unknown Miscellaneous” drug name • Include drug name and strength if possible • Needs to be built in PDM file • Instruction outlined in EHR Patch 6 notes • Specified medications should be entered in drug file and outside med entry converted ASAP • Can run a report to capture data for PDM update

23. Outside Medication

24. Outside Medication

25. Outside Medication • Second Methodology • Data entry into the MED Tab • Outside Med > right hand click in Outside Med > New Medication

26. Outside Medication

27. Practice Activities • Outside Medication processes in database

28. Questions and Discussions