Preparing your data base for Medication Reconciliation

1. Preparing your data base for Medication Reconciliation

2. (ORX) and (OTC) entry Tips • DO NOT use the Outside Rx menu [APSP OUTSIDE RX MENU] in RPMS for medication reconciliation (Entries do not display on the ORDERS tab or the MEDS tab.) • Pharmacists enter items in RPMS that are not prescribed at local facility. • Providers enter drugs they prescribe as medication orders in EHR.

3. Documenting (ORX) and (OTC) • OCA Pharmacy branch endorsed the method of documenting (ORX) and (OTC) items developed by Pat Cox and Dick Stowe • Provides a complete medication list in EHR • Can facilitate identification of drug interactions • Can facilitate ADR and allergy checks during prescribing and data entry by pharmacists

4. Ordering (ORX) and (OTC) in EHR

5. (ORX) and (OTC) v5/7 entry • Create both “Generic” and “specific” drug entries in the Drug Enter/Edit Menu • GENERIC NAME: OUTSIDE RX1// • DEA, SPECIAL HDLG: 9// • NATIONAL FORMULARY INDICATOR: Not Matched To NDF • Select SYNONYM: O1// • SYNONYM: O1// • INTENDED USE: QUICK CODE// • PRICE PER ORDER UNIT: 0// • ORDERABLE ITEM: OUTSIDE RX1 PILL

6. (ORX) and (OTC) entry Specific Drug Entry • (ORX) or (OTC) in Generic Name • DEA, SPECIAL HDLG • Fill in only necessary fields during drug Enter/Edit (See Handout)

7. (ORX) and (OTC) prescribed by facility providers

8. You can create quick order menus for (ORX) and (OTC) items

9. Documenting (ORX) and (OTC) not prescribed locally • Select Provider: SELF-PRESCRIBED,DRUG DSP • Name: SELF-PRESCRIBED,DRUG • Initials: DSP • NON-VA Prescriber: Tax ID: • Exclusionary Check Performed: Date Exclusionary List Checked: • On Exclusionary List: • Exclusionary Checked By: • Authorized to Write Orders: Yes • Requires Cosigner: No • Class: PHYSICIAN DEA# • Type: PART TIME VA# DS8888 • Remarks: • Synonym(s): DSP • Service/Section: PHARMACY

10. Documenting (ORX) and (OTC) not prescribed locally • Name: PRESCRIBER,OUTSIDE • Initials: OP • NON-VA Prescriber: Tax ID: • Exclusionary Check Performed: Date Exclusionary List Checked: • On Exclusionary List: • Exclusionary Checked By: • Authorized to Write Orders: Yes • Requires Cosigner: No • Class: PHYSICIAN DEA# • Type: PART TIME VA# OP9999 • Remarks: • Synonym(s): OP • Service/Section: PHARMACY

11. Medication Reconciliation A Claremore Indian Hospital Strategy for Targeting and Preventing Prescribing and Administration Errors

12. Justification for Reconciliation • Medication errors occur most frequently during prescribing and administering • U.S. Statistics • Errors harm 1.5 million people each year • Errors kill several thousand people each year • Errors cost 3.5 billion dollars each year • Up to 67% of med. histories have > 1 error • Up to 46% of errors occur when new orders are written at admission or discharge http://www.jcipatientsafety.org/25091/

13. Medication Reconciliation • A Process designed to prevent medication errors at patient transition points • Creating the most complete and accurate list possible (“home” medication list) • Comparing the list against admission, transfer, and or discharge orders • Updating the list as new orders are written • Communicating the list to the next provider of care http://www.jcipatientsafety.org/25091/

14. Medication Reconciliation Compatible with EHR and Pharmacy 5/7

15. Medication Reconciliation Process • Facilities must comply with JCAHO Patient Safety Goal 8 • Accurately and completely reconcile medications across the continuum of care

16. 2007 Patient Safety Goal 8A • Implement a process for comparing the patient’s current medications with those ordered for the patient while under the care of the organization.

17. 2007 Patient Safety Goal 8B • A complete list of the patient’s medications is communicated to the next provider of service when a patient is referred or transferred to another setting, service, practitioner or level of care within or outside the organization. The COMPLETE LIST of medications is provided at discharge from the facility.

18. Documentation will • Integrate information from all sources of care • Be available whenever medications are ordered, administered, or dispensed • Involve the patient or caregiver

19. Claremore’s Outpatient Process • Incorporates software capability to identify drug interactions, ADR, and allergy history of the patient • Utilizes a multi-disciplinary approach • Avoids redundant documentation • Provides a complete list of all medication use in the EHR • Engages the patient and family in the process

20. Claremore’s Outpatient Process • Initiate at or prior to triage • Print Med Reconciliation Health Summary • Select patient in EHR • Go to “REPORTS” Tab • Click on + sign next to “Health Summary” under Available Reports • Select “Medication Reconciliation” • Right click to display options, then select “Print”

21. Claremore’s Outpatient Process • Instruct Patient / Proxy to • Document actual use of listed medicines • Write additional medications used, dose, route & schedule at end of printed list • Other prescriptions • All OTC items • Home remedies • Herbals • Recreational drugs

22. Claremore’s Outpatient Process • Triage personnel provide assistance to patient / proxy when indicated

23. Claremore’s Outpatient Process • Document participation: • Initial worksheet • Go to “WELLNESS” tab • Click “Add” education • Select “Wellness Screening” under name look-up • Type “Med Rec” in comments field and click “Ok”

24. Claremore’s Outpatient Process • Provider reviews Medication Reconciliation H.S. “Worksheet” • Provider documents review and medication use plan using progress notes template fields

27. Claremore Outpatient Process • Medication Reconciliation “Drug” • Used prior to notes template development • Notified pharmacy that progress notes contained medication reconciliation drugs needing data entry • “Drug” deleted after (ORX) and (OTC) entry

28. Claremore Outpatient Process

29. Claremore Outpatient Process

30. Claremore’s Outpatient Process • Pharmacist enters outside prescription and OTC use into the RPMS pharmacy package • Pharmacist provides patient an updated Medication Reconciliation Health Summary and education about role in process • When new prescriptions are dispensed • When refills are dispensed

31. Claremore Outpatient Process • When patient does not have medication orders today • Medical Records routes “Worksheet” and patient chart to pharmacy for review and documentation • “Worksheet” is shredded after data entry

32. Claremore’s Inpatient Process • Documentation is on PAPER • Med. Reconciliation Health Summary (HS) is printed • PRIOR to admission to a room • Prior to transfer between units • Prior to readmission into unit • Prior to discharge or transfer • Education is provided to patient about purpose and participation in process

33. Claremore’s Inpatient Process • Documentation • Note date, time, and sign HS at time of review • File HS under Provider H&P as a PERMANENT part of the medical record • Providers document review within 24 hours of transfer between units