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Eligible Provider Core Objectives

Eligible Hospital Core Objectives

Medication Reconciliation: Entropy v. Order II

To follow-up from last week's post, I'd like to review the med rec workflow.

As I previously mentioned, it is critical to review the patient’s medication list at the time of admission.  Cancel medications that the patient is no longer taking. Add any medications not already on the list. If specific information about dose and frequency are unknown – add the medication name through the “document by history” tool.

You will frequently find that there are old and irrelevant medications on the list. Customizing your list view to include “start” and “compliance status” can help you filter the list.

Admission medication reconciliation can begin as soon as the medication list has been reviewed and updated.

Select “Continue”, to convert the ambulatory Rx to an inpatient medication order

Select “Do Not Continue”, to keep the Rx on the patient’s list as a Prescription without ordering for inpatient use.

Apart from facilitating a safe and accurate transition from home to hospital, admission med rec is not only required, but make discharge med rec a breeze.  It also promises correct formatting of discharge paperwork that the nursing staff uses for education and distribution.

“Do Not Continue After Discharge” - While these meds will not be prescribed at discharge, the inpatient medications will stay on the list of active medications until the patient until then, after which time it will drop off the list of active medications. 

“Continue After Discharge” is used to designate home medications that you want the patient to continue, but no new Rx is required.

“Create New Rx” for medications that you want the patient to take at home that do require a new prescription.  These can be electronically transmitted to the patient's pharmacy of choice, printed in the event of a scheduled agent, or prescribed but not sent in the event that a written Rx is preferred (a last and anachronistic resort).

Here's another version, another presentation mode:

Medication Reconciliation on Prezi

Medication Reconciliation: Entropy v. Order

A few weeks ago, the Depart Process was rolled out across the three Baystate hospitals.  The "depart" is basically a revamping of the discharge process that accounts for all pieces of information that need to be shared with the patient or transmitted to the patient's next care provider at the time of discharge.  This new method is comprised of a variety of tasks, but the most fundamental is one that has always been part of medical practice: Medication Reconciliation.  

When challenged about the importance or ownership of med rec, I've always responded that this is one of the cornerstones of being a good doc.  How can I provide even adequate care if I don't ask, record and reconcile what medications my patient is taking?  

So what is med rec?  It's a rather straightforward process that makes patient care more efficient:

1. At the time of encounter, whether the office or the hospital, review the list of current medications in the EMR and by asking your patient.
• REMOVE any medications no longer taken using Cancel/DC in the medication list or Do Not Continue in the Med Rec tool.
2. Document those medications, vitamins, supplements that the patient reports as active but not previously prescribed or documented.
3. Determine what new medications required for treatment of your patient, whether in the hospital or in the office, and prescribe accordingly.
4. Review the list and provide a copy to your patient, or enter orders per routine.

NB:  If the patient isn't taking the medication, then the medication does not belong on the list.  Do not hesitate to remove (unless these are protocol meds, e.g. chemotherapy cycles)

Next post: a pictorial review of hospital-based med rec