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Informatics: the science and practice of information processing, specially designed to enhance and enrich the practice of medicine

Sunday, November 11, 2012

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:









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