1. Electronic Medication Reconciliation

2. Select Medication Reconciliation @ Discharge order to begin the process for captain of the ship to complete form or for the consultants to review home and active inpatient medications on the form.

3. Order form will fill in with Home Meds (from the Admission Profile) and active Inpatient Medication orders

4. If you are the attending physician and wish to proceed with discharge medication reconciliation, select the I am Captain of the Ship checkbox.

5. Selecting I am Captain of the Ship activates the Continue at home controls for both Home Meds and Inpatient Meds.

6. Select medications from the Home Meds list and the Inpatient Medication list that you want the patient to take at home. *Do not select the same medications from both lists.

7. Click this checkbox if you would like to print prescriptions. Quantity and Refills for the discharge prescriptions being printed.

8. 1. Scroll to the bottom of the screen to enter any additional medications or prescriptions you may want the patient to take at home. 2. Click on this checkbox to activate. Enter the medication name and directions in the text box. 3. Select the box to print discharge prescriptions for the additional medications entered (optional).

9. Review the name of the patient and submit order

10. Under the Orders Tab, the summary line specifies that Med Reconciliation was completed electronically.

11. Example of discharge prescriptions that will print after you submit the order. The physician must sign each prescription and add DEA # if needed.

12. Nursing will print discharge instructions for the patient after all medication reconciliation is completed by captain of the ship and consultants. The copy the patient signs will be scanned back into electronic record and available to view in documents tab after discharge.

13. For consultants: On the order entry worksheet type in Med Rec. This is for review only Consultants do not submit this order.

14. If med rec has been completed by the captain of ship, You will see the details of what medications have been reconciled already, but you cannot add or edit form. Review and click Close. Open order entry worksheet to enter prescriptions. If med rec has not been completed by the captain of ship, the order form will display active and home medications. Review and click Close. Open order entry worksheet to enter prescriptions.

15. The discharge session will allow you to prescribe discharge medications and print prescriptions. Change session type to Discharge for prescription writing.

16. Example of medication ordered in Discharge session. Thumbs Up represents the discharge icon

17. Fill in the quantity and number of refills.

18. Example of a discharge prescription by a consultant that was entered prior to this order. The discharge prescriptions orders will display if they are ordered prior to the med rec order.

19. After the order is submitted, prescriptions will print automatically. Physician must sign each prescription and add DEA # if needed. When dictating the D/C summary: Under medications say see Medication Reconciliaton for medications (instead of the list). If sending D/C summary to outside doctor, end dictation with send med rec list along with the D/C summary. The final list of meds given to patient will be scanned by medical records and returned to the chart (with any written changes visible on the scanned list).

20. If there are more than 30 active medications the electronic form will not be able to be used. You will receive the above message; Maximum inpatient medication exceeded. If you are the attending and would like to reconcile, click on the I am Captain of the Ship box and a paper medication reconciliation form will automatically print. The paper form needs to be reconciled and signed.

21. Limitations of Electronic Medication Reconciliation Cannot reprint Discharge Rx Cannot print Discharge Rx from offsite locations. Cannot reorder existing Medication Reconciliation at Discharge order. The order will need to be discontinued and reordered. Electronic Reconciliation will accommodate a maximum of 30 active inpatient medication orders.

22. Questions ? Dr. Silverstein 350-3710