1. Outpatient Pharmacy Version 7 Medication Reconciliation Patient 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. “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

25. 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