3. Physician Admission and Discharge Medication Reconciliation Training Guide June 2015 2

5. ADMISSION MEDICATION RECONCILIATION

7. From the Inpatient Rounding List, select your patient and select Order Accessing the Admission Medication Reconciliation

9. From POM Orders screen, select Reconcile Meds

11. Before reconciling meds, note that the Medication Review column should reflect the admission date. If not, contact Nursing and ask them to review the patient’s medications.

13. Reconciliation ButtonsFunction DC (Discontinue)Completely stopping med for Inpatient and home settings. The Med will still appear on Discharge Med list unless the DC reason selected is wrong medication or wrong patient. Cont (Continue)Continue home medication as an inpatient. HoldWill not continue med as an inpatient, but the medication will show on Discharge Med Rec Select the appropriate action for each medication by selecting a radio bubble.

15. Actions may need to taken for some first dose medications. This is similar to the current process in POM.

17. After Selecting the Continue (CONT) button, use this workflow for medication substitutions. 1. Enter home med on POM orders screen 2. Note substitute medication 3. Select the Route 4. Select Done to continue the ordering process Home Medications not on Formulary Requiring Substitution 1 2 3

19. ORDERING ADDITIONAL INPATIENT MEDICATIONS

21. Ordering a new inpatient medication that is not a home medication 1.Select Inpatient Meds 2.Start typing desired medication 3.Continue POM medication ordering process 1 2

23. REVIEW AND SUBMISSION OF MEDICATION RECONCILIATION

25. Submitting the Completed Medication Reconciliation Select Submit to review the reconciled list of Inpatient and Home Medications.

27. Prior to finishing medication reconciliation the lists of medication are displayed for review. 1.Enter Password and Select OK to complete medication reconciliation 2.Select Cancel to return to medication reconciliation to make any necessary changes

29. Completed Admission Medication Reconciliation

31. Discharge Medication Reconciliation

33. From the Inpatient Rounding List select Discharge to navigate to the Discharge Desktop

35. To begin Discharge medication reconciliation select the red Edit button next to Medications.

37. On the previous paper medication reconciliation process, Home Meds and Inpatient Meds were displayed side by side on the Discharge Med Rec document. The updated electronic format will display as follows: Inpatient Medication will display first in blue Home Meds will display under the Inpatient Medication in black Medications ordered after the admission medication reconciliation appear only once in blue during the discharge medication reconciliation process. Inpatient Home New Inpt.

39. 1.Choose Continue (CONT) or Stop on the Home Medications (black entries) 2.If continuing an Inpatient medication (blue entries): a) Stop the home medication b) Select Convert (CONV) to continue the medication at home 3. Select Submit to save the medication reconciliation 3

41. Converting an Inpatient Medication to a Home Medication Converted Inpatient Medications require the following entries: Line 1 - Dose, Units, Route, Frequency, and Reason for Use Line 2 – Quantity or Days Select Done

43. Multiple physicians can act on a patient’s medication reconciliation. Submitting a partial completed medication reconciliation will trigger this message. Select “Yes” to leave some medications unreconciled. a) unsure of the home status of a medication at this time b) waiting for another physician to act on medication c) will complete reconciliation at a later time Select “No” to return to the medication reconciliation screen. ALL Home Medications must be addressed prior to discharge.

45. Completed Discharge Medication Reconciliation Medications EDIT button changes from Red to Blue, signifying all Home Medications have been acted upon. Medications are listed by actions taken: New Prescriptions, Continued, and Stopped.