Medication Reconciliation

The Medication Reconciliation page allows the clinician to perform medication reconciliation at admission, discharge, and transfer to ensure the patient's medication profile stays up-to-date. To access the Medication Reconciliation page, click the Medication Reconciliation button on the main page.

The following topics are discussed on this page. Use the links to jump to the desired area:

Introduction to Medication Reconciliation

To complete an ADMISSION Medication Reconciliation

To complete a DISCHARGE Medication Reconciliation

To complete a TRANSFER Medication Reconciliation

To access ePrescribing

To view Medication Reconciliation History

To generate the Home Medications Report

Working With Pending Reconciliations

Clinician Work Center and Medication Reconciliation

Introduction to Medication Reconciliation

Medication Reconciliation allows you to view a comprehensive list of all medications that a patient is on and ensure the accurate transfer of medication information across levels and transitions of care. To access the Medication Reconciliation page, use one of the following methods:

• (Preferred) From the Hospital Main page, select the desired patient using the Select button. Then, click the Med Reconciliation button. The Medication Reconciliation page is displayed.

OR

• Click the Med Reconciliation button on the main page. The Patient Search box is displayed. Begin typing the patient’s information (Last name, SSN#, or D.O.B.) in the blank field. After selecting the appropriate visit, click Select. See Selecting Patients for additional details. The Medication Reconciliation page is displayed.

The list of medications is displayed under 3 categories: Home Medications, Currently Ordered Medications, and Previous Visit Medications according to the type of service level transition you selected. In addition, symbols located in front of the medication indicate the order's current status:

To complete an ADMISSION medication reconciliation

1. SELECT TRANSITION: In the Service Level Transition field, use the drop-down list to select Admission. The Home Medications and Currently Ordered Medications lists are expanded and displayed.

2. UPDATE LIST: Click Update Now in the top of the list to update the patient's current home medication list from the ePrescribing portal (DrFirst). This button executes a synchronization with the ePrescribe functionality ensuring that the medication lists are up to date. Click this button to update the lists with any medications/refills that have been entered/modified. Note: You can view the Last Updated date/time just above the row of green buttons to see when the last update was performed.
   

3. REVIEW AN/OR ADD HOME MEDS: In the Home Medications list, for each medication listed, select to discontinue, continue as order, review as is, or replace the medication using the buttons located to the right. Or, use the Add Home Medication button to add a new medication to the list. See To add a home medication for details on using this page. Changes to home medications automatically update the master Home Medication list.

Note: For this transition level, if applicable, you can select Patient takes no Home Medications or Patient Unable to Report Home Medications. These options are not available if there are no medications listed on the profile.

4. REVIEW CURRENTLY ORDERED MEDS: In the Currently Ordered Medications list, for each medication listed, select to edit, continue, or discontinue the medication using the buttons located to the right:

1. 	Show Order Details: Click this button to display the details of the medication. Or, you can click Expand All (located at the top right of the list) to expand and show the details for all medications in the list. See To edit order details for additional information.
   	Edit: Click this button to edit the current medication order. The Medication Order Details window is displayed. Make the desired changes and click Save. You can also edit Special Instructions from the Edit Details box. Edits to home medications automatically update the master Home Medication list.
   	Continue: Click this button to mark this medication to be continued once the reconciliation is confirmed. After clicking the button the green button changes to gray to indicate it is marked for continuation once the medication reconciliation is confirmed.  Continuing them will not DC/reorder.
   	Discontinue Home Med: Click this button to mark the home medication to be removed. After clicking the button the green button changes to gray to indicate it is marked for removal once the medication reconciliation is confirmed.

    

5. REVIEW PREVIOUS VISIT MEDS: The Previous Visit Medications list defaults to collapsed. Click the arrow button to expand this section, if desired. For the medications in this list, select to edit, continue, or discontinue the medication using the buttons located to the right:

For additional information, see the Previous Visit FAQs.

6. ORDER MEDS - OPTIONAL: If you wish to order medications that are not listed, click the green Order button, located in the top bar. The Order Creation window is displayed. Enter order details per CPOE processes. See To create orders for additional details.
   
7. SAVE MED REC (to return later)- OPTIONAL: Click Save Med Rec to save the current selections and then return to finish the reconciliation process at a later time. When you return to the Medication Reconciliation and select Admission  in the Service Level Transition field, you will be prompted to edit the draft that has been created. Click Yes to return to where you were in the medication reconciliation process.
   
8. CONFIRM MED REC (finish Med Rec now): When finished making selections for the medications, click Confirm Med Rec. You must have a selection for every medication in the Home Medications and Currently Ordered Medications list to confirm the reconciliation. If not, a message is displayed. Once all the medications in the list have been addressed and the Confirm Med Rec button is clicked, any applicable alerts are displayed, including conflict checking (drug-food, drug-drug, drug-allergy, and drug-dose checking), duplicate checking (with orders in the visit and orders in the reconciliation queue), corollary orders, and questions. Address these alerts and click Continue. The Confirm box is displayed.
   
9. ENTER FINAL DETAILS AND SAVE:
1. The Effective Date/Time default to the current date and time. Modify, if desired, to indicate the date and time of the reconciliation process. (If you enter a future date and time, the medication reconciliation will be in a 'pending' status. See Working With Pending Reconciliations.)
2. The Reconciled By field displays the logged in user's name.
3. (OPTIONAL) In the On Behalf Of field, enter the name of the provider which you are entering the reconciliation for. Type the first few letters of the Provider Name or NPI in this field to locate and select the appropriate provider.

4. (OPTIONAL) In the Comment box, enter additional notes/comments regarding this reconciliation.

5. If you'd like to preview the report, click Summary. This provides an on-screen view of the list, with Home Medications, Currently Ordered, and Previous Visit tabs,  to discuss with the patient. Click Confirm from this view. Or, click Close to return to the Confirm box.
6. Click Save. If not entered by a provider, the medication reconciliation becomes a Pending Reconciliation where it can be edited, canceled, or acknowledged by the provider (see  on this page).
   
10. ACKNOWLEDGE THE MED REC: Once completed, the Medication Reconciliation must be acknowledged. See Working With Pending Reconciliations for details.

To complete a DISCHARGE medication reconciliation

1. SELECT TRANSITION: In the Service Level Transition field, use the drop-down list to select Discharge. The Home Medications list is displayed, grouped by the default setting defined in Maintenance > General > Medical Reconciliation > Group By. Use the Group By field to group the medications using an alternate method:
   

• Alphabetical: Lists all medications, home and facility in alphabetical order. Does not include orders listed in Previous Visit Medications section.
  

• Therapeutic Class:  Groups medications by their therapeutic class, as determined by the MediSpan class assigned in the formulary.  If a medication doesn’t have a therapeutic class noted in the formulary, it is shown in a separate section called Unknown. Does not include orders listed in Previous Visit medications section.
  

• Individual Sections: Groups medications by the following categories: Home Medications, Currently Ordered Medications, and Previous Visit Medications, just as they display in the other screens. 
  

2. UPDATE LIST: Click Update Now in the top of the list to update the patient's current home medication list from the ePrescribing portal (DrFirst). This button executes a synchronization with the ePrescribe functionality ensuring that the medication lists are up to date. Click this button to update the lists with any medications/refills that have been entered/modified. Note: You can view the Last Updated date/time just above the row of green buttons.
   

3. REVIEW MEDS: In the list, for each medication listed, select to edit, resume, continue, or stop taking each medication using the buttons located to the right.

• Home Medications: These medications are medications that the patient takes at home and are indicated with a house icon in the left hand column (see Introduction to Medication Reconciliation). This list must be updated by using the Update Now button to ensure that the most recent information is displayed.  Once updated, you can then manually add home meds to the list using the Add Home Med button. See To add a home medication for details on using this page. Changes to home medications automatically update the master Home Medication list. You can perform the following functions on home medications:

Note: For this transition level, if applicable, you can select Patient takes no Home Medications or Patient Unable to Report Home Medications. These options are not available if there are no medications listed on the profile.

• Currently Ordered Medications: These are medication that the patient is currently taking and are denoted in the left hand column with the red cross icon (see Introduction to Medication Reconciliation). Review each medication to validate (continue), edit, hold,or discontinue using the available action buttons:

• Previous Visit Medications: These medications are medications that the patient has taken during a previous visit.

4. ORDER MEDS - OPTIONAL: If you wish to order medications that are not listed, click the green Order button, located in the top bar. The Order Creation window is displayed. Enter order details per CPOE processes. See To create orders for additional details.
   
5. SAVE MED REC (to return later)- OPTIONAL: Click Save Med Rec to save the current selections and then return to finish the reconciliation process at a later time. When you return to the Medication Reconciliation and select Discharge  in the Service Level Transition field, you will be prompted to edit the draft that has been created. Click Yes to return to where you were in the medication reconciliation process.
   
6. CONFIRM MED REC (finish Med Rec now): When finished making selections for the medications, click Confirm Med Rec. You must have a selection for every medication in the list to confirm the reconciliation. If not, a message is displayed. Once all the medications in the list have been addressed and the Confirm Med Rec button is clicked, any applicable alerts are displayed, including conflict checking (drug-food, drug-drug, drug-allergy, and drug-dose checking), duplicate checking (with orders in the visit and orders in the reconciliation queue), corollary orders, and questions. Address these alerts and click Continue. The Confirm box is displayed.
   
7. ENTER FINAL DETAILS AND SAVE:
1. The Effective Date/Time defaults to the value set in maintenance (for discharges/transfers).  [The default value is set up in Maintenance > General Maintenance > Medication Reconciliation. Enter the appropriate information in the Hours Until Discharge field to identify the number of hours until discharge as a default.] Otherwise, enter the date and time when the patient will be leaving, e.g. time of transfer, time of discharge, etc. (If you enter a future date and time, the medication reconciliation will be in a 'pending' status. See Working With Pending Reconciliations.)
2. The Reconciled By field displays the logged in user's name.
3. (OPTIONAL) In the On Behalf Of field, enter the name of the provider which you are entering the reconciliation for. Type the first few letters of the Provider Name or NPI in this field to locate and select the appropriate provider.

4. (OPTIONAL) In the Comment box, enter additional notes/comments regarding this reconciliation.

5. If you'd like to preview the report, click Summary. This provides an on-screen view of the Home Medications, Currently Ordered, and Previous Visit lists, to discuss with the patient. Click Confirm from the Summary to finish the process. Or, click Close to return to the Confirm box.
6. Click Save. The following will occur:
• If the ePrescribe option has been selected for any of the medications during Step 3, the ePrescribing portal is launched.
• If not entered by a provider, the medication reconciliation becomes a Pending Reconciliation where it can be edited, canceled, or acknowledged by the provider (see Working With Pending Reconciliations on this page).

8. ACKNOWLEDGE THE MED REC: Once completed, the Medication Reconciliation must be acknowledged. See Working With Pending Reconciliations for details.

To complete a TRANSFER medication reconciliation

A Transfer med rec is used when you are transferring the patient from a location in the hospital to another location within the same hospital and the patient's visit number remains the same. If you are transferring a patient out of the facility to a different facility, use the Discharge med rec process.

1. SELECT TRANSITION: In the Service Level Transition field, use the drop-down list to select Transfer.  The Transfer fields are displayed.

2. In the Group By field, select how you'd like to group and display the medications: Individual Sections, Alphabetical, or by Therapeutic Class.

3. In the Transfer To field, select where the patient is being transferred:

• If you select Provider, the From Provider defaults to the patient's current provider. Select the appropriate receiving provider in the To Provider field. Type the first few letters of the physician name to display matching results. Then, select the appropriate provider from the list to select it.

• If you select Location, the From Location defaults to the current location. Use the drop-down list to select the appropriate receiving location in the To Location field.
  

• If you select Both, the From Provider and From Locations are displayed. Select the appropriate receiving provider (type the first few letters of the physician name) and location (use the drop-down list) in the To Provider and To Location fields.  

The medication list is displayed based on the selection in the Group By field. If by Individual Sections, the Currently Ordered Medications section defaults to expanded, the Home Medications and Previous Visit Medications sections default to collapsed. To expand the collapsed sections, click the right-facing arrow located next to the header.

2. UPDATE LIST: Click Update Now in the top of the list to update the patient's current home medication list from the ePrescribing portal (DrFirst). This button executes a synchronization with the ePrescribe functionality ensuring that the medication lists are up to date. Click this button to update the lists with any medications/refills that have been entered/modified. Note: You can view the Last Updated date/time just above the row of green buttons.

3. REVIEW MEDS:  In the list, for each medication listed, select to edit, resume, continue, or stop taking when the patient is transferred using the buttons located to the right.

• Currently Ordered Medications: These are medication that the patient is currently taking and are denoted in the left hand column with the red cross icon (see Introduction to Medication Reconciliation). Review each medication to validate (continue), edit, hold,or discontinue using the available action buttons:

• Home Medications: These medications are medications that the patient takes at home and are indicated with a house icon in the left hand column (see Introduction to Medication Reconciliation). This list must be updated by using the Update Now button to ensure that the most recent information is displayed.  Once updated, you can then manually add home meds to the list using the Add Home Med button. See To add a home medication for details on using this page. Changes to home medications automatically update the master Home Medication list. You can perform the following functions on home medications:

Note: For this transition level, if applicable, you can select Patient takes no Home Medications or Patient Unable to Report Home Medications. These options are not available if there are no medications listed on the profile.

• Previous Visit Medications: These medications are medications that the patient has taken during a previous visit.

4. ORDER MEDS - OPTIONAL: If you wish to order medications that are not listed, click the green Order button, located in the top bar. The Order Creation window is displayed. Enter order details per CPOE processes. See To create orders for additional details.
   
5. SAVE MED REC (to return later)- OPTIONAL: Click Save Med Rec to save the current selections and then return to finish the reconciliation process at a later time. When you return to the Medication Reconciliation and select Transfer  in the Service Level Transition field, you will be prompted to edit the draft that has been created. Click Yes to return to where you were in the medication reconciliation process.
   
6. CONFIRM MED REC (finish Med Rec now): When finished making selections for the medications, click Confirm Med Rec. You must have a selection for every medication in the list to confirm the reconciliation. If not, a message is displayed. Once all the medications in the list have been addressed and the Confirm Med Rec button is clicked, any applicable alerts are displayed, including conflict checking (drug-food, drug-drug, drug-allergy, and drug-dose checking), duplicate checking (with orders in the visit and orders in the reconciliation queue), corollary orders, and questions. Address these alerts and click Continue. The Confirm box is displayed.
   
7. ENTER FINAL DETAILS AND SAVE:
1. The Effective Date/Time defaults to the value set in maintenance (for discharges/transfers).  [The default value is set up in Maintenance > General Maintenance > Medication Reconciliation. Enter the appropriate information in the Hours Until Discharge field to identify the number of hours until discharge as a default.] Otherwise, enter the date and time when the patient will be leaving, e.g. time of transfer, time of discharge, etc. (If you enter a future date and time, the medication reconciliation will be in a 'pending' status. See Working With Pending Reconciliations.)
2. The Reconciled By field displays the logged in user's name.
3. (OPTIONAL) In the On Behalf Of field, enter the name of the provider which you are entering the reconciliation for. Type the first few letters of the Provider Name or NPI in this field to locate and select the appropriate provider.

4. (OPTIONAL) In the Comment box, enter additional notes/comments regarding this reconciliation.

5. If you'd like to preview the report, click Preview Report. This provides a printed report of the Home Medications, Currently Ordered, and Previous Visit lists, to send with the patient. Click Confirm from the Summary to finish the process. Or, click Close to return to the Confirm box.
6. Click Save. If not entered by a provider, the medication reconciliation becomes a Pending Reconciliation where it can be edited, canceled, or acknowledged by the provider (see Working With Pending Reconciliations on this page).
   
8. ACKNOWLEDGE THE MED REC: Once completed, the Medication Reconciliation must be acknowledged. See Working With Pending Reconciliations for details.

To access ePrescribing

To access ePrescribing functionality, click the Launch ePrescribe button. This button launches the ePrescribing portal, provided by DrFirst. See the section on ePrescribing for additional details on using this functionality.

From the Medication Reconciliation page, click the Update Now button to update the page with the ePrescribing profile information, including refill information. If the eprescribing portal is missing pertinent information, such as zip code, gender, etc. you will be prompted to enter that information. The date that the data was last updated or requested from DrFirst is displayed above the row of green buttons at the top of the page.

Clicking the Update Now button is limited to one time in 5 minutes to prevent system slowness. To ensure that medications are displayed/synchronized as expected, click Update Now. To ensure that the screen is refreshed and displaying the updated information, press <F5>, or go to another tab and then back to the current tab to refresh the web page.

To view Medication Reconciliation History

Select the History tab to view a history of medication reconciliation for this patient, including all visits. From the list, you can view the Reconciliation Date, Service Level Transition, and who completed the reconciliation. For each reconciliation, you can:

The Medication Reconciliation History page displays reports across all visits.  When viewing this page, the currently selected visit will default to expanded to allow better display and access to those reports.  If there are multiple pages of reports and a previous visit is selected, this may cause the page to open on Page 2 or greater.

When viewing medication reconciliation history, if more than one page of visit reports exist, the display is determined by the setting in Maintenance > General Application Set > Patient Chart > Paging. See Patient Chart.

To generate the Home Medications Report (Patient take-home report)

The Home Medications Report is the report that can be reviewed with and sent home with the patient.

To print the report, go to the Discharge Docs page and check the Home Medications report option. Complete the remaining fields and click the Generate Report button. There are three sections to the report: Start Medications, Continue Medications, and Stop Medications (which includes medications marked as discontinue or hold). In addition, there are signature lines for the nurse and patient if physical signature is required.

Working With Pending Reconciliations

If the medication reconciliation has been performed with a future date, the Pending Medication Reconciliation page is displayed when opening the Medication Reconciliation page. For a Pending Medication Reconciliation, you have three options: Edit, Cancel, or Acknowledge.

• Edit will open the Confirm box and allow editing of departure date/time or the addition of comments.  This is useful if the patient is leaving later than expected and the user wants to retain the status of the orders until the patient has left.  If the user wishes to review the orders that were handled during the medication reconciliation, they can click the Preview Report to see the Medication Reconciliation Report.  By design, edits cannot be made to the orders themselves; that would negate the medication reconciliation.  If changes need to be made, the reconciliation needs to be cancelled and performed again.

• Cancel will cancel the pending reconciliation.  This is useful if the patient is no longer going to be discharged or when the patient condition changes and new orders must be written.  This is also used if edits to the medication reconciliation are needed; the user should first cancel the existing pending reconciliation, then perform reconciliation again.

• Acknowledge processes the reconciliation at the time the button is selected.  All orders are immediately processed.  If the user wishes to change the time of the reconciliation before processing, they should edit the reconciliation first, then click Acknowledge.  Once acknowledged, reconciliations cannot be cancelled or edited.

Clinician Work Center and Medication Reconciliation

When a Pending Medication Reconciliation exists, an alert is sent to the Clinician Work Center.  This alert is dynamic – when the clinician acknowledges the medication reconciliation alert, it acknowledges the reconciliation just as if the user was on the medication reconciliation page.  It does not require the clinician to return to the medication reconciliation screen to complete the reconciliation. If edits need to be made, the clinician should return to the Medication Reconciliation page.

To view details

Click the button on either tab to view additional details regarding the reconciliation. The details include the action taken, the medication name, dose, route, frequency, start date, end date, and ordering physician.

Related Topics