Medication Reconciliation

Physician/Provider Workflow

3/7/13

On Admission

• The Pre-Admit Medication List (PAML) information may be collected by the nurse or provider

• All areas of entry to hospital use same PAML tool – Emergency Department– pre-op– direct admit

• Provider electronically stamps signature in HEO that list has been “acknowledged”

Provider acknowledgement screen

choose one of

the three options

Pre-Admit Med List

• Accessible to providers in multiple applications– StarPanel– HEO– StarNotes

• Allows importing of PAML data into other electronic documents

• Can be modified/updated at any time by provider or nurse

Click the arrow to

add to Pre-admit Med List (right

side) –Click Done

to save PAML list

In HEO you can click on PAML in the upper left window and view details of what the patient has reported as home medications. You can also modify at any time.

During admission

• Orders for medications are entered in HEO

• Upon transfer to another unit or level of care medications are reviewed and updated as needed

• HEO is the most up to date record of current medications

At Discharge

• Physician/Provider responsibility to reconcile medications– Use Discharge Process to compose patient

letter, and comply with all discharge requirements

– Compare home meds next to current inpatient medications

• Indicate those to continue, stop and start• Create prescriptions in RxStar

Review the Take Medications list imported from StarPanel Patient Summary (right side). Add medications to the list from the medication lists currently in HEO/Wiz & PAML (left side). To Stop a medication click the red button. To add medication from HEO or PAML list to home medication list, click the green button.

Once “Take Medication list” complete – Click Mark DMR Done to save new list to StarPanel patient Summary.

Click RxStar tab to complete new prescriptions for patient.

Tips for Providers Regarding Medication Reconciliation

• Having the PAML be as accurate as possible at the beginning (admission) saves documentation steps at discharge

• PAML can be completed by physicians and MUST be acknowledged electronically

• The final step at discharge is the MARK DMR DONE – which saves the new patient medication list to StarPanel

Questions?

• Please call the Help Desk at 3-HELP or 343-4357 with any questions or concerns.