Nursing Deck - University of Pittsburgh Medical Center M… · Nursing Deck . Introduction 2 ... Medication Leaflets — Slide 53 Patient Summary Overview — Slide 55 ... longer

1 Revised: 8/16/2011

Electronic Medication Reconciliation

and Depart Process Overview

Nursing Deck

Introduction

2

To achieve the highest standard of care that our system aspires to, as well

as to meet the reporting requests of multiple regulatory agencies, new

functionality/enhancements have been developed in Cerner.

This presentation will illustrate the following:

• Document Medications by Hx

• Electronic Medication Reconciliation

• Depart Functionality (including Medication Reconciliation, Discharge

Meds/Prescriptions, Diagnosis, Discharge Details, Discharge Depart

Order, Discharge Instructions/Education,

Follow-up and Medication Leaflets).

3

Table of Contents Medication Reconciliation will be electronic. The old discharge process will be replaced with

a new process. Several changes will occur in PowerChart as a result. The following slides

will walk you though the changes: ELECTRONIC MEDICATION RECONCILIATION, and

the NEW DEPART PROCESS. You may view the slides in order by pressing the Page

Down key, the Enter key, or the Space bar on the computer keyboard.

Document Medications by Hx Overview — Slide 4

Document Medications by Hx — Slide 5

Admission Medication Reconciliation — Slide 14

Accessing the Depart Icon — Slide 18

Depart Process Window Overview — Slide 20

Completing the Depart Process—Provider Only Actions — Slide 27

Discharge Medication Reconciliation — Slide 29

Discharge Prescriptions — Slide 30

Discharge Details — Slide 31

Discharge Depart Order — Slide 35

Completing the Discharge Process— Provider and Nurse Actions — Slide 38

Discharge Instructions/Patient Education —Slide 39

Reviewing Discharge Instructions —Slide 42

Follow up — Slide 48

Medication Leaflets — Slide 53

Patient Summary Overview — Slide 55

Clinical Summary Overview — Slide 63

Document Medications by Hx Overview • Must be completed within 90 minutes from the decision to admit

• Has been removed from the Admission Assessment form

• Document compliance on all medications including prescriptions (pill

bottles)

• If unable to complete Document Medications by Hx an option is now

available to mark the list “Leave Med History Incomplete-Finish Later”

• Accuracy and completeness are paramount when documenting drug,

dose, route, frequency and compliance. Providers will use this list to

complete the electronic admission medication reconciliation and medication

orders. Compliance details are easily visible to Providers.

• When the decision to admit is made, two tasks will now fire to the nurse task

list

• Document Medications by Hx - Rule (must be completed by nursing

within 90 minutes admission)

• Admission Assessment - Rule (must be completed by nursing within

24 hours of admission)

• For a detailed description of Document Medications by Hx Click on the

following link.

Document Medication by Hx

•

4 Return to Table of Contents

http://erecordhome.upmc.com/Training/PDFfiles/QuickTipsCareNet/DocMedsbyHxEV08162011.pdf

http://erecordhome.upmc.com/Training/PDFfiles/QuickTipsCareNet/DocMedsbyHxEV08162011.pdf

Document Medications by Hx- Rule Task

Double clicking on the Document

Medications by Hx - Rule Task

will open the Document Medications by Hx

Form.


Document Medications By Hx Form Click on the Document Medication by Hx button.


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In the Find field, type in the medication name. Select the medication

name that does not have dose information attached. An Order

Sentences window will display, select the route and dose that match

what is reported by the patient.

Document Medication By Hx

Return to Table of Contents

8 Status bar will

update

Status Bar: Complete Incomplete

Next, the Details window will open. Continue to fill in or modify any details. You may also enter Order

Comments if needed on the next tab. The last tab is the Compliance tab. Information should be entered

on the Compliance tab for new medications as well as updated for medications that pulled in from

previous encounters. When finished, click on Document History.



It is then necessary to sign the

form by clicking on the green

check mark.

Modifying Compliance-Prescriptions(pill bottles)

9

Nursing is responsible to Add/Modify compliance for prescriptions. It

is the responsibility of the nurse to review prescription medications

with the patient. It is no longer necessary to re-enter these

medications however, you must now Add/Modify Compliance for all

prescription medications.


Med History Incomplete – Finish Later

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Leave Med History

Incomplete-Finish Later was

added for nursing to indicate the

Med Hx is incomplete. The

status bar will not display a

green check mark.

If unable to complete the Document Medication by Hx, place a check mark

in the box Leave Med History Incomplete-Finish Later. Click Document

History. This will not place a green check mark on the Status bar for Meds

History.

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Once a check mark is placed in the box indicating, Leave Med History

Incomplete-Finish Later, the nurse must hover over the status bar to

retrieve the Incomplete status information. The Leave Med History

Incomplete-Finish Later box is no longer on view on the Document

Medication Hx Window.


Medication: Status Bar

Medication History Details

Reconciliation

History

The Status Bar indicates when Meds History, Adm. Meds Rec and

Disch. Meds Rec have been completed.

Return to Table of Contents 12

Nurses must complete the “Document Medication by Hx” (patient’s home

medication list) within 90 minutes from the decision to admit.

Status Bar:

Complete

Incomplete

Click on the Medication List to view medication information.

The Benefits of Medication

Reconciliation

• Transitioning from a paper process to an electronic

process completed by Provider (Physician, PA and

CRNP)

• Home medications are easily converted to admission

orders

• Home medications and inpatient orders can be easily

converted to prescriptions

• Ensures a more complete medication list for discharge

• Discharge medication list available electronically when

patient returns (Document Medication by Hx will be

updated with new medication list)


Admission Medication

Reconciliation

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Compliance icon -

Patient is not taking

Prescription

Documented

Medication by Hx

(home med)

Orange asterisk-

unreconciled meds

Icon guide


Reconciliation button available to

Providers only

Admission Medication

Reconciliation

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The Provider can hover over the compliance icon to display

the details of the medication compliance.


Admission Meds Reconciliation


Unreconciled Order(s) button: Indicates

the number of unreconciled medications.

Continue: Will convert to Inpatient Medication. Click radio button

under continue and medication will display under Medications After

Admission Reconciliation.

Do Not Continue :

•Leaves Documented Meds by Hx as Documented

•Leaves Prescriptions as Ordered

Benefits of Depart Process

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• Can begin the depart process at any time during the patient stay (as early as day of

admission).

• Providers are able to complete discharge Medication Reconciliation, Discharge

Meds/Prescriptions including printing prescriptions, Diagnosis, Discharge

Details, Discharge Instructions/Education and Follow-up Information.

• Nurses are able to complete Discharge Instructions/Education, Follow-up

Information and print Medication Leaflets.

• Process may be started/stopped at any time. Multiple Providers can contribute to the

document. Document may be saved by selecting Sign/Close.

• Consulting physicians may enter their follow-up information before the patient has been

discharged. That information will pull into the Discharge Instructions which is a huge

benefit for physicians so that patients receive correct follow-up information for all

consulting physicians.

• CORE/Quality Discharge instructions such as CHF, Stroke and Warfarin will automatically

pull into the new format.

• Multiple discharge instructions can be incorporated in the patient instructions, however,

these instructions need to be reviewed to eliminate conflicting information (for example

diet and activity). This is the responsibility of both the Provider and the Nurse.

• The actual Discharge Depart order can be done at a later time - this is the final step.


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Customizing the Toolbar to Access the Depart Icon

• The Depart icon is located in the Actions Toolbar. In order to see the Depart

Icon, you will need to customize it to your view.

• You can expand the toolbar by clicking on the arrow at the end of the toolbar to

see all the icons.

• To move the icon on the toolbar, click on the arrow located at the right edge,

hover over Add or Remove Buttons, and select Customize. While the Customize

Toolbars window remains open, click on the icon and drag it to the preferred

position.

For more information on customizing the toolbar, click on the following link.

Customizing Toolbars


http://erecordhome.upmc.com/Training/PDFfiles/QuickTipsPowerChart/PChartOrgToolbarsEV.pdf

Accessing the Depart Icon

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The Clinical Note will no longer be used for discharge.

Providers (Physicians, CRNPs, and PAs) will now be

ELECTRONICALLY entering patient discharge action items

including: medication reconciliation and creating a final medication

list, discharge meds /prescriptions (printing electronic

prescriptions), diagnosis, and any other details or orders related to

discharge using the Depart icon on the Actions Toolbar.


To open Depart, click on the Depart icon from the Toolbar.


When you click on the Depart icon, the Depart window will open:

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Once the Depart window is open, action items

will be displayed on the left. You will notice

highlighted options - •Provider Only Actions

•Provider & Nursing Actions

•Nursing Only Action

The Provider will complete the first group of

action items, the Provider and/or Nursing will

complete the second group, and Nursing will

complete the third group.

Notice the blue circles in front of each action item. If an action item has not been started,

it will be empty. If it has been started, but not completed, it will be half full. A full circle

indicates that action item has been completed.

Changing from an empty circle to a half full one is automatic. However, the full circle is

dependent on the user clicking on it when the action item is completed.


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Not Started

Started

Completed

To complete the Depart Process, users will open and enter information into

each action item. To open an action item, click on the icon on the right.


On the right, you will see two tabs Patient Summary and Clinical Summary.

The default is the Patient Summary Tab. As action items are completed on

the left, the Patient Summary will be created. These are the discharge

instructions that will be printed and given to the patient.


The Clinical Summary Tab - As action items are completed on the left, the

Clinical Summary will also be created. This is the discharge information

that will be printed and sent with patients who are discharged to other

facilities.


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Current State – Sign -creates a

final document which cannot be

edited

Current State – Clinical Note

Future State – Depart Process Future State – Sign/Close stores

the document and allows for future

modification


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To sign the documentation click on Sign/Close button. Selecting the X will

cause the documentation to be lost.

Signing the Depart Process


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Completing the Depart Process -

Provider Only Actions


Providers will complete Medication Reconciliation and Discharge

Meds/Prescriptions. As providers complete Medication Reconciliation the blue

circle will be filled in. As Diagnoses are added, they will be listed below the

action item on the left.


Provider Only Actions

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Discharge Medication Reconciliation

Continue After Discharge: Documented Medication remains as “Documented” –

No Prescription is created.

Create New Rx: Creates New Prescription.

Do Not Continue After Discharge: Discontinues Document Medication by Hx – no

longer on patients profile

Continue After Discharge and Create New Rx for Inpatient Medications that have NOT been verified

by Pharmacy will be grayed out (dithered).

Discharge Prescriptions


Providers will now be creating electronic prescriptions for medications,

labs, DME and radiology. These prescriptions will print to the default

printer attached to the PC and require a signature by the Provider.

Prescriptions must be signed by Provider

Discharge Details – Provider Only Action

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Current state — Discharge Order with 6

required fields (must be placed when

patient ready for discharge).

Future state — Activity, Diet, and Disposition

(along with other non-required details) can be

started ahead of time.


The Discharge Details window will open to the Depart Discharge Form. The

Provider will select appropriate details for the patient. Required fields include:

Activity, Diet, and Disposition and are highlighted in yellow.

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Additional Discharge Instructions can be provided by selecting radio

buttons at the bottom of the form (not required).

Disposition


Current State - Facilities use various processes (paper and electronic) when

patients are discharged to Post Acute Facilities or Behavioral Health Units.

Future State -When Skilled Nursing Facility or WPIC-Inpatient BHU are

selected under Disposition, another section will open for Provider to

complete.

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Orders for Next Facility

The following information will pull-forward from the

Admission Assessment:

•Pneumonia vaccine administered

•Pneumonia vaccine date/time

•Flu vaccine

•Flu vaccine administered

•Flu vaccine date/time

•Healthcare Decision Maker (s) name and phone number

The additional section contains the

necessary information required by

the facility the patient is being

discharged to. Once information is

selected use the “circle back” button

to return to the main section.

Discharge Depart Order

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The final Provider Only action item is Discharge Depart Order.

The discharge order (Discharge Depart Order) is the last step in

getting the patient discharged. If the patient is ready to leave when the

Provider is completing the depart process, the Provider can enter that

order from here (Discharge Depart Order action item).

OR

If the depart process has been completed in advance, this order can be

entered from the order matrix.


Future State: Entering the Discharge Depart Order without details will be the last step to let

nursing know the patient can leave the hospital.


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Current State: Completing the Discharge Order with all the details such as activity, diet,

follow up etc. is the first step when discharging a patient and is not entered ahead of time.


Clicking on the Discharge Depart Order action icon will

open the Add Order window. This order will be entered when

the patient is ready to leave the hospital. The order has 3

fields — Requested Start Date/Time, Special Instructions,

and IV Therapy (Remove IV). There are no required fields.

Entering the Discharge Depart

Order

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The first Provider & Nursing action item is Discharge Instructions/Education.

Completing the Discharge Process -

Provider & Nursing Actions


39


Future State – Clicking on the Discharge Instructions/Education action item will open the Patient Education window.

Providers and/or Nursing can add the Discharge instructions from here.

Current State – The Discharge Instructions Form is a multi-select PowerForm used by Providers and Nursing.

Discharge Instructions/Education

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Once the Patient Education window opens, a search field and several

buttons across the top of the tab will display.

• “Suggested” instructions may display based on the diagnosis entered by the

Provider.

• Click on All and type in the instruction you are looking for in the search field, all

results will display in the window below alphabetically. Double-click on desired

instructions.

• “Departmental” and “Personal” allow you to save “favorite” type instructions. All

allows you to search all the instructions in the system.

.



Double click on selected

instructions on left to display in

the window on right. As you

add instructions, all the ones

that you have chosen will be

listed to the left.

Searching Discharge Instructions Using All Function

Reviewing

42

Review the discharge instructions by checking the Patient Summary. Review for conflicting information

(such as diet and activity) and redundancy. Discharge instructions cannot be modified from inside the

Patient Summary. Modifications must be made by opening the action items Discharge Details or

Discharge Instructions/Education. If making changes to Discharge Instructions/Education, these forms

can be treated like Microsoft Word Documents and modified as such.


Please be aware that certain

Discharge Instructions/Education

cannot be modified due to quality

measures. Examples include:

CHF, stroke, warfarin and VTE.

Reviewing When Provider chooses a diet

from the Depart Discharge

Powerform, the selection will

appear under “What should I

eat?” in the Patient Summary.

In this example the Regular diet

has been selected.


When a Provider selects a discharge instruction there may be a diet associated with that

instruction that will appear on the Patient Summary.

44

Reviewing


Reviewing

Conflicting diets are noted on the “What should I eat?”

section and the Discharge Instruction section of the

Patient Summary.

After discussing the conflict

with the Provider, the Provider

or Nurse can modify the

discharge details by clicking

the Discharge Detail action

icon contained in the Provider

Only Actions section.


Modifying Conflicting Data

Once the Discharge Details Powerform

opens, deselect the conflicting diet (in this

example the Regular diet has been

deselected) and select the See

Diagnosis/Procedure Specific Instructions

option. See Diagnosis/Procedure Specific

Instructions now displays in the “What

should I eat?” section in the Patient

Summary. Sign the Powerform using the

green checkmark (not shown).


As Discharge Instructions are added, they will be listed under the action

item on the left.


Follow-Up Information

48

The second Provider & Nursing action item is Follow-up Information.

This is where a consulting physician can add follow up information for a

patient prior to the patient’s actual discharge. Follow up information can

be added at anytime.


The Follow-Up Information window will open. Providers and/or Nursing can

add Follow-up details.

• Who – Search by Provider, Organization/Clinic, or add Free Text

information

• When – Date/Time

• Where – Providers or Organizations/Clinics, business addresses will

automatically populate

49


The check mark next to the address will indicate that it will be included in the

patient discharge instructions. If you do not wish to include it, uncheck the

box.

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To add a new address, click

on Add Address and a new

window will open to

complete.

The new address

will now display.


A reason for follow up may be added by using the Quick Picks or

Predefined Comments.

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The default for follow-up appointment will be with

the patient’s PCP in 1 week.

Sign will add the information to the Patient Summary.

Print will give you the ability to print the Patient

Summary at this point in the depart process.

Cancel will exit Follow-up Information without any

actions.

To choose a Predefined

Comment, double click on

the comment. It will now

appear in the Edit Comments

box. If you need to modify

the Predefined Comment

update as needed within the

Edit Comments box.


As Follow-up Information is added, it will be listed under the action

item on the left.



Selecting Medication Leaflets opens the Medication Leaflet window.

Medication Leaflets

The Nursing Only action item is Medication Leaflets.

Medication Leaflets can still be printed from the eMar and Medication

Administration Wizard.

54

Type medication in search field and click the ellipsis button to search. The

Medication Leaflet will display.

Selected instruction will display under the Selected Leaflets to the left. Previously

selected instructions will display to the right.

Medications Leaflets


It is important to print medication leaflets from this window.

The medication leaflets do not print with or save to the patient summary.

55

Patient Summary Overview

As action items are completed they pull to the Patient Summary. The next

slides will highlight selected information.


Reviewing Patient Summary - Medicines

56

When Medication

Reconciliation

is complete the

medications will pull

to the Patient

Summary in the grid

format.


Patient Summary- Medicines

Medications will be listed in grid format

• Home Medications to be taken in the Morning

• Home Medications to be taken in the Afternoon

• Home Medications to be taken in the Evening

• Home Medications to be taken at Bedtime

• Home Medications to be taken As Needed

• Medications That You Should Stop Taking

• Medication List Summary


Patient Summary-Medicines

58


Patient Summary-Medicines


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“What is my main

Medical problem?” is

added when the

provider selected the

diagnosis.

“When are my

appointments?” is

added when the

provider selected follow

up.

“Activity/Exercise and

What should I eat”

comes from the

Powerform the provider

completed.

Allergies are pulled from

documentation.

Patient Summary


Home Care information

pulls from Home Care

documentation (not

shown).

61

If there are any topics that you need

to add, you can add free text

information by clicking on the blue

hyperlink Visit Information

Comment (see below).

A box will open where you can add what is

needed. Then Click ok and it will display in

the patient summary.

Information pulls from the

Discharge Depart

Powerform completed by

the Provider.


Printing Patient Discharge Materials

62

• Print Patient Discharge Summary or Clinical Summary

• Patient Discharge Summary signature sheet - requires a patient’s

signature and this sheet is to be placed in the chart

• Print My UPMC Safe Discharge


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• The Clinical Summary

contains information that

will be used by other

clinicians

• This document will be

printed when a patient is

discharged to all outside

facilities (LTAC, SNF,

BHU, and Rehab)

• At the top is patient

demographic data,

providers and medical

information

•This is followed by last

charted vital signs, final

medication list, meds

given today

Clinical Summary Overview


Clinical Summary

• PendingTests/Exams,

Order Information,

Patient Education/

Follow Up, Home

Health Care

Information

• You will see an

Additional Comments

hyperlink. If you click

on the hyperlink, you

will get a pop up box

where you can free

text information (Not

Shown.)


• When ready to print,

click the print option in

the lower right corner.

You have reached the end of this presentation. Thank you for

taking time to review.
