Crosscheck against patient's electronic medical record
6
Compare current medications with prescribed medications
7
Identify discrepancies or medication inconsistencies
8
Approval: Clinician review of discrepancies identified
9
Discuss discrepancies with the prescribing provider
10
Adjust medication orders if necessary
11
Resolve and document medication reconciliation in the system
12
Update the master patient medication list
13
Approval: Provider review of final medication list
14
Inform patient about medication changes if any
15
Educate patient on proper medication usage and adherence
16
Document patient education in the system
17
Finalize and save the updated patient record in Epic
18
Generate patient medication reconciliation report
19
Send the report to the relevant care team members
Identify the patient's current medication list
This task involves identifying the patient's current medication list. By doing so, we ensure that we have an accurate understanding of the medications the patient is currently taking. This information is crucial for effective medication reconciliation and avoiding any potential drug interactions or discrepancies. To complete this task, gather the patient's current medication list from the patient or their caregiver.
Collect medication information from the patient
In this task, collect the necessary medication information from the patient. This information can include the medication name, dosage, frequency, and any special instructions. Gathering this information directly from the patient helps ensure accuracy and allows for thorough medication reconciliation. Introduce yourself and create an environment of trust to encourage open communication. Ask leading questions such as 'Are you currently taking any medications?' and 'Are there any specific instructions or precautions you follow?' to ensure a comprehensive collection of medication information.
Input patient medication data into Epic
This task involves inputting the medication data collected from the patient into Epic - our electronic health record system. By inputting the information into Epic, we ensure that the medication data is securely stored, easily accessible, and can be used for future reference. Pay attention to accurately enter the medication names, dosages, frequencies, and any special instructions provided by the patient.
Verify accuracy of manual data entry
To ensure the accuracy of the manually entered medication data in Epic, verify the information entered against the original source document or the patient's own medication list. Crosscheck the medication names, dosages, frequencies, and any special instructions. If any discrepancies are found, indicate them and flag them for further investigation or clarification.
1
Information Matches
2
Information Does Not Match
3
Unclear/Inconsistent Information
Crosscheck against patient's electronic medical record
In this task, crosscheck the manually entered medication data in Epic against the patient's electronic medical record. This crosscheck helps ensure that the medication data is consistent across different sources and reduces the risk of errors or omissions. Pay attention to any differences or discrepancies between the manual entry and the electronic medical record, noting any inconsistencies for further investigation or resolution.
1
Information Matches
2
Information Does Not Match
3
Unclear/Inconsistent Information
Compare current medications with prescribed medications
This task involves comparing the current medications listed in Epic with the prescribed medications. By doing so, we can identify any discrepancies or inconsistencies between what the patient is actually taking and what has been prescribed. Look for any differences in medication names, dosages, frequencies, or special instructions. Keep an eye out for potential medication errors or discrepancies that may require further action.
1
Medications Match
2
Medications Do Not Match
3
Unclear/Inconsistent Information
Identify discrepancies or medication inconsistencies
During the comparison of current medications with prescribed medications, keep an eye out for any discrepancies or inconsistencies. These may include differences in medication names, dosages, frequencies, or special instructions. Identify and document these discrepancies to ensure they are properly addressed and resolved. Promptly communicate any identified discrepancies to the prescribing provider for further clarification, adjustment, or reconciliation.
1
Medication names differ
2
Dosages differ
3
Frequencies differ
4
Special instructions differ
Approval: Clinician review of discrepancies identified
Will be submitted for approval:
Identify the patient's current medication list
Will be submitted
Collect medication information from the patient
Will be submitted
Input patient medication data into Epic
Will be submitted
Verify accuracy of manual data entry
Will be submitted
Crosscheck against patient's electronic medical record
Will be submitted
Compare current medications with prescribed medications
Will be submitted
Identify discrepancies or medication inconsistencies
Will be submitted
Discuss discrepancies with the prescribing provider
After identifying discrepancies or inconsistencies in the patient's medication list, initiate a discussion with the prescribing provider to seek clarification or further action. Clearly communicate the identified discrepancies and any concerns you may have. Ask open-ended questions like 'Can you provide more information about the prescribed medication?' or 'Is there a reason for the discrepancy?'. Use active listening skills to better understand the provider's perspective.
Adjust medication orders if necessary
Based on the discussion with the prescribing provider, determine if any adjustments to the medication orders are necessary. If the identified discrepancies are due to errors or outdated information, update the medication orders accordingly. Ensure that any adjustments are accurately reflected in Epic for future reference and adherence. Document the rationale and details of the medication adjustments for proper record-keeping.
1
Increase medication dosage
2
Decrease medication dosage
3
Change medication frequency
4
Change medication
5
No adjustments necessary
Resolve and document medication reconciliation in the system
This task involves resolving any discrepancies or inconsistencies identified during the medication reconciliation process. Use the information gathered from discussions with the prescribing provider and any necessary adjustments to ensure that the medication reconciliation is accurate and up to date. Document the details of the medication reconciliation in Epic to provide a clear record of the process and outcomes.
Update the master patient medication list
To ensure the accuracy of the patient's medication information for future reference, update the master patient medication list. Include any adjustments made during the medication reconciliation process and ensure that the list is comprehensive and up to date. Keep the list organized and easily accessible for healthcare providers and other relevant stakeholders.
Approval: Provider review of final medication list
Will be submitted for approval:
Adjust medication orders if necessary
Will be submitted
Resolve and document medication reconciliation in the system
Will be submitted
Update the master patient medication list
Will be submitted
Inform patient about medication changes if any
If any medication changes were made during the medication reconciliation process, inform the patient about these changes. Explain the reasons behind the changes and address any potential concerns or questions the patient may have. Encourage the patient to actively participate in their medication management and emphasize the importance of adherence to the updated medication plan.
Educate patient on proper medication usage and adherence
In this task, educate the patient on proper medication usage and adherence. Emphasize the importance of taking medications as prescribed, following any specific instructions, and adhering to the medication schedule. Provide clear and easy-to-understand information about potential side effects, precautions, and any necessary lifestyle modifications. Encourage the patient to ask questions and seek clarification to ensure comprehension.
Document patient education in the system
After providing patient education on proper medication usage and adherence, document the details of the education session in the system. This documentation helps ensure continuity of care and provides a reference for future healthcare providers. Include any important points discussed, patient concerns or questions, and any additional resources provided to the patient.
Finalize and save the updated patient record in Epic
After completing the medication reconciliation process and making any necessary updates, finalize the patient's record in Epic. Ensure that all relevant information, including medication changes, education documentation, and reconciled medication lists, is properly saved in the patient's electronic health record. This step helps ensure the accuracy and accessibility of the updated patient record for future healthcare needs.
1
Record Finalized
2
Record Not Finalized
3
Unclear/Inconsistent Information
Generate patient medication reconciliation report
Generate a comprehensive patient medication reconciliation report to document the entire medication reconciliation process and outcomes. Include details such as the patient's current medication list, identified discrepancies, discussions with the prescribing provider, medication adjustments, patient education sessions, and any other relevant information. This report serves as a summary and reference for healthcare providers and can facilitate continuity of care.
Send the report to the relevant care team members
After generating the patient medication reconciliation report, distribute it to the relevant care team members. Ensure that the report reaches the appropriate healthcare providers, nurses, and pharmacists involved in the patient's care. This step helps facilitate communication and collaboration among the care team, ensuring that everyone is informed about the medication reconciliation outcomes and any necessary follow-up actions.
