Medication List Tool Emergency Department Implementation.
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Transcript of Medication List Tool Emergency Department Implementation.
Medication List Tool
Emergency Department Implementation
Medication List Tool Changes Objectives:1. State the rationale for replacing PAML/Med List with
the new Medication List Tool (MLT) in the ED Triage Form and Inpatient Nursing Admission History (Peds & Adult)
2. Describe features of the Medication List Tool (MLT) and associated workflow
3. Understand implementation and support plans for VUH and VCH
Medication List Tool Implementation
June 17 VUHJune 10 MCJCHV( except NICU/ NBN)
Inpatient Nursing Medication List Tool (MLT) embedded in Adult & Peds Nursing Admission History Starform (replacing PAML)
Emergency Department Medication List Tool (MLT)
Embedded in Nurse Triage MLT embedded in provider
workflow (tentative)
June 24 VUH & VCH ED
Why Change?
• Patient Dissatisfaction– Patients are asked multiple times to
supply the same information about medications taken at home
• Wasted Time– Redundant work being done due to lack
of integration of current tools
Why Change?• SAFETY - There is not one source of truth for home medications– Numerous members of the team collect medication lists yet
these lists are not shared and there is lack of confidence in the list.
For example, RN collects medication list in triage form yet this information doesn’t display in the provider workflow when completing the H&P. The provider collects yet another list.
– Failure to reconcile medications during transitions (home to hospital, hospital to home) results in medication errors
IMPLICATIONSAdverse drug events, ED visits,
hospital admissions and readmissions, prolonged length
of stay, patient and provider dissatisfaction
Up to 67% inpatients have at least 1 discrepancy between the prescription medication list obtained by the admitting provider and the patient’s actual pre-
admission medication regimen (Tam)
On average, each patient on a general medicine service has more than 1 discrepancy with
potential for harm in the admission or discharge orders
(Pippins)
59% of admission medication discrepancies could result in patient harm if they persist beyond discharge (Gleason)
Medication Errors at Vanderbilt
In a quality improvement study of general medicine patients:• ~90% of patients had an error in their MD-
obtained admission med list during night shift
In a randomized study of cardiac patients:• ~50% of patients experienced a clinically
important medication error within 30 days post-discharge (Kripalani)
• ~42% of patients had at least 1 error in pre-admission medication list (Salanitro)
• ~39% had at least 1 error in discharge medication list (Salanitro)
Background Replacing PAML and other medication list tools with the new Medication List Tool (MLT) in the Nursing Admission History and ED Triage form is phase 1 of the One Medication List project
Goals of the One Medication List project:1) One source of truth for medications2) All members of the team access and edit the same list3) Processes, tools and expectations for the medication list
management are standardized across VUMC
One Medication List Project Implementation
• VPH completed a successful pilot in March Medication List Tool (MLT) in VPH
Nursing Admission History (replace PAML)
MLT embedded in the VPH provider H&P
• Perioperative workflow analysis and adoption of MLT is in progress
• OB is on hold until system updates occur later this year
One Medication List Project• Embed MLT in the Adult and Pediatric
ED Triage form and Nursing Admission History Replace PAML with MLT
• Provider workflow will be part of future phases Embedded in provider admission
process, i.e., documenting H&P Exit check during the discharge process Long term goal is for the providers to
have the ability to enter orders for medications from the list
Implementation – continued
Current Medication Reconciliation ToolsPAML
NEW
New Medication List Tool MLT
The Med List Tool
The MLT Summary page display in the Admission History &
Triage Note
Embedded in Admission History
Embedded in Triage Note
Last completed list visible with date, time and collector
included
Click Edit or Pencil icon to open the tool and make
changes
Left column pulls previous VUMC medication list from
Patient Summary (PSS)– such as from clinic visit,
last hospitalization.NON EDITABLE
Right column is “SCRATCH PAD” which is an EDITABLE
version of the previous VUMC medication list.
EDIT list to reflect medications patient is
currently taking prior to admission
The Med List Tool
• MLT will open a new window when clicked from the triage screen
Med appears with strikethrough
Click “X” to delete a med that is no longer being taken
Make a mistake? Use the UNDO icon
How to DELETE a medicationDELETE icon
Click EDIT icon to edit medication information
Denote edits to dose, route, frequency, indication, start date (OPTIONAL), comments. Specify
date/time last dose taken if appropriate.
Changes are highlighted for easy review
Click SAVE when revisions completed
How to EDIT a medicationEdit Icon ->
Type Medication Name. Select from list if appropriate
Denote dose, route, frequency, start date, indication,
comments. Specify date/time last dose taken if appropriate
Click Save
Click Add Medication
New Med highlighted for easy review
How to ADD a medication
Type medication information that is known, i.e. “little blue pill for BP”
Incomplete medication information
Select “Submit” and then “No Current Medications” if the patient does not have any home medications. • This button will only be available when the
scratch pad has no meds listed or all meds have been deleted.
Select “Unable to Obtain” and denote reason, if obtaining medication history is not possible.
How to Save MLT
Preview- Displays the list without the strikethroughs and highlights.
Click a second time return to display with strikethroughs and highlights
Submit for Review- saves the list and prompts the provider that the
medication list collection by nursing is complete and ready for the provider to review/edit/ send
to Patient Summary
Icons & Displays
Click to display all comments. Click again to
hide commentsThe View icon displays detailed medication information including; history, creation date, and editor
Edit
Click to display icons to print, show/hide comments or
display list of edits by visit
Delete
View
• Click Actions to open
• Click Med List Tool to open
• May have to customize menu to have Med List Tool available as an option
Click Med List Tool to open
Click Actions to open
Accessing the Med List Tool (MLT) in Star Panel
MLT and the Provider
Integration of MLT into ED provider workflow is tentatively planned for June 24• A column will be added to the ED Whiteboard “M” that will link to the MLT and will
flash if not completed by the provider within an hour of the patient being placed in a room
• MLT will be embedded in the ED H&Ps• Medication lists from the MLT will be presented in the ED Discharge Med
Reconciliation process
Once the Nurse Submits for Review, the Provider will review the list obtained in the Triage Form and will have the option to:• Edit the list and/or to Save to Pt. Summary if there is a high confidence that the list is
accurateOR
• Document that the list has been Reviewed but Don’t Save to Pt. Summary if the confidence level in the accuracy of the list is low (i.e. patient is poor historian or unable to give a complete home medication list). A reason will be required.
OR• Document Unable to Obtain a medication list
Implementation & Support
IMPACT TO PATIENTS IN THE ED WHO ARE ADMITTED AND AWAITING BEDS• June 10: VCH PAML link in the Peds Nursing Admission History will be replaced
with MLT• June 17: VUH PAML link in the Adult Nursing Admission History will be
replaced with MLTSupport: System Support Services staff will be rounding in the ED. Contact the help desk (343-4357) for assistance.
IMPACT TO ALL ED PATIENTS (VCH & VUH)• June 24: Medication List Tool will be embedded into the Triage form Support: System Support Services will provide 24h support onsite in the ED X 4 days then via call to help desk (343-4357).