Medication reconciliation

This is the process of adjusting inpatient and outpatient medications at discharge. There are a number of ways to do it, as outlined below:

  • For patients with few (if any) outpatient meds: If you think you know which meds need to be ordered (maybe the patient didn’t have many to begin with), just go to the Meds tab, highlight the inpatient medications you want them to take as outpatient, and go to the toolbar at the top… Action > Transfer to Outpatient.
  • Compare: Use the template under Patient Data Objects > Medication data to generate a list of inpatient and outpatient meds. Insert the lists into a blank document, print, and compare the differences. Make those adjustments by ordering (or discontinuing the right meds in the Outpatient meds list).
  • Use the following to compare meds in alphabetized order and inpt/outpt:

    Reports tab > (+) Health Summary > Medication Reconciliation (scroll halfway down)

 

Warfarin

If the patient is being started on it for the first time, they need an Anticoag Clinic consult. Go to:

Consults tab > New Consult (left side) > Pharmacy (left side) > Anticoagulation Clinic Outpatient Consult request

Make sure your team nurse is aware (they have to do patient education).

 

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