Technical Reference Guide: Profile's Admission Medication Reconciliation Feature

overview & requirements the following reference article provides an overview of the functionality and workflow of the admission medication reconciliation feature in profile this article is intended for system administrators, as well as technical and clinical users who want to learn more about this feature's functionality and workflow it is also beneficial for individuals who require additional detail it will focus on the following topics stage 1 creating, editing, assessing, and saving the admission reconciliation record docid\ x5ygt7otdwhuqpq2rdhabthe patient's medication reconciliation listing page docid\ x5ygt7otdwhuqpq2rdhablaunching the patient admission reconciliation feature docid\ x5ygt7otdwhuqpq2rdhabinterpreting the admission reconciliation listing page docid\ x5ygt7otdwhuqpq2rdhabrole action logic docid\ x5ygt7otdwhuqpq2rdhabnavigation when the admission reconciliation record is opened for editing docid\ x5ygt7otdwhuqpq2rdhabstarting a new admission reconciliation record docid\ x5ygt7otdwhuqpq2rdhabcreating a new record docid\ x5ygt7otdwhuqpq2rdhabadding a medication list to the admission reconciliation record docid\ x5ygt7otdwhuqpq2rdhabsteps to add medications to the list docid\ x5ygt7otdwhuqpq2rdhabadding medication from the formulary docid\ x5ygt7otdwhuqpq2rdhabadding an ad hoc medication docid\ x5ygt7otdwhuqpq2rdhabcapturing historical information for patient's medication list docid\ x5ygt7otdwhuqpq2rdhabassessing medication for in patient medication treatment docid\ x5ygt7otdwhuqpq2rdhabcompleting the validation and assessment of the entire medication list docid\ x5ygt7otdwhuqpq2rdhabsaving (as a draft) docid\ x5ygt7otdwhuqpq2rdhabstage 2 submitting or signing the admission reconciliation record docid\ x5ygt7otdwhuqpq2rdhabsubmitting the admission reconciliation record for review docid\ x5ygt7otdwhuqpq2rdhabsign as reviewed before sending to provider (co signature) docid\ x5ygt7otdwhuqpq2rdhabsubmit to provider docid\ x5ygt7otdwhuqpq2rdhabprovider's signature the final authorisation of medications docid\ x5ygt7otdwhuqpq2rdhabauto creation of tasks docid\ x5ygt7otdwhuqpq2rdhabload to medchart docid\ x5ygt7otdwhuqpq2rdhab requirements profile version 9 0 9 and above self hosted customers will need iis and http set up please contact intrahealth for more information admission reconciliation is a feature of the medchart liscensed module for inpatient medication management please contact the intrahealth support team at help\@intrahealth com to enable medchart for configuration information, please read configure and setup the admission medication reconciliation feature in profile docid\ jqnurrfmfzw4taw mcoaa stage 1 creating, editing, assessing, and saving the admission reconciliation record note for a general step by step guide, please read start admission medication reconciliation in profile docid\ efzr4polc23wywhlc6woq for more detailed information on launching the patient admission reconciliation feature, understanding its functionality and workflow, please continue reading the following article the patient's medication reconciliation listing page for information on how to launch the patient admission reconciliation feature, and to understand its functionality and workflow, please read the following launching the patient admission reconciliation feature the admission reconciliation feature can be launched from clinical / medical record / med reconciliation a new admission reconciliation window for the patient will open interpreting the admission reconciliation listing page once the page has been launched, you will notice a table is displayed with several columns, as shown in the image below note the heading of the page will list the name of the patient followed by 'medication reconciliations' by default, there will be no records for newly admitted patients for re admitted patients, where a medication reconciliation was previously completed, historical records will be available for a patient with an in progress admission reconciliation, the in progress record will be visible the columns in the table will be populated based on the line item created and its status please read the table below for more details on each of the columns found in in the admission medication reconciliation listing table 1 medication reconciliation list column description reviewed by lists the user who has signed for review plus the date and time of the action taken the reviewer's username will be displayed the date format is dependent of the date and time format set in profile if no review was completed, it will be blank signed by lists the user (provider) who has signed for final authorisation plus the date and time of action taken signed by will include the provider's username the date format is dependent of the date and time format set in profile if no signature was completed, it will be blank status lists the status of the record the potential statuses are in draft ready for review ready for provider signature completed action lists the available actions for the specific admission reconciliation record, open and delete open this action opens the admission reconciliation record if the user has the ability to edit, then when the record is opened, all fields will be editable if the user does not have the ability to edit, then when the record is opened, all fields will be in read only if the user does not have the ability to sign, then when the record is opened, no signing options will be made available when there is no assignee, i e , the record is not assigned to anyone for signing, then all users with permission to edit can open and edit the record when there is an assignee, i e , the record is assigned to someone or a signing group, only the assignee or a user belonging to the assigned group can open and edit the record delete this action is available from the actions drop down it is available for users with roles that have permissions to create and edit, delete, and sign an admission reconciliation record this action is available in any status of the record except when the record is in the complete status this action triggers a confirmation modal and after the action is confirmed, it removes the record from the table role action logic the table below summarises the expectations around the various role actions table 2 role action logic for performing medication reconciliation actions users med rec med chart can edit can prescribe can create new order nurse/doctor or role permitted actions use case 1 yes yes no no no no they will have access to the med reconciliation view from the patient's medical record and launch the admission reconciliation window they will automatically have the view access to the admission reconciliation table in the admission reconciliation window the create new button should be disabled the open action should always be enabled and the record will be opened in read only view the delete action should be disabled medications will not be loaded to medchart during the authorisation process they will not have access to view the medications loaded to medchart once the reconciliation process is complete use case 2 yes yes yes no no no they will have access to the med reconciliation view from the patient's medical record and launch the admission reconciliation window the create new button can be enabled or disabled enabled if there are no records created yet enabled if all of the records in the record table are completed disabled if there is an admission reconciliation record in progress the open action should always be available, and the record can be opened in edit view or read only view in edit view when the record is in draft in edit view when the record has been submitted for review and the user accessing it is the assignee for reviewing in read only view when the record is signed as reviewed in read only view when the user accessing the record is the one that has submitted the record for review or authorisation and they are not the one that the record has been assigned to for review in read only view when the user accessing the record is the one that signed the record as reviewed in read only view when the record is completed the delete action can be enabled or disabled enabled always enabled for all users with the above mentioned action roles and regardless if the user , who has submitted the record for review or authorisation, is the assigned user or has signed the record as reviewed disabled for all users with the above mentioned action roles when the record is completed medications will not be loaded to medchart during the authorisation process they will not have access to view the medications loaded to medchart once the reconciliation process is complete use case 3 yes yes yes yes yes yes they will have access to the med reconciliation view from the patient's medical record and launch the admission reconciliation window the create new button can be enabled or disabled enabled if there are no records created yet enabled if all of the records in the record table are completed disabled if there is an admission reconciliation record in progress the open action should always be available, and the record can be opened in edit view or read only view in edit view when the record is in draft in edit view when the record has been submitted for review and the user accessing it is the assignee for reviewing in edit view when the record has been submitted for authorisation and the user accessing it is the assignee for authorisation in read only view when the record is submitted for review and the user is not the assignee for reviewing in read only view when the record is signed as reviewed and the user is not the assignee for authorisation in read only view when the user accessing the record is the one that has submitted the record for review or authorisation and he is not the one that the record has been assigned to for review or authorisation in read only view for when the user accessing the record is the one that signed the record as reviewed and they are not assigned for authorisation in read only view when the record is completed the delete action can be enabled or disabled enabled anyone who has the ability to create and edit automatically has the ability to delete disabled once the record is marked as completed it cant be deleted medications will be loaded to medchart during the authorisation process they will have access to view the medications loaded to medchart once the reconciliation process is complete navigation when the admission reconciliation record is opened for editing note when the admission reconciliation record is opened for editing in the admission reconciliation window in profile, the user cannot go back to the table view in a direct way to navigate back to the table page from a record page in edit mode, users need to close the current admission reconciliation window starting a new admission reconciliation record the following steps are required to start a new admission reconciliation record creating a new record click on the create new button to create a new record it's important to note that this button is disabled if there are any admission records currently in progress a new modal window launches, prompting the user to create the 'shell' for the new record you will be asked to enter a unique record name for the admission reconciliation description this is required it is important to note that a default name will be displayed with "\<patient name> \<current date>" this is a mandatory field all characters are allowed the name must be a minimum of two characters; maximum number of characters is 250 the name must be a unique description, different from any existing active records created the system validates this to ensure that the same description does not already exist if the description given already exists, the following validation error message is displayed 'record with that name already exists please use a unique one' there is an option to load initial medication list from the drop down with the same name it's important to note that this is not a mandatory field the usual scripts option takes the medications from the usual scripts list from profile's script feature not making a selection from this drop down is also possible however, if no option is selected (at this time), it cannot be loaded after the fact once all of the fields in the modal are completed, click on the create button this will launch the user into the admission reconciliation record where the workflow begins click the add medications button to add medications in the manner you specified previously if medications are imported via usual scripts, they are automatically validated if fields such as dose, frequency, and route are incomplete, but required per the preferences specified at preferences/scripts and instructions/interface , then they fail validation for example, if a usual script is imported without a route, users are required to fill out the route field before proceeding medications that fail validation open in a dedicated update medication details modal window, prompting the user to complete required details before proceeding once missing details are completed, a confirmation modal appears, confirming that the medication has been saved successfully, and the medication now appears in the incomplete section of medication reconciliation for further assessment adding a medication list to the admission reconciliation record once a user has created a blank new record, they can begin adding or editing the medication list it is important to note that if no medications were pre loaded (see step 4c in the creating a new record docid\ x5ygt7otdwhuqpq2rdhab section above) the user can start adding medications one by one all medications added to the medication list will appear in the left hand panel of the screen medications from this list that have not been validated and assessed will be considered incomplete this means that a care team member has not captured all of the required information to validate the medication and/or assess if the medication needs to be part of inpatient treatment at anytime, if a user needs to remove a medication from the list, they can click on the delete icon next to the medication, as shown in the image below steps to add medications to the list the user needs to click on the add medication button choose either the add formulary or the ad hoc options adding medication from the formulary when adding medication from the formulary, the user will be prompted to select a commercially available strength medication user enters the medication in the search field three characters must be entered for the search to return any results the search will be presented in the left hand view the right hand view will display the highlighted or selected medication, as well as the following selected medication name, strength, and form the generic equivalent a list of available templated instructions (recorded in the formulary) it is important to note that this list may include none an add new button that allows users to enter a new set of instructions from scratch if a user chooses to enter a new set of instructions , they will click the add new button a new modal will open, and will prompt them to enter the new instructions to be recorded for the selected medication the new instructions will not be recorded in the formulary the new instructions will include fields listed in table 3 formulary new instructions fields and logic once a user enters mandatory fields, they can click ok users can otherwise click cancel , which will take them back to the formulary screen to select a templated instruction , users can select the applicable instruction a checkmark will be displayed beside the selected instruction user clicks on ok and medication and instructions will be added to the admission reconciliation medication list table 3 formulary new instructions fields and logic field name optional (o) / mandatory (m) field type logic take m text field the input will prevent the user from typing when 250 characters are reached for medications selected from the formulary, this field will be populated with selected medication name, strength and form for ad hoc medications, the following will be true blank by default this field is mandatory all characters are allowed max characters are 250 error message for a required field "please enter name " error message for minimum added characters "the name must be at least 2 characters " error message for maximum added characters "the name may not exceed 250 characters " dose type o drop down list normal option is shown by default options taken from profile emr (short codes prn o checkbox not checked by default dose unit m text field can contain only numbers, decimals or range, ex 1 7 blank by default error message for a required field "please enter dose unit " error message for minimum added characters "the name must be at least 1 character " error message for maximum added characters "the dose unit may not exceed 250 characters " the input will prevent the user from typing when 250 characters are reached dose measure m drop down list options are taken from profile select placeholder shown by default predictive text matching applies as the user types (profile 10 0 3 onwards) error message for a required field "please select dose measure " frequency m drop down list options are taken from profile select placeholder shown by default predictive text matching applies as the user types (profile 10 0 3 onwards ) free text additions are also supported for this field and the entered input is saved (profile 10 0 3 onwards ) error message for a required field "please select frequency " route o drop down list options are taken from profile select placeholder shown by default predictive text matching applies as the user types (profile 10 0 3 onwards ) error message "please select route " for a required field if either of the following is true profile version is 10 0 5 or later, but less than 10 0 8 profile version is 10 0 8 or later, and "allow blank route for all prescription ordering (prior + med chart)" at preferences/scripts and instructions/interface tab is not checked do not use structured directions, use dose directions only o checkbox not checked by default when selected, it disables and clears the dose type drop down list, prn checkbox, dose measure ’ drop down list, frequency ’ drop down list, and the route drop down list dose directions mandatory once the do not use structured directions, use dose directions only checkbox is selected free text field enabled and optional if do not use structured directions, use dose directions only checkbox is not selected the text from the field will be appended to the newly created instruction or as a stand alone new instruction all characters are allowed max characters are 500 error message for a required field "please enter dose directions " error message for minimum added characters "the dose directions must be at least 2 characters " error message for maximum added characters "the dose directions may not exceed 500 characters " the input will prevent the user from typing when 500 characters are reached adding an ad hoc medication when adding an ad hoc medication from the formulary, a modal will be displayed for users to enter the non formulary medication the modal will include fields listed in table 3 formulary new instructions fields and logic docid\ x5ygt7otdwhuqpq2rdhab , as seen above capturing historical information for patient's medication list part of the medication reconciliation workflow consists of obtaining/validating historical information regarding each medication itemised in the list the validation section will include the fields listed in table 4 validation section fields and logic docid\ x5ygt7otdwhuqpq2rdhab , below table 4 validation section fields and logic, below field name optional (o) mandatory (m) field type logic started o calendar picker with a checkbox called a pprox date? future date cannot be selected date can be selected, and the checkbox approx date? can be selected alongside the date, or as a stand alone if only the checkbox approx date? is selected and no date is selected, then only approx date? will be shown in the started input last ordered o calendar picker future date cannot be selected v alidation provided by o drop down list of options options include patient guardian clinician unable to verify only one option can be selected from the options ordered by o free text field all characters are allowed max characters are 250 current state m drop down list of options and a checkbox called with med container? options include taking as prescribed taking with modified instructions no longer taking unable to verify with med container? when the option unable to verify is selected, then the checkbox with med container? is not applicable (disabled) last taken at o calendar picker with a checkbox called approx date? future date cannot be selected date can be selected, and the checkbox approx date? can be selected alongside the date, or as stand alone if taken differently, please specify mandatory only when taking with modified instructions is selected in the current state field free text area all characters are allowed min character is two; max characters are 500 notes o free text area all characters are allowed max characters are 500 assessing medication for in patient medication treatment once the medication has been validated with all of the historical information (see the "patient's medication reconciliation listing page" docid\ x5ygt7otdwhuqpq2rdhab section of this article) the medication now needs to be assessed as to whether it should be continued as part of the in patient treatment this is the section that determines if the medication will be applied to the patients medchart and careflow for administration (see the "medchart" docid\ x5ygt7otdwhuqpq2rdhab section of this article below) the assessment section will include the fields listed in table 5 assessment section fields and logic, below table 5 assessment section fields and logic field name optional (o) / mandatory (m) field type logic medication plan m drop down list options include continue on medchart as recorded this option is selected if the patient is to continue taking the medication exactly how it has been entered in the validation section once selected, it adds the medication item to the continue section of the left side panel continue with modification this option is selected if the patient is to continue the medication but the directions need to be modified slightly (i e dose increased from 1 tablet to 2 tablet) once selected, it triggers the new instructions modal once finished with the modal, the medication item is added to the continue section of the left side panel and the medication instructions are crossed out discontinue this option is to be selected if the medication is not required to be continued as part of the inpatient treatment once selected it adds the medication item to the discontinue section of the left side panel and the original medication description and medication instructions are crossed out replace medication from formulary this option is to be selected if the patient is to continue medication therapy but doctor wants to do a therapeutic substitution and switch to a medication from the formulary once selected, it triggers the formulary modal once finished with the modal, the medication item is added to the new section of the left side panel and the original medication description and medication instruction are crossed out under the new medication description and medication instruction replace medication from ad hoc this option is to be selected if the patient is to continue medication therapy but doctor wants to do a therapeutic substitution w/ a non formulary medication once selected, it triggers the ad hoc medication modal once finished with the modal, the medication item is added to the ‘new’ section of the left side panel and the original medication description and medication instruction are crossed out under the new medication description and medication instruction only one option can be selected from the options at a time completing the validation and assessment of the entire medication list as each medication item gets reviewed, validated and assessed, the information on the left hand panel will reflect the changes the left hand side is grouped into four sections based on the assessment status incomplete all the medication items added when creating the new admission reconciliation record for the selected usual scripts option and/or added through the ad hoc option and formulary option, are listed under the incomplete section continue when a medication item assessed to be continue on medchart as recorded or continue with modification discontinue when a medication is assessed to discontinue new when a medication is assessed to be replace medication from formulary or replace medication from ad hoc this left hand panel is a good view to review the completion of the list if a user wished to delete a medication that was added to the list, they can click the delete icon and delete the medication from the list a verification message will be displayed to confirm the delete action saving (as a draft) users can save the current state of the admission reconciliation record page by clicking the save button at the bottom of the page a record can only be saved by a user with the appropriate role action see the "set up role actions" docid\ jqnurrfmfzw4taw mcoaa section of the how to configure and setup the inpatient admission medication reconciliation feature in profile article saving the record assumes it is not ready to submit for review or approval (see "stage 2 submitting or signing the admission reconciliation record section below) if the system is unable to save, an error will be displayed stage 2 submitting or signing the admission reconciliation record submitting the admission reconciliation record for review submitting an admission reconciliation record for review assumes a two factor signature is required for approving a medication reconciliation record, as inpatient homes often require a nurse or non provider to review the medication list, validation and assessment entered per medication note if a review signature is not required or needs to be bypassed, there is a process for this users can select the send to provider option to submit an admission reconciliation record, the following steps need to be followed user will click on the submit button and select send for review it's important to note that all medications need to be validated and assessed before the submit button is enabled (see above sections on "assessing" and "validating" medications docid\ x5ygt7otdwhuqpq2rdhab in this article, above or read "step 3 " and "step 4 " docid\ efzr4polc23wywhlc6woq in the how to launch, create a new record, add and assess medications in profile's admission medication reconciliation feature) article a modal will appear prompting users to select the individual reviewer or reviewer group who will be performing the review the reviewer drop down list will contain only users or groups with signing permission for review groups created under the type medication review group will be listed, as will each group member individually (see the "setting up signing groups" docid\ jqnurrfmfzw4taw mcoaa section of the how to configure and setup the inpatient admission medication reconciliation feature in profile article) groups that have no members added (empty groups) will not be listed as an option user will click on send for review once this is done, a task will automatically be created in profile for the selected nurse or group (see the "auto creation of tasks" docid\ x5ygt7otdwhuqpq2rdhab section of this article, below an admission record set for review notification will appear user will be prompted to click ok the user will be navigated to the home table for medication reconciliation feature shown in "the patient's medication reconciliation listing page" docid\ x5ygt7otdwhuqpq2rdhab section of this article sign as reviewed before sending to provider (co signature) when a nurse receives a task to review a patient's reconciliation, they can navigate to the appropriate patient's medication record (manually by going to clinical / med reconciliation or by clicking the link from the task) the medication reconciliation record will be seen in a pending review status the following steps need to be followed user will click on the ellipses icons from the actions column and select open the user can edit the record if needed if the record is ready to be signed as reviewed, the admission nurse will click on the sign as reviewed button this action assumes that the record has been reviewed for its completion and accuracy and is now ready for final signature by the prescribing provider) clicking the sign as reviewed button triggers a two step process (in following sequence) sign as reviewed user will be prompted to enter their profile username and password once successfully validated the user will be prompted to complete the next step to submit for authorisation once the two steps are completed, the reviewed by and date column is populated with the user's name, date and time of signing as reviewed the user who completed the review will be required to go to the task that was created for them, and mark the status as completed submit to provider if the admission reconciliation was initially signed as reviewed or if the review was bypassed, the final step to complete this record is to submit the record to the provider for final approval the user must select who will be the approver of the final medication reconciliation record and approve the medications that should be continued for inpatient care the groups created under the type medication signing group will be listed in the drop down along with the group members all members will be listed individually (see the "setting up signing groups" docid\ jqnurrfmfzw4taw mcoaa section of how to configure and setup the inpatient admission medication reconciliation feature in profile article) empty groups that have no members added will not be listed as an option a task will be created for the provider or group (group members) in profile (see the auto creation of tasks docid\ x5ygt7otdwhuqpq2rdhab section of this article below) note when a group is selected, tasks are sent to all group members any member that received the task can sign the admission reconciliation, as authorised if a member accessed the admission reconciliation and it has already been signed as authorised by another member, then they should see the record in read only view, and their task will be automatically closed 3 the status of the record is changed to ready for provider signature note if there was an error during the signing and or submitting the record for review, an error message will be displayed to the user like the ones below provider's signature the final authorisation of medications when a provider receives the task to perform a final approval of a patient's reconciliation, they can navigate to the appropriate patient's medication record manually by going to clinical / med reconciliation or by clicking the link from the task the medication reconciliation record will be shown in a ready for provider signature status the steps for completing a provider signature are as follows provider will navigate to the patient's admission record table page and click on the ellipses icon from the actions column and select open the provider can edit the record if needed the provider can click on the first sign as authorised button doing so will trigger the following a modal will open, and the provider you will be prompted to enter their profile username and password they must then click on the sign as authorised button if successfully validated, the admission reconciliation record will be marked as completed and the continued medications will be applied to the medchart as authorised prescriptions the system will also allow providers to sign a record that includes no medications and or no medications that are to be continued for patient's inpatient care note if there was an error during the signing and or submitting of the record for review, an error message will be displayed to the user auto creation of tasks upon submitting the admission reconciliation for review and or final approval, a task will be auto created for the individual or group selected when a group is selected, tasks are sent to all group members any member that received the task can review the admission reconciliation if a member accessed the admission reconciliation and it has already been reviewed by another member, then they should see the record in read only view, and their task will be automatically closed when a task is sent to the group (if group is selected for reviewing or group authorisation), in order to see the task in their task list window in profile, the users need to set a task filter with the holder option set to me and my groups table 5 task properties task properties expected value when auto created subject admission reconciliation \[description name] holder drop down if group is selected = group if user provider/user text field name or group patient patient name due date of creation status pending creator default to user who has submitted request priority high explanation and links link to the admission reconciliation tab for patient example of a task sent to group for reviewing example task sent to individual reviewer example task sent to provider load to medchart after the admission reconciliation is signed as approved by the provider, the admission reconciliation medication list is loaded to the patient's medchart in profile author column should list the name of the user that edited the admission reconciliation list orderer column should list the name of the user that signed the admission reconciliation as approved signed by column should list the name of the user that signed the admission reconciliation as approved signed column after the provider signs the admission reconciliation as approved and the medication list from the record is loaded to medchart, the value in this column should change from no to yes learn more for more information on profile's inpatient admission medication reconciliation featureplease click on the article links below start admission medication reconciliation in profile docid\ efzr4polc23wywhlc6woqsubmit or sign the admission reconciliation record in profile docid\ ap4azbx8csbjwhvuqxozyconfigure and setup the admission medication reconciliation feature in profile docid\ jqnurrfmfzw4taw mcoaafaqs admission medication reconciliation docid\ c3uttcinfw0eqgyiuglvgprofile's admission reconciliation feature docid\ slyqibth24jmy5c eg2m