About Admission Medication Reconciliation

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The first step in Admission Medication Reconciliation is to document the current medication history, including compliance and last dose information, on the Home Medications tab. Once the medication history is complete, the provider will complete Admission Medication Reconciliation. Your organization determines the communication method used to notify the provider that the medication history is complete. This notification may be a verbal hand-off or the user responsible for medication history documentation may send a to-do to the provider using a modeled form or send a message via the CareConnect Inbox. Alternatively, providers may look for compliance to be documented in the Home Medications tab.

Prerequisite:

Complete the Medication Reconciliation configuration.

Admission Medication Reconciliation tab

The Admission Medication Reconciliation tab is divided into three main sections.

Section 1 is a list of all the medications that have been recorded at time of admission. This includes both reported and prescription medications documented from previous admissions or as part of the outpatient programs.
Section 2 is called the Inpatient Medications Scratchpad. Any active orders form the Orders This Episode tab will populate here. While recommended practice indicates that no inpatient orders should be placed prior to when Admission Medication Reconciliation occurs, the reality is that client presentation may require it. These orders will populate this section with a defaulted action of 'CONT' for Continue.
Section 3 is the order details pane. Here users can place new orders for the inpatient stay and edit details for any orders on the Inpatient Medications Scratchpad.

Navigate the Admission Med Reconciliation tab

Users will review the Home Medications list and determine which orders should be added to the scratchpad for inpatient administration. Prior to loading the medication information, the system will check to determine if a match is available for each order in the Home Medications section. In the instance where the Action column is prepopulated with a NO MATCH indicator, this means the system was not able to safely identify a best match from the system. Those orders cannot be added to the scratchpad.

The user can select one or more orders in the Home Medications list to add to the scratchpad. Users can highlight multiple rows to be added by pressing and holding the Shift or Ctrl key. Once the orders are selected and highlighted in green, click Add to Scratchpad. At this point the system will start the process of converting the pre-admission medications to inpatient orders. Any dose conversion logic configured will apply here.

The following screen represents an admission reconciliation where every possible action has been recorded. The description for each action is shown here.

An inpatient order that was discontinued during medication reconciliation. To undo this action, highlight the row and select the Undo button beneath the Scratchpad.
An inpatient order that was modified during medication reconciliation. The original order indicated 40 MG BID and was updated to 80 MG BID. A modify action will discontinue the current inpatient order and place a new order with the new details.
These are orders that were added from Home Medications to the Scratchpad. The substitution icon with the Prevacid order indicates that a product substitution has occurred. Hover over the icon to see a notification and guidelines. Also note the 'missing details' flag indicates there are missing required details.
A home medication that was held during Admission reconciliation. This medication remains as an active home medication and is presented to the user at discharge. If the order should be end-dated completely, that can be done on the Home Medications tab outside of medication reconciliation. To undo a hold, select the Undo button in the Action column.
A new order added to the inpatient list of orders for administration in the facility.

Note: The Reconcile & Sign option is not available until all pre-admission medications have been designated as Add to Scratchpad or Hold. Additionally, any missing required details need to be completed prior to signing. During reconciliation, users will receive the same passive alerts indicating interactions as they do during order entry for both Orders This Episode and Home Medications. These alerts can be managed individually or at signing time.

Additional navigation

The arrow indicators in the middle of the left side of the window allow the user to fully expand the pre-admission medication list or the order details. Clicking once will expand the list up or down depending on the selection, clicking in the opposite direction will stop mid screen, and another click will expand full screen in the opposite direction.
The Restart Reconciliation button allows a user to restart a reconciliation. When selected, all current selections will be reset and the home and inpatient orders will be reloaded.
Partial reconciliation is not currently available in medication reconciliation. A user must take an action on all inpatient and pre-admission orders before restart reconciliation is available.
A nurse can perform an admission reconciliation on behalf of a physician by choosing the ordering physician at time of Reconcile and Sign. All order actions will still go to the physician for validation.
Order groups are not available to be added to the inpatient scratchpad during Admission Reconciliation.
Once Admission Reconciliation is complete, it cannot be redone. Any new additions to the home medication list will need to be added manually to the inpatient medication list If added to Home Medication list as well, these medications will be present for discharge reconciliation.
Users will be able to navigate to other areas of myAvatar and return to Admission Reconciliation with their work saved. However, should a user navigate to either Home Medications or Orders This Episode, they will be prompted that their work will be lost if they continue.
If a user navigates to another client and navigates back, they will be presented with a message indicating that new orders may have been added. They will be given the option to continue with their in-progress reconciliation or restart. If they choose to continue, any new inpatient or home medications will not be reflected in the orders presented for reconciliation.
When an external pharmacy is configured, additional details such as refills, days supply, and dispense quantity will also be required and or available during reconciliation.

Pre-Admission Episodes

Medication reconciliation can occur during pre-admission. This functionality was added specifically to support planned admissions where the medication history is captured prior to admission. In these instances, providers can finalize a medication reconciliation that can be activated later by the provider or nurse when the client is officially admitted to the facility. Activated orders will not require an additional physician signature unless the organization is using external pharmacy mode and controlled substances are being prescribed. In this case, two-factor authentication will be required prior to sending orders to the pharmacy. This option is only available for pre-admission episodes. There is no configuration required.

Pre-Admission

Admission (Pre-Activation)

Admission (Post-Activation)