Medication List Tool Changes Objectives:1. State the rationale for replacing PAML with

the new Medication List Tool (MLT).2. Describe features of the Medication List Tool

(MLT) and associated workflow.3. Understand implementation and support

plans VUH and VCH

Medication List Tool Changes

June 17 VUH

June 10 MCJCHV

Background Replacing PAML with the new Medication List Tool (MLT) in the Nursing Admission History 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 the medical center

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.

• ED and 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• Adult and Pediatric Nursing Admission

History is the next step. • Replace PAML with MLT

• Provider workflow will be part of future phases • Embedded in provider admission

process ie 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.

Med List Tool (MLT) will replace PAML in the Admission History

Current

New

Last completed list visible with date, time and collector included

The MLT Summary page will be displayed in the Admission History.

Click Edit to open the tool and make changes

I’ve already told someone the medications I’m taking and they

typed it in the computer.

Why are you asking again?

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 PAML 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) result in medication errors

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 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)

The problem(s)Too many different lists and difficult to know which one to

use/update

Existing tools do not meet provider and patient needs (too slow, systems don’t link, displays not user friendly, inadequate decision support, inconsistent use of lay language, lack of standardization)

No standard approach to collection, documentation, and communication of med lists across sites of care

Inefficient use of resources, potential for patient harm

How to use the MLT• We have established the reasons for taking a

home medication list• We have defined the best way to collect a

medication history (associated educational module)

• The next several slides will discuss details of how to use the new Med List Tool step by step

Ways to access the Med List Tool (MLT)

• MLT will be embedded in the Nursing Admission History• To initiate MLT click on

“edit” in the upper right corner of the list

• If the MLT needs editing after the admission history is completed, it can be accessed from the actions menu (more detail in upcoming slide)

Current Medication Reconciliation Tool PAML

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

NEW

New Medication List Tool MLT

The Med List Tool

Med appears with strikethrough

Click “X” to delete a med that is no longer being taken

Make a mistake? Note the undo icon

How to delete a medicationDelete Icon ->

Click Edit icon to edit medication information

Denote edits to dose, route, frequency, 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, 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 ie 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

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/ finalize

Icons & Displays

Click to display all comments. Click again to

hide commentsThe View icon displays detailed medication

information including hi

Edit

Click to display icons to print, show/hide comments or

display list of edits by visit

Delete

View

Accessing Med List Tool from StarPanel

Click Actions

Click Med List Tool

If the MLT needs editing after the admission history is completed, it can be accessed from the actions menu

Implementation & Support

• June 10 MCJCHV – June 17 VUH Medication List Tool will replace PAML in the Nursing Admission

History Medication List tool will be available from the Actions Menu &

OPC in Star panel

• Implementation Support

• System Support Services will provide 24h Support onsite X 4 days then via call to help desk

• System Support Staff will round on each of the units

Debriefing meetings will be held the first weekTime to identify and quickly address issues