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).