Meds Tab

PATH:
Patients
>
Patient Encounters
>
Meds Tab
ROLE PRIVILEGES NEEDED: <udl-white>Medication Kits<udl-white> | <udl-white>Approve Patient Medication<udl-white>
RULES: <udl-white>Medication Comments Required<udl-white> | <udl-white>Medications - Approved By - Required<udl-white> | <udl-white>Medications - Ability To Add NDC<udl-white> | Medication Approval Signature Required

SETUP: <udl-white>Medication Kits<udl-white>

ADD MEDICATION | ADD MEDICATION KIT | PRINT MEDICATION PROFILE | APPROVE MEDICATION PROFILE  | MED ADMIN | MED TAKEN  | FAX MEDICATIONS  | APPROVAL HISTORY  | STATUS   | APPROVE MEDICATIONS TAKEN  | ADMIN HISTORY | MASS INACTIVATION  | EDIT MEDICATIONS | DISCONTINUE MEDICATIONS (ONE AT A TIME) | WARNINGS  | FOOD INTERACTIONS | VIEW CONTACT INFO  | NATIONAL DRUG CODE (NDC)  | NOTE ICON | DROP DOWN ITEMS | SIDE EFFECTS | PHARMACOLOGY | PATIENT EDUCATION | PATIENT EDUCATION (SPANISH) | MANAGE HOLD HISTORY | ADD NDC | EDIT NDC | PRINT MEDICATION   | DELETE MEDICATION  | DRUG TO DRUG INTERACTIONS | ADDING MEDICATIONS NOT IN DATABASE  | QUIZ

For patient medications, go to Patients > Patient Encounters > choose your patient > go to the Medications tab.  Here you have the following options:

ADD MEDICATION<returntomenu>menu↑<returntomenu>  

When adding medications to the Medication Tab, select the <icon-greenplussign>xxx<icon-greenplussign> <udl-orange>Add Medication<udl-orange> link.

This will bring up the medication entry screen.  Enter the type of order that you are adding

Enter the description of the medication and select enter.  This will bring up a list of medications in the Drug Database to choose from.  If you do not find the drug in the database please see the link below regarding adding medications not in the drug database.  

Enter the Dosage (this should auto-populate from the medication you chose...

Patient Dosage and Frequency...

Route...

Quantity...

Start Date...

End Date if you are discontinuing the medication...

Type, which includes:

Prescribed by...

Administered by, which includes:

Comments / Reason For Med...

You can add comments if needed regarding the medication such as "PRN SOB", Prescription numbers, etc.

Pharmacy...

NOTE: You must have the vendor on the Clinical Tab as a Pharmacy or DME company in order to choose them as an option when adding meds.

Physician Notified (if not the certifying physician)...

Approved by (this would be the nurse that is adding the medications).  

Indicate if you would like to generate an Interim Order for this medications...

Add your effective date for the medication

and either <btnw>    Save/Add    <btnw> more meds... OR <btnw>    Save/Close    <btnw> 

ADD MEDICATION KIT<returntomenu>menu↑<returntomenu>  

To add a medication Kit by selecting the link <icon-greenplussign>xxx<icon-greenplussign> <udl-orange>Add Medication Kit<udl-orange>.

  1. Medication Kit - Select the Medication Kit from the drop down
  2. Medications - Update medications information as necessary  for the Patient (you can remove medications from the list, change dose, frequency, and/or route and type of medication  information)
  3. Entry Type - Select the type of entry from the drop down  list as necessary (defaults to New)
  4. Start Date - Enter a date when this patient will start taking the medications listed in the kit
  5. End Date
  6. Prescribed by - Select  the physician from the drop down list that prescribed the medications listed  in the kit (optional)
  7. Administered by - Select who is administering the medication  from the dropdown list (optional)
  8. Comments - Enter  the name of this kit in the“Comments” section (identifies the kit you used as a note for each medication listed within  the Medications profile; the comment also appears on physician orders)
  9. Pharmacy - Select  the Pharmacy that is filling the medications listed from the dropdown list (optional)
  10. Physician Notified - Select  the name of the physician that you notified about all the medications listed  from the dropdown list (optional)
  11. Approved By - Select  the name of the clinician that is approving the medications documented (optional unless you have an agency rule that  requires this)
  12. Hospice Covered - For Hospice, indicate whether or not the medications are "Hospice Covered".
  13. Create Interim Order - Check the box to create an interim order only  if the medications are not on the original physician orders for the certification period (optional)
  14. Cancel - Select cancel to cancel adding meds.

All medications that were part of the Medications Kit  display in the Medications profile.    You can edit/change/end each individual medication as necessary.  

PRINT MEDICATION PROFILE<returntomenu>menu↑<returntomenu>  

You can filter the medication information you want to print as well as fax to other entities (i.e., physician, facility, etc.).  Items that you can choose to send include:

To print this report, select the <icon-printer>xxx<icon-printer> <udl-orange>Print Medication Profile<udl-orange> link.

Select the <btnw>   Export   <btnw> button when you have finished setting all of your options. The report displays on your screen.   You can print/save this report using your  browser functions.

You can also filter by a date if you want to print/fax a listing of more current medications.   Click here to learn more about Printing/Faxing Medication Profile.

APPROVE MEDICATION PROFILE<returntomenu>menu↑<returntomenu>  

When the nurse has completed the medication profile, she can approve it by selecting <icon-positive>xxx<icon-positive> <udl-orange>Approve Medication Profile<udl-orange>.  This will take a screen shot of the medication profile at the time of approval.

There is a certification statement that you agree to when you sign the Medication Profile.  This statement appears with you signature when you view the "Approval History".

From here you will choose your name as approving the profile.

Select <udl-orange>Enter Approval Signature<udl-orange> to add your signature.

Select <btnw>    Accept    <btnw> to add your signature.  Click here to learn more about Associate Signature Application

Enter any comments needed regarding this.

Indicate whether or not you would like to create an interim order for you Major Drug Interactions.

Enter an effective date for your approved medication profile

Select <btnw>    Save   <btnw> when finished.

To remove an approval signature, select <udl-orange>Remove Approval Signature<udl-orange>.

MED ADMIN<returntomenu>menu↑<returntomenu>  

Click here to learn more about Medication Administration

MED TAKEN<returntomenu>menu↑<returntomenu>  

Click here to learn more about Meds Taken

FAX MEDICATIONS<returntomenu>menu↑<returntomenu>  

You can fax a list of a patient’s current medications to a physician, facility or other entity/individual that is requesting this information, directly from the Patient Encounter file.  To fax the medications list, select the <icon-fax>xxx<icon-fax> <udl-orange>Fax Medications<udl-orange> link.

Select the drop down <btn>   Louisiana Labour of Love       ▾   <btn> to the right of Agency to select your agency (only if you have more than one agency; defaults to the first agency in the list).

Select a physician or facility from the dropdown list to send a fax (physicians must be set up on the “Phys/Fac” tab for them to show up on in the dropdown list; all physicians/facilities must have a fax number), or you can enter a name in the “To the Attention of” field

Enter a fax number if necessary (fax numbers display if you select a physician or facility from the dropdown list)

Check (or remove the checkmark) to include/exclude the cover page (defaults to “include”)

Enter text for the cover page (only if you intend to send a cover page; otherwise leave blank)

Select the <udl-orange>Medications List Fax Pdf<udl-orange> link if you want to view the document before you send the fax

Select the <btnw>    Send Fax    <btnw> button to send the fax or select the <btnw>   Close   <btnw> button if you do not want to send the fax at this time.

After you send a fax, the “Meds” tab displays. Additionally, “Faxed document” and “Uploaded Document” note types display with a link to view the document you faxed.

If you want to view a fax that you previously sent within the faxing option:

APPROVAL HISTORY<returntomenu>menu↑<returntomenu>  

To see a history of the medication approval, select the drop down to the right of "Approval History" (will not show up unless there is a history).  

You will see a list of Approved Medication Profiles to choose from.  Choose the one that you desire to see.

Choose which options you would like to see in the approval history and <btnw>    Export    <btnw>. This will bring up a PDF file of the profile and list the associate that approved it and the date it was approved as well as what the profile looked like when approved.

STATUS<returntomenu>menu↑<returntomenu>  

If you choose the drop down <btn>   Active       ▾   <btn>, to the right of "Status" you will be able to see that you can filter the medications by "All", "Active" or "Inactive".

APPROVE MEDICATIONS TAKEN<returntomenu>menu↑<returntomenu>  

Select the link for <icon-positive>xxx<icon-positive> <udl-orange>Approve Medications Taken<udl-orange> to approve the medications taken.

There is a certification statement that you agree to when you sign the Medication Profile.  This statement appears with you signature when you view the "Approval History".

Choose the month that you want to approve medications taken

Indicate whether you want to "Include No Responses".

Select <udl-orange>Enter Approval Signature<udl-orange> to add your signature.

Select <btnw>    Accept    <btnw> to add your signature.  Click here to learn more about Associate Signature Application

Enter any comments needed regarding this.

Select <btnw>    Save   <btnw> when finished.

To remove an approval signature, select <udl-orange>Remove Approval Signature<udl-orange>.

ADMIN HISTORY<returntomenu>menu↑<returntomenu>  

Select the drop down to the right of Approve Medication Taken History to review the approval history.

Choose the approval history that you would like to view.

ADMIN HISTORY REPORTS<returntomenu>menu↑<returntomenu>  

Admin History <btnw>   PDF     ▾  <btnw> view which includes:

Admin History <btnw>   Spreadsheet     ▾  <btnw> view which includes:

Select the <btnw>   Export   <btnw> button when you have finished setting all of your options.

MASS INACTIVATION<returntomenu>menu↑<returntomenu>  

You can quickly inactivate (DC) multiple medications with the same date and create an interim order.   Select the <icon-greenplussign>xxx<icon-greenplussign><udl-orange>Mass Inactivate<udl-orange> link.

Enter an “end” date for all medications you want to inactivate and select one/multiple medications listed (defaults to all,  but you can pick which ones you want to inactivate on the same date you entered), check the box to create an Interim Order as necessary. Change the effective date of the interim order (defaults to current date; typically this will be the same date as the “end” date [or prior]) and select the <btnw>    Save    <btnw> button.

EDIT MEDICATIONS<returntomenu>menu↑<returntomenu>  

The medication link <udl-orange>acetaminophen-oxycodone...<udl-orange> allows you to make changes to the current medications.

Select <btnw>    Change Medication/Dosing    <btnw> .  

Once you click this, the "Entry Type" will change to "Changed" and the "Approved By" will change to the logged in user.

To change the medication, you can leave the Entry Type as changed.  Make the necessary changes and select <btnw>    Save Medication/Dosing  <btnw> when finished.

DISCONTINUE MEDICATIONS (ONE AT A TIME)<returntomenu>menu↑<returntomenu>  

To DC a medication, select the medication link <udl-orange>lisinopril(prinivil) tablet<udl-orange> to be discontinued.

To discontinue the medication, change the Entry Type to "Discontinued", enter the end date for the medication and if you need an interim order created for either order, select "Create Interim Order" and then select <btnw>    Save Medication/Dosing    <btnw> .

Whether you just changed the med or discontinued the med, you can also see both "Inactive" drop down.  If you made a change, the new change will be located under the active medications.

WARNINGS<returntomenu>menu↑<returntomenu>  

If you select the Warning <icon-warning>xxx<icon-warning> icon to the right of the medications as below, it will bring up a list of warnings for the drug as below.

FOOD INTERACTIONS<returntomenu>menu↑<returntomenu>  

If you select the Interactions <icon-asterisk>xxx<icon-asterisk> icon here to the right of the medication it will bring up a list of food interactions for the drug as below. </icon-asterisk>

VIEW CONTACT INFO<returntomenu>menu↑<returntomenu>  

Select the address book <icon-addressgray>xxx<icon-addressgray> to the left of the physician will bring up the physician's contact information.

Select the address book <icon-addressgray>xxx<icon-addressgray> to the left of the pharmacy will bring up the pharmacy's contact information.

NATIONAL DRUG CODE (NDC)<returntomenu>menu↑<returntomenu>  

Some locations want to cross reference the National Drug Code (NDC) with medications that a Patient is taking. You can now add the appropriate National Drug Code (NDC) to the Patient Encounter.  Before you can include the National Drug Code (NDC) as part of the Patient's medication profile, you must first activate the agency rule. After you activate this Agency rule, you will see a new column in the medications profile labeled "NDC". See below to Add/Edit/Remove NDC.

This column lets you know if a National Drug Code (NDC) exists for the medication(s) listed. Responses in the column are "Yes" if an NDC exists or "No" if you have not added the NDC. If you hover over the "Yes" response, you will see the NDC number you attached. Additionally, you have links available that let you add/edit the National Drug Code (NDC) for any/all medications that you previously documented within the medications profile.

NOTE ICON<returntomenu>menu↑<returntomenu>  

To see "Comments" entered for medications, hover over the <icon-noteyellow>xxx<icon-noteyellow> icon.

A popup will display with the information contained within the medications comments section.

DROP DOWN ITEMS<returntomenu>menu↑<returntomenu>  

The Drop Down option includes:

To the left of the printer icon, select drop down <icon-action>xxx<icon-action> icon.

SIDE EFFECTS<returntomenu>menu↑<returntomenu>  

A PDF of the <icon-se>xxx<icon-se> <udl-orange>Side Effects<udl-orange> ...

PHARMACOLOGY<returntomenu>menu↑<returntomenu>  

A PDF of the <icon-redpill>xxx<icon-redpill> <udl-orange>Pharmacology<udl-orange>...

PATIENT EDUCATION<returntomenu>menu↑<returntomenu>  

A PDF of the <icon-pted>xxx<icon-pted> <udl-orange>Patient Education<udl-orange>...

PATIENT EDUCATION (SPANISH)<returntomenu>menu↑<returntomenu>  

A PDF of the <icon-pted>xxx<icon-pted> <udl-orange>Patient Education in Spanish<udl-orange> 

MANAGE HOLD HISTORY<returntomenu>menu↑<returntomenu>  

You can put a medication “on hold” if the Patient does not need to take the medication for a short period of time and will eventually resume taking the medication based on physician’s orders.  Select the <udl-orange>Manage Hold History<udl-orange> link from the pop-up list

Enter a “start” date for when the patient temporarily stops taking the medication and or “end” date for when the patient will resume taking the medication (you can leave this blank if it is unknown at this time; you will be able to edit the information as necessary)

Enter any comments explaining why the medication is not being taken at this time

Check the box to create an Interim Order as necessary

Enter a date that the Interim Order (defaults to current date; typically this will be the same date as the hold “start” date [or prior]) and select the <btnw>    Save    <btnw> button

After you enter the “hold” start date, you will see this information display within the following areas of the application:

If you need to edit the “hold” information, select the <udl-orange>Manage Hold History<udl-orange> link from the pop-up list

Select the “Edit Hold” <icon-greenpencil>xxx<icon-greenpencil> icon to make changes to the existing information

Make any changes as necessary including updating the “end” date and comments and select the <btnw>    Save    <btnw> button

If you need to put a medication on hold for a subsequent timeframe, select the <udl-orange>Manage Hold History<udl-orange> link from the pop-up list

Select the <udl-orange>Add new hold dates<udl-orange> link from the history pop-up

Enter a “start” date for when the patient temporarily stops taking the medication and an an “end” date for when the patient will resume taking the medication (you can leave this blank if it is unknown at this time; you will be able to edit the information as necessary). Enter any comments explaining why the medication is not being taken at this time. Check the box to create an Interim Order as necessary. Enter a date that the Interim Order (defaults to current date; typically this will be the same date as the hold “start” date [or prior]) and select the <btnw>    Save    <btnw> button

ADD NDC<returntomenu>menu↑<returntomenu>  

Select the <udl-orange>Add NDC<udl-orange> link from the pop-up listing (Add NDC pop-up displays; Search field displays the name of the medication with a listing of all possible NDC's to select)

Check the box next to the product name that has the NDC you want to assign

Select the <btn>   Save   <btn> button (attaches the NDC you selected to the medication)

When the <udl>Meds<udl> tab redisplays, the "NDC" column will say "Yes" for that medication. Hover over the "Yes" response to see the NDC you added

EDIT NDC<returntomenu>menu↑<returntomenu>  

To edit an existing Nation Drug Code (NDC), use the following path, select the <udl-orange>Edit NDC<udl-orange> link from the pop-up listing (Edit NDC pop-up displays; Search field displays the name of the medication; the grid shows the response you previously selected)

Remove the medication listed in the "Search" field

Enter any portion of the first word that appears in the medication description (i.e., Amiodarone 100 mg oral tablet, enter "amio"; grid displays all available NDC's for amiodarone)

Check the box next to the product name that has the NDC you want to assign and select the <btn>   Save/Close   <btn>  button (attaches the new NDC you selected to the medication)

When the <udl>Meds<udl> tab redisplays, hover over the "Yes" response to see the new NDC you added.

To delete the NDC you previously attached to a medication, select the <udl-orange>Edit NDC<udl-orange> link from the pop-up listing (Edit NDC pop-up displays; Search field displays the name of the medication; the grid shows the response you previously selected)

Remove the checkmark from the Product Name/NDC your previously added

Select the <btn>   Save/Close   <btn>  button (removes the NDC you previously attached to the medication)

When the <udl>Meds<udl> tab redisplays, the NDC column will show "No" for this medication.

PRINT MEDICATION<returntomenu>menu↑<returntomenu>  

The Printer <icon-printer>xxx<icon-printer> icon allows you to print out the following information for the medication.</icon-printer></icon-printer>

Select the <btnw>   Export   <btnw> button when you have finished setting all of your options.

DELETE MEDICATION<returntomenu>menu↑<returntomenu>  

If the medication is not associated with an order, and you need to delete it, select the Trash Can <icon-trashcan>xxx<icon-trashcan> icon

DRUG TO DRUG INTERACTIONS<returntomenu>menu↑<returntomenu>  

Once you have entered several medications, you will now see "Drug to Drug Interactions" at the bottom of the Medications Tab.  You can filter by selecting the drop down <btn>   All     ▾   <btn> under Severity

If you hover over the interactions <icon-paper>xxx<icon-paper> icon to the right of the interaction, you will get a pop-up that gives you the drug to drug interactions.

ADDING MEDICATIONS NOT IN DATABASE<returntomenu>menu↑<returntomenu>  

Add your medication as you normally do but when you search, you will not find the medication in the drop down menu.  Here I have added oxygen as it is not currently in the drug database.  You can see that it did not pop-up in the drop down.

Fill out the remainder of your medication entry screen and select either <btnw>    Save/Add    <btnw> or <btnw>    Save/Close    <btnw>

You will get an alert "The medication you entered cannot be found in the medication database".  You will also have a link to click <udl-orange>Click here to add an unknown medication to the Encounter<udl-orange>.  Select the link to add the medication.

You will now get a warning <color-red>Warning:  Adding this medication will disable warnings and interaction information<color-red>.  Select <btnw>    Save/Add    <btnw> or <btnw>    Save/Close    <btnw> to continue.  This does not disable all medication interactions, just the ones for the oxygen with other meds.

It will add your medication as follows:

Interactive Tutorial