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Starting Continue Home Medications

To begin the process of continuing or changing a patient’s home medications during an emergency room visit:
  1. Select the patient from your Patient List tab.
  2. Start Continue Home Meds by either:
    • Selecting the Actions drop-down at the top right corner of the window, and then selecting Continue Home Meds under the Medication Reconciliation heading;
    • Clicking the Home Meds link in the center column, and then clicking Continue Home Meds button in the upper right corner of the Home Medications screen.
    • Clicking the Orders link in the center column, and then clicking the Continue Home Meds button in the middle of the Orders screen.
    • Selecting the Actions drop-down in the Patient Search tab after selecting a patient visit from the search results, and then selecting Continue Home Meds under the Medication Reconciliation header.
The Continue Home Medications window opens and displays any home medications. The most recent visit is selected in the Continue Home Meds for Visit field.

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Submitting Home Medications for an Emergency Room Visit

As part of the emergency room evaluation for a patient, you can choose to continue or change some or all of the patient’s home medications and add any additional hospital orders as follows:
  1. Review the list of medications under the Home Medications column and determine if you need to:
  2. Determine if you need to do any additional actions such as:
    • (Optional) Click the Show Clinical Data button to review any lab results, test results, or other patient data. See Displaying Patient Information in the Physician Portal User’s Guide for more information on all the available display options except for Home Meds and Discharge Orders. For information on the Home Medications link, see Viewing Home Medications in the Patient Data Display. For information on the Discharge Orders link, see Reviewing Discharge Orders in the Patient Data Display.
    To return to the list of home medications, click either the Return to Med Rec button in the upper right corner of the screen or the Continue Home Meds button in either the Home Medications or Orders screen.
  3. Review and then resolve any medication interaction warnings or alerts. See Reviewing Medication Interaction Pop-up Warnings and Inline Alerts
  4. Click Submit Orders. If your facility requires you to enter an additional electronic signature and/or if Co-Signature is implemented, you will see a Signature dialog display. Proceed to the next step; otherwise the Continue Home meds window closes and you are returned to the Patient Data Display window. All continued or changed home medications are then routed to appropriate destination (for example, a printer for future action) and also added to the patient’s Existing orders for the current visit list (click on the Orders link display).
  5. Enter one of the following depending on what Signature dialog displays:
    • Enter your password or PIN, and then click OK.
    The Continue Home Meds window closes and you are returned to the Patient Data Display window. All continued or changed home medications are then routed to appropriate destination (for example, a printer for future action) and also added to the patient’s Existing orders for the current visit list (click on the Orders link display).
    • Enter the name of the provider who can co-sign the orders for you (using either the Search field or Recently Selected link), and then click OK.
    If only one provider can co-sign orders for you, this name will automatically populate in the co-signing field. You cannot search for another provider.
    The Continue Home Meds window closes and you are returned to the Patient Data Display window. All continued or changed home medications are then routed to appropriate destination (for example, a printer for future action) and also added to the patient’s Existing orders for the current visit list (click on the Orders link display).
    • Enter your password or PIN, enter the name of the co-signing provider (using either the Search field or Recently Selected link), and then click OK.
    If only one provider can co-sign orders for you, this name will automatically populate in the co-signing field. You cannot search for another provider.
    The Continue Home Meds window closes and you are returned to the Patient Data Display window. All continued or changed home medications are then routed to appropriate destination (for example, a printer for future action) and also added to the patient’s Existing orders for the current visit list (click on the Orders link display).
When orders are routed to a co-signing provider, they are routed as either a printed order sheet or made available in whatever system your facility uses for managing order deficiencies depending on how your system is configured.
If a record of all your submitted orders is routed to a printer (determined by your administrator), the printed form will display the list of the patient’s continued home medications and the electronic signature of the ordering physician.

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Continuing a Home Medication for a ER Visit

You can continue the home medication as a hospital order if there are no changes required.
  • Click the radio button next to Continue/Change under the Action for Hospitalization column next to the home medication. If the Order Details window appears, make sure all required fields are completed and then click Done. The medication order displays under the Hospital Orders column and begins with New: to designate it is a new hospital order. The order is then ready for submission unless a interaction warning or alert needs
    resolution.
If you need to remove a hospital order that you entered in error, click Edit next to the order and select Delete from the drop-down.

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Changing a Home Medication for an ER visit

You can modify the home medication or choose a different medication for inclusion in the list of hospital orders:
  1. Click Change in Continue/Change under the Action for Hospitalization column next to the home medication. The Order Search window displays any possible matching Formulary (including matching medications in the same therapeutic class) and Non-Formulary medications (if enabled). You now have the ability to either change to a different medication in the same therapeutic class or modify the existing medication.
    If the search comes back with “No matches,” and you have the ability to add a medication order as custom “free text” order, then you can use the Add as free text button to add your order. See Using Free Text to Add an Order; otherwise, see your system administrator.
  2. Select the desired medication, using one of the following ways:
    • To modify one or more of the details of the existing home medication, select the medication again from the list of search results; or
    • To change to a different medication in the same therapeutic class, select the desired medication from the list of Formulary medications.
    If you choose a non-formulary medication, you may see a pop-up window requiring a reason for using a non-formulary medication. Select the reason and click Continue.
    If you select a medication that has all the required information completed, it is added to the Hospital Orders list. If you want to make changes to the order, proceed to the next step. If the Order Details window displays, proceed to Step 4 to complete your changes.
  3. Select the New: hospital order in the Hospital Orders list. The Order Details window displays.
  4. Enter any changed or new information into the Order Details window, and then click Done when the order is complete.
    When changing to a matching formulary medication in the same therapeutic class, you must enter the correct dosage. The search function does not calculate and match the correct dosage for each corresponding therapeutic class medication.
To prevent medication substitution by the pharmacy, you need to check Dispense as written.
The medication order displays under the Hospital Orders column with the prefix New: and a Delta icon displays in the column next to the new order to indicate that a change has occurred from the original home medication order. The order is then ready for submission unless a warning or non-critical alert needs resolution.
If you need to remove a hospital order that you entered in error, click Edit next to the order and select Delete from the drop-down.

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Adding a Hospital Order for an ER Visit

While in the Continue Home Meds window, you can also add a hospital order if needed. To add any type of new order to the list of Hospital Orders:
  1. Click the Add button next to the Hospital Orders column heading. The Search For Order window displays. You can choose one of the following ways to add an order:
    • Using the Favorites list, continue to Step 2.
    • Using the Search field, continue to Step 3
    • Creating a free text order if you cannot find the order you want on the Favorites list or by searching, see Using Free Text to Add an Order.
  2. If you are adding an order or order set from the list of Favorites, select the appropriate category under Favorites and then the desired order. One of the following actions occurs:
    • The order displays at the bottom of the Hospital Orders column under a highlighted heading Additional New Hospital Orders. The order displays with the prefix New:. The order is ready for submission.
    • The Order Details window displays. Complete any required information and click Done to add the order to bottom of the Hospital Orders column under a highlighted heading Additional New Hospital Orders. The order displays with the prefix New:. The order is ready for submission.
    • The order set form displays. Check the desired orders, including any highlighted required orders to create the desired set of orders, and then click Done with Order Set. The orders display at the bottom of the Hospital Orders column under a highlighted heading Additional New Hospital Orders. The order displays with the prefix New:. The orders are ready for submission.
    You may also see either the Order search triggered or additional orders added when you check an order in the order set form, depending on the requirements set up within the form. You can also modify an order on the form by selecting the order and making changes to the Order Details window.
  3. If you are using the Search field to add an order, enter the name of the desired order or order set. As you enter the order into the Add Order search field, a list of possible matches displays.
    If no matches are found, then you may create a custom order using the Add as free text button if it is available. See Using Free Text to Add an Order; otherwise see your system administrator.
    1. (Optional) Select a tab for the desired category to narrow the search results if desired.
    2. Select the order or order set from the search results.
    • If the Order Details window displays, complete the required information (highlighted in red) and any other requirements and then click Done.
    The order displays at the bottom of the Hospital Orders column under a highlighted heading Additional New Hospital Orders. The order displays with the prefix New:. The order is ready for submission.
    • If the order set form displays, check the desired orders, including any highlighted required orders to create the desired set of orders, and then click Done with Order Set. The orders display at the bottom of the Hospital Orders column under a highlighted heading Additional New Hospital Orders. The order displays with the prefix New:. The orders are ready for submission.
    You may also see the Order search triggered or additional orders added when you check an order in the order set form, depending on the requirements set up within the form. You can also modify an order on the form by selecting the order and making changes to the Order Details window.

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Modifying a Hospital Order for an ER Visit

If you need to change any of the hospital orders, you can modify the order as follows:
  1. Select the order listed in the Hospital Orders column or click Edit and then select Modify. The Order Details window displays.
  2. Make any desired changes and then click Done. The modified order displays in the Hospital Orders column. The order is ready for submission unless a warning or an alert needs resolution.
If you need to remove a hospital order that you entered in error, click Edit next to the order and select Delete from the drop-down.

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Restarting a Discontinued Home Medication

If, after admitting the patient, you need to restart a previously discontinued home medication, use the Continue Home Medications feature as follows:
  1. Start Continue Home Medications. See Starting Continue Home Medications.
  2. Click Continue in the Action for Hospitalization column for the medication you wish to restart.
    If the Order Search window appears, select the appropriate medication.
    The medication order displays under the Hospital Orders column and the Status column displays New. The order is then ready for submission unless a warning or non-critical alert needs resolution.
  3. Click Submit Orders. The continued order is added to the patient’s list of orders.

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Saving as a Draft in Continue Home Medications

If you should need to stop and save any work done in Continue Home Medications, you can click the Save as Draft button. Once you click the Save as Draft button, you will exit the Continue Home Medication window and return to the Patient Data Display. To return to your saved work, select the patient and then select Continue Home Meds from the Actions menu in the Patient Data Display or click on the unfinished orders link and click the Continue button for the patient.

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Viewing Existing Orders in the Continue Home Meds Window

Within the Continue Home Meds window, you can choose to view the patient’s list of existing orders. If there is an existing hospital order for a home medication, you will see it displayed in the Hospital Orders column with the prefix Existing:. You can also check to see what other existing medications that the patient is taking by clicking the Existing Hospital Meds tab next to the Continue Home Meds tab. Any medication orders submitted in Commure Pro will display as italicized.
If there isn’t an Existing Hospital Meds tab next to the Continue Home Meds tab, then the patient doesn’t have any existing orders.
The window updates to display all the patient’s existing orders along with their Start date and Status. Click either the Back button or Continue Home Meds to return to the list of home medications.

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Viewing Home Medications in the Patient Data Display

You can view the patient’s list of home medications prior to any emergency room or inpatient visit. In the Patient Data Display, there is a Home Medication link available. You can access this link in the following ways:
  • Using the Patient list: Select the patient from your patient list, and then click the Home Meds link in the center column.
  • Using Show Clinical Data: Click the Show Clinical Data button, and then click the Home Meds link in the center column. The Home Medications link displays the name, the route, frequency, and dose of each home medication for the current visit. You can select any column to do an alpha numeric sort by the contents of that column.
    You can only view the list of home medications in the Home Medications display. To make changes for a visit, you must use the Medication Reconciliation features - Continue Home Medications, Admissions Medication Reconciliation, or Discharge