Reconciling Medications For Discharge

​

Starting Discharge Medication Reconciliation

To begin the process of stopping, continuing or changing a patient’s medications orders or adding other discharge orders:

1. Select the patient from your Patient List tab.
2. Start Discharge Med Rec by either:
   • Selecting the Actions drop-down at the top right corner of the window, and then selecting Discharge Med Rec under the Medication Reconciliation heading;
   • Clicking the Discharge Orders link in the center column and then clicking the Discharge Med Rec button in the middle of the Discharge Orders screen; or
   • Clicking the Orders link in the center column, and then clicking the Discharge Med Rec button in the middle of the Orders screen
   • Clicking the Home Meds link in the center column, and then clicking the Discharge Med Rec button at the upper right corner of the Home Medications display.
   • Selecting the Actions drop-down in the Patient Search tab after selecting a patient visit from the search results, and then selecting Discharge Med Rec under the Medication Reconciliation header.
   When you use any of these methods to start an order, you might see clinical decision support (CDS) alerts (see Reviewing Clinical Decision Support Alerts.) You might also see alerts about drug or allergy interactions, or duplicate orders (see Reviewing Medication Interaction and Duplicate Order Alerts.) These alerts can provide clinical data or inform you of other issues related to an order.
   The Discharge Medication Reconciliation window opens and displays any current medication orders. The most recent visit is selected in the Discharge Med Rec for Visit field. If the Manage Discharge Orders window displays, your patient’s discharge plan is finalized or there is finalized activity in MEDITECH (new prescriptions, renewed home medications, converted hospital medications). To make any changes to the patient’s discharge orders, see Making Changes to Finalized Discharge Orders (MEDITECH only).

​

Submitting Discharge Orders without any Home or Hospital Medication Orders

If a patient does not have any home medications or hospital medication orders to reconcile for discharge, you can still enter new discharge orders and submit them within the Discharge Med Rec window.

1. Click the here link in Click here to enter discharge orders within the Discharge Med Rec screen. See Adding a Discharge Order for more information.
2. Reconcile and submit the discharge orders. See Reconciling All Discharge Orders.
   You cannot submit any orders if a pink banner displays at the bottom of the screen stating:
   Signed Admission Order Needed: An electronic admit order does not exist on this patient. Follow the facility admission order entry process. You need to get a signed admission order completed.

​

Submitting Discharge Orders using Finalize Discharge Medication Reconciliation (MEDITECH Only)

If your organization uses MEDITECH, you may also have the ability to finalize your discharge orders (Finalize DMR) when you complete the reconciliation process. Use of Finalize DMR is to notify the nursing staff to start the discharge process for the patient. If this is implemented, you will see a checkbox labeled Finalize DMR to the left of the Reconcile and Submit button and a Notification highlighted in red above it. If you check this option and reconcile your orders, a notification will happen to start the discharge for the patient. However, depending on how your organization implemented this feature, you may not be able to change any of your discharge orders once submitted. Check with your system administrator to understand how this function is implemented. You need to complete the following procedure to reconcile and finalize all the medications and discharge orders:

1. Review all current medication orders which includes the patient’s home medications (See Reviewing All Medication Orders) and any existing discharge orders (See Reviewing Existing Discharge Orders).
2. Choose a course of action for each home medication order. See Choosing a Course of Action for Discharge. All home medications must have a course of action selected before you can select the Finalize DMR checkbox (not enabled until all prerequisites are met).
   If your patient does not have any home medications, you will see either No known home medications or Unable to obtain home medications under the Home Medications section.
3. Enter discharge orders from a discharge order set listed next to the Notification section highlighted in red above the Reconcile and Submit button (prerequisite to enable Finalize DMR).
   You may have more than one discharge order set listed and available for use. If you choose to add discharge orders from one of the discharge order sets, the Notification section will prompt: “Do you want to complete an additional order set?” You can choose to add more discharge orders from another discharge order set if desired, but it is not required.
4. Review the list of medications under the Home Medications column, as well as any CDS alerts that display.
5. (Optional) Choose a course of action for any hospital medications. See Choosing a Course of Action for Discharge. While you decide the course of action for each hospital order, you can also choose to do the following:
   • (Optional) Remove a home medication if mistakenly entered. See Deleting a Home Medication.
   • (Optional) Click the Show Clinical Data button to review any lab results, test results, or other patient data without exiting the Medication Reconciliation process. 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 Viewing Discharge Orders.
   Click the Return to Med Rec button to return to the Discharge Medication Reconciliation screen.
   • (Optional) Add a new discharge order. See Adding a Discharge Order.
   • (Optional) Delete a new or existing discharge order. See Deleting a Discharge Order.
   • (Optional) Modify a new discharge order. See Modifying a New Discharge Order.
   • (Optional) Modify an existing discharge order that was either a home or hospital medication. See Modifying Existing Discharge Orders.
6. Review and resolve any CDS alerts that display.
7. Select the Finalize DMR checkbox next to the Reconcile and Submit button, once you have completed all required actions.
   The Finalize DMR checkbox is not enabled until all home medications have a course of action selected for reconciliation and at least one discharge order from a discharge order set listed in the Notification section is added.
8. Reconcile and submit the medication and other discharge orders. See Reconciling All Discharge Orders.
   You cannot submit any orders if a pink banner displays at the bottom of the screen stating:
   Signed Admission Order Needed: An electronic admit order does not exist on this patient. Follow the facility admission order entry process. You need to get a signed admission order completed.

​

Making Changes to Finalized Discharge Orders (MEDITECH only)

For organizations using MEDITECH, if the patient’s discharge plan is finalized or there is finalized activity in MEDITECH (new prescriptions, renewed home medications, converted hospital medications), the Manage Discharge Orders window will display. The only changes you can make are to either add or delete discharge orders. “Not all home medications have been reconciled. Please review full list of home medications in MEDITECH.” You will need to finish reconciling these home medications in the MEDITECH system. To make changes to the patient’s discharge orders:

1. (Optional) Click the Show Clinical Data button to review any lab results, test results, or other patient data without exiting the Medication Reconciliation process. 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 Viewing Discharge Orders.
   Click the Return to Med Rec button to return to the Discharge Medication Reconciliation screen.
2. Click the Add link next to the Discharge Orders column to add an additional discharge order. For more information see Adding a New Discharge Order.
3. Review and resolve any CDS alerts that display.
4. Click Edit next to the discharge order, and then select Delete from the pop-up to remove the new discharge order or cancel the existing discharge order (order displays with a strike through).
   You can only delete existing orders that were created in Commure Pro and not modified in MEDITECH. If the order was created or modified in MEDITECH, you will see a pop-up that states “MEDITECH Rxs cannot be deleted in Commure Pro.”
5. Once you have completed making changes to the patient’s discharge orders, click the Submit button. See Reconciling All Discharge Orders for more information.
   You cannot submit any orders if a pink banner displays at the bottom of the screen stating:
   Signed Admission Order Needed: An electronic admit order does not exist on this patient. Follow the facility admission order entry process. You need to get a signed admission order completed.

​

Reconciling Medication Orders for Discharge (Standard Process)

You must reconcile all hospital medication orders and home medication orders before discharging the patient. However, if enabled, you can choose to do a partial reconciliation of medication orders for discharge (check with your administrator). You may also add other discharge orders such as physician consults. You need to complete the following procedure to reconcile all the medications unless the Manage Discharge Orders screen displays, then see Making Changes to Finalized Discharge Orders (MEDITECH only) as your patient’s discharge plan is finalized or there is finalized activity in MEDITECH (new prescriptions, renewed home medications, converted hospital medications).

1. Review all current medication orders which includes the patient’s home medications (See Reviewing All Medication Orders) and any existing discharge orders (See Reviewing Existing Discharge Orders).
2. Choose a course of action for each medication order. See Choosing a Course of Action for Discharge. If you are doing a partial medication reconciliation, only select a course of action for the medications that you wish to reconcile. If your patient does not have any home medications, you will see either No home meds available to reconcile or Unable to obtain home medications under the Home Medications section. You will only need to choose a course of action for any hospital medications. While you decide the course of action for each home medication or hospital only order, you can also choose to do the following:
   • (Optional) Remove a home medication if mistakenly entered. See Deleting a Home Medication.
   • (Optional) Click the Show Clinical Data button to review any lab results, test results, or other patient data without exiting the Medication Reconciliation process. 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 Viewing Discharge Orders.
   Click the Return to Med Rec button to return to the Discharge Medication Reconciliation screen.
   • (Optional) Add a new discharge order. See Adding a Discharge Order.
   • (Optional) Delete a new or existing discharge order. See Deleting a Discharge Order.
   • (Optional) Modify a new discharge order. See Modifying a New Discharge Order.
   • (Optional) Modify an existing discharge order that was either a home or hospital medication. See Modifying Existing Discharge Orders.
3. Review and resolve any CDS alerts that display.
4. Reconcile and submit medication and other discharge orders. See Reconciling All Discharge Orders.
   You cannot submit any orders if a pink banner displays at the bottom of the screen stating:
   Signed Admission Order Needed: An electronic admit order does not exist on this patient. Follow the facility admission order entry process. You need to get a signed admission order completed.

​

Reviewing All Medication Orders

The Discharge Med Rec screen displays all current medication orders including home medications and any hospital medication order in the Current Orders list. Icons are used to signify the status of the medication orders as follows: You can view the list of medication orders in one of two ways:

• Grouped by Home Medications and Hospital Only Medications with the Group by home/hospital checkbox selected.
• Listed in alphabetical order by the home medication name first if applicable with the Group by home/hospital checkbox not selected.

​

Reviewing Existing Discharge Orders

If the patient visit has any existing discharge orders that were either submitted and reconciled from your back-end EHR or previously reconciled within Commure Pro, these orders will display in the Discharge Orders column as follows:

• Continued or changed home and hospital medications display with a Green Arrow icon under the Action for Discharge column and the discharge orders display under the Discharge Orders column with an Existing: label. The name of the provider and the date/time the order was reconciled also displays. Changed medication orders will also display with a Delta icon to signify a change was made.
• Stopped home and hospital medications display with a Red X icon under the Action for Discharge column and a Stopped label displays under the Discharge Orders column with the name of the provider and the date/time the order was reconciled.
• Additional discharge orders display under the heading Existing Discharge Orders.
  Discharge orders reconciled in Commure Pro will display as italicized.

​

Choosing a Course of Action for Discharge

Before you can complete the reconciliation of medication orders for discharge, you must decide to either stop, continue, or change every home and hospital medication order. You cannot complete the reconciliation process until every medication order has a course of action unless your facility allows you to submit a partial medication reconciliation (check with your administrator). The Action for Discharge column displays a red highlighted background to indicate an action is required. Any medication order that you choose to continue or change will become a discharge order when you complete the reconciliation.

​

Stopping a Medication Order for Discharge

If you determine that a home medication or a hospital medication is not required for discharge, you can choose to stop it as follows. You must review and resolve any CDS alerts that display.

• Click Stop under the Action for Discharge column for the medication order or
• Click the Stop Remaining Meds button at the bottom of the Discharge Medication Reconciliation window to stop all medications that were not changed or continued.
  If the home medication order was changed upon admission, you will see both the original home medication and the active hospital medication orders. You will have the option to select either the home medication or the active hospital medication order for a course of action.
  The red highlight in the Action for Discharge section is removed and the word Stop displays, and Stopped displays in the Discharge Orders column. If you stopped a medication in error, you can undo the Stop order action as long as you do so prior to submission for reconciliation. You can undo the Stop order action in one of the following ways:
  • Hover over the Action For Discharge until radio buttons for Stop and Continue/Change appear, and then select either select the radio button for Continue (see Continuing a Medication Order for Discharge) or click the Change link (see Changing a Medication Order for Discharge).
  • Click Edit next to the medication order to display the menu of options, and then select Undo Stop to return the medication order to its original state.

​

Continuing a Medication Order for Discharge

You can continue the home medication or hospital medication as a discharge order if there are no changes required.

1. Click the radio button next to Continue/Change under the Action for Discharge column next to the medication order.
   If the home medication was changed upon admission, you will see both the original home medication and the active hospital medication orders. You will have the option to select either the home medication or the active hospital medication order for a course of action.
   The medication order displays under the Discharge Orders column. The order is then ready for reconciliation unless a warning or non-critical alert needs resolution. If either the Order Search window or Order Details window displays, proceed to the next step.
   If you decide that you do not want to continue the medication, you can click Edit next to the continued order in the Discharge Orders Column and select Delete. The order will return to its original state.
2. Review and resolve any CDS alerts that display.
3. If the Order Search window displays, your order does not have a valid route. You must select the correct medication in the search results and complete any required fields in the Order Details window, and then click OK. If only the Order Details window appears, you have missing required information. Complete any highlighted required information, and then click Done.
   (MEDITECH only) If the Total # of Doses is populated and the dispense form is in Tablet, Capsule, Caplet, or Lozenge, then the Dispense quantity will auto-populate based on the dose, frequency, strength, and # of doses (all the fields must be completed).
   The medication order displays under the Discharge Orders column. The order is then ready for reconciliation unless a warning or non-critical alert needs resolution.

​

Changing a Medication Order for Discharge

You can modify the medication order or choose a different medication for inclusion to the list of Discharge Orders. As you complete this task, you must review and resolve any CDS alerts that display.

1. Click the Change link in Continue/Change under the Action for Discharge column next to the medication order. The Order Search window displays any possible matching Formulary (including matching medications in the same therapeutic class) and Non-Formulary (if enabled) medications. 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 see Using Free Text to Add a Discharge Order; otherwise, see your system administrator.
2. (Optional) Select the Weight Based Medications Only checkbox if you only want to see this type of medication order.
   The Weight Based Medications Only checkbox only displays if your facility has weight based dosing functionality enabled.
3. Select the desired medication, using one of the following ways:
   • To modify one or more of the details of the existing medication, select the same medication with the desired changes from the list of search results; or
   • To change to a medication in the same therapeutic class, select the desired medication from the list of 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 Discharge Orders list with a Delta icon displays to signify a change was made to the home medication order. If the Order Details window displays, proceed to the next step to complete your changes.
4. Enter any changed or new information into the Order Details window. To prevent medication substitution by the pharmacy, you need to check Dispense as written. Click Done when the required information is completed.
   (MEDITECH only) If the Total # of Doses is populated and the dispense form is in Tablet, Capsule, Caplet, or Lozenge, then the Dispense quantity will auto-populate based on the dose, frequency, strength, and # of doses (all the fields must be completed).

The medication order displays under the Discharge Orders column with a Delta icon displays to signify a change was made to the home medication order.

​

Deleting a Home Medication

If you discover that a home medication was incorrectly entered, you can remove it as follows:

• Click Edit next to the home medication order, and then select Delete home medication entered in error from the pop-up.

​

Adding a Discharge Order

You can add more medication orders to your patient’s list of Discharge Orders. You may also add new non-medication orders or order sets if you have Commure Pro CPOE™. You can add a new order, repeat an existing order using the Order Again feature, or use free text to add an order that isn’t found using the search function.

​

Adding a New Discharge Order

To add any type of new order to the list of Discharge Orders:

1. Click the Add button next to Discharge 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 a Discharge Order.
   All new orders that you add will be listed in a new section called Additional Discharge Orders, designated by a gray bar and displayed below the list of Discharge Orders. Each order will have a New: prefix. You must review and resolve any CDS alerts that display.
   To keep the Search For Order window open to add more hospital orders, check the Keep Window Open checkbox in the upper right corner of the Search For Order window.
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 is added to the Additional Discharge Orders section. The order is ready for reconciliation unless a warning or an alert needs resolution.
   • The Order Details window displays. Complete any required information, and then click Done to add the order to the Additional Discharge Orders section.
   Links to external websites, such a drug reference sites, may have been setup by your Administrator. If medication order details links are available, then a link displays in the top-right corner of the Order Detail window. If more than one link has been setup, a Drug References link displays, and the individual links are displayed in a drop-down menu.
   • The order set form displays. Check the desired orders (may need to scroll to see complete form), including any highlighted required orders to create the desired set of orders, and then click Done with Order Set.
   The orders are added to the Additional Discharge Orders section. The orders are ready for reconciliation unless a warning or an alert needs resolution.
   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 a Discharge Order; otherwise see your system administrator.
   1. (Optional) Select a tab for the desired category to narrow the search results if desired.
   2. (Optional) Select the Weight Based Medications Only checkbox if you only want to see this type of medication order.
   The Weight Based Medications Only checkbox only displays if your facility has weight based dosing functionality enabled.
   3. Select the order or order set from the search results. If the Order Details window displays with required information highlighted go to Step d, or if the order set form displays go to Step e.
   4. If the Order Details window displays, complete the required information (highlighted in red) and any other requirements, and then click Done.
   For weight based dosing medication order changes, see Modifying the Order Details of a Weight Based Dosing Medication Order.
   (MEDITECH only) For medication orders, if the Total # of Doses is populated and the dispense form is in Tablet, Capsule, Caplet, or Lozenge, then the Dispense quantity will auto-populate based on the dose, frequency, strength, and # of doses (all the fields must be completed).
   The order is added to the Additional Discharge Orders section. The order is ready for reconciliation unless a warning or an alert needs resolution.
   5. 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.
   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.
   The orders are added to the Additional Discharge Orders section. The orders are ready for reconciliation unless a warning or an alert needs resolution.

​

Repeating an Existing Order for Discharge

You can repeat an existing lab or test for discharge when you check their results:

1. Click the Show Clinical Data button in the upper right corner of the Discharge Medication Reconciliation window to view the results of a completed lab or test order.
   Click the Return to Med Rec button if you want to return to the Discharge Medication Reconciliation window or click the Discharge Med Rec button found in the Orders screen.
2. Click either Lab Results or Test Results in the center column, and then select the desired order.
3. Click Order Again and choose one of the following actions, depending on your choice of order:
   • If you choose to repeat a test, you have the following choices:
   • Order Details window displays. Complete any required information and click Done.
   Links to external websites, such a drug reference sites, may have been setup by your Administrator. If medication order details links are available, then a link displays in the top-right corner of the Order Detail window. If more than one link has been setup, a Drug References link displays, and the individual links are displayed in a drop-down menu.
   • Test is added, no further action is required.
   Search For Order window displays if the order cannot be found. Choose the desired order, and complete any required information for the Order Details window, and then click Done if prompted.
   You are returned to the Discharge Medication Reconciliation window. A new section called Additional Discharge Orders designated by a gray bar displays below the list of Discharge Orders. The new order displays with a prefix New: below the Additional Discharge Orders heading in the lower right corner.
   • If you choose to repeat a lab, the Order Again window displays. Choose to repeat the entire panel or specific components, and then click OK.
   The new order is added to a new section called Additional Discharge Orders, designated by a gray bar and displayed below the list of Discharge Orders. The order will have a New: prefix.

​

Using Free Text to Add a Discharge Order

If you do not find any matches for your discharge order using the Search function, you can create a free text order.

1. Click Add as free text in the search window. A dialog box appears with the possible order types available for custom orders.
2. Select the correct order type, such as Medications. A blank Order Details window displays.
3. Enter the name of the order in the Description field, complete the rest of the order details including any required information, and then click OK.
   Links to external websites, such a drug reference sites, may have been setup by your Administrator. If medication order details links are available, then a link displays in the top-right corner of the Order Detail window. If more than one link has been setup, a Drug References link displays, and the individual links are displayed in a drop-down menu.
   The new order is added to a new section called Additional Discharge Orders, designated by a gray bar and displayed below the list of Discharge Orders. The order will have a New: prefix.

​

Deleting a Discharge Order

If you decide you no longer need a new discharge order (prior to submitting it) or an existing discharge order under the Existing Discharge Orders heading, you can delete the order as follows:

• To delete a new discharge order, click Edit next to the discharge order, and then select Delete from the pop-up. The new discharge order is removed. If the discharge order was an action for a home medication or for an active hospital only medication, you will need to provide a another course of action for that home medication. Review and resolve any CDS alerts that display.
• To delete an existing discharge order under the Existing Discharge Orders heading, click Edit next to the existing discharge order, and then select Delete from the pop-up or if you want to delete all the discharge orders, click the Delete All link next to the Existing Discharge Orders heading. The deleted order(s) will display with a strike-through the order.
  To undo a delete prior to reconciling, click Edit next to the deleted existing discharge order, and then select Undo Delete from the pop-up.

​

Modifying a New Discharge Order

If you need to change any of the unsubmitted new discharge orders, you can modify the order as follows:

1. Select the order listed under either the Discharge Orders or Additional Discharge Orders column in one of the following ways:
   • Click on the new discharge order that you wish to modify, or
   • Click Edit next to the discharge order, and then select Modify from the pop-up, or
   • Hover over the Action For Discharge column next to the order, and then select Change.
   The Order Details window displays.
2. Make any desired changes and review and resolve any CDS alerts that display.
3. Click Done.
   Links to external websites, such a drug reference sites, may have been setup by your Administrator. If medication order details links are available, then a link displays in the top-right corner of the Order Detail window. If more than one link has been setup, a Drug References link displays, and the individual links are displayed in a drop-down menu.
   For weight based dosing medication order changes, see Modifying the Order Details of a Weight Based Dosing Medication Order.
   (MEDITECH only) For medication orders, if the Total # of Doses is populated and the dispense form is in Tablet, Capsule, Caplet, or Lozenge, then the Dispense quantity will auto-populate based on the dose, frequency, strength, and # of doses (all the fields must be completed).
   The modified order displays under either the Discharge Orders (for continued or changed home medications or existing hospital only medications) or Additional Discharge Orders (for new orders that were not a home medication or existing hospital only medication) column and the Delta icon displays to signify a change was made. The order is ready for reconciliation unless a warning or an alert needs resolution.

​

Modifying Existing Discharge Orders

You can modify any reconciled discharge order that was home or hospital medication order as follows. You must review and resolve any CDS alerts that display.

• To continue or change a stopped discharge order, hover over the Action for Discharge column next to the stopped order and select either Continue (see Continuing a Medication Order for Discharge) or Change (see Changing a Medication Order for Discharge).
• To modify an existing discharge order that was a home or hospital medication order, you can do any of the following:
  • Click Edit next to the discharge order, and then select Modify from the pop-up, or
  • Hover over the Action For Discharge column next to the order, and then select Change, or
  • Click on the existing discharge order that you wish to modify.
  If you wish to undo your modification, click Edit next to the modified order and then click Undo Modification.
  See Changing a Medication Order for Discharge for more information.
• To stop an existing discharge order that was a home or hospital medication order, hover over the Action For Discharge column next to the order, and then select Stop. See Stopping a Medication Order for Discharge for more information.

​

Reconciling All Discharge Orders

After you have decided upon an action for the home medications and existing hospital medications, added any new discharge orders, and resolved any interaction alerts, you are ready to complete the reconciliation process. If you decide you are not ready to submit your orders, you can choose to save your orders until you are ready by clicking Save as Draft. See Saving as a Draft in Discharge Medication Reconciliation for more information.

1. Click Reconcile and Submit at the bottom of the Discharge Medication Reconciliation window to reconcile the medication orders and submit all the discharge orders for routing.
   You cannot submit any orders if a pink banner displays at the bottom of the screen stating:
   Signed Admission Order Needed: An electronic admit order does not exist on this patient. Follow the facility admission order entry process. You need to get a signed admission order completed. If you click Cancel at the bottom of the Discharge Medication Reconciliation window, the window closes, and none of your changes are saved. If your facility allows you to submit a partial medication reconciliation and you have chosen to do this, you will see a warning message display when you select Reconcile and Submit. Click the Submit Partial Med Rec button if you wish to submit a partial medication reconciliation with only the medication orders that have a course of action selected. Click the Go Back button if your submission was done in error. 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 Discharge Medication Reconciliation window closes and you are returned to the Patient Data Display window. All orders including 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).
2. Enter one of the following depending on what Signature dialog displays:
   • Enter your password or PIN, and then click OK.
   The Discharge Medication Reconciliation window closes and you are returned to the Patient Data Display window. All orders including 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 Discharge Medication Reconciliation window closes and you are returned to the Patient Data Display window. All orders including 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 Discharge Medication Reconciliation window closes and you are returned to the Patient Data Display window. All orders including 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). All medication orders submitted in Commure Pro will display in_italics_ when viewing a printout or existing orders in the Commure Pro system.
   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.

A record of all your submitted orders for discharge may be routed to a printer (determined by your administrator) and the printed form will display the list of the patient’s new home medications and any associated hospital medications and prior home medications, a separate list of any discontinued home medications, and a list of additional discharge orders. Each list will display an electronic signature of the ordering physician.

​

Reconciling Additional Medication Orders after Completing Discharge Medication Reconciliation

If your patient should need additional medications for discharge added after you submitted and reconciled them, you can return to the Discharge Medication Reconciliation or Manage Discharge Orders window and reconcile these additional home medications as follows:

1. Start the Discharge Medication Reconciliation process as described in Starting Discharge Medication Reconciliation.
2. Reconcile the additional medications as described in Reconciling Medication Orders for Discharge (Standard Process) or in Making Changes to Finalized Discharge Orders (MEDITECH only).

​

Saving as a Draft in Discharge Medication Reconciliation

If you should need to stop and save any work done in Discharge Medication Reconciliation, you can click the Save as Draft button. Once you click the Save as Draft button, you will exit the Discharge Medication Reconciliation window and return to the Patient Data Display. To return to your saved work, select the patient and then select Discharge Med Rec from the Actions menu in the Patient Data Display or click on the unfinished orders link and click the Continue button for the patient. If you log out with draft orders saved, you can choose any of the following actions:

• Click Continue Ordering to return to the Order Entry window to either complete (Sign/Submit) the draft orders or remove (Cancel) the draft orders. To resume Discharge Medication Reconciliation, select the patient from the patient list and then select Discharge Med Rec from the Actions menu in the Patient Data Display to enter the Discharge Medication Reconciliation window with the saved unsubmitted orders.
• Click Keep Orders and Exit Commure Pro to keep the orders saved as drafts for a later order session. Log back in to resume Discharge Medication Reconciliation for this patient, select the patient from the patient list and then select Discharge Med Rec from the Actions menu in the Patient Data Display to enter the Discharge Medication Reconciliation window with the saved unsubmitted orders.
• Click Discard Orders and Exit Commure Pro if you do not wish to keep the orders for a future session.

​

Viewing Discharge Orders

You can review your patient’s list of discharge orders as follows:

• Reviewing Discharge Orders in the Patient Data Display
• Reviewing Discharge Orders from a Previous Visit

​

Reviewing Discharge Orders in the Patient Data Display

You can review a patient’s list of submitted discharge orders from the Discharge Orders display option in the Patient Data Display. You can access this display option in the following ways:

• Using the Patient list: Select the patient from your patient list, and then click the Discharge Orders link in the center column.
• Using Show Clinical Data: Click the Show Clinical Data button, and then click the Discharge Orders link in the center column. The Discharge Orders link displays all the submitted discharge orders in the upper half of the screen unless the discharge plan was completed in MEDITECH. If a discharge plan is finalized, the following message displays: “Visit has a Finalized Med/Discharge Plan in MT. Please see MT for full set of Discharge Orders.” Otherwise, you can select an order and see the Order Detail in the lower half of the screen.
  You can only view the list of discharge order and their order detail in the Discharge Orders display. To make changes for a visit, you must use the Medication Reconciliation feature - Discharge Medication Reconciliation.

​

Reviewing Discharge Orders from a Previous Visit

To review discharge orders from a prior visit from within the Discharge Order Entry window:

1. Select the prior visit from the Discharge Med Rec for Visit drop-down. The Discharge window changes to display the discharge orders for the prior visit with a warning message stating “Patient is already discharged from the selected visit.”
2. Click OK to remove the warning message.