Reconciling Medications For Discharge With ePrescribing

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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.

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).

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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 to begin adding discharge orders. 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:

You need to get a signed admission order completed.

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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), past prescription history (See Reviewing a Patient’s Past Prescription History), and any existing discharge orders (See Reviewing Existing Discharge Orders).
2. Check to see if there is a default pharmacy set up (your facility must be set up for ePrescribing) and that it is the correct pharmacy for the patient. Add or change the pharmacy if needed. See Checking the Default Pharmacy.
3. 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.
4. 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.
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. Do a final review of any alerts and take any actions if needed. See Reviewing Clinical Decision Support Alerts.
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 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:

You need to get a signed admission order completed.

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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) Review the patient’s clinical and prescription information as follows:
   • (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) Click the External Med History link to review the last six months of the patient’s prescription history. See Reviewing a Patient’s Past Prescription History.
2. (Optional) Change the default pharmacy (see Checking the Default Pharmacy).
3. Click the Add button next to the Discharge Orders column to add an additional discharge order. For more information see Adding a Discharge Order.
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.”
   If a medication order was electronically sent, an electronic cancellation notification will be sent to the pharmacy.
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:

You need to get a signed admission order completed.

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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), past prescription history (See Reviewing a Patient’s Past Prescription History), and any existing discharge orders (See Reviewing Existing Discharge Orders).
2. Check to see if there is a default pharmacy set up (your facility must be set up for ePrescribing) and that it is the correct pharmacy for the patient. Add or change the pharmacy if needed. See Checking the Default Pharmacy.
3. 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 known home medications 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.
4. Do a final review of any medication interaction warnings and alerts and take any actions if needed. See Reviewing Clinical Decision Support Alerts.
5. 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:

You need to get a signed admission order completed.

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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.

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Reviewing a Patient’s Past Prescription History

If your facility provides access to the patient’s external prescription history, the link External Med History will display under the Show Clinical Data button in the upper right corner of the Discharge Orders screen. You can review up to 6 months of past medications if your patient consents to the display of this information.

1. Click the External Med History link to review a patient’s prescription history. The External Med History window opens. By default, all of the prescriptions are displayed in an expanded view. You can collapse individual rows by clicking a prescription name, or collapse the entire list by clicking Collapse All at the bottom of the window. To expand list, click Expand All, or click an individual row that you want to expand.
2. Review the patient’s prescription information. Prescriptions are grouped by medication and then sorted by last filled date. Each prescription will display the Last Filled Date, Quantity/Day Supply, Substitutions, Pharmacy, and Prescriber name. To view Dispense Details for a prescription, hover your cursor over the Information icon in the Details column.
3. Click the Close button to close the window.

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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.

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Checking the Default Pharmacy

Before you reconcile any medication orders for discharge, you should check that a default pharmacy is set up and that it is the correct pharmacy for your patient. A default pharmacy is where all prescriptions will go by default. Find the Rx Default Destination: setting located in the upper right section of the Discharge Med Rec window or Discharge Orders section of the Patient Data Display and check to see if a default pharmacy is set up with the correct pharmacy. If this information is correct, proceed to choosing a course of action for each medication order (see Choosing a Course of Action for Discharge) if you are reconciling medication orders for discharge. You can change the default pharmacy at any time prior to submission of the orders and all prescriptions using the default pharmacy will automatically update to the new pharmacy. You can also change the default pharmacy for submitted prescriptions. If you need to add or change the default pharmacy, you can do it as follows:

• Change a default pharmacy to another listed patient pharmacy, see Changing the Default Pharmacy using the List of Patient Pharmacies.
• Add or change a retail pharmacy, see Adding or Changing a Retail Default Pharmacy.
• Add or change a mail order pharmacy, see Adding or Changing a Mail Order Default Pharmacy.
• Add or change a default pharmacy using a phone number, see Searching by Phone number to Add or Change the Default Pharmacy.
• Change the default pharmacy for submitted discharge prescriptions, see Changing the Default Pharmacy for Submitted Prescriptions.

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Changing the Default Pharmacy using the List of Patient Pharmacies

You can quickly change the default pharmacy to another patient pharmacy without using the search.

1. Click Edit Pharmacy. The Select Default Pharmacy window displays. If a patient has a list of pharmacies (including a default pharmacy) where they have had their prescriptions sent (from Commure Pro only), they will be displayed under Patient Pharmacies.
2. Select one of these pharmacies (including reselecting the default pharmacy) which will close the window and add it as the Rx Default Destination in the Discharge Med Rec window.
   To delete any of these preselected patient pharmacies, click Delete next to the pharmacy name.

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Adding or Changing a Retail Default Pharmacy

You can search for and add a local retail pharmacy for the patient’s medication orders.

1. Click the Select Pharmacy link to add a default pharmacy or click Edit Pharmacy to change the default pharmacy.
2. Select the Retail tab under the Search for a Pharmacy section if not selected when window displays.
3. Enter a location to search for nearby pharmacies using one of these methods:
   • Select the Home icon to auto-populate the patient’s home address in the Nearby: field (shown by default).
   • Select the Hospital icon to auto-populate the hospital address in the Nearby: field.
   • Enter a different address, city, or zip code in the Nearby: field to find pharmacies that are near that location.
   • (Optional) Enter a pharmacy name or other information in the Optionally refine by: field to narrow the results.
4. Click Search to display the results. Results are displayed based on the pharmacy’s proximity to the address that is defined. In the search results, you can see the pharmacy name, address, distance, contact details, and Specialty Types available at each pharmacy. Pharmacies that do not accept e-prescriptions appear with a Not Accepted icon. Specialty Types are indicated by these icons:

5. To switch between List view and Map view, select List or Map next to the Search button.
   • In List view, you can add more filters to narrow down the results using the City or Pharmacy filters displayed to the left of the search results.
   • In Map view, you can drag the map, and zoom in or out, to adjust the search area, and the results are updated automatically.
6. Select the desired pharmacy from the search results by clicking the Add icon next to the pharmacy name. The Select Default Pharmacy window closes and the newly selected pharmacy now displays as the Rx Default Destination in the Discharge Med Rec window.

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Adding or Changing a Mail Order Default Pharmacy

You can search for and add a mail order pharmacy for the patient’s medication orders.

1. Click the Select Pharmacy link to add a default pharmacy or click Edit Pharmacy to change the default pharmacy.

The Select Default Pharmacy window displays.

2. Select the Mail Order tab under the Search for a Pharmacy section.
3. Scroll through the list of pharmacies displayed to find the desired pharmacy or enter the name of the pharmacy in the Search by name: field and click Search to display the results. You can see the pharmacy name, address, distance, contact details, and Specialty Types available at each pharmacy. Specialty Types are indicated by these icons:

4. Select the desired pharmacy from the search results. The Select Default Pharmacy window closes and the newly selected pharmacy now displays as the Rx Default Destination in the Discharge Med Rec window.

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Searching by Phone number to Add or Change the Default Pharmacy

1. Click the Select Pharmacy link to add a default pharmacy or click Edit Pharmacy to change the default pharmacy. The Select Default Pharmacy window displays.
2. Select the Search by Phone tab under the Search for a Pharmacy section.
3. Enter the 7 or 10 digit phone number in the Search by Phone number: field, and then click Search.
4. Select the pharmacy from the search result. The Select Default Pharmacy window closes and the newly selected pharmacy now displays as the Rx Default Destination in the Discharge Med Rec window.

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Changing the Default Pharmacy for Submitted Prescriptions

If the default pharmacy is changed for a patient with submitted prescriptions done either by the back-end system or using Edit Pharmacy from the Discharge Orders display option or Discharge Med Rec window, you can choose to resend these submitted prescriptions to the new default pharmacy which will also cancel the submitted prescriptions as follows:

1. Change the default pharmacy for a patient with submitted prescriptions from either the Discharge Orders display option or the Discharge Med Rec window unless it was already changed by the back-end system.
2. Enter the Discharge Med Rec window for the patient if you are not already in the Discharge Med Rec window, see Starting Discharge Medication Reconciliation. The Default Pharmacy Changed dialog displays.
3. Select the Yes - Change to new pharmacy button.
   If you do not want to change the default pharmacy for submitted orders, select the No - keep old pharmacy button.
   You are returned to the Discharge Med Rec window.
4. (Optional) Complete any additional discharge orders if desired.
5. Select the Reconcile and Submit button and enter any password or PIN if prompted (see Reconciling All Discharge Orders for more information). When the Review Prescriptions window displays, it will show you the new prescriptions with the new default pharmacy and any canceled prescriptions for the old default pharmacy which will display either as electronically canceled or needing to be called in (if old default pharmacy does not accept electronic cancellations). If a submitted prescription was sent to a secondary pharmacy or printer, they will not display as they are not changed.
6. Select the Reconcile and Submit button from the Review Prescriptions window. The Discharge Order display option displays the submitted prescriptions with the new default pharmacy as the Rx destination. To see any canceled prescriptions, check the Include Canceled eRx’s checkbox in the upper left corner of the Discharge Orders display option. Canceled prescriptions will display with a cross-through. If the canceled prescriptions cannot be electronically canceled, an Action Required window displays notifying you that you need to cancel the prescriptions previously submitted with the old default pharmacy. Also in the window is a list of the affected prescriptions and the pharmacy information. Proceed to the next step.
7. Call the pharmacy to cancel the prescriptions, and then select the Pharmacy Has Been Called button.

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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.

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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:

• 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.

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Continuing a Medication Order for Discharge

You can continue the home medication or hospital medication as a discharge order.

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 Select Medication window opens unless the Clinical Decision Support Warnings window opens.
   • If the Clinical Decision Support window opens, go to Step 2
   • If the Select Medication window opens, go to Step 3.
2. Review any CDS alerts (see Reviewing Clinical Decision Support Alerts for more information).You can choose one of the following actions:
   • Resolve any warnings or missing details and then, click OK. The Select Medication window displays. Proceed to the next step.
   • Click Don’t Order if you do not wish to add the medication order to the list of discharge orders. You are returned to the Discharge Med Rec window.
3. Review the list of medications covered by the patient’s medical plan in the Select Medication window. The original medication order displays with an icon that indicates formulary status (On Formulary Preferred, On Formulary Not Preferred, Not on Formulary, Not Reimbursable, Formulary Status Unknown, or Over the Counter Medication). A higher number denotes a higher status on the payer formulary. You can hover over the Question Mark icon to see an explanation of the statuses. Additionally the copay cost, covered pharmacy types (retail, mail order, specialty, and/or long term care), and any coverage restrictions for the selected medical plan are shown. If there are other medication alternatives, these are displayed under the Payer Alternatives column along with their formulary status, copay cost, covered pharmacy types, and any coverage restrictions for the selected medical plan. Click the Info icon to display even more detail on coverage for a medication.
   If the patient has more than one medical plan, the system defaults to the one with the highest formulary status unless a different plan was previously selected in the same discharge session; then the previously selected plan is used. If the patient has more than one plan and the desired plan is not selected, you can change the plan by selecting a different plan from the Change Plan: drop-down at the bottom right corner of the table.
4. Select the appropriate medication. The Order Details of the medication order displays.
   You must select the medication order even if only the original medication order displays.
5. Complete any missing required fields.
   (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).
   You can also doing the following:
   • Change where the prescription is sent to as follows:
   If you change the default pharmacy from within one of the prescriptions, it will update the rest of the prescriptions going to the default pharmacy.
   • Printer - select the radio button next to Printer to print out the prescription for the patient.
   • Default Pharmacy (patient preferred pharmacy where all prescriptions are sent by default) - select Edit Pharmacy next to Default Pharmacy to change where the prescription is sent or if no default pharmacy is specified, click the Select Pharmacy link to add a pharmacy (see Checking the Default Pharmacy for more information)
   • Other Pharmacy (different pharmacy than default) - click the Select Pharmacy link if no pharmacy is listed or select Edit Pharmacy to change where the prescription is sent (see Checking the Default Pharmacy for more information). This allows you to send a medication prescription to an alternative pharmacy from the default pharmacy. It does not change the default pharmacy for the patient.
   If patient prescription benefit information is not available from the third-party organization that coordinates e-prescribing, then orders must be sent to a Printer.
   • Add notes to the pharmacy - enter any comments/instructions in the Notes to Pharmacy text box. These comments/notes go only to the pharmacy not to the patient.
   If WBD is selected as the Dose, then the Notes to Pharmacy field is automatically appended with Weight-Based Dosing information when the order is sent to the pharmacy.
   • Add Special Instructions for the patient (in addition to the patient instructions) - enter any comments/instructions in the Special Instructions text box. The patient instructions are what will be given to the patient - printed on the prescription label.
   The Special Instructions field accepts up to 140 characters when e-prescribing an order to a pharmacy. If additional space is needed, send the prescription to a printer, which allows up to 600 characters.
   NOTE: Patient Instructions are automatically generated but the provider can always select to use the special instructions fields in the Dose and Frequency along with the Special Instructions text box.
6. Click Done when everything is completed. The medication order displays under the Discharge Orders column and the Rx column displays a check to indicate there is a prescription. Hover over the checkmark to display the pharmacy information for an order. An asterisk indicates it is the default pharmacy.
   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.

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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.

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.
   The Select Medication window opens unless the Clinical Decision Support Warnings window opens.
   • If the Clinical Decision Support window opens, go to Step 4
   • If the Select Medication window opens, go to Step 5.
4. Review any alerts (see Reviewing Clinical Decision Support Alerts for more information). You can choose one of the following actions:
   • Resolve any warnings or missing details and then, click OK. The Select Medication window displays. Proceed to the next step.
   • Click Don’t Order if you do not wish to add the medication order to the list of discharge orders. You are returned to the Discharge Med Rec window.
5. Review the list of available medications based on the patient’s medical plan in the Select Medication window. The selected medication order displays with an icon that indicates formulary status (On Formulary Preferred, On Formulary Not Preferred, Not on Formulary, Not Reimbursable, Formulary Status Unknown, or Over the Counter Medication). A higher number denotes a higher status on the payer formulary. You can hover over the Question Mark icon to see an explanation of the statuses. Additionally the copay cost, covered pharmacy types (retail, mail order, specialty, and/or long term care), and any coverage restrictions for the selected medical plan are shown. Click the Info icon to display even more detail on coverage for a medication. If there are other medication alternatives, these are displayed under the Payer Alternatives column along with their formulary status, copay cost, covered pharmacy types, and any coverage restrictions for the selected medical plan.
   If the patient has more than one medical plan, the system defaults to the one with the highest formulary status unless a different plan was previously selected in the same discharge session; then the previously selected plan is used. If the patient has more than one plan and the desired plan is not selected, you can change the plan by selecting a different plan from the Change Plan: drop-down at the bottom right corner of the table.
6. Select the appropriate medication. The Order Details of the medication order displays.
   You must select the medication order even if only the original medication order displays.
7. Complete any missing required fields. For weight based dosing medication order changes, see Modifying the Order Details of a Weight Based Dosing Medication Order.
   If the Total # of Doses is populated, and the Dispense Form is in “Tablet, Capsule, Caplet, or Lozenge,” then auto-populate the “Dispense” number field based on the dose, strength, and # of doses.
   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.
   You can also doing the following:
   • Change where the prescription is sent to as follows:
   If you change the default pharmacy from within one of the prescriptions, it will update the rest of the prescriptions going to the default pharmacy.
   • Printer - select the radio button next to Printer to print out the prescription for the patient.
   • Default Pharmacy (patient preferred pharmacy where all prescriptions are sent by default) - select Edit Pharmacy next to Default Pharmacy to change where the prescription is sent or if no default pharmacy is specified, click the Select Pharmacy link to add a pharmacy (see Checking the Default Pharmacy for more information)
   • Other Pharmacy (different pharmacy than default) - click the Select Pharmacy link if no pharmacy is listed or select Edit Pharmacy to change where the prescription is sent (see Checking the Default Pharmacy for more information). This allows you to send a medication prescription to an alternative pharmacy from the default pharmacy. It does not change the default pharmacy for the patient.
   If patient prescription benefit information is not available from the third-party organization that coordinates e-prescribing, then orders must be sent to a Printer.
   • Add notes for the pharmacy - enter any comments/instructions in the Notes to Pharmacy text box. These comments/notes go only to the pharmacy not to the patient.
   If WBD is selected as the Dose, then the Notes to Pharmacy field is automatically appended with Weight-Based Dosing information when the order is sent to the pharmacy.
   • Add Special Instructions for the patient (in addition to the patient instructions) - enter any comments/instructions in the Special Instructions text box. The patient instructions are what will be given to the patient - printed on the prescription label.
   The Special Instructions field accepts up to 140 characters when e-prescribing an order to a pharmacy. If additional space is needed, send the prescription to a printer, which allows up to 600 characters.
   NOTE: Patient Instructions are automatically generated but the provider can always select to use the special instructions fields in the Dose and Frequency along with the Special Instructions text box.
8. Click Done when everything is completed. The medication order displays under the Discharge Orders column and the Rx column displays a check to indicate there is a prescription.
   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.

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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.

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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.

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Adding a New Medication Discharge Order

To add a new medication order to the list of Discharge Orders:

1. Click the Add button next to Discharge Orders column heading or click the here link in Click here to enter discharge orders within the Discharge Med Rec screen.
2. The Search For Order window displays. You can select a favorite medication order or enter the medication into the Search field and select the desired medication.
   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.
   One of the following happens:
   • If CDS alerts display, go to Step 3.
   • The Select Medication window displays, go to Step 4.
   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.
3. Review any alerts (see Reviewing Clinical Decision Support Alerts for more information). You can choose one of the following actions:
   • Resolve any warnings or missing details and then, click OK. The Select Medication window displays. Proceed to the next step.
   • Click Don’t Order if you do not wish to add the medication order to the list of discharge orders. You are returned to the Discharge Med Rec window.
4. Review the list of available medications based on the patient’s medical plan in the Select Medication. The original medication order displays with an icon that indicates formulary status (On Formulary Preferred, On Formulary Not Preferred, Not on Formulary, Not Reimbursable, Formulary Status Unknown, or Over the Counter Medication). A higher number denotes a higher status on the payer formulary. You can hover over the Question Mark icon to see an explanation of the statuses. Additionally the copay cost, covered pharmacy types (retail, mail order, specialty, and/or long term care), and any coverage restrictions for the selected medical plan are shown. Click the Info icon to display even more detail on coverage for a medication. If there are other medication alternatives, these are displayed under the Payer Alternatives column along with their formulary status, copay cost, covered pharmacy types, and any coverage restrictions for the selected medical plan.
   If the patient has more than one medical plan, the system defaults to the one with the highest formulary status unless a different plan was previously selected in the same discharge session; then the previously selected plan is used. If the patient has more than one plan and the desired plan is not selected, you can change the plan by selecting a different plan from the Change Plan: drop-down at the bottom right corner of the table.
5. Select the appropriate medication. The Order Details of the medication order displays.
   You must select the medication order even if only the original medication order displays.
6. Complete any missing required fields. For weight based dosing medication order changes, see Modifying the Order Details of a Weight Based Dosing Medication Order.
   (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).
   Canadian sites prescribing controlled substances: When you select the Dosing Schedule checkbox, you must then enter dosage values for the required fields - number of intervals, number of tablets per interval, and frequency of each interval (once, daily, weekly.) When you have entered all of the values, Commure Pro calculates the total number of tablets required for the order. You can also specify the total number of tablets before you select the Dosing Schedule checkbox. The dosage values are then calculated based on the number of tablets and intervals you want for the medication.
   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.
   You can also doing the following:
   • Change where the prescription is sent to as follows:
   If you change the default pharmacy from within one of the prescriptions, it will update the rest of the prescriptions going to the default pharmacy.
   • Printer - select the radio button next to Printer to print out the prescription for the patient.
   • Default Pharmacy (patient preferred pharmacy where all prescriptions are sent by default) - select Edit Pharmacy next to Default Pharmacy to change where the prescription is sent or if no default pharmacy is specified, click the Select Pharmacy link to add a pharmacy (see Checking the Default Pharmacy for more information)
   • Other Pharmacy (different pharmacy than default) - click the Select Pharmacy link if no pharmacy is listed or select Edit Pharmacy to change where the prescription is sent (see Checking the Default Pharmacy for more information). This allows you to send a medication prescription to an alternative pharmacy from the default pharmacy. It does not change the default pharmacy for the patient.
   If patient prescription benefit information is not available from the third-party organization that coordinates e-prescribing, then orders must be sent to a Printer.
   • Add notes for the pharmacy - enter any comments/instructions in the Notes to Pharmacy text box. These comments/notes go only to the pharmacy not to the patient.
   If WBD is selected as the Dose, then the Notes to Pharmacy field is automatically appended with Weight-Based Dosing information when the order is sent to the pharmacy.
   • A dd Special Instructions for the patient (in addition to the patient instructions) - enter any comments/instructions in the Special Instructions text box. The patient instructions are what will be given to the patient - printed on the prescription label.
   The Special Instructions field accepts up to 140 characters when e-prescribing an order to a pharmacy. If additional space is needed, send the prescription to a printer, which allows up to 600 characters.
   NOTE: Patient Instructions are automatically generated but the provider can always select to use the special instructions fields in the Dose and Frequency along with the Special Instructions text box.
7. Click Done when everything is completed. The medication order displays under the Additional Discharge Orders section and the Rx column displays a check to indicate there is a prescription.

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Adding a New Non-Medication Discharge Order

To add a new non-medication order to the list of Discharge Orders:

1. Click the Add button next to Discharge Orders column heading or click the here link in Click here to enter discharge orders within the Discharge Med Rec screen. 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.
   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 Details window displays. Complete any required information, and then click OK to add the order to the Additional Discharge Orders section.
   • 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 OK.
   (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.

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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 or Manage Discharge Orders 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 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.
   • 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 OK 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.

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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 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.
   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.

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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.
• 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. If the existing discharge order is a submitted prescription, deleting the order will trigger a cancellation of the prescription to the pharmacy when you submit the order (see Reconciling All Discharge Orders for more information).
  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.

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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 Select Medication window displays.
2. Make any desired changes to Select Medication window (see Changing a Medication Order for Discharge for more information), and then click OK. For weight based dosing medication order changes, see Modifying the Order Details of a Weight Based Dosing Medication Order. 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 a checkmark in the Rx column to signify a change was made. The order is ready for reconciliation unless a warning or an alert needs resolution.

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Modifying Existing Discharge Orders

You can modify any submitted prescription order that was a home or hospital medication order as follows:

• 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 a submitted prescription 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.
  See Changing a Medication Order for Discharge for more information. When you complete the modification of the prescription, the original prescription order will display with a strike through indicating that the order will be canceled and the new order will display underneath the canceled order. If the existing discharge order is a submitted prescription, canceling the order will trigger a cancellation of the prescription to the pharmacy when you submit the order (see Reconciling All Discharge Orders for more information).
  If you wish to undo your modification, click Edit next to the modified order and then click Undo Modification.

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Canceling a Submitted Prescription

You can cancel a prescription order that was already sent to the pharmacy as follows:

• To cancel an existing prescription order that was a home or hospital medication order, hover over the Action For Discharge column next to the order, and then select Stop.
• To cancel an existing prescription order listed under the Existing Discharge Orders section, click Edit next to the existing discharge order, and then select Delete from the pop-up or if you want to delete all the submitted prescriptions, click the Delete All link next to the Existing Discharge Orders heading. When you complete the cancellation of the prescription, the prescription order will display with a strike through indicating that the order will be canceled. Canceling the order will trigger a cancellation of the prescription to the pharmacy when you submit the order (see Reconciling All Discharge Orders for more information).

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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.

1. Click Reconcile and Submit at the bottom of the Discharge Medication Reconciliation window.
   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 go to Step 3 to review the submitted prescriptions.
2. Enter one of the following depending on which Signature dialog displays:
   • Enter your password or PIN, and then click OK.
   • 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.
   • 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.
   If a controlled substance is included in the list of orders, then the Review Prescription Drug Monitoring Program screen may display. If this screen displays, proceed to Step 3. If the Review Prescriptions window displays, go to Step 4.
3. (Optional) If a controlled substance is included among the list of discharge orders, then the Review Prescription Drug Monitoring Program screen displays. This report includes the information that will be reported to the state’s Prescription Monitoring Program database that tracks the controlled substances that have been prescribed and dispensed. The report also includes information about the controlled substances a patient may be on, or has been on in the past. Review the report and then choose one of the following options to proceed:
   • Click Next to confirm that the report is accurate, to go to the Review Prescriptions screen.
   • Click Back to return to the Discharge Med Rec window to make changes.
4. Review the list of prescriptions and pharmacy information to ensure it is correct. The Review Prescriptions window can display any of the following information depending on the actions taken in the Discharge Medication Reconciliation or Manage Discharge Orders window:
   • New Retail Prescriptions
   • New Mail Order Prescriptions
   • New Prescriptions to be printed and signed
   • Electronically Canceled Prescriptions
   • Canceled Prescriptions to be called in
   If they are correct, click Reconcile and Submit; otherwise click Back to return to Discharge Med Rec window to make changes.
   If there is a mismatch on the patient information between the EHR and Insurance record, a warning will display under the patient name stating:
   Warning: Some patient demographic information does not match the PBM records. See details.
   Click the See details link to review the mismatching information. This information should be communicated to the patient so they can correct the issue with the insurance company. If a controlled substance is included among the list of discharge orders, then the Sign Controlled Substance E-Prescriptions window displays. This is part of the two-factor authentication required for e-prescribing controlled substances. Enter the security code from your linked device, and then click OK. The Discharge Order display option displays the submitted prescriptions with the new default pharmacy as the Rx destination. To see any canceled prescriptions, check the Include Canceled eRx’s checkbox in the upper left corner of the Discharge Orders display option. Canceled prescriptions will display with a cross-through. If the canceled prescriptions cannot be electronically canceled, an Action Required window displays notifying you that you need to cancel the prescriptions previously submitted with the old default pharmacy. Also in the window is a list of the affected prescriptions and the pharmacy information. Proceed to the next step.
5. Call the pharmacy to cancel the prescriptions, and then select the Pharmacy Has Been Called button.

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About Reconciling Discharge Orders with a Controlled Substance

When submitting a discharge order that includes a controlled substance, there are additional steps required and unique scenarios that are part of the Discharge Medication Reconciliation workflow. Prescription Drug Monitoring Program Screen (PDMP) Before e-prescribing an order with a controlled substance, the Review Prescription Drug Monitoring Program screen must be reviewed to ensure that all of the information is accurate. Depending on your site’s configuration, this screen will be either the Narx Care report or the PMP Gateway report. This screen displays the information that will be reported to the state’s PDMP database for tracking the prescribing and dispensing of controlled substances, and tracking information about which controlled substances a patient may be on, or has been on in the past. Two-Factor Authentication (2FA) All providers authorized and configured to e-prescribe controlled substances are required to review and confirm the information in the Review Prescription Drug Monitoring Program report through a two-factor authentication. Two-factor authentication requires that a code from a linked device (mobile device) be entered to confirm the identity of the provider e-prescribing the order.

• If the authentication is successful, then all orders are submitted and e-prescribed orders are sent to their defined destination.
• If the authentication is canceled, then orders are not submitted and users are returned to the Review Prescriptions screen.
• If the authentication fails, an error message displays. Any uncontrolled substances that are included in the order are submitted; controlled substances are saved a draft.

Additional Scenarios Below are some notes to clarify the unique scenarios around e-prescribing a controlled substance:

• E-prescribing a controlled substance (EPCS) requires user configuration beyond the configurations required for e-prescribing medications in general (eRx). Speak with your Administrator about the requirements for EPCS functionality.
• There may be a scenario when an order with a controlled substance must be printed because EPCS is not available. Below are some common scenarios:
  • If a provider is setup for e-prescribing (eRx enabled), but they have not been granted user permissions for order entry of controlled medications, then their orders for controlled medications must be printed (Printer will be the only destination available in the Order Detail screen; default pharmacies are disabled).
  • EPCS will not be available if patient demographic or address details incomplete (Printer will be the only destination available in the Order Detail screen; default pharmacies are disabled).
  • EPCS will not be available if a patient’s Default Pharmacy does not fulfill orders for controlled substances. Providers can choose Printer as the prescription destination, select Other Pharmacy and choose a pharmacy that includes Controlled Substances service, or change the Default Pharmacy to a pharmacy that includes Controlled Substances service. Fore more information on changing pharmacies, see Checking the Default Pharmacy.
• Modifying a controlled substance order: After an order with a controlled substance has been printed, the Rx Destination (Printer) cannot be changed if the order is modified.
• Failed controlled substance order: If an EPCS order fails to be submitted and is sent to a printer instead, the printed copy will include the following text: “Prescription was sent electronically to [Pharmacy name] on [date] at [time], but the transmission failed.”
• E-prescribing a controlled substance (EPCS), specifically schedule II medications, is limited to one order per ordering session. If you attempt to order more than one schedule II medication, you will see a message that you have already created a prescription for the medication, and that you are unable to prescribe the same schedule II medication again during the ordering session. This includes adding discharge orders, and the scenario where a home medication has been continued; if a schedule II home medication has been continued, the same medication cannot be ordered again as a discharge order.

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Viewing the EPCS Prescriber Report

Providers who are configured to e-prescribe a controlled substance (EPCS) require the ability to generate a log of the controlled substance prescriptions that they have issued, or that have been issued in their name, over the past two years. The EPCS Prescriber History Report allows providers to view a report of their controlled substance prescriptions on-demand, and create an archive by printing the report or saving a PDF file.

Show Settings that control this feature

Admin - CPOE - Configuring the EPCS Prescriber History Report

To see your EPCS prescriber history:

1. Click the EPCS History tab.
2. At the top of the screen, select the timeframe for the report that you want to generate.
   • Last 30 days
   • Last 90 days
   • Last 6 months
   • Last year
   • Last 2 years
   A report is displayed that includes information about the controlled substance prescriptions submitted in your name, including when the order was prescribed, information about the patient, and information about the medication order. You can sort the report contents by clicking one of the heading columns, including by the Date the prescription was issued, Patient Name, Medication Name, and more.
3. To archive the report, click Print . A print preview displays with options for sending the current report to a printer, or saving a PDF of the report.
   To create a PDF, be sure to choose the option to Save as PDF or Print as PDF as the destination rather than Adobe PDF (the exact option depends on the web browser you are using).

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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 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).

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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.

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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

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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.” For discharge orders not finalized in MEDITECH, you do the following:
  • Review the list of ordered prescriptions and where the prescriptions were sent. If you wish to see canceled prescriptions, select the Include Canceled eRx’s checkbox below the Discharge Orders heading in the upper left corner.
  • Check the default pharmacy listed next the Rx Default Destination: located above the list of discharge orders. You can also change the default pharmacy for future prescriptions using Edit Pharmacy or selecting the Printer radio button. See Checking the Default Pharmacy for more information.
  If you wish to change the pharmacy for existing prescriptions, you need to modify the existing prescription from within the Discharge Medication Reconciliation window by either changing the pharmacy. See Changing the Default Pharmacy for Submitted Prescriptions.
  • Sort the list of prescriptions. Select the Discharge Orders heading to sort by medication name or the Rx Destination heading to sort by pharmacy name alphabetically in ascending or descending order .
  • View the Order details of a specific discharge order by selecting it.
  If you need to change a discharge order (other than the pharmacy destination), you must use the Medication Reconciliation feature - Discharge Medication Reconciliation.

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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.