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Medications module user manual

1. mmm mne enema nnn nan 2 Figure 1 2 Navigating the Medicanons FORM vas 2 FICS I A PEE P 3 Figure bA Ener Upadi 5 Figure 2 1 View Current Medications screen nnn 7 Figure 2 2 Sorting 6 44 4 rtrt rnr nnr r rO enema eese nasa rasan eda sena e nea nana 8 FOUE 29 ASO TU T TT 8 Figure 2 4 View History of Medications screen ee rrur ErP EEA SS EEA nna nena nean nan nnn 9 Figure 2 5 Sorting by Date Generic or Brand Dip 9 Figure 2 0 Cancelled ind or obe Rara ERR c SHARED Ei ebat dpt cd oven e aC MD RR S oa E Vos 10 Foure Alergles to Drug S OO 12 6 NOW REU E A EE A E E A ees 12 Figure 2 9 Search for DEUS Sa Fa d ut 13 PIOUS SIG oaan ER EA EE AA etd 13 Figure 2 11 Standard DOSE A fva Vedere 13 POUE z URC OSS US TU 14 MENT 14 Figure Auxillary Directions LISE 5 55
2. 27 Process 11 Electronically Verifying a Medication Mna DEI PUN ania aswel VEMM ORA 29 Process 12 Generating a Medication Reconciliation 32 Process 13 Entering Medication Reconciliation Data 36 Process 14 Generating an Outpatient 38 Process 15 Generating a Renal Medication Profile 1 ee mmm nennen nennen nnns 41 Process 16 Generating a Hospital Admission Orders 4 11 1 00 4 nennen nana nnns 44 Process 17 Generating a Patient Medication 1 48 Electronic Kidney Health Record eKHR 1 INTRODUCTION TO THE EKHR MEDICATIONS MODULE 1 1 Purpose of the Medications Module The Medications module 15 tool to track all patient medication information both current and historical for Manitoba Renal Program patients The Medications module provides one centralized location to manage all medication related information across the Manitoba Renal Program addition it includes the ability to easily verify data entered review medications with the patient and print any reports required to support the pharmacy function of the Manitoba Renal Program 1 2 Medications Module User Roles The Medications
3. 2 4 4 36 3 2 Outpatient Prescription RETE r rnr r 38 3 2 1 Steps to Generate an Outpatient Prescription 38 3 3 Renal Medication ol eR C 41 3 1 1 Steps to Generate a Renal Medication Profile cccccecsececetseceeeeeueeeaueeeaueeeeeeeeseeuteeauteeaueetsesersesetes 41 3 4 Hospital Admission Physician Orders mmm mne nennen nennen nan nns 44 3 4 1 Steps to Generate a Hospital Admission Physician Orders 44 3 5 guis wisis PT M 48 3 5 1 Steps to Generate a Patient Medication Card 1 4 4444 40 44 4 1 6 48 Medications Module Appendix Appendix 1 Processing and Paper Verifying Medication Order Entry into the eKHR 51 As Outpatient MeGICaHDIS ier 51 By 57 Ll UnitClerk Processing Orders 57 22 Staf INSEE OCS SSO RIPE CIUS 61 Tables and Figures Tape ee ee ee eee 1 Table 2 e ee re ee re 6 Figure 1 1 Where to the Medications 1
4. Figure 2 19 Fixed Period Medication 21 Electronic Kidney Health Record eKHR 8 Select enter the Start date 9 Select enter the End date 10 Enter the Minimum dose specified 11 Enter the Maximum dose when indicated 12 Using the drop down arrow select the Unit of Measure UOM specified 13 Using the drop down arrow select the Directions specified 14 Enter those directions not found in Dose Directions in the Auxiliary directions field 15 Double check all medication information entered for accuracy NOTE Medication information once saved cannot be deleted edited or corrected in the eKHR 16 Click the Save button The Entered on and Entered by fields at the bottom of the Medication form auto populate with the current date and the name of the person logged into the eKHR 22 Electronic Kidney Health Record eKHR Medications Module 2 2 5 Entering an Increase or Decrease Dose Medication NOTE To simplify information presented on the patient s Medications Card the Increase Dose and Decrease Dose types are not currently used A medication in which there is an increase or decrease dosage over a period of time is entered as Standard Dose with details regarding the increase or decrease in dosages specified in the Auxiliary Directions field 23 Electronic Kidney Health Record eKHR 2 3 Discontinuing Updating Medication With most medications the directio
5. t a h gapaule s 240 mg EN ESOMEPRAZOLE NEXIUM Take 40 mg once daily PO EDS to Augusti gt PRENNE s 918 Take 100 mg at for log cramps RAMIPRIL 55 5 2 5 mg at bedtime PO e CT RE SODIUM POLYSTYRENE SULFONATE Take 1 doses directed PO Take only if diractad by unit for ecnergency or 21 NOV 13 ZOPICLONE Take 7 5 15 al bedtime PO Page 1 of 1 Verified by sidnature date If required faxes orders to hospital pharmacy stamps and signs order as faxed Yellow highlights updated discontinued order indicates date and whether order 15 discontinued increased or decreased the End date Discontinue date column on previous Profile d Draws a diagonal line across previous Profile to indicate it is superseded 62 Electronic Kidney Health Record eKHR Renal Medication Profile CURRENT MEDICATIONS Printed by SHARON EDMUNDS Allergies MKA PHN 111878 040 D WARF SLEEPY DOB 98 JAN 1830 Medications To Administered d During Dialysis Discont date Drug End date Diank dus Drug Name j ACETAMINOPHEN s00mgiGAFF 16mgiCODNE PHOSPHATE 30mg ALPRAZOLAM Take 5 mg twice daily PO ASA 81 MG ENTERIC COATED Take 1 tablets once daly PO 8 2 ts If required processes other non Renal Medication Profile or
6. Annual m ed review patient attends clinic starts dialysis or transitions Menu Bar WewRxTab _ Give Medication Card to patient select repart options Run report for T 7 Print medications paci report Select Print icon Sort medications Patent Medication Card All Steps 1 Log into the 2 Open Medications form 3 Search for the patient in the eKHR a Check that patient s name and PHIN number are correct 4 Select the Medication Card button located at the bottom of the View Rx Tab WARFARIN SODIUM COUMADING 9 JUN 201 3 PO 4 as directed by physician alternating WITH 2 as directed by physician alternating Last verified on Verified by Entered on Entered by 20 JUN 201 David 4 g JLIN 201 3 Sharon Edimindson Verity History Current Reconciliation Report Qutpatient Prescription Medication Profile Discrepancy Report Hospital Admission __ dic tion Card Figure 3 19 Patient Medication Card button The Report My Medication List appears 48 Electronic Kidney Health Record eKHR Medications Module REPORT My Medication List 112831661 CHANDLER ADAM Single Pat Figure 3 20 Patient Medication Card parameters 5 Select report options as indicated above a Run report for Current Patient b Print Medications Current Medications Sort Medications by Generic N
7. FERROUS SULFATE 1 9 JUN 201 3 PO 900 at bedtime Take 300 mg orally at bedtime days then increase ta 600 PREDNISOME 1 9 JUN 201 3 PO Take 50 orally each day for 2 weeks then take 40 orally each day for 2 weeks SODIUM COUMADIN 1 9 JUN 201 3 PO 4 as directed by physician alternating A F WITH 2 as directed by physician alternating Figure 3 9 Print Prescription checkboxes 5 Select the Outpatient Prescription button located at the bottom of the View Rx Tab Bir WARFARIN SODIUM COUMADIN f19 JUN 2013 4 as directed by physician alternating e WITH 2 as directed by physician alternating Last verified on Verified by Entered on Entered by JUN 2013 David Verify History Current Reconciliation Report Discrepancy Report Figure 3 10 Outpatient Prescription button The Manitoba Renal Program Outpatient Prescription form appears Refer to Figure 3 12 6 Print Outpatient Prescription Report ri Stamp the Outpatient Prescription with a Patient s addressograph information b Unit s address stamp TOME Tei ey health Outpatient Prescription neg onos day SULFATE POD mg Fu mart we any imu Puer apr tc mg cra at for days he iri J
8. 300mgCAFF 18mgCODNE PHOSPHATE 30mg ATYLENOL WITH CODEINE MO 3 ALPRAZOLAM 28 11 13 CALCITRIOL ESOMEPRAZOLE NEXIUM GABAPENTIN pia on 24 SEP 2043 by SHARON EDMUNDSO DOG 1930 Dose Directions Schedule Take 6000 unit s twice weakly Subcutaneous Take 125 mg every 4 weak Ww Doselrectons Scheduie Take 1 2 every 6 hrs as needed PO lt 0 5 twice dally PO ASA 81 ENTERIC COATED IL ue once daily FO NE IEEE LN gt papel ce Take 0 25 megla 3 imes a week hedtime on empty stomach Take 40 mij add _ Take 25 52 3404 hrs needed 00 PO daily as heeded BO M capsule 240 mg MO Take 40 mg nce daily PO EDS fo August 2015 Take 100 mg i for leg cramps Take 25 mg at bedtime PO setis Take 1 tebletis at bedtime PO SODIUM POLYSTYRENE SULFONATE Take 1 dose s directed PO Take KAYEXALATE Paga 1 af 1 diracbad by dialysis urit for emergency or missed dialysis Taka 75 16 mg al ahaa Veriflad by sidnature date Electronic Kidney Health Record eKHR b Transcribes medication to MAR and initials as transcriber on Physicians Orders form If required faxes orders to hospital pharmacy stamps
9. REBLAVTE Patella at beatin PO SODIUM POLYSTYRENE 1 dosejs as directed PO Take only if KAYEXALATE directed by dialysis unit for emergency or missed dialysis _ Taka 7 5 16 mg al bediime Bn Page 1 af 1 e Removes verification alert flag 60 Electronic Kidney Health Record eKHR 3 Staff nurse a Performs second nurse check and co signs Medication orders transcribed by another nurse to Non Renal Medication Profile orders b Removes nurse to check flag 2 Staff Nurse Processing Orders All Steps 1 Physician writes medication order and flags chart with colour designated by site PHYSICIAN S ORDERS See Reverse for Banned Abbreviations MEDICATION amp IV ORDERS ENERAL ORDERS 7576 fo 6000 uni Physician s Signature generi aguivalant authorized toa s bates t Fax ffo Time EA amp enl Transeribert Nurse 2 Staff Nurse a Transcribes medication order to MAR and initials as transcriber on Physicians Orders form If required faxes orders to hospital pharmacy stamps and signs order as faxed Processes any non Renal Medication Profile orders if required e g dry weight changes dialysate bath changes lab tests d Flags chart with colour s designated by site
10. TT karami a a coner aatia iral be tried rara ad 74 CONFIDENTIALITY CAUTION MD Signaturu P Mfano This ie in Vo be Ip ac Eu wi er i pesca dh i MD License amp 25 5325 d 9 4b Use of this foren for purposes or by persons amthorived under the P Controlled Drags and Substances Act and its regulations i n criminal Name Printed Parow n d Once all new entries are verified correct signs and dates bottom of new Profile 55 Electronic Kidney Health Record eKHR Renal Medication Profile CURRENT MEDICATIONS Allergies PHN 111 876 040 DWARF SLEEPY Medications To Be Administered During Dialysis Start date Discont date Drug Name Dose Directions Schedule 4 5 13 EPOETIN ALFA EPREX HD Take 8000 unit s twice weekly 24 SEP 13 SODIUM FERRIC GLUCONATE FERRLECIT HD Medications Patient Takes At Home Start date End date Discont date Drug 17 SEP 13 ACETAMINOPHEN i5ma CODNE PHOSPHATE Take 0 5 twice daily PO CITALOPRAM DOCUSATE CALCIUM Take 2 capsule s once dally needed PO 1 2 2 ESOMEPRAZOLE Take 40 mg once daily EDS to August Take 200 mg at bedtime for leg camps _ REPLAVITE Take 1 tablet
11. 10 Electronic Kidney Health Record eKHR Medications Module 2 2 Entering a New Medication 2 2 1 Entering a Standard Single Dose Medication Use these steps to enter a new standard dose medication into the eKHR 1 a medication with one dose and one direction one row on the Medication form Process 4 Entering Standard Medication Receive medication for entry inta the Search for Patient Medications search for Enter Route of es Medication Administration View Rx Tab Ho Enter drug allergies or no known allergies nterUpdate Tab Enter Select zm Double check entr Save ent Directions Auxiliary dose when directions if required Select Unit af Measure Enter Start e Stand arc Rete Minimum Dose Type dose Select Enter indicated Enter Update Tab All Steps 1 Log into the eKHR 2 Open Medications form a Select Monitoring gt Medications Search for the patient the eKHR by Name or a Click on the Name drop down arrow The Choose a Patient dialogue box appears b Click in the Find field after the sign Start entering the patient s last name the more letters entered the more refined the search or enter the patient s PHIN d Click the Find button Select the correct patient from the list that appears f
12. Electronic Kidney Health Record eKHR Medications Module Version 1 1 January 13 2014 manitoba renal program UN ELECTRONIC kidney health RECORD kidneyhealth a Medications Module Table of Contents 1 Introduction to the eKHR Medications Module 1 1 1 PUlDose or The 1 1 2 Medications Module 65 1 1 3 Where to Find the Medications F OLD piri ria 2 1 4 Navigating tne Medicanons FON 2 1 4 1 e E REPRE DR C 3 1 4 2 Enter Update TaD seers mie 5 1 5 2 6 2 Using the Medications Module 7 2 1 tn ene ns ee eons hind ui Rent Teen nner errr tere 7 2 1 1 Viewing a Patient s Current Medications 1 4 4 04 4 4 1 na nns 7 2 1 2 Viewing a Patient s History of 5 6 nennen nnn 8 2 13 Viewing a Patient s Cancelled Medications mmn nennen nens 10 2 2 Entering New Medication SUPPE Pr eras VU 11 2 2 1 Entering a Standard Single Dose Medication
13. one day A BISACODYL a a ME SIM si ie every moming Electronic Kidney Health Record eKHR b Initials the yellow highlighted discontinued and or changed medications on previous Profile where change is Indicated in the End date Discontinue date column Renal Medication Profile CURRENT MEDICATIONS 23 JUL 2013 Printed SHARON Allergies PHN 111878 040 NAME DWARF SLEEPY Medications To Administered During Dialysis Start date Enddate Discont date Drug DOB gi JAN 1830 Medications Patient Takes At Home Enddate Discont date Drug 17 8EP 13 55 ACETAMINOPHEN 3 mglCAFF 16mg CODNE PHOSPHATE 30mg TYLENOL WITH CODEINE NO 3 _ ALPRAZOLAM 1 13 81 ENTERIC COATED A once daily PO 29 JUL 13 77 7 BISACODYL 2777 Aake 5 mg at bedtime needed PO Adds red eKHR entry verified stamp beside order the Physicians Orders form and signs stamp PHYSICIAN S ORDERS to Sen for Banned Abbrev MEDICATION amp LY ORDERS m mem meme em A Fr s n s 4 F M ee TEM ey TI d E J 1 do Physician 5 Signature Ganaric ized GENE
14. 2 1 11 2 2 2 Entering an Alternate Day Dosing Medication 4 4 44 4 1011 17 2 2 3 Entering a Combination Dosing Ex e OR EORR UE 19 2 2 4 Entering a Fixed Period Medication mmm nemen nnn 21 2 2 5 Entering an Increase or Decrease Dose 23 2 3 Discontiriuitig or Updating A Medication pi bad ra an fad Pod UE ap RU 24 2 3 1 Steps to DISCONTINUE a Medication mmm nenas 24 2 3 2 steps to Update a Medi 25 2 4 Cancelling ENIES 55 4 4 5 45 E ca anat 27 2 4 1 Steps to Cancel a Medication Rae e CAR eve aa hr i 27 2 5 Verimying a Medication Entry in th KAR OO CO Eo SUM Ev EY CREE ER EY Rea 29 2 5 1 Steps to Electronically Verify a Medication Entry the Hm 29 3 eKHR Medications Reports Forms 31 3 1 Medication b rx 32 3 1 1 Steps to Generate a Medication Reconciliation Form 32 3 1 2 Steps to Enter Medication Reconciliation Data the
15. 26 Electronic Kidney Health Record eKHR 2 4 Cancelling Incorrect Medication Entries Occasionally users make or discover incorrect medication entries Either the medication was entered for the wrong patient or the wrong medication information was entered for the right patient E g incorrect dosage unit of measurement and or direction Incorrect medication entries are cancelled in the eKHR Medication entries once saved cannot be deleted edited or corrected in the eKHR It is important to double check each entry before clicking the Save button If an error is made or discovered in entering medication information after it has been saved follow the Steps to Cancel a Medication below 2 4 1 Steps to Cancel a Medication Process 10 Cancelling a Medication O O 9 Check that Highlight medication Medications a medication to i shove as E P atient ipd medicatian cancellation cancelled inthe History of Medications View Rx Tab ViewRx Tab EnterU pdate Tab All Steps l Log into the eKHR 2 Open Medications form a Select Monitoring Medications 9 Search for the patient in the eKHR by Name or PHIN d Click on the Name drop down arrow The Choose a Patient dialogue box appears b Click in the Find field after the sign C Start entering the patient s last name the more letters entered the more refined the search or enter the patient s PHIN d Click the F
16. Click the OK button The View Rx Tab for the selected patient opens in the Current Medications view g Check that patient s name and PHIN number to ensure the correct patient is selected 11 Electronic Kidney Health Record eKHR Medications Module 4 Check that Allergies to Drug field is completed a If not click on the Enter Update Tab b Enter patient s known drug allergies or state if patient has no known drug allergies NOTE Drug allergy information must be entered to save a new or updated medication entry Allergy information can be entered via the Enter Update tab or the General 2 tab on the Patient gt Demographics menu state if patient has no known drug allergies Enter allergies using the format A ergies Signs symptoms Medications Drane 1 1 Figure 2 7 Allergies to Drugs Field Click the OK button 5 Search for the Medication a Click on the Enter Update Tab b Click in the Generic or Brand name field Click on the New button to open an empty field rg Medications PHN eas MM BETTY ALFRE Single Pat Dose a Automatic Display l Start date End date Figure 2 8 New Rx button 12 Electronic Kidney Health Record eKHR Medications Module d Click on the Generic or Brand Trade name drop down arrow the first 3 letters of drug name the Find field Br
17. Generic Brand Verity Print Drug name Generic Brand date Discontinued Doze Directions Schedule E EALCITRIOL EXIGE 025 megla at bedtime 3 times a week Sz Figure 2 2 Sorting Medications 2 1 2 Viewing a Patient s History of Medications The History of Medications screen displays current ended and discontinued medications Process 2 Viewing History of Medications Open Medications Forni Open History View History b Medications i oft M ev Medications Log inta View Rx Tab All Steps Follow Steps 1 3 for Viewing a Patient s Current Medications then 4 Open the View History of Medications screen a Click on the History button located at the bottom of the View Rx tab Last verified on Verified Entered Entered 29 MAY 201 3 Sharon Edmincdzon Verify History Current Discrepancy Report Rx Report Reconciliation Report Medication Profile Exit um Outpatient Prescription Report My Medications Figure 2 3 History button Electronic Kidney Health Record eKHR The View History of Medications screen appears 27 wig His tory of Medic ations PHN 112831661 Name CHANDLER ADAM Single Pat uas Codeine dizziness rash to Drugs Figure 2 4 View History of Medications screen 5 View the list of current and previous medications for the selected patient
18. gt Medications 3 Search for the patient in the eKHR by Name or PHIN a Click on the Name drop down arrow The Choose a Patient dialogue box appears Electronic Kidney Health Record eKHR b Click in the Find field after the sign Start entering the patient s last name the more letters entered the more refined the search or enter the patient s PHIN d Click the Find button Select the correct patient from the list that appears f Click the OK button The View Rx Tab for the selected patient opens in the Current Medications view g Check that patient s name and PHIN number to ensure the correct patient is selected 4 Highlight the medication to be discontinued a Find the medication to be discontinued on the View Rx Tab b Highlight the medication to be discontinued C Click on the Enter Update Tab to view the selected medication 5 Select enter the Discontinue Date Allergies PENICILLIN to Drugs Enter Update Generic E substitute BrandTrade EPOETIM ALFA R 15 MAY 2013 Route of pean Drug Start date 14 2013 LEE Sli directions Cancel prescription Figure 2 20 Discontinue Date 6 Click the Save button 2 3 2 Steps to Update a Medication Process 9 Updating a Medication order Open SEE for Highlight Select Enter discontinue Log inta Medications medication ta be Di
19. which includes the drug names generic or brand start dates and where applicable the end and or discontinued dates and the dose directions schedule information NOTE The list of medications can be sorted by date generic or brand name in the History of Medications view 33 View History of Medications PH 1 29925333 APPLEAHITE BETTY amp LFRE Single Pat vancomycin SOB amp fever Ferrlect intalerance diarrhea amp wt loss k5 to Drugs Views Rx Enterpdate Verity Print Drug name Generic Brandy Start End date Discontinued DoseDirections Schedule PO 1 tablet s twice daily ACETAMINOPHEN TYLENOL EXTRA 5 emm JUL 2015 PO 1 2 tablet s as needed Patient buys over E the counter E 325magA DX copio NEIN O JUL 201 3 PO 1 tablet s every 4 hrs needed E 5 PERCOCET 81 Mi ENTERIC COATED 3 PO 1 tablet s ance daily Bi fenus CALCIUM LIPITOR aces O JUL 201 3 PO 20 at bedtime ROCALTROL aces JLIL 2013 Po A Last verified on Verified by Entered Entered by 03 OCT 20 3 Sharon Edmundson 1 S JUL 201 3 Sharan Edmundson History Current Reconciliation Report Outpatient Prescription Medication Profile Exit Discrepancy Report Hospital Admission Report Medication Card Figure 2
20. 5 Sorting by Date Generic or Brand Name Electronic Kidney Health Record eKHR Medications Module 2 1 3 Viewing a Patient s Cancelled Medications Occasionally users make or discover incorrect medication entries either the medication was entered for the wrong patient or the wrong medication information was entered for the right patient Incorrect medication entries are cancelled in the eKHR Cancelled medications can be viewed via the History of Medications screen Process 3 Viewing Cancelled Medications 9 Open History i O pen Show Lag inta amp KH Medications Sealed p EU Cancelled P atient edi cation aan Farm Ew dictions View Rx Tab All Steps Follow Steps 1 3 for Viewing a Patient s Current Medications then 4 Open the History of Medications View a Click on the History button located at the bottom of the View Rx tab 5 Show Cancelled Medications a Click the Show Cancelled checkbox All cancelled medications appear in an italicized magenta coloured font W Take 2 gram s every hemodialysis as necessary Give x 1 dose for Cacorr less than EIN U JUL 2013 PO Take 0 25 mg once daily as needed 0 25 mg every morning 0 5 mg at bedtime WITH 0 5 mg at B sss 40 JUL 2013 PO Take 0 25 mg once needed T TU Figure 2 6 Cancelled Medications
21. Decrease dose by 10 n mg every 2 weeks until 10 mg daily then continue 10 JUL 2013 Figure 2 15 Entered on and Entered by I nformation 15 Electronic Kidney Health Record eKHR Medications Module NOTE The following dialog box appears when the medication entered is already listed as a current medication for the patient You already have a current prescription withthe same Generic name Would you like ta add another to add No to cancel and go to existing Rix Figure 2 16 Existing Medication Warning Message Dose Templates The Dose Template feature of the Medications Module is not currently used 16 Electronic Kidney Health Record eKHR 2 2 2 Entering an Alternate Day Dosing Medication Use these steps to enter a medication with different dosages on different days Process 5 Entering Alternate Day Dosing Medication _ Receive medication for Search for _ Search for Enter Route of entry into the ER Patient Drugs entered es Medication Administration eKHR View Rx Tab Enter drug allergies known allergies Enter Update Tab Enter Second amp Subsequent E Doses Select Enter Select Information a A Alternate Day Start date st an P ee D osing Min dose IFECHONS dose Min dose required dose Directions Enter First Double check
22. E RV TERN a 36 Figure 3 6 Medication Reconciliation Data Entry 144 nenne nemen nena nan nns 36 Figure 3 7 Reconciliation SEEN nd UC RATE VENAE ERA ESAE RSEN ED KV HER RD E IDE deu 37 Figure 3 8 Medication Reconciliation Data 37 Foure 2 9 PHDEPPESSEHDHONAUISCKDONBS a 39 Figure 3 10 Outpatient Prescription tob da 39 Medications Module Figure 3 41 Stamping Outpatient eae Meena et 39 Foure 3 12 Outpatient Pres 40 Figure 3 13 Medication Profile 41 Figure 3 14 Medication Profile enema nennen nena nan nnn 42 Figure 3 15 Renal Medication Profile Current 5 2 nennen 43 Figure 3 16 Hospital Admissions Report DUMON seis aras EE 44 Figure 3 17 Hospital Admission Orders Report parameters 4 4 44 04 4 1 nana nnn 45 Figure 3 18 Hospital Admission Physician Orders report 2 pages 41 0 0 0 6 47 Figure 3 19 Patient Medi
23. Electronic Kidney Health Record eKHR Medications Module The REPORT Medication Review Reconciliation Clinic Medications Orders screen appears 2 REPORT Medication Review Reconciliation Clinic Admission and Discharge Medications Orders atient PHM CLARE JONO nreport ReportParameters 925 urrent Patient Emire rtis iiet port Settings Sort Medications by Mut put Format or Run Report Exit Figure 3 3 Medication Reconciliation parameters Select report options as indicated above a Run report for Current Patient b Report Type Medication Review Reconciliation or Clinic Medication Orders Sort Medications by Generic Name Click Run Report 2 page Medication Review Reconciliation or Clinic Medication Orders Report Form appears Refer to Figure 3 4 Print Medication Review Reconciliation or Clinic Medication Orders Report Use the report to proceed with Medication Reconciliation process 33 Electronic Kidney Health Record eKHR Medications Module Page 1 Winnipeg Regional Office regional de la Authority sante de Winnipeg kid neyhea Ith Cong For Health A de notre sant manaha renal program Medication Review Reconciliation Report Note This list may not Include following type of drugs Investigati antiretroviral oncology physician sample herbal or se
24. Medications All Steps 1 Physician writes outpatient prescription and flags chart with colour designated by site Outpatient Prescription SOGH Hemodialysis Unit 2300 McPhillips Street Winnipeg MB Phone 204 632 3447 Fax 204 632 0536 Mt cf FAXED THIS ORIGINAL PRESCRIPTION MUST BE MADE PART OF THE FATIENT CHART Delivery Patient will pick up Deliver to O Deliver te Tin yale unit af nexr d very time O Defer preecnptien MeEestive order transcribed Onder dor index duuble Checks aim fen ice Mie AL fia EYMAPM Change an O Medication Cand Completed ty siven top i Patient giver verbal ra on media enge Lmpenon or 444 FHESCREBER CHUTIMCATHIN 4 L K nts X df O Tk af ee No deg ede E ton oll stows d Eig ego and ferr oro cen Tha en rad ini Lacu C ioc eel rd ini ime ai Quer oben f vc CONFIDENTIALITY CAUTION MD Signature _ fi Far Lich eA eae Py cand p TT od ber rd 535 m En rrr 1 1 Pa ao dc alor cet e
25. Outpatient Prescription Process 14 Generating an Outpatient Prescription Select Receive arder for Opern Outpatient Log into eKHR Medications search for medication s for Patient Outpatient Prescription Form Prescription Menu E ar View Rx Tab Stamp Outpatient Physician UM Process and verify select Outpatient E Prescription with authorizes ae Prescription Button Select Printicon accressograph Outpatient Outpatient Prescription as Appendix and unit addess Prescription Sutpatient Prescription Form All Steps l Log into the eKHR 2 Open Medications form 3 Search for the patient in the eKHR a Check that patient s name and PHIN number are correct 4 Select the medication s to be included in the Outpatient Prescription a To include all current medications click the Print All checkbox or b To include only specific medications click the print checkbox next to those medication s 38 Electronic Kidney Health Record eKHR Verity All Drug name Generic Brandy Start End date Discontinued Doze Directions Schedule E Sms 19 4 2013 res ore E CALCIUM CARBONATE 625 MG APO EI 9 JUN 2013 PO 3750 at bedtime 2500 3times daily CAL 250 Take 2500 mg doses with with breakfast lunch CEPHALEXIN suus JLIN 20H 3 PO 500 mg twice daily FROM 20 JUM 2013 TO 03 JUL 2013 03 JUL 201 3
26. PO EDS to August 2015 Take 200 mg al bedtime PO for leg cramps Take 2 5 mg at bedtime PO 9 eE A 3JUL POLYSTYRENE SULFONATE take i dosis es PO Take only i directed by dialysis for emergency or missed dialysis 21 13 ZOPICLONE Take 7 6 15 mg at bedtime PO b Faxes orders and completes Medication Change Form if required and signs off order processed C Yellow highlights updated discontinued order indicates date and whether order is discontinued increased or decreased in the End date Discontinue date column on previous Profile d Draws a diagonal line across previous Profile to indicate it has been superseded 52 Electronic Kidney Health Record eKHR Renal Medication Profile 29 JUL 2043 CURRENT MEDICATIONS Printed by SHARON Allergies PHN 111876 040 NAME DWARF SLEEPY Medications To Be Administered During Dialysis Start date Enddate Discont date Drug Name Dose Directions Sche EPOETIN ALFA EPREX Take 8090 unli s twice Subcutaneous SODIUM FERRIC GLUCONATE Take 125 mg ________ FERRLECITJHO Medications Patient Takes At Home Startdate Enddate Discont date Drug Name ACETAMINOPHEN AFF Tamg CODNE PHOSPHATE s ALPRAZOLAM AY mg twice daily ASA 81 ENTERIC COATED Take 1 tablet s once daily PO BISACODYL 7 Take 5 mg at be
27. continue IF FAXED THIS ORIGINAL PRESCRIPTION MUST BE taking 10 mg orally each day MADE PART OF THE PATIENT CHART WARFARIN SODIUM 4 mg every 3 days altemating WITH 2 Delivery Instructions COUMADIN mg every 3 days alternating WITH 2 mg 2 every 3 days PO Take 4 mg on Day 1 O Patient will pick up take 2 mg on Day 2 take 2 mg on Day 3 L Deliver to patient s home und code Deliver to dialysis unit at next delivery time Defer prescription until requested Manitoba Renal Program Use Only Faxed INITIAL DATE DD Y Y Y Y Medication order transcribed by Order double checked by MRP Medication Change Form Medication Card Completed by Given to patient by Patient given verbal instructions on medication change O person phone by PRESCRIBER CERTIFICATION THIER represents original of the Rx drug order The pharmacy addresses noted above the only Intended recipient and there no others The original has been invalidated and securely fled and will not be transmitted elsewhere at another time Quantity must be stated Mitte Repeat O Meets EDS worde and numbers ee on atl CONFIDENTIALITY CAUTION all above unless otherwise indicated This fax confidential and Is Intended to be recelved by the addressee only If the reader Mm not the Intended recipient thereof you are advised that dissemination distributon or MD Signatures copying of t
28. dela Health Authority sam Winnipeg foe kidneyhealth Aes ee Hospital Admission Physician Orders ee ee oie e ed eae um Erg T PATIENT DWARF DOC 27 45 2044 11 38 DOB8 ST HAN TEOGO iy Shan ALLERGIES catorum of Ext 5 ron To Be Adminictered During ALFA 2000 unita of weedy hec un EPRIEX GIVEN iki EXIDILIM FERRIC 125 2 GLUCOMATE HVEN IN DiAL Y EIE home Precorintion 025 m mma 0 5 bettie PO 0 25 mg once PS LEJ NE ures dey eed Topl oth 2 Mentha 55 Hydro 1 in FERROUS Q0 mg Decima PO 300 mg 7 diya EDO mg for 7 hen mg 2 pupa 12 meuh PROPIONATE CUSALMETEROL E 250 MD 1 dpa Luft eye Peete bey 25 duly Hold am ees on ie 0 4 once daily Apply Gatch in fas PATCH INTPOC DUR 46 Electronic Kidney Health Record eKHR Page 2 Regional DiTice r gional Health A
29. ei b Initials the yellow highlighted discontinued and or changed medications on previous Profile where change is Indicated in the End date Discontinue date column Renal Medication Profile CURRENT MEDICATIONS Printed by SHARON EDMUNDS Allergies PHN 111878 040 DWARF SLEEPY DOB 05 15 1930 Medications To Administered During O End date Discont date Drug Dose Directions Schedple Medications Patient Takes At Home Enddate Discont date Drug Name noe ACETAMINOPHEN 300mg CAFF 18mg CODNE PHOSPHATE 30mg JTYLENOLWITHCODEINENO 3 ALPRAZOLAM ems mg twice daily PO ASAP ENTERIC COATES once dally PO Electronic Kidney Health Record eKHR Adds red eKHR entry verified stamp beside order on the Physicians Orders form and signs stamp PHYSICIAN S ORDERS mi Sea Reverse WRHA Banned Abbreviations MEDICATION amp LV ORDERS GENERAL ORDERS oOo E Date ET Er MN fer 5 Signature La NEL e LLL ized AP A T TE L fato south Copy Fax Time n i Once all entries verified correct signs and dates bottom of Profile Renal Medication Profile 24 201 CURRENT MEDICATIONS Printed b VERRRORCEDRUNDSS Allergies PHM 111878040 NA
30. enter the patient s PHIN d Click the Find button e Select the correct patient from the list that appears 29 Electronic Kidney Health Record eKHR f Click the OK button The View Rx Tab for the selected patient opens in the Current Medications view g Check that patient s name and PHIN number to ensure the correct patient is selected 4 Check the new unverified medication entries in the eKHR are correct against the original order s J If not correct ensure steps are taken to Cancel an Incorrect Medication Entry Section 2 4 and enter the correct information on the Medications form 6 Select the medication s that have been verified as correct a If verifying all current medications click on the Verify All checkbox b If verifying a specific medication click on the checkbox beside that medication Drug name Generic Brandi ala ERG date Discontinued Dose Directions Schedule 29 MAY 2013 OOo PO 100 mg once daily 28 MA Y 201 3 PO 500 twice daily 250 mg once daily Take 250 mg with breakfast 28 MANY 201 3 PO 500 mg twice daily FROM 29 MAY 2013 TO 1 4 JUN 2013 14 2013 29 201 3 PO 300 at bedtime FROM 29 MAY 2013 TO 04 04 2013 600 at bedtime FROM 05 JUN 28 MAY 201 3 E B twice weekly Take 5 ma Monday Friday m Figure 2 23 Verify Medication checkbox WRF SODIUM COOLILS DIN 7 Click on the Verify button The fi
31. in the event that the patient presents to Emergency or is admitted to an inpatient unit 3 4 1 Steps to Generate a Hospital Admission Physician Orders Report Process 16 Generating a Hospital Admission Orders Report me Patient in for Select Hospital Emergency or Medications Patient Admission admitted to hospital Forn R epot ViewRxTab elect report options e len Run report for SelectRun Select Print c mem send form 10 Report type report icon Dialysis Yes Sort medications Com plete and authorize report Inpatient unit Ho 7 report as printed completionita Emergenc Report Clinic Admission and Discharge Medication Orders screen Hospital Admission Physician Orders form All Steps 1 Log into the 2 Open Medications form a Select Monitoring gt Medications The View RX Tab opens and the View Current Medications screen appears 3 Search for the patient in the eKHR a Check that patient s name and PHIN number are correct 4 Select the Hospital Admission Report button located at the bottom of the View Rx Tab Last verified on Verified by Entered on Entered by 20 JUN 201 3 David 1 9 JUM 201 3 Sharon Edmindson Verify History Current Reconciliation Report Discrepancy Report Outpatient Medication Profile Exit Medication Card Hospita
32. s at bedtime PO SODIUM POLYSTYRENE SULFONATE 1 dose s as directed PO onlyif KAYEXALATE directed by dialysis ut for emergency or ZOPICLONE Removes alert flag 4 Staff Nurse a Gives Medication Change Form if required to patient initials and dates in MRP Medication Change Form Given to Patient box on the Outpatient Prescription form b Checks box that Patient given verbal instructions on medication change initials and dates on the Outpatient Prescription form 56 Electronic Kidney Health Record eKHR B Medications Given in Dialysis 1 Unit Clerk Processing Orders All Steps 1 Physician writes medication order and flags chart with colour designated by site Unit Clerk PHYSICIAN S ORDERS MEDICATION amp LV ORDERS E Dated bg any Fax Tira Transcriber See Reverse for Banned Abbreviations Enters medication eKHR and prints Renal Medication Profile Current Medications Profile Renal Medication Profile CURRENT MEDICATIONS Allergies PHN 111 878 040 DWARF SLEEPY Medications To Be Administered During Dialysis _ date Enddate Discont date Drug Name 24 SEP 13 EPOETIN ALFA HD HD ic ations F Pationt Home Start date End date Discont date Drug Name 17 5 13
33. times daily TAL 5007 Take 2500 ma 2 tablets 2500 three times E gy ALFA EPREX mes zB JUN 201 3 Subcutaneous 6000 unit s every 7 days EN pum ALFA EPREX JUM 201 5 Subcutaneous 6000 unit s every 7 days Ell METOPROLOL TARTRATE san MA ZUM 3 PO 12 5 mg twice daily PROLOL poses REPLAMITE ses MAY 2013 PO 4 tablets at bedtime 21 NN 5 Entered by Verify History t Reconciliation Report DUCENTE p mmn Medication Profi ofile Discrepancy Report Hospital Admission Report Medication Card Figure 1 3 View Rx Tab 1 Patient The currently selected patient and their PHIN number 2 Allergies to Drugs Patient s allergies including signs and symptoms 3 Set List This 15 a filter that will allow the user to view the history of one specific drug for a patient For this function to be enabled the history button should be set 4 Show Cancelled When History button is selected use Show Cancelled to include those medications that have been cancelled due to an error in data entry NOTE Cancelled medications will show in a magenta colour 5 Sort both History and Current views use Sort to list the patient s medications prescriptions by date generic name or brand name 6 Verify All Use this check box to select all current medications when performing verification NOTE If not verifying all medications selec
34. to gt Alert for second nurse to check order transcription gt Alert for unit clerk to enter medication into eKHR e Performs second nurse check and co signs medication orders transcribed by another nurse to MAR then removes nurse to check flag 61 Electronic Kidney Health Record eKHR 3 Unit Clerk a Enters medication in eKHR and prints Renal Medication Profile Current Medications Profile Renal Medication Profile am CURRENT MEDICATIONS Printed by SHARON EDMUNDSO Allergies NKA PHN 111876040 NAME DWARF SLEEPY DOB 06 J4N 1930 Medications To Be Administered During Dialysis Start dato Discant date Drug Name Dose Directions Schedule EPOETIN ALFA EPREX HD Take 8000 unitis twice Os SODIUM FERRIC GLUCONATE Take 125 mg every 4 waaks IV FERRLECIT HD DoselDirectionsiSchedule ACETAMINOPHEN 300mg CAFF Taka 1 2 tsblei s every 6 hrs as needed 1img CODNE PHOSPHATE 30mg commend TYLENOL WITH CODEINE NO 3 nav ALPRAZOLAM 0 5 ma twice dally SE HG em COATED ena d M EM nie BIBACODYL 5 mg al bedtime as needed empty stomach _ CITALOPRAM 40 mg every morning ME PETS deco mamme UU T7
35. 12 Using the drop down arrow select the Directions specified 3151 bid Code English AMHS every morning and bedtime ASDIR HD as directed during hemodialysis ASDIRECT directed by physician twice daily BID D twice daily on dialysis days BID TID 2 to 3times a day BID TIDP 2 to 3times a day as needed BIDPRN twice daily as needed 2 times per month BIMHD two times per month during hemodialysis BIN twice weekly 210 3 times a week D times ner wee co Figure 2 13 Directions List 13 Select enter those directions not found in Dose Directions in the Auxiliary directions field a Use Drop down arrow to select Auxiliary directions b If appropriate directions not listed select Other Specify and enter appropriate directions 14 Electronic Kidney Health Record eKHR Fa Medications Figure 2 14 Auxiliary Directions List 14 Double check all medication information entered for accuracy NOTE Medication information once saved cannot be deleted edited or corrected in the eKHR 15 Click the Save button The Entered on and Entered byfields at the bottom of the Medication form auto populate with the current date and the name of the person logged into the eKHR ees take 30 minutes BF PERINDOPRIL COVERSYL 2013 PO Take 8 mg at bedtime E lake 1 tablet s twice daily Vimovo Take 50 mg once daily
36. 2 1 10 112020 2 User SEDMUNDSON Database File Patients Treatment Monitoring Maintenance Scheduling Reports Help Dialysis Access Lab Results Pt Infectious Status Immunization Hx Medications Medication Reconciliation Figure 3 5 Where to Find Medication Reconciliation The Medication Reconciliation screen appears Medication Reconciliation Selection Mode Patients DOB 5 Single Pat m Reconciler Reconciliation Transition Int Unint Unknown Total Interview Reconciliation No of Entered B i Name Type Discr i Modality Dialysis Centre ee ___ E EI BE s g jj 5 ij E BH I iy 5 1 um J s E BE I 1 sg j Jj E El B8B E E a of fT T ag 5 Ls Save Exit Figure 3 6 Medication Reconciliation Data Entry screen 36 Electronic Kidney Health Record eKHR 3 Search for the patient in the eKHR a Check that patient s name and PHIN number are correct 4 Enter the Medication Reconciliation data a Entered by auto populates with name of person logged into eKHR b Select Profession using drop down arrow C Select Reconciliation Type using drop down arr
37. 3 15 Figure 2 15 Entered on and Entered DY Informatii S d uev tn 15 Figure 2 16 Existing Medication Warning Message 2 1 44 ne nnne nene nna nans 16 Figure 2 17 Alternate Day DOSING eme voa Fur Sas a 17 Foure 218 Combination 19 Foure 2 19 Fed Period Me AIC all OM 21 ONS 77777 2 2 2 2 2224244 1222 202420 25 Foure Roe Meere OUO 26 Figure D O i er ee E SI UM REN 28 Figure 2 23 Verify Medication 4 mmm nana nnns 30 Figure 2 24 Last Verified on and Verified by 2 2 24 mmm nnnm 30 Figure 3 1 eKHR Reports 7 Forms isses n eere ri ance ka ea n cel re o Pa E e d Ipae e Tr acra fel red caa 31 Foure 3225 RCON 6 geom 32 Figure 3 3 Medication Reconciliation 1 1 ene nene nennen rares aa nena nnns 33 Figure 3 4 Medication Review Reconciliation Report 2 35 Figure 3 5 Where to Find Medication Reconciliation Vue x MORENO GEO Y XE EIGENEN ENT EN GIEVA S
38. ERROUS SULFATE 4 9 JUM 201 3 PO 900 at bedtime Take 300 mg orally at bedtime for 7 days then increase to EJ PREDMISONE 9 JUM 201 3 Take 50 orally each day for 2 weeks F then take 40 mg orally each day for 2 weeks E WARFARIN SODIUM COUMADIN sanas JLIN 2013 PO 4 directed by physician alternating M WITH 2 az directed by physician alternating Last verified on Verified by Entered on Entered by 20 JLIN 201 3 Tenio Dawid 1 9 201 3 Sharon Edmindzan Verify History Current Reconciliation Report Outpatient Prescription Medication Profile Exit Discrepancy Report Hospital Admission Report Medication Card Figure 3 1 eKHR Reports Forms buttons 31 Electronic Kidney Health Record eKHR 3 1 Medication Reconciliation Medication reconciliation is a process that includes generating a comprehensive list of all medications the patient has been taking at healthcare transition points identifying and documenting discrepancies and working to resolve medication discrepancies The eKHR generates a report form of the patient s current medications a tool which pharmacists use when conducting medication reconciliation as part of annual reviews of a patient s medications and when the patient attends renal clinic starts dialysis transitions between modalities sites or is discharged from hospital Once medication reconciliation is comp
39. H CODEINE 3 Take 5 mg at bedtime as needed Talis 0 35 mogts T f bed Take 40 mg every moming PO 25 50 mgevery3io4hrsasneeded PO Take 2 capsule s once daily needed capsule 240 mg Ta 2015 Take 2 5 mg at bedtime PO MES r directed by dialysis unit for emergency or ctions Schedule tablet s every 6 hrs as needed 0 5 twice lime empty stomach 2 2 ke 40 mg once dally EDS to August 1 4 6599 dialysis In the order double checked box on the Outpati verified initials and dates ent Prescription form writes eKHR entry 54 Electronic Kidney Health Record eKHR Medications Module SOGH Hemodialysis Unit 2300 McPhillips Street Winnipeg MB Phone 204 632 3467 Fax 204 632 9536 9 13 Faxd El Jot IF FAXED THIS ORIGINAL PRESCRIPTION MUST BE MADE PART OF THE PATIENT CHART Delivery Instructions O Patient will pick up O Detiver to pation s home Deliver to Getysis unit at next delivery time O Defer prescription until requested PRESCRIRER CERTIFICA THIN Ef nte Repent x i Meets EDS regentis te iei gina pida ray Te pam bane Le pr unie clama eel dba mu tei bera Ped
40. ME DWARF SLEEPY 05 1 1930 Medications To Be Administered During Dialysis Start date End date date Drug Name Dose Directions Schedule ____ EPOETIN ALFA EPREX HD Take 8000 uniia twice weekly SODIUM FERRIC GL CONATE Take 125 mg every 4 weeks IV __ FERRLECIT HD Medications Patient Takes At Home m End date Discont date Drug Name Dose Directions Schedule ACETAMINOPHEN 3O0mg CAFF Take 1 2 tablet s every 6 hrs as needed 185mg CODNE PHOSPHATE 20mg PO _ TYLENOL V WITH CODEINE 3 _ Take 1 tabletis once dally PO Take B mg al badtime as nesaded PO CALCITRIOL 0 25 megla 3 times a week PO at ed meonempiysicnach GFFAEOPRAM Take 40 mg every moming PO DIMENHYDRINATE Take 25 50 mg every 3 to 4 hrs as needed ee DOCUSATE CALCIUM Take 2 capsule s once daily needed Take 40 mg once daily EDS In August memes OnE RO ems n rama een ee ee nn na nomme 9 20 15 29 018 SABAPENTIN Take 100 mg al bedtime PO for leg cramps 2 5 at bedtime
41. RAL ORDERS mp 3 Tim d Once all entries verified correct sign and date bottom of Profile 64 Electronic Kidney Health Record eKHR Renal Medication Profile 24 3 201 CURRENT MEDICATIONS Printed by SERROR EDWUNSSS Allergies PHN 111 875 040 DWARF SLEEPY DOB 05 1 1930 Medications To Be Administered During Dialysis Start date Enddate Discont date Drug Name Dose Directions Schedule EPOETIN ALFA EPREX HD Take 6000 twice wealy SODIUM FERRIC GLUCONATE Take 125 mg every 4 weeks IV Medications Patent Takes At Home Startdate Discont date Drug Name Dose Directions Schedule ACETAMINOPHEN 300mgiCAFF Take 1 2 tablet s every 6 hrs needed PO 15mg CODNE PHOSPHATE omg SODIUM POLYSTYRENE SULFONATE Take 4 as directed PO Take only If direciad by dialysis unit Tor emergency er 21 NOV 13 ZOPICLONE Removes verification alert flag 65
42. RBONATE 625 reds Statdatelri JUL 2013 Auxiliary M End date MERERI directiont Cancel prescription Cther b Comment hs ET Indication Indication Indications ther Indication Dose Se Template Automatic Display Dose Type _ Start date End date Min Loh Directions Single Record 13 JLIL 2013 Em 4Atternate Day Dosing Combination Casing Fixed Period Increase Dose E Decrease Dose d Copy Hew Hew Dose Template Save Exit Figure 2 18 Combination Dosing 19 Electronic Kidney Health Record eKHR 8 Enter the FIRST DOSE information Select enter the Start date b Enter the Minimum dose c Enter the Maximum dose when indicated d Using the drop down arrow select the Unit of Measure UOM e Using the drop down arrow select the Directions specified 9 Enter the SECOND DOSE and subsequent doses information Select enter the Start date b Enter the Minimum dose Enter the Maximum dose when indicated d Using the drop down arrow select the Unit of Measure UOM e Using the drop down arrow select the Directions specified 10 Enter those directions not found in Dose Directions using the Auxiliary directions field 11 Double check all medication information entered for accuracy NOTE Medication information once saved cannot be deleted edited or corre
43. RIL REPLAVITE _ SODIUM POLYSTYRENE SULFONATE KAYEXALATE ZOPICLONE b Initials the yellow highlighted discontinued and 7777 Take 40 mg every moming PO _ Take 1 tablet s at bedtime PO missed dialysis Printed on 08 2015 Printed by SHARON EDMUNDSO 06 JAN 1930 Doso Directions Schedule Take 6000 unit s twice weekly _Subeutan ous S 0 1 Take 125 mg every 4 weeks IV FERRLECIT HD Dose Directions Schedule Take 1 2 tablet s every 6 hrs as needed PO Take 1 tablet s once daily PO 0 25 meg s 3 times a week at bedtime on empty stomach Take 25 50 mg every 3 to 4 hrs as needed PO MEC Ir TS icapsule z240mg Take 40 mg once daily PO EDS to August 2015 EN Take 200 mg at bedtime PO for leg cramps Take 2 5 mg at bedtime PO Take 1 dose s as directed PO Take only if directed by dialysis for emergency or Take 7 5 15 mg at bedtime PO or changed medications on previous Profile where change is indicated in the End date Discontinue date column Medications Patient Takes At Home Start date Enddate Discont date Drug Name 17 SEP 13 ACETAMINOPHEN 300mg CAFF 15mg CODNE PHOSPHATE 30mg siete cpa 81 ENTERIC COATED BISACODYL 00 0 GABTRGU 774 29 JUL 13 29 JUL 13 KAYEXALATE A WIT
44. ame 6 Click Run Report button The Patient Medication Card appears refer to Figure 3 21 ie Click the Print icon 8 Give mail the Patient Medication Card to patient 49 Electronic Kidney Health Record eKHR Winnipeg Regional Office r gional de la Health Authority sant de Winnipeg kicdneyhea i Lannig tor heat A de notre sant Patient Medication Card CHANDLER ADAM manirobao rero nrogrmo PHN 112 831 661 Printed on 12 JUL 2013 DOB 40 SEP 1540 Split medicabons given on dialysis Yes DRUG ALLERGIES Codeine dizziness rash Medications To Be Administered During Dialysis Medications Patient Takes At Home ALLOPURINOL FERROUS SULFATE PREDNISONE WARFARIN SODIUM COUMADIN Medications to Take Only When Needed Medication Additional Notes Direction prevent gout 200 mg at bedtime Orally Start 300 mg orally at bedtime for 7 days then increase to 600 mg orally at bedtime for 7 days and then increase 900 mg orally at bedtime Continue 900 mg orally at bedtime Take on an empty stomach and separate from Calcium by at least 2 hrs 50 mg once daily Orally Start with 50 mg orally each day for 2 weeks then decrease to 40 mg orally each day for 2 weeks then decrease to 20 mg orally each day for 2 weeks and then continue taking 10 mg orally each day 4 mg every 3 days alternating WITH 2 mg every 3 days alternating WITH 2 mg every 3 days Orally Take 4 mg o
45. and signs order as faxed d Yellow highlights updated discontinued order indicates date and whether order 15 discontinued increased or decreased the End date Discontinue date column on previous Profile Draws diagonal line across previous Profile to indicate it is superseded Renal Medication Profile CURRENT MEDICATIONS Printed by SHARON EDMUNDSO Allergies PHN 11 878 040 DWARF SLEEPY Medications To Be Administered During Dialysis 2 Start date Enddate Discont date Drug Name Dose Directions Schaedule 24 SEP 13 EPOETIN ALFA EPREX HD Take BOQU unli s twice weakly poema s Lie canum comes nuuc omens noun loi nod bisbal sma iaa a meena L2 03 2 ER2 EISES E DEIET DEIR Ress ee DOR es 658 _Subeut Bneous zm fms teen ITE TEE 4 13 SODIUM FERRIC GLUCCONATE 125 mg every 4 waaks IV IFERRLECIT HD _ DOB 06JAN 1930 Medications F Patient Takes At At Home Startdate Enddate Discomt date Drug Name 17 SEP 13 ACETAMINOPHEN i5mg CODNE PHOSPHATE 30mg WITH CODEINE NO 3 _ eee ee 26 JUL 13 ALPRAZOLAM 0 5 twice dally Da EE COATED a 7 BISKGGDVL modd EE Ee EY EE ceca saca
46. andnameiTradename Drugs Enter a partial value to limit the list ta see all values Warning Entering ta see all values may take a very long time Entering criteria that can be used to reduce the list may be significantly faster Find rep BrandiTrade Generic Figure 2 9 Search for Drugs Click the FI ND button g Select the correct medication from the list that appears h Click the OK button 6 Using the drop down arrow select the Route of Administration ndication1 Figure 2 10 Route of Admin field 7 Select the Standard Dose Type button Dose Tempe Automatic E Alternate Day Dosing _ Combination Dosing Fixed Period _ E Decrease Dose j Hew Hew Rx Dose Template Save Exit Figure 2 11 Standard Dose Type 8 Select enter the Start date 9 Enter the Minimum dose specified 10 Enter the Maximum dose when indicated 11 Using the drop down arrow select the Unit of Measure UOM specified 13 Electronic Kidney Health Record eKHR Other it Indication NI eee 2 tablespoon Templ tablet s Dose Type i Directions units ja Alternate Day Dosing unit s hour Combination Dosing unit s mL Fixed Period Increase Dose 4 Decrease Dose 8g Copy Hew Hew Rx Dose Template Save Exit Figure 2 12 Unit of Measure List
47. ar HAE nr s mg iri Gantinus idR OT Tahoe enki EST AI trom Oaia ADDRE aa ina bee 4 Pera ET 4 FREON SORE ao mae eo Bian with mg har rra ye ddr 46 ma orally E rane canum s ed Figure 3 11 Stamping Outpatient Prescription 8 Have physician authorize the outpatient prescription 9 Follow steps for processing and paper verifying Outpatient Medications outlined in Appendix 1 39 Electronic Kidney Health Record eKHR Winnipeg Regional Office r gional de l Health Authority vm kidneyhea Ith En bna i P nir annis kami nee PIE TOUT SANT Y TTT Outpatient Prescription ALLOPURINOL 10D mg once daily PO FERROUS SULFATE 300 mg at bedtime PO Start 300 mg arally at bedtime for 7 days then increase to 800 mg orally at bedtime for 7 days and then increase to 800 mg 22 orally at bedtime Continue 900 mg 02 30 2013 orally at bedtime Take on an empty CHANDLER ADAM stomach and separate from Calcium by ADDRESS at least 2 hrs WIN MB RST 1 6 PREDNISONE 50 mg once daily PO Start with 50 mg Pharmacy arally each day for 2 weeks then SS decrease to 40 mg orally each day for 2 Fax amp weeks then decrease to 20 mg orally each day for 2 weeks and then
48. cation Card 48 Figure 3 20 Patient Medication Card 49 Figure 3 217 Patient Medication 50 Processes Process 1 Viewing Current 6 4 7 Process 2 VIEWING History of Medicati ns in nantes 8 Process 3 Viewing Cancelled 1 2 04 6 10 Process A Entering standard MOGI Cation 11 Process 5 Entering Alternate Day DOSING Medication 2 2 17 Process 6 Entering Combination Dosing MediCqdLblOD oki das xad aera en ei ord Dn v ad sanas 19 Process 7 Entering Fixed Period 444 21 Process 8 Discontinuing MCG ICAUIOM cinisadsat ooe ornin oaran ASAKE dcs IR BORED tdv 24 Process Updating a Med Can Onl 3 5 5 15 DET 25 Process 10 Cancelling a
49. crie Hr pred MID Dicens 152955 Use of this form Tor purpeers by peron under the T Drugs amd Substances Act nnd its regulations li a criminal aec MB Printed Browne Electronic Kidney Health Record eKHR 2 Unit Clerk a Enters medication and prints new Renal Medication Profile Current Medications Profile Renal Medication Profi Renal Medication Profile 201 CURRENT MEDICATIONS Printed by SHARON EDMUNDSO Allergies NKA PHN 111 876 040 NAME DWARF SLEEPY Medications To Be Administered During Dialysis Start date Enddate Discont date Drug Name Dose Directions Schedule 24 SEP 13 EPOETIN ALFA EPREX HD Take 6000 unit s twice weekly 24 SEP 13 SODIUM FERRIC Take 125 mg every 4 weeks IV FERRLECIT HD Medications Patient Takes At Home Start data End date Discont date Drug Name 47 SEP 13 ACETAMINOPHEN 300mg CAFF Take 1 2 tablet s every B hrs needed 0 i5ma CODNE PHOSPHATE 30mg PO ALPRAZOLAM ENTERIC COATED 125 20 13 34 SEP 14 gt ennn s ee aseeseen rr a Take 0 25 megis 3 times aweek POat tr bedtime on empty stomach CITALOPRAM Take 40 mg every moming PO Me EE TS 10 2 1 E ESOMEPRAZOLE NEXIUM Take 40 mg once daily
50. cted the eKHR 12 Click the Save button The Entered on and Entered by fields at the bottom of the Medication form auto populate with the current date and the name of the person logged into the eKHR 20 Electronic Kidney Health Record eKHR Medications Module 2 2 4 Entering a Fixed Period Medication Use these steps to enter a medication given for a specified duration An End date only applies when a medication is prescribed for a definite time frame e g antibiotics Start and End dates are required End dated medications will automatically expire at the appropriate date and move to the patient s medication history Process 7 Entering Fixed Period Medications Search for Enter Route of a es Medication Administration Receive medication for entry into the i WewRxTab allergies na known allergies E nterUpdate Tab 9 2 3 Select Unit of Measure Select seledi Double Directions Enter check entry Auxiliary for accuracy Minim nim Enter Start date indicated Enter Update Tab All Steps Follow Steps 1 6 for Entering a Standard Dose Medication then 7 Select the Fixed Period Dose Type button Genere nde Dug Startdate12 jUL 2013 direction s
51. ders e g dry weight changes dialysate bath changes f Flags chart with colours designated by site to gt Alert that verification of Profile is required gt Alert that non Renal Medication Profile orders to be checked e g transcription to MAR dry weight or dialysate bath changes 4 Verifier Pharmacist CRN Staff Nurse trained in verification a Assesses accuracy of each new updated medication entry on Profile against the written physician s order gt If Incorrect indicates errors on Profile and flags chart alerting Unit Clerk that correction s are required gt If correct initials in the right margin beside the new updated medication Renal Medication Profile CURRENT MEDICATIONS Printed by SHARON EDMUNDS Allergies PHN 111876 040 DWARF SLEEPY DOB 06 JAN 1930 Medications Administered During Dialysis Discont date Drug Name Dose Directions Schedule EPOETIN ALFA EPREX HD Take 8000 unit s twice weakly 24 SEP 13 mE SODIUM FERRIC GLUCOMATE Take 125 mg every 4 weeks _ AFERRLECIT HD MEE Madications Patient Takes Home Start date End date Discont dale Drug Mame DoselDirections Schedule 17 SEP 13 ACETAMINOPHEN 300mgCAFF 1 2 tabletis every 6 hrs as needed 15mg CODNE PHOSPHATE 30mg PO t car caeco WITH CODEINE MO e 28 JUL 13 ALPRAZOLAM Take 0 5 mg twice dally PO XUL 758585788 AS VS ceo
52. dtime as needed CALCITRIOL 0 25 mogis times week at CITALOPRAM Take 40 mg every moming PO DIMENHYDRIMATE Take 25 50 mg every 3 to 4 hrs as needed 2 capsule s once daily needed Take 1 4 diracted PO Take only if directed by dialysis unit for emergency or 21 NOV id Page 1 nf 1 e Flags chart alerting that verification required 3 Verifier Pharmacist CRN Staff Nurse trained in verification a Assesses accuracy of each new updated medication entry on the new Profile against the written prescription gt If incorrect indicates errors on Profile and flags chart alerting Unit Clerk that correction s are required gt If correct initials in the right margin beside the new updated medication 53 Electronic Kidney Health Record eKHR Renal Medication Profile CURRENT MEDICATIONS Allergies NKA PHN 111876 040 DWARF SLEEPY Medications To Be Administered During Dialysis Start date date Discont date Drug Name 24 SEP 13 EPOETIN ALFA EPREX Medications Patient Takes At Home Start date End date Discont date Drug Name 17 SEP 13 ACETAMINOPHEN 15mg CODNE PHOSPHATE 30mg ALPRAZOLAM ASA 81 MG ENTERIC COATED ee CALCITRIOL UL 777 29 JUL 13 24 SEP 13 CITALOPRAM E DIMENHYDRINATE 29 JUL 12 DOCUSATE CALCIUM ESOMEPRAZOLE NEXIUM SRBAPEHTWU C 7878787 RAMIP
53. elds Last verified on and Verified by will auto populate with the current date and the user s name respectively View Enter Update ALL CHEMICALS Show Cancelled Sort Date Generic Figure 2 24 Last Verified on and Verified by Fields 30 Electronic Kidney Health Record eKHR Medications Module 3 MEDICATIONS REPORTS FORMS The Medications Module includes reports forms that are used in the processes of verifying new or updated medication orders communicating medication information to patients community pharmacies and other providers of care Links to the various forms and reports are found at the bottom of the View Rx Tab in the View Current Medications screen za View Current Medications CLARE JONG single Pat Allergies Codeine dizziness and rash to Drugs M Set List Generic Brand Generic ALL CHEMICALS Show Cancelled Sort Date Generic Brand Print All Drug name Generic Brandi Startiend date Discontinued Dose Directions Schedule ll m s ALCITRIGL Ex PO 0 25 mcus at bedtime 3 times a week 4 CALCIUM CARBONATE 625 MG IET 19 01 2013 PO 3750 at bedtime 2500 mg 3 times daily 250 Take 2500 mg doses weith wih breakfast lunch Br CEPHALEXIM KEFLEX JLIN 2013 PO 500 twice daily FROM 20 JUN 2013 TO ml 03 30 2013 JLIL 20 3 03 JUL 201 3 F
54. entry for accuracy Directions nterUpdate Tab All Steps Follow Steps 1 6 for Entering a Standard Dose Medication then 7 Select the Alternate Day Dosing button PHM 420270122 Mame DWARF HAPPY Single Pat Vancomycin shortri Editor to Drugs Take 5 mg Monday Friday and 6 Saturday Sunday Enter Update Generic WARFARIN SODIUM Foute of Drug 95 E other specify Other 1 directions z Other Take 5 mg Monday Friday Indication Dp Indication Ose Template Automatic Display Dose Type Start date End date Min Max LOM M eT Combination Dosing 22 Fixed Period 22 Increase Dose L2 Decrease Dose Figure 2 17 Alternate Day Dosing 17 Electronic Kidney Health Record eKHR 8 Enter the FIRST DOSE information Select enter the Start date b Enter the Minimum dose c Enter the Maximum dose when indicated d Using the drop down arrow select the Unit of Measure UOM e Using the drop down arrow select the Directions specified 9 Enter the SECOND DOSE and subsequent doses information Select enter the Start date b Enter the Minimum dose c Enter the Maximum dose when indicated d Using the drop down arrow select the Unit of Measure UOM e Using the drop down arrow select the Directions specified 10 Ent
55. er those directions not found in Dose Directions in the Auxiliary directions field 11 Double check all medication information entered for accuracy NOTE Medication information once saved cannot be deleted edited or corrected in the eKHR 12 Click the Save button The Entered on and Entered by fields at the bottom of the Medication form auto populate with the current date and the name of the person logged into the eKHR 18 Electronic Kidney Health Record eKHR Medications Module 2 2 3 Entering a Combination Dosing Medication Use these steps to enter a medication with different dosages at different times on the same day Process 6 Entering Combination Dosing Medication Search for Enter Route of Medication Administration Receive 7 medication for entry into the Medications Fam heck Alergie i Drugs entered Enter drug allergies ar na known allergies Enter Update Tab 5 Enter First Enter Second Dose Dose Select Information Inform ation Auxiliary Combination Start date Start date check entry Dosing Min dose Min dose Max Dose dose UOM Directions Dire gions for accuracy Enter Update Tab All Steps Follow Steps 1 6 for Entering a Standard Dose Medication then 7 Select the Combination Dosing Dose Type button Enter sJpdate Generic T Brand Trade EE PERRIER CALCIUM CA
56. his fax Is strictly prohibited Use of this form for purposes or by persons not authorized under MD License the Controlled Drugs and Substances Act and its regulations is a criminal act Page 1 of 1 Figure 3 12 Outpatient Prescription Form 40 Electronic Kidney Health Record eKHR Medications Module 3 3 Renal Medication Profile The Renal Medication Profile provides a patient s complete current or historical view of medication record NOTE The Renal Medication Profile Current Medications is used as the record of current medications in the renal health record replacing the Renal Medication Flow Sheet 3 1 1 Steps to Generate a Renal Medication Profile Process 15 Generating a Renal Medication Profile A medication is added updated or Open Tor eer elect Medication eon edo e Log into rom Patient Profile button patient s profile View Rx Tab select report options Process and verity jum ul seled Run report seled Print icon medication order as per P rnt medications Appendix 1 Sort medications by i Report Medication Profile screen Renal Medication Profile All Steps 1 Log into the eKHR 2 Open Medications form a Select Monitoring gt Medications The View RX Tab opens and the View Current Medications screen appears 3 Search for the patient in the eKHR a Check that patient s name and PHIN nu
57. ications in the eKHR Electronic verification can be done when pharmacists enter medications directly into the eKHR or in conjunction with medication reconciliation performed with new dialysis starts hospital discharges annual medication reviews and transfers between sites modalities Pending electronic verification a pharmacist clinical resource nurse or staff nurse trained in verification will verify the accuracy of medication entry as reflected on the Renal Medication Profile Current Medications known as paper verification Appendix describes the paper verification process Process 11 Electronically Verifying a Medication O Check that PReceive Open medication entry medication Log into eKHR ications ae in orderns Form correct against original orders View Rx Tab Enter llpdate Tab required cancel incorrect medication entry and enter correct medication Inform ation Select Endof me dicatian s Verify as correct werified as correct Rx All Steps 1 Log into the eKHR 2 Open Medications screen a Select Monitoring gt Medications 9 Search for the patient in the eKHR by Name or PHIN a Click on the Name drop down arrow The Choose a Patient dialogue box appears b Click in the Find field after the sign C Start entering the patient s last name the more letters entered the more refined the search or
58. ind button e Select the correct patient from the list that appears f Click the OK button The View Rx Tab for the selected patient opens in the Current Medications view g Check that patient s name and PHIN number to ensure the correct patient is selected 4 Highlight the medication to be cancelled a On the View Rx Tab find the medication with the incorrect entry b Click on the medication to highlight it Click the Enter Update Tab to view the medication entry 27 Electronic Kidney Health Record eKHR 5 Cancel the medication a Click on the Cancel prescription checkbox b the Comments field enter the field where the error was found which 15 important information for future reference and ensuring data accuracy NOTE The comment field 15 limited to 50 characters Medications single Pat Figure 2 22 Cancel Prescription 6 Click the Save button 7 Check that the medication shows as cancelled a Click on the View Rx tab b Click on the History button at the bottom of View Rx Tab Click the Show Cancelled checkbox cancelled medications will appear in an italicized magenta coloured font d Check that the medication just cancelled appears 28 Electronic Kidney Health Record eKHR in the eKHR All medications entered into the must be verified for accuracy Only pharmacists and physicians can electronically verify med
59. ing dialysis or post dialysis 7 Dose Type Select the dose type button appropriate for the new or updated medication Dose Types are described in Section 1 5 below Electronic Kidney Health Record eKHR 8 Start Date Use to enter the date when a medication starts NOTE This field auto populates with the current date change to ordered start date if different 9 End Date Use to enter the date when a medication ends only applies when a medication is taken for a definite time frame e g antibiotics 10 Dose The dose fields provide information about the prescribed medication s dose including minimum dose maximum dose if prescribed unit of measure and directions for administration 11 Drug The concentration of the ingredient in total amount given 12 Auxiliary Directions Additional information about the prescription of the drug This includes a free text entry field for Other notes 1 5 Dose Types The following table describes the Dose Types used in the eKHR s Medications module Table 2 Dose Types Standard Standard medication entry one dose with Allopurinol 100 mg orally once daily One direction one row Alternate Day Different dosages on alternating days Synthroid 50 mcg on Monday Wednesday Dosing Friday amp Sunday and 75 mcg on Tuesday Thursday amp Saturday Combination Different dosages at different times on the Calcium carbonate 625 mg Apo Cal 250 Dosing same day Take 2 tablet
60. ion to MAR dry weight or dialysate bath changes 58 Electronic Kidney Health Record eKHR 2 Verifier Pharmacist CRN Staff Nurse trained in verification a Assesses accuracy of each new updated medication entry on Profile against the written physician s order gt If incorrect indicates errors on Profile and flags chart alerting Unit Clerk that correction s are required gt If correct initials in the right margin beside the new updated medication Renal Medication Profile CURRENT MEDICATIONS Printed by SHARON EDMUNDS Allergies HKA PHN 111878040 DWARF SLEEPY DOB 1930 Medications Be Administered During Dialysis Discont date Drug Name DoselDirections Schedule EPOETIN ALFA EPREX HD Take 8000 unit s twice weakly 24 SEP 13 i A SODIUM FERRIC GLUCOMATE Take 125 mg every 4 weeks IV _ FERRLECIT HD Madications Pationt Takes At Home o date End date Discont date Drug Name _ DoselDirections Schedule 17 SEP 13 ACETAMINOPHEN 300mg CAFF Taka 1 2 every 6 hrs needed 15mg CODME PHOSPHATE 30mg PO e i c i M WITH CODEINE NO 3 nEE 28 JUL 13 ALPRAZOLAM 7 0 5 mg twice dally PO nile e ENTERIC COATED once daily FO are imes a week PO at mining aie
61. l Admission Report 2 Figure 3 16 Hospital Admissions Report button The Report Clinic Admission and Discharge Medication Orders screen appears 44 Electronic Kidney Health Record eKHR H REPORT Clinic Admission and Discharge Medications Orders 1 128 315 61 CHANDLER ADAM single Pat port Parameters Current Patient Patent List port Settings Report Type Sort Medications by uc Generic Hospital Discharge Medication Orders L Hospital Admission and Discharge Medication Orders Output Format Run Report Exit Figure 3 17 Hospital Admission Orders Report parameters 5 Select report options as indicated above a Run report for Current Patient b Report Type Hospital Admission Medication Orders C Sort Medications by Generic Name 6 Click Run Report button The Hospital Admission Physician Orders appears refer to Figure 3 18 7 Click the Print icon 8 5 the patient being admitted directly from dialysis a If yes complete and authorize the Hospital Admission Physician Orders form b If no provide the Hospital Admission Physician Orders form as printed to Emergency 9 If admitted send completed Hospital Admission Physician Orders form as part of the admission package with the patient to the unit 45 Electronic Kidney Health Record eKHR Page 1 Office r gienal
62. leted pharmacists will enter record key points about the reconciliation in the eKHR for reporting and monitoring purposes 3 1 1 Steps to Generate a Medication Reconciliation Form Process 12 Generating a Medication Reconciliation Form Open Select Log into eKHR Medications o z Reconciliation Form biutton Tab Report Ree tion Reviews Reconciliation screen P rint Proceed with Run report Reconciliation reconciliation report process Report Medic ation Review Medication ReviewR econciliation or Select report options nin report for report type sort m edicationz by Annual m edicatian review patient attends clinic starts or transitions Reconciliation screen Clinic Medication Orders R eport All Steps 1 Log into the eKHR 2 Open Medications form 3 Search for the patient in the eKHR a Check that patient s name and PHIN number are correct 4 Select the Reconciliation Report button located at the bottom of the View Rx Tab gir eom SODIUM COUMADIN 19 JUN 2013 PO 4 mg directed by physician alternating WITH 2 mg as directed by physician alternating verified verified by Entered on Entered by 20 JUN 201 3 Tenia David 1 9 JUM 201 3 Sharon Edmindson Verify History 7 Reconci ID Dutpatient Prescription Medication Profile Exit Figure 3 2 Reconciliation Report button 32
63. lf selected over the counter medications Always review the Ist wit patient or rellable aitermative caregiver PATIENT CHANDLER ADAM PHN 112 831 661 D2 JUL 2013 15 55 DOB 40 SEP 1940 Printed by Sharon Edmindson This report was generated from the eKHR database DRUG ALLERGIES Codeine dizziness rash Prescription Directions ALLOPURINOL r FERROUS SULFATE 300 mg at bedtime PO Start 300 mg orally at bedtime for 7 days then increase to 600 mg orally at bedtime for 7 days and then increase to 000 mg orally at bedtime Continue 80D mg orally at bedtime Take an empty stomach and separate from Calcium by at least 2 hrs PREDNISONE 50 mg once daily PO Start with 50 mg orally each day for 2 weeks then decrease to 40 mg orally each day for 2 weeks then decrease to 20 mg orally each day for 2 weeks and then continue taking 10 mg B WARFARIN SODIUM COUMADIN 4 mg every 3 days altemating WITH 2 mg every 3 days alternating WITH 2 mg every 3 days PO Take 4 mg on Day 1 take 2 mg on Day 2 take 2 mg on Day 3 and then repeat 34 Electronic Kidney Health Record eKHR Page 2 Winnipeg Regional Office regional de la Health Authority sant de Winnipeg Caring for Health l coute de matre sant kid neyhealth ca Medication Review Reconciliation Report Node This may not Include fne following type of drugs Investigational antiretroviral oncology physician sample herbal or self selec
64. mber are correct 4 Select the Medication Profile button located at the bottom of the View Rx Tab Last verified an verified by Entered Entered l 20 JUM 201 3 Terjo David 18 JUM 201 3 Sharon Flaite Verify History Current Discrepancy Report Rx Report Reconciliation Report Medication Pr ao J Ex Outpatient Prescription Report T Figure 3 13 Medication Profile Button 41 Electronic Kidney Health Record eKHR Medications Module The Report Medication Profile screen appears t8 REPORT Medications Profile Figure 3 14 Medication Profile parameters Select report options as indicated above a Run report for Current Patient b Print Medications Current Medications Sort Medications by Chemical Click Run Report button The Renal Medication Profile Current Medications appears refer to Figure 3 15 Print Renal Medication Profile Current Medications Follow steps for processing and paper verifying medication order entry into the eKHR as outlined in Appendix 1 42 Electronic Kidney Health Record eKHR Winnipeg Regional Office r gional dela Health Authority sant Winnipeg Caring for Health l coute de notre sant kidneyhealth ca ran iodui ena py iuge Renal Medication Profile Printed om 02 JUL 13 CURRENT MEDICATIONS Printed by SHARON EDMINDSON Allergies Codeine dizzine
65. module includes four types of permissions access for users each type of access is independent of the other gt Data Entry User is able to enter and update medication information for a patient including cancelling existing medications gt View Only User is only able to view medication information user is not able to update medication records gt Medication Verification User is able to electronically verify any medication information entered in the eKHR gt Print Reports User is able to print reports from the Medications module The following table summarizes users of the Medications module and their permissions access to the module Table 1 User Roles Data Entry View Only Medication Print Lists Verification Physician Clinical Resource Nurse Unit Clerk Pharmacy Technician Application Administrator MRP General User Electronic Kidney Health Record eKHR Medications Module 1 3 Where to Find the Medications Form Main Menu Monitoring Sub Menu Medications ie 12 1 10 112020 2 User sSEDMUNDSON Database MERITT File Patients Treatment Monitoring Maintenance Scheduling Reports Help fa Dialysis Access Lab Results Ft infectious Status Immunization Hx Medications Medication Reconciliation manitoba renal program is ELECTRONIC kidney health RECORD Figure 1 1 Where to Find the Medications Module the Medications Form The 2 tabs of the Medications module ca
66. n Day 1 take 2 mg on Day 2 take 2 on 3 and then repeat cycle This medication list was considered correct at the time of printing However you have had a recent medication change or you may be taking additional non prescription or herbal medications that are nat listed here this is the case please notify a member of your team who will help ensure pur medication list is as accurate as possible This medication list is an important component of your care Please ensure that it is kept up to date We suggest that you keep a copy of the list at all times so that you can show it to any health care providers involved in your care The list represents the medicagens prescribed or sej drecied bated on informadon provided to rhe renal health care trm as af the date printed This pbrmacon mus 5e verified with the and or agazmt other mormanon xource upan Tevigwing Figure 3 21 Patient Medication Card 50 Electronic Kidney Health Record eKHR APPENDIX 1 PROCESSING AND PAPER VERI FYI NG MEDI CATION ORDER ENTRY INTO THE EKHR Appendix describes the processes used to enter medications into the eKHR and to verify the accuracy of medications entered as reflected on the Renal Medication Profile Current Medications Profile The entry and paper verification of both outpatient medications and medications given in dialysis either processed by the unit clerk or staff nurse are included A Outpatient
67. n be found near the top of the form and will be frequently referred to in this manual The current tab that the user is viewing appears in the foreground and is coloured grey The inactive tab is coloured teal To switch to tabs click on the tab you wish to view a View Current Medications HN CLAPTON ERIC Single Pat Allergies PENICILLIN SOLFA DRLIGS to Drugs lt Set List Generic Brand Generic PALL CHEMICALS 00007 CHEMICALS Show Cancelled Sort Date Generic Brand verify Print Drug name Generic Brand Start End date Discontinued Dose Directions Schedule MI Figure 1 2 Navigating the Medications Form Electronic Kidney Health Record eKHR 1 4 1 View Rx Tab The View Rx tab automatically opens when the Medications form is loaded Each line in the table represents a medication displaying the latest information for that medication if available in each column Within this tab users can view the current medications or the history of medications for a patient Ea View Current Medications CLAPTON ERIC Single Pat Penicilin amp Sulpha drugs Hives swelling difficulty breathing lt M Show Cancelled Sort Date 8 Generic Brand List Generic Brand Generig LL CHEMICALS verify Print 6 E ALCIUM CARBONATE 1250 MG APO EE 2013 3750 mg at bedtime 2500 3
68. ns are open ended meaning that possible changes are subject to events that cannot be reasonably foreseen at the time of writing the prescription these cases End Dates are not specified Changes in the patient s condition circumstances may require that a medication be discontinued or that the dosage and or directions for the medication be adjusted If discontinued the existing medication is closed by entering a Discontinued Date If adjusted the existing medication is closed by entering a Discontinued Date and a new medication is created with the same date NOTE There are circumstances in which both an End Date and a Discontinued Date would both be specified Example The physician initially prescribes Vancomycin 500mg q dialysis x 8 however it is discontinued sooner as lab results indicate that the microorganism is sensitive to Ancef Start Date 12 ul 2013 End Date 29 Jul 2013 Discontinued Date 19 Jul 2013 The End Date remains 29 2013 to capture that the original prescription was for 8 doses but the patient s condition circumstances necessitated a change 2 3 1 Steps to Discontinue a Medication Process 8 Discontinuing a Medication Select Enter Discontinue date Open Medications Form Hiahliaht Medication ta be discontinued An order to discontinue medication All Steps 1 Log into the 2 Open the Medications form a Select Monitoring
69. ow Find 36 Reconciliation Demand 3 manth Review B moanth Review IU nn d Find 1 Cancel 1 Figure 3 7 Reconciliation Type screen Enter select Transition Date if applicable Enter select Reconciliation Date No of Rx auto populates from eKHR data Modality auto populates from eKHR data Dialysis Centre auto populates from eKHR data Enter Comments as required on the reconciliation completed for this patient d e f g h ra Medication Reconciliation Patient A PHN DOB 20 SEP 2000 Name CLARE JONO Selection Mode Single Pat Reconciler Reconciliation Transition Int Unint Unknown Total Interview Reconciliation Profession Discr i Physician TEST m i EJ a ES __ Figure 3 8 Medication Reconciliation Data fields 5 Click the Save button to complete the documentation of the reconciliation process 37 Electronic Kidney Health Record eKHR Medications Module 3 2 Outpatient Prescription Pharmacists can use the eKHR to generate a Manitoba Renal Program Outpatient Prescription form which when printed and authorized is used to order outpatient medication s NOTE Pharmacists can only generate an Outpatient Prescription after a medication has been verified in the eKHR 3 2 1 Steps to Generate an
70. ppears TH View Current Medications PHN single Pat Allergies 01 to Wu bs Set 115 Generic Brand Generic Show Cancelled Sort Date Generic Brand Figure 2 1 View Current Medications screen 3 Search for the patient in the eKHR by Name or PHIN a Click on the Name drop down arrow The Choose a Patient dialogue box appears b Click in the Find field after the sign C Start entering the patient s last name the more letters entered the more refined the search or enter the patient s PHIN d Click the Find button e Select the correct patient from the list that appears Electronic Kidney Health Record eKHR Medications Module f Click the OK button The View Rx Tab for the selected patient opens in the Current Medications view g Check that patient s name and PHIN number to ensure the correct patient is selected 4 View the list of current medications for the selected patient which includes the drug names generic or brand start dates the end dates where applicable and the dose directions schedule information NOTE Medications can be sorted by date generic or brand name in the Current Medications view fea View Current Medications PHN Name CLARE JONO single Pat d Allergies Codeine diztiness Cod d drash ioris odeine dizziness and ras 3 View Rx Set List Generic Brand Generic ALL CHEMICALS Show Cancelled f Sort Date
71. re required fields ra Medications PHM 15764940 DWARF single Pat 7 pee Vancomycin shortness of breath amp fever s to Drugs Enter Update Generic 2 CALCCIUM C ARDC INMATE 1250 MG Route 14 i Drug NET EN Cancel prescription Auxiliary directions gt er LI Comment k5 Indication Indication Indications zi Other 222 Q bs m r 8 9 Template hae jose Type _ SNR 70 Combination Dosing 1 NEN Fixed Period e Increase Dose ol Decrease Dose Copy Hew Hew Rx Dose Template Save Exit Figure 1 4 Enter Update Tab Discontinue Brand Trade edl aate 4 APO CAL 250 f 4 End date Allergies to Drugs list of the patient s drug allergies Generic The patient s medication listed by its Generic name Brand Trade Name The patient s medication listed by its Brand or Trade name se m Ye Discontinue Date Use to enter the date a pre existing medication closes when a change in dosage and or directions occurs 5 Route of Administration Use this field to identify the route of administration for the selected medication 6 HD RN Use this drop down to indicate drugs given pre dialysis dur
72. s a ess cnm oa gi enema eee iT B um I t ETETE eee DoseiDy ctions Schedule Take 142 tablat s every 6 hrs as needed Take 0 25 imas a a week PO at a erg PPR tea ag a nen P PG PITE ___ E LENIN 11 ILLU FI ETE PL LE DOCUSATE CALBIU once daily needed c sso Ad capsule 240 mg 23 13 ESOMEPRAZOLE NEXIUM Take 40 mg once dally PO EDS ta Augus 29 JUL 3 7 7 RAM RIL 0 Take 25 mg at bedtime PO GC ERE ERR E 283073 SODIUM POLYSTYRENE SULFONATE 1 dose s diracted PO Take oniy if directed dialysia unit for emergency or missasddiaysis Egg ee 515 ma 7 MCN CES Page 1 nf 1 f Processes other non Renal Medication Profile orders e g dry weight changes dialysate bath changes g Flags chart with colours designated by site to gt X Alert that verification of Profile is required gt Alert that non Renal Medication Profile orders to be checked e g transcript
73. s orally with breakfast and Supper and 1 tablet orally at lunch Fixed Period Medication given for a specified duration Cephalexin 500 mg orally twice daily X 14 Start and End dates must be entered days Increase Dose Increase in dosage over a period of time NOTE I ncrease Dose type is not Not currently currently used Enter as a Standard Dose used with increasing dose details specified in Auxiliary Directions Decrease Dose Decrease in dosage over a period of time NOTE Decrease Dose type is not Not currently currently used Enter as a Standard Dose used with decreasing dose details specified in Auxiliary Directions Electronic Kidney Health Record eKHR 2 USING THE MEDICATIONS MODULE 2 1 Viewing Patient Medications All patient medication information both current and historical can be found in the Medications form The Medications form is intended to capture and present only those medications actually administered to or taken by the patient Medications that are put on hold should be discontinued If the patient begins taking the medication again at a later date it will be entered as a new prescription 2 1 1 Viewing a Patient s Current Medications Process 1 Viewing Current Medications Open eT Search for View Current View Rx Tab All Steps i Log into the eKHR 2 Open Medications Form a Select Monitoring gt Medications The View Current Medications screen a
74. scontinue P atient k medication Form discontinued date View Rx Tab Enterupiate Tab Double check E Copy data to a B Check amp update flelds as per new prescription entry for accuracy Tab 25 Electronic Kidney Health Record eKHR All Steps Follow Steps 1 6 to Discontinue a Medication then 7 At the bottom of the Enter Update Tab click the Copy New button The discontinued prescription will be copied to a new entry field with a current Start Date ea Medications PHN ME ALFRE cun CE Start date 19_JUL 2013 mmm End date Dose i Start date XJ End date U O M mt 10 40 2013 1 0 20 Figure 2 21 Copy Medication button 8 Check the following fields as if entering new medication and update fields as required according to the new prescription Generic Name of medication Brand Trade Name of medication Route of Administration Dose Type Start date End date when indicated Dosage details including minimum dose maximum dose when indicated unit of measurement and directions for administration e Auxiliary Directions 9 Double check all medication information entered for accuracy NOTE Medication information once saved cannot be deleted edited or corrected the eKHR 10 Click the Save button
75. ss rash PHN 112 831 661 NAME CHANDLER ADAM DOB 10 SEP 1540 Medications To Be Administered During Dialysis Start date End date Discont date Drug Name Dose Directions Schedule Medications Patient Takes At Home Start date d dat Discont date Drug Name Dose Directions Schedule 20 MAY 13 ALLOPURINOL 100 mg once daily PO 600 mg twice daily 250 mg once daily PO Take 250 mg with breakfast Take 500 02 JUL 13 FERROUS SULFATE 300 mg at bedtime PO Start 300 mg orally at bedtime for 7 days then increase to 600 mg orally at bedtime for 7 days and then increase to BOD mg orally at bedtime Continue BOD mg orally at bedtime Take an empty stomach and separate from D 2 JUL 13 PREDNISONE 50 mg once daily PO Start with 50 mg orally each day for 2 weeks then decrease to 40 mg orally each day for 2 weeks then decrease to 20 mg orally each day for 2 weeks and then continue taking 10 mg orally O2 JUIL 13 WARFARIN SODIUM COUMADIN 4 every 3 days alternating WITH 2 mg every 3 days alternating WITH 2 mg every 3 days PO 4 Day 1 take 2 mg on Day 2 take 2 mg Day 3 and then repeat cycle Verified by signature date Page 1 of 1 Figure 3 15 Renal Medication Profile Current Medications 43 Electronic Kidney Health Record eKHR Medications Module The Hospital Admission Report is used to communicate information regarding the patient s medications to other providers of care
76. t only check boxes beside those medications being verified Electronic Kidney Health Record eKHR Medications Module 7 Drug I nformation These fields provide information about the patient s medication including the Drug Name Generic or Brand Start End and Discontinued Dates and details about the Dose Directions and Schedule for administration 8 Notes Click on notes icon to view existing discrepancy notes to add a new discrepancy note for a medication Also use to flag a medication for which verification is needed 9 Verify Use the Verify button to indicate that selected medication s has been verified as correct after which the ast verified on date and verified by name will appear 10 History Click on the History button to view both previous and current medications for the selected patient 11 Current Click on the Current button to view current medications for the selected patient 12 Report s The reports buttons link the user to the selected report Reconciliation Report Outpatient Prescription Medication Profile Hospital Admission Report and Medication Card Electronic Kidney Health Record eKHR 1 4 2 Enter Update Tab Clicking on the Enter Update tab opens a form containing a number of fields used to enter information for a new medication or update information for an existing medication for a patient Note as with other sections of the eKHR that fields with blue labels a
77. ted over the counter medications Always review the Est with patient or PATIENT CHANDLER ADAM PHN 112 831 661 2 JUL 2013 15 55 DOB 10 SEP 1940 Printed by Sharon Edmindson This report was generated from the database DRUG ALLERGIES Codeine dizziness rash Discrepancies and drug related concerns Physicians please review and write new prescriptions to change add or discontinue Source of information circle Patient family PharmaMet Outpatient Chart LTC MAR Hospital MAR Other Community Pharmacy irenal Community Pharmacy iother Home medication system circle Vials Blister pack Dosette Other Time taken to complete medication reconciliation including interview time Completed By Signature Figure 3 4 Medication Review Reconciliation Report 2 pages 35 Electronic Kidney Health Record eKHR Medications Module 3 1 2 Steps to Enter Medication Reconciliation Data in the eKHR Process 13 Entering Medication Reconciliation Data Loginto ekHE Enter medication reconciliation for data profession reconciilatian Patient type transition date if save entry applicable reconciliation date comm ents Medication Reconciliation screen Open Medication Completion of Reconciliation medication reconciliation All Steps 1 Log into the eKHR 2 Open Medications form a Select Monitoring gt Medication Reconciliation MERIT 1
78. uthority kidneyhealth Liep Hw rimal Se li 3l amp dmieslon Physician Orders dns eal cere Tie pi ed Dres m PATIENT DWARF DOC 115 784 Ji 11 17 CH 1030 iy Sharan DRUG ALLERGIES debe Be Taken home bbe baci 15 30 um ony 1 dreded by 12 15 POL REME iL ke etree eed deb eg duly PO z2 JUL 1 COL ADI a Figure 3 18 Hospital Admission Physician Orders report 2 pages 47 Electronic Kidney Health Record eKHR Medications Module 3 5 Patient Medication Card Pharmacists can use the eKHR to generate a Patient Medication Card following the completion of medication reconciliation done at annual reviews of a patient s medications and when the patient attends renal clinic starts dialysis transitions between modalities sites or is discharged from hospital The Patient Medication Card provides a complete list of medications the patient should be taking 3 5 1 Steps to Generate a Patient Medication Card Process 17 Generating a Patient Medication Card Open EU search for Select Medication Log into 075 Patient Card button

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