Problem: Some inpatients at Wave 2 sites were admitted before Wave 2 launch. Key information was transferred to Connect Care charts as part of a cutover process. This information was then validated by prescribers immediately after launch. If an admission order was missed, or medication reconciliation was not completed, efforts to discharge the patient post-launch can be blocked.
Context: When experiencing discharge challenges, an important first check should be for a valid admission order. Next, confirm that medication reconciliation has been completed. Patient transfers and discharges require a completed medication reconciliation so that accurate medication information follows the patient. Unattended admission order or MedRec work will be flagged in the "Sidebar Summary" that appears in the right sidebar of an open chart.
Solution: Attending to the following two checks should resolve most discharge blocks:
- Check for an Admission Order by looking in the "Order History" section of the "Orders" activity, and add an admission order if found missing.
- Open the Admission navigator (tab) with the chart open in the current inpatient encounter.
- Select the "Admission Orders" section (bottom of the navigator left column).
- Select "Review Home Medications":
- Ensure this list includes all medications that the patient was taking prior to admission.
- This step may already have been completed by nursing or pharmacy, as indicated by the "Med List Status" at the bottom of the listing.
- Select "Reconcile Home Medications" (must be done by prescriber):
- Complete documentation of reconciliation decisions by selecting "Don't Order" for any medications that were already ordered as part of cutover.
- If all home medications listed were already ordered for cutover, use the "Mark unreconciled Don't Order" button at the top of the screen for convenience.
- Review the new reconciliation actions and then Sign at the bottom of the right sidebar.