Medication List Tool Changes
Objectives:
1. State the rationale for replacing PAML with
the new Medication List Tool (MLT).
2. Describe features of the Medication List Tool
(MLT) and associated workflow.
3. Understand implementation and support
plans VUH and VCH
Medication List
Tool Changes
June 10 MCJCHV
June 17 VUH
Background
Replacing PAML with the new Medication List Tool (MLT) in
the Nursing Admission History is phase 1 of the One
Medication List project.
Goals of the One Medication List Project:
1) One source of truth for medications
2) All members of the team access and edit the same list
3) Processes, tools and expectations for the medication list
management are standardized across the medical center
One Medication List Project
Implementation
• VPH completed a successful pilot in
March
• Medication List Tool ( MLT) in
VPH Nursing Admission History
(replace PAML)
• MLT embedded in the VPH
provider H&P.
• ED and Perioperative workflow
analysis and adoption of MLT is in
progress
• OB is on hold until system updates
occur later this year
One Medication List Project
• Adult and Pediatric Nursing Admission
History is the next step.
• Replace PAML with MLT
• Provider workflow will be part of
future phases
• Embedded in provider admission
process ie documenting H&P
• Exit check during the discharge
process
• Long term goal is for the providers
to have the ability to enter orders
for medications from the list.
Med List Tool (MLT) will replace PAML
in the Admission History
Current
The MLT Summary page will be
displayed in the Admission History.
New
Click Edit to open the tool
and make changes
Last completed list visible with date,
time and collector included
I’ve already told someone the
medications I’m taking and they typed
it in the computer.
Why are you asking again?
Why Change?
• Patient Dissatisfaction
– Patients are asked multiple times to
supply the same information about
medications taken at home
• Wasted Time
– Redundant work being done due to lack
of integration of current tools.
Why Change?
• Safety - There is not one source of truth for home medications
– Numerous members of the team collect medication lists
yet these lists are not shared and there is lack of
confidence in the list.
For example, RN collects medication list in PAML yet
this information doesn’t display in the provider
workflow when completing the H&P. The provider
collects yet another list.
– Failure to reconcile medications during transitions (home
to hospital, hospital to home) result in medication errors
Up to 67% inpatients have at least 1 discrepancy
between the prescription medication list obtained by
the admitting provider and the patient’s actual preadmission medication regimen (Tam)
IMPLICATIONS
Adverse drug events, ED visits,
hospital admissions and
readmissions, prolonged length
of stay, patient and provider
dissatisfaction
59% of admission medication
discrepancies could result in
patient harm if they persist
beyond discharge (Gleason)
On average, each patient on a
general medicine service has
more than 1 discrepancy with
potential for harm in the
admission or discharge orders
(Pippins)
Medication Errors at Vanderbilt
In a study of cardiac patients:
50% of patients experienced a clinically
important medication error within 30
days post-discharge (Kripalani)
42% of patients had at least 1 error in
pre-admission medication list (Salanitro)
39% had at least 1 error in discharge
medication list (Salanitro)
In a quality improvement study of general
medicine patients:
– ~90% of patients had an error in their MDobtained admission med list during night
shift
The problem(s)
 Too many different lists and difficult to know which one
to use/update
 Existing tools do not meet provider and patient needs
(too slow, systems don’t link, displays not user friendly,
inadequate decision support, inconsistent use of lay
language, lack of standardization)
 No standard approach to collection, documentation,
and communication of med lists across sites of care
Inefficient use of resources, potential for patient harm
How to use the MLT
• We have established the reasons for taking a
home medication list
• We have defined the best way to collect a
medication history (associated educational
module)
• The next several slides will discuss details of
how to use the new Med List Tool step by
step
Ways to access the
Med List Tool (MLT)
• MLT will be embedded in the Nursing Admission History
• To initiate MLT click on
“edit” in the upper right corner of the list
• If the MLT needs editing after the admission history
is completed, it can be accessed from the actions
menu (more detail in upcoming slide)
Current Medication Reconciliation Tool
PAML
The Med List Tool
New Medication List Tool
MLT
Left column pulls previous
VUMC medication list from
Patient Summary (PSS)– such as
from clinic visit, last
hospitalization.
NON EDITABLE
NEW
Right column is “SCRATCH PAD”
which is an EDITABLE version of
the previous VUMC medication
list.
EDIT list to reflect medications
patient is currently taking prior
to admission
How to delete a medication
Delete Icon ->
Click “X” to delete a med
that is no longer being taken
Med appears with
strikethrough
Make a mistake? Note the undo icon
Click Edit icon to edit
medication information
How to edit a medication
Edit Icon ->
Denote edits to dose, route,
frequency, start date (OPTIONAL),
comments. Specify date/time last
dose taken if appropriate.
Click Save when revisions
completed.
Changes are highlighted
for easy review.
Click Add Medication
How to add a medication
Type Medication Name. Select
from list if appropriate
Denote dose, route, frequency,
start date, comments. Specify
date/time last dose taken if
appropriate
Click Save
New Med highlighted for
easy review
Incomplete medication information
Type Medication Information that is
known ie Little blue pill for BP
Select “Unable to Obtain” and denote
reason, if obtaining medication history is
not possible.
Select “submit” and then “ No Current
Medications” if the patient does not have any
home medications. This button will only be
available when the scratch pad has no meds
listed or all meds have been deleted.
How to Save
Preview- Displays the list without
the strikethroughs and highlights.
Click a second time return to display
with strikethroughs and highlights
Submit for Review- saves the list
and prompts the provider that the
medication list collection by nursing
is complete and ready for the
provider to review/edit/ finalize
Icons & Displays
Delete
Edit
View
Click to display icons to
print, show/hide comments
or display list of edits by visit
The View icon
displays detailed medication
information including hi
Click to display all
comments. Click again to
hide comments
Accessing Med List Tool from
StarPanel
Click Actions
Click Med
List Tool
If the MLT needs editing after the admission history is completed,
it can be accessed from the actions menu
Implementation &
Support
• June 10 MCJCHV – June 17 VUH
 Medication List Tool will replace PAML in the Nursing Admission
History
 Medication List tool will be available from the Actions Menu &
OPC in Star panel
•
Implementation Support
• System Support Services will provide 24h Support
onsite X 4 days then via call to help desk
• System Support Staff will round on each of the units
Debriefing meetings will be held the first week
Time to identify and quickly address issues