Home Forums Discussions General Discussion Reconciling meds more quickly

I am not sure if this happens to everyone. My idea would be helpful to everyone but extraordinarily helpful to someone like our practice. Due to the volume of patients we see and only one MA, we rarely have time to go through an entire patient's medication list to reconcile them.

Lately, I have been doing them on each patient as I see them. Some of them will have a list of 10, of which, they are on only four. That means I have to inactivate each of the other six one at a time and, even more of a problem, spend time clicking through that field that comes up for the reason -- which I rarely use. This takes quite a bit of time.

Wouldn't it be helpful, if there were a box on the left next to each medication that you could check off. You could then place a check by the six medications and click on Inactivate selected, and they would all be done at one time.

Any thoughts?

Yes would be nice.

Ideal would have been a federal mandate to centralize sharing of medications including ability to push a reconciliation throughout various EMRs and pharmacies.

That and mandated universal EHR access lab/ test / note data via HIE.

These are the only 2 things the feds should have required. Instead we got mandated reportable health conditions and other quality "junk".

Your idea is a useful one, Bert.
Maybe even more important for adult patients who are on more meds than kids.

At the very least...a simple improvement is to make it an option for that "reason for stopping" the medication to come up or not.

Jon,

They already have the ability to do that. If you want to give the reason (and many times it is important), you would right-click and select inactivate. That puts the box right next to your pointer.

If you don't want to have the box pop up, you click on the Inactivate button at the bottom right. Perfect solution.

Unfortunately, although this is a great idea that would help the program tremendously and everyone would benefit from it, it will end up on the cutting floor because only three people indicated they like it.

We're missing a way for us to stop a med and communicate that to the pharmacy.

That sounds dreamy.

Currently - we print a med list, give it to the patient at check in, have them review them while waiting, hand it to the MA at check in, who updates that while charting their HPI.

A multi- delete option would be dreamy.

I’d also like that feature to inactivate patients that haven’t been seen in a long time. Apparently - my provider wasn’t inactivating patients on the regular and has over 6,000 patients that haven’t been seen for 5+ years still in active status.

Sigh.

One. At. A. Time.

I don't understand, Bert. Whether I right-clock on the med and hit inactivate OR select it and hit the inactivate button, either way the "Reason for inactivate" button comes up. I never put a reason- I wish I could choose to never see that box.

No, that's the point. You make the right-click bring up the box and the button you click after selecting the medication not bring up the box. The best of both worlds. I rarely use the box either. It drives me crazy.

But with psyche meds I use it a lot. Over three years, the patient has been on Seroquel, Abilify, Prozac, Lamictal, etc and all inactivated. When I go to prescribe another med, I want to know why Seroquel, Abilify, Prozac and Lamictal didn't work.

I am suggesting a user option... for those of us who never enter a reason in the box.
The option would be for the box to never show up.

Not a big deal, just an idea.

AGREEEEED!!

As a general internist - spend a LOT of time reconciling meds -
I agree with reducing clicks - if reason to stop a med is noteworthy - I note that in HPI, Med Hx or area where allergies are documented.
I don't like constantly evading the question and the extra clicks.

Does AC have a good way of knowing if users want this - perhaps ask forum users to rank usefulness on scale 0 (hate it) - 10 (essential).
In the yellow box - AC could announce when it wants feedback on a feature??

This has always been an issue. We talk about it at the Clinician's Advisory Board with AC management all the time.

I have instituted Likes (like on Facebook).

If you like the idea click on it. You can also click on a like and see everyone who liked it.

TRY TO ONLY USE THE LIKE FEATURE FOR POSTS THAT ARE ABOUT RECOMMENDATIONS.

Amen to reason for d/c'ing psych meds. Unfortunately if an antidepressant works for several years and then stops, it never works again (I've never seen an exception). Also need to know if it was a mild or more serious reaction for example akathesia with 2nd generation antipsychotics.

I am in the minority here. I use the inactivate box often. I do not use it for things that are routinely just for a few day. I use it for things like Shrinkrap pointed out. If a med stops working or there is a side effect, I will write this in the inactivate box. The note in the inactivate box then put a note in the chart and in the history of the meds. My complaint is how long it takes to get the history for the med to load when I want to look at it again.

Only slightly off-topic...

Gino posted elsewhere about having user meetings that include watching users go through common procedures like removing old meds. This was one of the significant benefits of those meetings -sessions were titled something like "How I do it...".

We can all learn so much from seeing the way others do things. Often there is no one "correct way" but equally often we are doing our routines, not knowing there is an easier way.

I think people are missing my point. Unless users have never noticed this which I find impossible. There are two ways to inactive a med:

right click

click on the inactivate at the bottom

Make one bring up the box

Make one not bring up the box.

And as much as we always say this that would take LESS than one line of code.

OK, so if you right click on the medication, inactivate then no response box comes up.

If you click the inactivate box at the bottom left of the med list, the reason why box would then prompt you for a response?

Is this the idea?

Yes. That seems rather easy to code.

<<Select box(inactivate)
.)discontinue medication<<
Bring up reasonbox:yes|no
>)no..>

What if say a right click on a medication for the inactivation process allows direct inactivation of that specific medication, but also the option to open up a window with the medication list on the left hand side and the right hand side of the window is a easy-to-read grid of inactivation reason choices. The first column is inactivate without comment or unspecified reason, so if that is your style, it is easy to just click straight down that column as needed. But, for added documentation with ease, the next columns are common causes such as no longer needed, unavailable, changed to another medication, side effect, dependency concern, cost, non-formulary... you get the idea. The last column button could open an optional text window to make a comment (which will work by itself or with any of the other columns). One click for each medication inactivation, and can inactivate multiple at a time before hitting save... Hitting a button on the grid should cause its corresponding medication to be clearly highlighted for visual clarity is also suggested.

This is a good topic, glad it was started.

Hey this is cool. The number of "likes" you get show up in your profile on the left of the posts.