June 28, 2011 -- Patient Discharge Medication List available on most care units
A Patient Discharge Medication List (PDML) is generated when the provider completing the discharge orders selects the medications to be included. The process of writing medication orders for discharge includes reviewing and reconciling the patient's pre-admission medication list (PAML) with the current inpatient orders. The PDML addresses all of the relevant medications:
New discharge medication orders
Medications continued from the inpatient stay or resumed from pre-admission
Pre-admission medications that should not be resumed
Features—This document is designed to be patient-friendly. Orders are organized, translated, and annotated to make it easier for the patient to understand the treatment.
Medications to be taken are listed in a section labeled "Your new medication list." If the list spans multiple pages, this heading is continued on each page as needed.
The terminology is presented in everyday English. For example, the route for PO medications is described as "by mouth" and TID frequency is listed as "three times a day."
Each medication to be started on discharge is highlighted with "This is a new medication."
Each medication to be continued or resumed with adjustments to the dose and/or frequency is highlighted: "This is a change in how much of this medication to take " and/or "This is a change in when to take this medication."
Medications that are to be taken for a limited duration are listed in a distinct section with the heading "Take these medications for the specified number of doses."
PRN Medications are listed in a distinct section with the heading "Take these medications ONLY if you need them."
Pre-admission medications that should not be resumed are listed in a distinct section with a large stop sign.
Discharge orders that have been manually reconciled with "take as typed" pre-admission medications include a note "This is the same as..."
Editing—The PDML reflects the medication reconciliation and orders on the Face Sheet/Discharge Medications list. Only MDs, NPs, and PAs can edit this list. See Ordering Medications for Discharge. The PDML is not available until all the of the pre-admission and current inpatient medications have been reconciled, and the discharge orders have been signed. RNs are not able to change the PDML; contact the ordering provider to request a change.
RN Responsibilities—As part of the medication reconciliation process, RNs review the pre-admission medication list (PAML) with the patient. Before the patient is discharged, the nurse reviews the PAML and the discharge medication orders, then documents the review on the nursing discharge medications form. The RN also prints the PDML and reviews it with the patient.
Generating a paper copy—The PDML is printed separately from the post-hospital care plan. It can be printed from the nursing discharge Medications folder, the face sheet/discharge Medications folder, and the Print folder. The PDML is saved with the discharge orders when it is printed. See Printing Discharge Orders, Forms, and Instructions.
Discharging the patient—Each patient who is discharged home should be given a copy of their list at the time of discharge. When the patient is ready to go home, the RN checks the discharge orders to be sure that the medications have not changed. If there are changes, the nurse prints a new copy of the PDML, and reviews the changes with the patient. The last version printed is saved in both the patient's Discharge Orders in the medical record for the visit, as well as on the Reports tab of the Clinical Data Repository (CDR). See Viewing Reports in Results.
Instructions and Overviews:
See also: