Decentralized Pharmacy Queue—Reconcile

• For patients on care units with a direct order interface to the pharmacy, review and approval can be completed in the pharmacy system.

• For all locations, complete medication reconciliation by signing off in the Pre-Admission Medication List builder (PAML). See Pharmacy Reconciliation at Admission or Transfer.

• If you haven't already:

1. Click Tools (ALT+L).

2. Click Decentralized Pharmacy Queue (ALT+D).

3. To list a particular patient, inpatient care unit, or ED Treatment area:

• The first inpatient care unit in the alphabetical list is selected by default. To change, select a different care unit from the Unit list.

• To display the patient who is selected in the CAS (if any), click Use CAS Patient.

• To list patients in the entire ED, click the ED Area option. Select a treatment area to limit the list.

• If you are reviewing from a unit list, double-click a patient name to open his or her medication review list in one step.

• If you are using the CAS patient or a single-click list selection, click the available button:

• f the selected patient is on a unit interfaced with pharmacy, click PAML/View (ALT+P).

• If the orders must be processed using the decentralized queue, click Approve/Review (ALT+A).

• Review and approve active medication orders.

• As needed, add notes to a selected order, or view existing notes. (review and approval only)

• Reconcile active medication orders with the pre-admission medications list (PAML).

The status of the patient's PAML is displayed between Allergies and the list of active medications awaiting review. The PAML may be in progress, awaiting the review of a second clinician, or reviewed by a second clinician. You can update the PAML, but you cannot save it as ready for review, and you cannot sign off as the second clinical reviewer.

• For patients on care units with a direct order interface to the pharmacy, click the vertical +PAML Meds+ (ALT+P) to the right of the active medications list to display the pre-admission medications. For more information, hold the mouse pointer over the object for a moment:

• To display the entire text of a line

• To display the full text of an abbreviated Planned Action on Admission (PAA)

• To display a key to all of the PAA abbreviations (PAA column heading)

• For all locations, you can open the PAML from the Decentralized Queue to print and update the list.

1. Click PAML (ALT+M) to open the PAML Builder.

2. To generate a paper copy of the list, click Print on the right beneath the Pre-Admission Medication List (PAML).

3. You can update the PAML if you have information on the patient's medications at admission. See Updating the PAML.

4. Click Cancel to close the PAML without changes. See Saving the PAML to update the list.

• Check the PAML against the patient's active medication orders. All medications except those flagged to discontinue should have a corresponding medication order written in MGH Provider Order Entry. These medication orders are NOT written automatically when the medications are recorded in the PAML.

• To open Knowledge Link:

• Click .

• Click Exit (ALT+E) to return to the orders list.

• Click Pop Out (ALT+P) to detach the KnowledgeLink window from the CAS.

• Toggle between Order Entry and KnowledgeLink by clicking the icons in the taskbar.

• Click to close the Knowledge Link window.

• Sign your changes:

1. For patients on care units with a direct order interface to the pharmacy, click Reconcile Admit (ALT+A). For all other locations, click Sign (ALT+S).

2. Type your signing key.

3. Click OK (ALT+O).

• Repeat the process for all patients as needed.

• To close the Decentralized Pharmacy Queue:

1. Click Close (ALT+C)

2. Click Exit to UCM (ALT+X).

Approved orders are removed from the queue and signed off in the order entry record. Orders marked as reviewed remain in the queue until approved.