Changes to Medication Reconciliation in the Absence of a Specific Order

Per The Joint Commission regulations, all patient level-of-care transitions require that an Order Reconciliation be performed. Orders are continued or discontinued based on what the Provider specifies during Order Reconciliation. 

At times, not all orders are reconciled. Starting on Monday, October 18, a change will be made in Epic which will affect how orders placed in one of the peri-operative phases of care with certain frequencies behave when the order is not reconciled during the level-of-care transition. The affected phases of care are: pre-op, intra-op and PACU.  

During that medication reconciliation, in the absence of an order reconciliation action :

• Some orders will automatically be stopped (ie: "auto-discontinued")
  • Those with "Frequency: Until discontinued"
  • Those with "Continuous PRN frequency
• And some orders will be routinely continued; they will not be stopped automatically:
  • Those in which the dose is titrated (ie: vasopressors and sedatives)
• Finally, in the absence of a specific order to continue them, continuous IV fluids will be stopped.

This step ensures that duplicate intravenous orders won't all be continued - as a patient moves from pre-op to intra-op to the PACU and then the floor These changes have been validated by a multi-specialty group consisting of clinicians from Patient Safety and Quality, Nursing, Pharmacy and Informatics.