Meds Rec: two-step process

Step One: Medication History

A record of the medicines a patient was supposed to be taking at the point they came in to hospital.

1. In the Patient’s record in Clinical Portal click the Medication/IDL tab
2. From menu on left click Medication
3. Click Full Review
4. From Review Type* drop down select Medication History
5. Click Import Medications, then Import and Continue in the pop-ups
6. For all Imported medications click into each one and select Add to List or Dismiss as appropriate
7. Make sure you carefully check every medicine to make sure the patient is still taking it, and that the dose and other details are correct
8. If adding to list examine the details, modify if needed and then click Add
9. For all Previous medications click into each one and Modify / Stop / Withhold / Continue as appropriate
10. Add medications if needed by clicking Add Medication and filling in the required fields
11. Fill in the Sources used drop down with at least 2 sources
12. Once a decision has been made on every Imported or Previous medication click on Next Review in the top right. This will trigger the second part of the process.

Step Two: Admission Review

A record of any changes made at admission to a patient’s existing medicines.

1. The medications recorded in the Medication history will be listed
2. For all medications click into each one and Modify / Stop / Withhold / Continue as appropriate
3. Make sure you carefully check every medicine to make sure the patient should still be taking it, and that the dose and other details are correct
4. Once a decision has been made on every medication click on Complete