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PAS PROCESS TRAINING

INSTRUCTORS MANUAL
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TABLE OF CONTENTS
Overview
Overview of Unit of Instruction4
Goal of Instruction.5
Target Population5
Instructional Sequence and Delivery Approach.6
How to Use this Manual.9
Resources and Materials List.10
Overview of Lessons and Assessments..12
Objectives14
Lesson Plans
Lesson 016
Lesson 1...18
Lesson 220
Lesson 322
Lesson 424
Lesson 526

Lesson 628
Lesson 730
Assessments
Lesson 0 Assessment..32
Navigating EPIC Checklist.33
Entering PTA Medication into EPIC Checklist.35
Research Quiz Part 137

Navigating Allscripts Checklist..39

Research Quiz Part 240
Researching and Entering Medication Information Review Performance Assessment........42
Interviewing the Patient Checklist45
Verification Call Checklist46
PAS PTA Medication List Checklist47
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Putting It All Together Assessment

Directions.48
Rubric.49
Handouts
PAS Shadow Questionnaire..51
EPIC Guided Practice Handout54
Criteria for Creating a Personal Patient List in EPIC.62
Adding a PTA Medication63
Guiding Principles.64
Researching EPIC Discussion Guide..68
Discussion Guide for Allscripts.69
Discussion Guide for PAS Reference Book. 72
Video Links..73
References74
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OVERVIEW

Overview of Instructional Unit

This unit is designed to provide training for new Pharmacy Admission Specialists (PAS). Some

components may also be used to update skills for more experienced PAS who have shown a need for more

support or who may need to renew competencies.

The medication reconciliation process compares the medications taken by a patient prior to admission

to a facility with the medication orders at the facility. The Joint Commission (TJC), the accrediting body for

health care organizations, stipulates that the medication reconciliation process must be completed with 24

hours of admission (Sentinel Event Alert, Issue 35, 2006). This process begins with compiling an accurate list of

the patient's home medications which are also referred to as prior to admission (PTA) medications. At Poudre

Valley Hospital, it is the job of the Pharmacy Admission Specialist (PAS) to compile and verify this list. The PAS

must collect, record and communicate to the provider an accurate list of the patient's PTA medication using

every means possible.

An accurate list may sometimes be obtained by simply interviewing the patient and calling his/her

pharmacy to verify doses and directions. However, there are times when the patient may not be able to give

an accurate account of his/her medications, or the given pharmacy may not have all the information. These

situations require the PAS to be resourceful and efficient with time to have the list prepared within the target

time frame. The PAS may need to contact the patient's primary care physician (PCP) or other doctor that is

treating the patient. Searching patient documents available in previous encounters with the hospital can also

provide meaningful information. Even in simple situations research is conducted using a variety of resources

to compile an accurate list of the patient's medications.

Once the list is as complete as is possible it must be entered accurately into the electronic health

record (EHR). There are times when one PAS will begin work on a patient list, but not be able to complete it by
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the end of the shift, or the list will need to be left until the next day when the patient's pharmacy is open. In

those instances, the work that has been done must be clearly communicated to the next team member who

will be finishing the list. The known information should be updated in the EHR so that it can be viewed in a

standardized format.

Goal of Instruction

During any shift, the Pharmacy Admission Specialist (PAS) will assess the patient lists in the Electronic

Health Record (EHR) to determine which Prior to Admission (PTA) Medication lists require review by PAS, and

for each patient's list of PTA medications the PAS will include all appropriate medications according to the

current guiding principles and standard practice in place at Poudre Valley Hospital (PVH) so that the PTA

medication list is available as soon as possible so that the provider has time to perform the reconciliation

within 24 hours of the patient's admission.

Target Population Overview

The position of Pharmacy Admission Specialist was created in the fall of 2010. The job description

requires that the Pharmacy Admission Specialist have at least a high school diploma or GED. A minimum of 2

years experience as a retail or hospital pharmacy technician or pharmacy technician certification and 1 year of

experience as a retail or hospital pharmacy technician is also required. All of the current PAS meet these

requirements. The lessons in this Unit of Instruction will be used primarily as training for any new team

member who must also meet these requirements.

In order to perform the tasks involved in compiling a medication list for reconciliation, the PAS must be

able to speak, read and write in English. The PAS must have basic computer literacy which includes being able

to type information into the electronic health record. The PAS must be able to conduct face to face interviews

with patients who are being admitted to the hospital. The PAS must be able to use the telephone and fax

machine to obtain patient medication information. Pharmacy Admission Specialists must be able to manage
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time effectively. They must be able to work independently and as part of a team. Each team member must

also be familiar with common drug names and be knowledgeable enough about the medications to ask

pertinent questions of both the patient and those from whom they receive verifying information.

Instructional Sequence and Delivery Approach

The plan of instruction consists of seven lessons of 1 to 2 hours each. Each lesson is composed of Pre

Instructional Activities, Content Presentation, Learner Participation, Assessment and Follow-through Activities.

The task analysis done of the instructional goal revealed that the process could be divided into 4 main tasks:

1. Navigating EPIC

2. Entering Prior to Admission (PTA) Medications

3. Using Resources

4. Step by Step PAS Process.

The lessons were developed to build upon one another using scaffolding techniques. Step 4 is a performance

activity that brings all previous knowledge and skills together to complete the process of compiling the PTA

list, verifying the information, and updating the patients EHR (electronic health record).

The lessons are to be presented to the new PAS by an experienced PAS during training which takes

place over approximately 8 days. There will be time in between lessons for practice as well as for other

activities that orient the new PAS to the hospital policies and procedures. The introduction of each lesson will

be determined by the readiness of the new PAS to proceed; therefore the process may be accelerated or

slowed down depending on the needs of the learner.

The entire unit is designed to take approximately 9 hours. Table 1.1 describes the names of each

lesson, a short description, and the type of assessment and the approximate time to present/move through
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the instruction. Multiple lessons may be covered during a single shift. However, it is important that the new

PAS be given time to reflect on the material and practice skills taught. Table 1.2 gives a recommended training

calendar when includes the lessons, shadowing of experience PAS, and time for reflection and practice.
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Table 1.1
Lesson Description Assessment Time
Lesson 0: Access to Introduction to Webpage, Pre Training Questionnaire 20 minutes
Training Materials downloading and completing
documents.
Lesson 1: Navigating Introduction to PAS process and Performance Assessment 2 hours
navigating the EPIC Hyperspace A checklist is used to assess observed
EPIC environment. tasks

Lesson 2: Entering Search, select and edit entries in Performance Assessment 2 hours
Medications into EPIC the PTA medications screen A checklist is used to assess observed
tasks
Lesson 3: Using Using resources within EPIC to Objective Exam 1 hour
Resources, Part One compile and verify PTA
medication list
Lesson 4: Using Logging in and navigating Objective Exam 1 hour
Resources, Part Two Allscripts. Using the PAS
Reference book
Lesson 5: Review of Review of Tasks 2 and 3 Performance Assessment 1 hour
Researching and Use of a Rubric to determine
Entering Medication proficiency in researching information
Information and entering medication information
Lesson 6: Patient Information and techniques Performance Assessment 1 hour
Interviews and needed to conduct thorough A checklist is used to assess observed
Verification of patient interviews and verbal tasks and product
Medications verification of medications.
Lesson 7: Putting it All Trainee completes entire process Performance Assessment 1 hour
with active patient Use of a Rubric to determine
Together proficiency in completion of entire
PAS Process
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Table 1.2
PAS Training/Orientation Schedule
Day Activities Date
Completed
Day 1 Shadow experienced PAS taking notes
Fill out PAS shadow Observation Form and submit
electronically
Complete Medication Competencies
Day 2 Lesson 1 Navigating EPIC
Lesson 2 Entering PTA meds
Shadow experienced PAS--observe process
Day 3 Lesson 3 Researching in EPIC
Lesson 4 Researching in Allscripts and using PAS Reference
book
Shadow experienced PAS
Practice entering medication lists
Day 4 Practice researching appropriate resources
Practice entering med lists
Lesson 5 Review Researching and Entering meds
Day 5 Lesson 6 Interviewing the patient and verifying with
pharmacies
Day 6 Practice entire process with supervision of experienced PAS
Day 7 Practice entire process with feedback for experienced PAS
Day 8 Lesson 7--Putting It All Together Assessment
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How to Use This Manual

Each of the lesson plans and all of the documents needed to complete the lessons are provided in this
manual for convenience; however, the material is meant to be accessed on the website
uchealthnorthpas.weebly.com. All the materials are for this unit of instruction can be accessed through the
training page on the website.
Each of the documents can be printed for convenience. Many of the documents that need to be
turned in are google forms which may be submitted online.
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Resources and Materials Needed

The new PAS will have completed New Employee Orientation where logging in to ones individual
desktop and Outlook email will have been presented. The new PAS will also need to have access to the EPIC
Hyperspace environment and Allscripts to complete this training. These permissions are typically handled by
the Pharmacy Medication Safety Manager.

Physical Resources
o Computer Workstation with Internet access
o Clipboard
o Pen
o Sample Medication Lists
o PAS Reference Book
o Telephone
Access to
o Individual Desktop log in
o Allscripts
o EPIC Hyperspace
Instructional Materials
o Handouts
PAS Shadow Reflection Form
Navigating EPIC Handout
Criteria for Creating a Personal Patient List in EPIC Adding a PTA Medication Handout
Guiding Principles Table
Putting It All Together Performance Assessment Instructions
o Assessments/Checklists
Navigating EPIC Checklist
Entering PTA Medication Checklist
Research Quiz Part 1
Research Quiz Part 2
Navigating Allscripts Checklist
Review of Researching and Entering Medication Rubric
Interviewing Patients Checklist
Verification Call Checklist
PAS PTA Medication List Checklist
PAS Process Rubric
o Discussion Guides
Researching EPIC Discussion Guide
Discussion Guide for Allscripts
Discussion Guide for PAS Reference Book
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Links
o UCHealth North PAS website
o SME Video
o Allscripts Video
o Discontinue Decision Power Point
o Interviewing the Patient Video
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Overview of Lessons and Assessments

Lesson 0
In this lesson, the new PAS will be introduced to the training webpage and how to gain
access to and print needed documents. The PAS will be given documents to be completed
throughout the training period that review the pre-requisite material.

Lesson 1
This lesson introduces the new PAS to the PAS process. They will shadow an
experienced PAS to get an overview of the process in real time. They will then learn to navigate
the EPIC environment by working in the EPIC SME environment to become familiar with the
interface. Additionally they will learn how to personalize their experience somewhat by
creating a personal patient list.
Assessment: Navigating EPIC Checklist filled out by experienced PAS who has observed
the complete the steps.

Lesson 2
Updating the PTA Medications list in EPIC is the main focus of this lesson. Not only will
the new PAS learn how to enter medications to the list, but they will also learn how and when
to edit information that has been previously entered according to the guiding principles.
Assessment: New PAS will perform process indicated in the PTA Medication Checklist as
observed by experienced PAS

Lesson 3
EPIC contains a lot of useful information to a PAS. Finding that useful information is the
purpose of this lesson. The new PAS will learn when and where to look in the EPIC environment
for information that will help them compile a list and verify the information.
Assessment: Score of 80% or better on Research Quiz Part 1
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Lesson 4
Sometimes the information that is needed is not to be found in EPIC. Lesson 5 will
introduce the new PAS to Allscripts which is another EHR that some providers use. It will often
have pertinent information that can be accessed by PAS to help in completing the process.
Another useful tool is the PAS Reference Book. The new PAS will also be given an overview of
some of the information in this book.
Assessment: Score of 80% or better on Research Quiz Part 2
Lesson 5
Lesson 5 is a review of researching and updating medication information. The new PAS
will research information on a current patient using all available resources. They will then enter
the information into SME per guiding principles and checklists.
Assessment: Lesson 5 Performance Assessment Rubric

Lesson 6
In this lesson the new PAS will learn the techniques and tip needed to conduct patient
interviews and get verification of medications from pharmacies and other providers. The new
PAS will interview patients and verify the information.
Assessment: Performance of processes outlined on the Interview and Pharmacy
Information checklists.

Lesson 7
The new PAS performs the entire process on current patients while experienced PAS
shadows.
Assessment: PAS Process Rubric
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Objectives

Given the PAS training website url, the PAS will locate, open, complete and submit the Pre Training
Questionniare.
Given the document names, the PAS will locate and download the pre requisite competencies.
Given access to EPIC environment, the PAS will navigate to different areas/screens with 100% accuracy
according to the Navigating EPIC checklist.
Given a set of criteria, the PAS will create a Patient List in EPIC with 100% accuracy.
Given a list of PTA medications, the PAS will enter each medication into the EPIC SME test environment
according to PVH PAS standard practice and guiding principles with 100 % accuracy based on the PTA
Medications Checklist
Given a patient's name and date of birth or MRN number and a scenario that requires background
information be obtained, the PAS will analyze the known information to determine where the
appropriate background information may be found in EPIC with 80% accuracy.
Given a type of background information, the PAS will demonstrate where this information may be
found in either EPIC with 100% accuracy.
Given a type of background information, the PAS will demonstrate where this information may be
found in Allscripts with 100% accuracy.
Given a scenario in which more information is needed to compile an accurate PTA medication list, the
PAS will determine which resources in the PAS Reference Book could be used to find the needed
information with 80% accuracy.
Given the name and date of birth of a patient, the PAS will use all applicable resources to research
medication history and enter the findings into the EPIC SME environment according the guiding
principles with a score of 3 (satisfactory) on the rubric.
Upon completion of list the PAS will compile all hard copy materials used and attach to Medication
Reconciliation Report to create a packet of work for that patient with a score of 3 (satisfactory) on the
rubric.
Given the name and DOB or MRN number of an actual patient, the PAS will compile available
medication information 100% of the time.
Given all available medication information, the PAS will interview the patient or other knowledgeable
person and analyze answers in order to compile an up to date list of medications including all the
applicable steps according to the Interviewing Patients Checklists.
Given patient name, DOB and pharmacy, the PAS will interview pharmacy personnel to verify
medication information analyzing responses and asking clarifying questions including all applicable
steps on the Verification Call Checklist with 100% of the time.
During any shift, the PAS will apply knowledge of PAS process and Guiding Principles to select a patient,
research and update PTA Medications, document verification source, and file all documentation in the
daily file with a score of 3 (Competent) or better on the PAS Process Rubric.
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Lesson Plans
Title: Lesson 0: Access to Training Materials

Lesson Overview: This lesson will introduce new PAS UCHealth North website where training materials may be
obtained and assessments turned in.

Resource Materials:
Computer Workstation with individual log in
Access to the Internet
Lesson 0 Documents at training website

Objectives:

Given the PAS training website url, the PAS will locate, open, complete and submit the Pre Training
Questionniare.
Given the document names, the PAS will locate and download the pre requisite competencies.

Time: 20 Minutes

Before the lesson: Make sure all necessary links are accessible

Step 1: Pre-Instructional Activity

Explain that all documents needed for completion of this portion of orientation are located on the
uchealthnorthpas website and that the documents may be downloaded and printed from there. Also
explain that some of the exercises will be submitted electronically

Step 2: Content Presentation and Learner Participation

Demonstrate how to get to the webpage. (CP)
New PAS navigates to given areas as explained. (LP)
Point out links for each lesson and the corresponding documents (CP)
New PAS opens Pre Training Questionnaire (LP)
New PAS fills out the questionnaire and submits it electronically (LP)

Step 3: Assessment
PAS Pre Training Questionnaire.
Prerequisite Competency forms.

Step 4: Follow-through Activities

Assist new PAS in creating a private folder to store documents for future reference.
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Title: Lesson 1: Navigating EPIC

Lesson Overview: This lesson will introduce the trainee to the overall PAS process and how to log in and
navigate within the EPIC Hyperspace Environment.

Resources/Materials
Computer workstation
Clipboard and Pen
Documents
o PAS Shadow Reflection Form
o SME Video
o EPIC Guided Practice
o Navigating EPIC Checklist
o Criteria for Creating a Personal Patient List in EPIC

Objectives:

Given access to EPIC environment, the PAS will navigate to different areas/screens with 100% accuracy
according to the Navigating EPIC checklist.
Given a set of criteria, the PAS will create a Patient List in EPIC with 100% accuracy.

Time: 2 hours

Step 1: Pre-instructional ActivitiesPAS shadow activity

Trainee will be paired with experienced PAS and observe during the start to finish completion of a
patient's PTA Medication list. The trainee will observe and record observation using the PAS Shadow
Questionnaire. The observations will then be discussed with experienced PAS and/or PAS team leader.
The experienced PAS will present the Navigating EPIC Handout and explain that the trainee will learn
how to log in and navigate in the EPIC environment during this lesson.

Steps 2 and 3: Content Presentation (CP) and Learner Participation (LP)

Trainer will assist the new PAS on logging in to the EPIC SME environment. (CP and LP)
Trainer will point out the layout of the PAS view using either side by side terminals or with projector.
(CP)
Guided Practice for Dashboard, ED Track Board, Patient Station, Patient lists, Patient Summary, and
Admission Navigator. Trainer will use Checklist as a guide to introduce the new PAS to each area of
EPIC (CP) Trainee will mirror. (LP)
Review of definitions of each area and how to navigate back and forth. (CP)
Trainer will demonstrate how to create and edit a personalized list. (CP)
New PAS will create personal patient list with given set of criteria. (LP)
Using the Navigating EPIC handout, the new PAS will practice dependently techniques presented. (LP)
Trainer observe and give feedback. (CP)
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Step 4: Assessment

Trainer will use the Navigating EPIC checklist to assess mastery of task by presenting the given/criteria
and having new PAS perform the task.

Step 5: Follow-through Activities

The new PAS will again shadow experienced PAS evaluating the differences in the SME and Live
environments. Compare and contrast initial observations with observations following practice in the
SME practice environment either verbally or in writing.
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Title: Lesson 2 Entering Medications into EPIC

Lesson Overview: In this lesson the new PAS will learn how to search, select and edit entries in the PTA
medications screen. Special situations, notes vs instructions, and icons will also be covered.

Resources/Materials:

EPIC workstation
Sample Medication lists from previous encounters including at least one MAR
Logging in to SME Video
Documents
o Adding a PTA Medication
o Entering PTA Medication Checklist
o Guiding Principles
o Discontinue Decision Power Point
o Entering Meds Process Flowchart

Objectives:

Given a list of PTA medications, the PAS will enter each medication into the EPIC SME test environment
according to PVH PAS standard practice and guiding principles with 100 % accuracy based on the PTA
Medications Checklist

Time 2 hours

Step 1: Pre-instructional Activities

Discussion/reflection of previous lesson on navigating EPIC and new PAS observations.
Answer any questions from previous lesson that new PAS might have.
Overview of today's lesson
o Entering/editing medications into Epic
o Icons
o Notes versus instructions
o Guiding principles

Step 2: Content Presentation

Logging in to SME video
Adding a PTA Medication Handout
o Can be used either as script for guided practice or by the new PAS individually as a guide
through the basic steps of adding new PTA medications into EPIC
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Discussion of notes versus instructions including use of common smart texts

o Instructions include sig, start/stop dates, days of week or month the medication is taken, other
doses patient takes in conjunction with present entry
o Notes appropriate when explaining how patient takes differently than prescribed, information
on whether medication is formulary, notes on whether or when the information can be
verified, etc.
Introduction of Guiding Principles and decision Power Point for discontinuing or flagging previous
entries.
o Discussion of special scenarios and guiding principles.
RX versus patient reported
Definition of PTA medication
When to use multiple entries
How to read and input information from a MAR
o Present Sample MAR and point out where each type of information can generally be found.
o Point out any information that is only for the Facility and should not be included in our list
Give sample medications for guided practice; observe new PAS; give feedback

Step 3: Learner Participation

Guided practice on entering common meds and looking for formulary indication
New PAS enters a simple list into SME environment, then prints the Medication Reconciliation
Report of that list and analyzes for completeness, errors, etc. using the appropriate checklist and
guiding principles handouts
New PAS enters a more complicated list which includes various dosing, need for both free text
instructions and order notes and again prints and analyzes the report.
New PAS receives peer feedback on each of the two reports above.
New PAS enters information from a MAR into EPIC and analyzes the corresponding Medication
Reconciliation Report.
New PAS updates a list that has been previously entered using the appropriate decision making to
either edit, flag, or discontinue each entry. Peer/trainer feedback on printed report using PTA
medication checklist.

Step 4: Assessment
Perform processes as indicated by the PTA medication checklist with 100% accuracy.

Step 5: Follow-through Activities

New PAS uses PTA medication checklist and guiding principles to analyze list generated by experienced
PAS on a recent patient encounter.
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Title: Lesson 3 Using Resources Part 1

Lesson Overview: This lesson will introduce resources within EPIC that may be used to compile and verify
information to be used in updating the PTA Medication list.

Resources/Materials:
Computer workstation with access to SME
Documents
o Researching EPIC Discussion Guide
o Research Quiz Part 1

Objectives:
Given a patient's name and date of birth or MRN number and a scenario that requires background
information be obtained, the PAS will analyze the known information to determine where the
appropriate background information may be found in EPIC with 80% accuracy.
Given a type of background information, the PAS will demonstrate where this information may be
found in either EPIC with 100% accuracy.

Time: 1 hour

Step 1: Pre-instructional Activities

Brainstorm with new PAS some of the information they would like to have before going to interview a
patient about their PTA medication.
Ask what information they think they would need before going to talk to a patient about their
medication. Explain that we will be looking at some tools to help us find this information.

Step 2: Content Presentation

Demonstration and discussion of EPIC research tools. Ask How do you think each of these tools might
be beneficial? Name each item below and elicit feedback.
Then:
o Discussion and demonstration of Notes activity
Progress Notes
PAS
Other providers
H & P physician notes
ED Notes
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o Discussion and demonstration of Chart Review activity

Media tab
Notes tab
Previous encounters
After Visit Summary (AVS)
Medication History
Infusion Appointments
Anticoagulation
Office Visits
Pre Admission
Nurse Triage
o Discussion and demonstration of Demographics activity
o Clinical Archive
o Discussion and demonstration of Admission Activity
Reconciled Medication Dispenses
Verify Rx Benefits
Rx Snapshot

Step 3: Learner Participation

New PAS navigates to each area in EPIC as it is being discussed
New PAS makes notes and performs activities on Research EPIC handout

Step 4: Assessment
Complete Research Quiz Part 1 with at least 80% accuracy. (Upload completed quiz to Completed
Assessments folder on SkyDrive)

Step 5: Follow-through Activities

Discussion of quiz results
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Title: Lesson 4 Using Resources Part 2

Lesson Overview: This lesson will lead the trainee through logging in and navigating in Allscripts and using the
PAS Reference Book to research patient information.

Resources/Materials:
Computer workstation
PAS Reference Book
Documents
o Discussion Guide for Allscripts with Video Link
o Discussion Guide for PAS Reference Book.
o Navigating Allscripts Checklist
o Research Quiz Part 2

Objectives:
Given a type of background information, the PAS will demonstrate where this information may be
found in Allscripts with 100% accuracy.
Given a scenario in which more information is needed to compile an accurate PTA medication list, the
PAS will determine which resources in the PAS Reference Book could be used to find the needed
information with 80% accuracy.

Time 1 hour

Step 1: Pre-instructional Activities

Review and discuss what has been covered so far. Ask trainee to describe verbally or in writing a
situation in which they might use the resources covered so far.
Trainer explains that sometimes the desired information is not in the EPIC. We will cover other
resources available to gain needed information.

Step 2: Content Presentation

Demonstration of Allscripts using Logging In to Allscripts video
o Logging in to keep a separate window
o Give new PAS some time to look/click around in the environment and then ask, What are
some similarities and differences you see between EPIC and Allscripts. Then discuss:
Navigating/uses Chart Viewer tab
Sorting the view
Dr. Notes
Anti-coagulation information
Navigating/uses Medication tab
Current/Past Medications
Printing the list
Information i icon

Trainer discusses the PAS Resource book

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o Phone number
o Pharmacy hours
o VA process
o Assisted Living Table
o PVH information
o Formulary OTC item table

Step 3: Learner Participation

Guided practice will lead trainee to research in Allscripts and the PAS Reference book including printing
reports/list and explaining how to find given information in each resource.

Step 4: Assessment
Navigating Allscripts Checklist
Complete Research Quiz Part 2 with at least 80% accuracy.

Step 5: Follow-through Activities

Explain that on the next lesson we will take what we have learned and do a mock research and entry of
a complete med list from start to finish.
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Title: Lesson 5 Review

Lesson Overview: This lesson will review researching and entering medication information.

Resources/Materials:
Computer workstation
Documents
o Lesson 5 Assessment Documents
Experienced PAS Instructions
New PAS Instructions
Lesson 5 Performance Assessment Rubric

Objectives:
Given the name and date of birth of a patient, the PAS will use all applicable resources to research
medication history and enter the findings into the EPIC SME environment according the guiding
principles with a score of 3 (satisfactory) on the rubric.
Upon completion of list the PAS will compile all hard copy materials used and attach to Medication
Reconciliation Report to create a packet of work for that patient with a score of 3 (satisfactory) on the
rubric.

Time: 1 Hour

Step 1: Pre-instructional Activities

Briefly review the resources: EPIC, Allscripts, PAS Reference Book
Answer any questions

Step 2: Content Presentation

Present Assignment and go over rubric

Step 3: Learner Participation

New PAS is given name and DOB of current patient. (See Experienced PAS instructions for this
Performance Assessment).
New PAS prints Medication Reconciliation Report for that patient from EPIC hyperspace
Trainee conducts research using EPIC, Allscripts and Reference Book making notes and printing
appropriate information.
New PAS compares findings and compiles a list of still unknown information
New PAS will input list of medications into EPIC SME using guiding principles and checklist to guide.

Step 4: Assessment
Perform patient interview and updating of EHR as indicated in the Review of Researching and Entering
Mediation Rubric
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Step 5: Follow-through Activities

Trainer asks new PAS to refer back to list of yet unknown information. Ask What kinds of questions
would you need to ask the patient?
Explain that the next lesson will be about conducting the patient interview and calling to verify the
medication.
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Title: Lesson 6 Patient Interviews and Verification of Medications

Lesson Overview: This lesson will focus on the information and techniques needed to conduct thorough
patient interviews and verbal verification of medications from pharmacies and other providers.

Resources/Materials:
Epic Workstation
Clipboard
Pen
Telephone
Documents
o PAS Interview Video Link
o PAS Shadow Reflection Form
o Interviewing Patients Checklist
o Verification Call Checklist

Objectives:
Given the name and DOB or MRN number of an actual patient, the PAS will compile available
medication information 100% of the time.
Given all available medication information, the PAS will interview the patient or other knowledgeable
person and analyze answers in order to compile an up to date list of medications including all the
applicable steps according to the Interviewing Patients Checklists.
Given patient name, DOB and pharmacy, the PAS will interview pharmacy personnel to verify
medication information analyzing responses and asking clarifying questions including all applicable
steps on the Verification Call Checklist with 100% of the time.

Time: 1 hour

Step 1: Pre-instructional Activities

New PAS will again shadow experienced PAS making note of interview techniques both with the
patient and with the pharmacy over the phone.
Discussion of observation

Step 2: Content Presentation

Interviewing the Patient Video
Experienced PAS will highlight necessary parts of the patient interview
o Introduction
Identify self, patient, and purpose of the visit
o Request for pharmacy information
o Request list or bottles
o Review of any known information and request of last taken times
o BEDC
o Wrap-up
Trainer will highlight necessary parts of pharmacy interview
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o Introduction
Identify self, purpose of call, patient
Marking of current list
When to ask for dates and provider
When to ask for insurance information
Other tips
o Trainer will assist trainee in selecting a patient to interview

Step 3: Learner Participation

Write a script, outline, or checklist to aid you in conducting patient interviews and calling pharmacies.
Conduct research to prepare for interview
Interview patient while seasoned PAS shadows
Call pharmacy to verify information

Step 4: Assessment
Perform processes as indicated by the Interview and Pharmacy Information Checklist used during
observation of performance
Seasoned PAS will use information collected by trainee to update PTA medication for the patient.
o Seasoned PAS will give feedback on any missing information or inaccuracies as well as feedback
on those items well done.

Step 5: Follow-through Activities

Trainer asks what trainee feels most comfortable about. Discuss any trainee questions or concerns.
Next lesson: Putting it all together: Trainee will complete entire process for current patient.
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Title: Lesson 7 Putting It All Together

Lesson Overview: In this lesson the new PAS will put all the steps together from start to finish.

Resources/Materials:
Computer workstation
Clipboard
Telephone
Access to patient
Documents
o PAS PTA Medication List Checklist
o Putting it all together Performance Assessment Instructions
o PAS Process Rubric

Objectives:
During any shift, the PAS will apply knowledge of PAS process and Guiding Principles to select a patient,
research and update PTA Medications, document verification source, and file all documentation in the
daily file with a score of 3 (Competent) or better on the PAS Process Rubric.

Time: 1 hour

Step 1: Pre-instructional Activities

Have new PAS explain verbally or in writing the PAS Process
Give new PAS a copy of performance instructions and rubric

Steps 2 and 3: Content Presentation (CP) and Learner Participation (LP)

Discussion of previous lessons and feedback (CP and LP)
Assist new PAS in selecting a patient (CP and LP)
Answer any questions (CP and LP)
Explain how to document on PAS productivity log (CP)
New PAS will select a patient, do all the research, interview patient, verify information, update PTA
medication list, document verification in Progress Note, communicate with provider when list is
complete, file complete packet with work done including final Medication Reconciliation Report. (LP)

Step 4: Assessment
Complete processes as indicated by the PAS Process Rubric.
Step 5: Follow-through Activities
Discuss other possible scenarios with new PAS and how it should be handled.
30

Assessments
31

Lesson 0 Assessment

PAS Pre Training Questionnaire:

1. Describe your experience inworking in a pharmacy. Have you worked in retail, hospital or

both? How many years of each type of experience do you have?

2. What have you enjoyed most about working in pharmacy settings?

Check all that apply:

Working with patients

Solving complex problems

Vareity of learning experiences

Using technology

Other

3. Please explain why you chose the responses to the previous question.

4. Please describe what you know abou the job of a Pharmacy Admission Specialist (PAS). What

do the PAS do? How is it important?

5. Rate your interest in training to be a PAS on a scale of 1 to 4 with 1 being very interested and 4

being not at all interested.

6. Please explain why you chose the answer to the previous question.

7. Describe your experience with using computers and technology. At what point in yourlife did

you start using computers? How do uou use computers/technology to solve problems? What

situations in which you use computers and technology are you most and least comfortable?
32

8. How do you feel about making decision to solve problems scale of 1 to 4 with 1 being I love the

challenge and 4 being A necessary evil?

9. When you are presented with a complicated problem, how do you solve it? What steps do you

take to find a satisfactory conclusion? What resources would you use?

10. What do you anticipate will be your biggest challenge in learing to do the PAS work? Explain

why you think it will be a challenge. What support and resources would help you to overcome

the challenge?
33

Navigating EPIC Checklist PAS Name_______________________

Observer___________________________

New PAS instructions: Use this checklist as a guide. You will need to be able to do all this tasks to be fluent in
navigating EPIC

Experienced PAS instructions: This Checklist will be used to help determine if the training PAS is able to
navigate in the EPIC Hyperspace Environment. Ask the new PAS to complete each performance described
below and observe. Note all areas completed and the date of completion in the checklist below. Any items not
completed leave blank for future observation.
Given Performance Completed Date
An EPIC workstation, user id and Log on to EPIC
password or activated employee name
badge
From any screen in EPIC Open the Patient list screen
From the patient list screen Select and open the Pharmacy Admission
Specialist All Patients list
Given a list of categories Create a custom list in the patient lists screen
Given any patient list screen and a Will sort the list according to the given
category type category in default and opposite order
Given a patient name from any patient Will open the patient chart and locate the
list (including the ED Track Board) admission navigator
From any screen in EPIC Navigate to (open) the ED Track board screen
From the ED Track Board Screen Will identify and navigate to the All Patients
Tab
From the ED Track Board Screen Will identify and navigate to the To Be
Admitted Tab
Given a patient's name or MRN number Locate the Patient Station Icon to locate and
from any screen in EPIC open the patient chart
From an open patient chart Use the activity tabs to locate the Patient
Summary
From the patient summary view Print the Medication Reconciliation Report
From the patient summary view List other report options available
From any view in the patient chart Open the Chart Review Activity by clicking on
the Chart Review tab
34
From the Chart Review Activity
From the Chart Review Activity
When asked verbally or in writing
From the Chart Review Activity
From the Notes Tab in the Chart Review
Activity in a patient chart
From an open patient chart
From an open patient chart
From the Medications Activity
From the Medications Activity
From an open patient chart
From the demographic activity
From an open patient chart
From Admission Activity
From the Review PTA Medication screen
From the Admission Activity
From the med rec status screen
From the Review PTA Medication
From the Admission Activity
Select and open the most recent Hospital
Encounter
Select and Open the Media Tab
Name 2 items that might be found in the
Media tab useful to PAS
Select and Open the Notes tab
List verbally or in writing the categories into
which the list may be sorted
Open the Notes Activity
Open the Medications Activity
Select the facility administered medications
tab
Select the PTA medications tab
Select the demographic tab
List verbally or in writing three types of
information listed on the default tab
Select the Admission Activity
Open the Review PTA Medication screen
List verbally or in writing the three main areas
within the screen (pharmacy, medications,
med list status)
Open the Med Rec Status screen
List any PTA medications that have been
reviewed by the provider.
List verbally or in writing the 5 possible
options for Med List Status
Create and Sign Verification Progress Note
35

Entering PTA Medication into EPIC Checklist PAS Name

Observer
Given Performance Completed Date
A list of PTA medications Enter each medication into
EPIC SME practice
environment according to
PAS standard practice
Given a medication name and dose Search the EPIC database
for the correct medication
From the search results of a given Select the entry that
drug name and dose corresponds to the dose
the patient is taking
Given a PTA medication that has Choose to either edit,
been entered previously into the discontinue, or flag for
list and updated information about review with provider
the medication based upon the guiding
principles.
Given a PTA medication that has Distinguish between a
been entered previously into the patient reported or
list prescription entry based
upon the icon of the entry
Given a patient reported Correctly choose to edit or
medication previously entered into remove and reenter based
the PTA medication list on the updated
information
Given a patient reported Discontinue the
medication previously entered into medication with a
the PTA list that patient is no longer Discontinue reason of
taking Medication Hx: Patient
reported, no longer
taking
Given a patient reported Open the order composer
medication previously entered into and edit the directions
the PTA medication list with the
same dose but different direction
Given a patient reported Discontinue the
medication previously entered into medication with the
discontinue reason of
36

the patient's PTA medication list for Medication Hx: Therapy

which the dose has changed change and entered the
new dose and direction
into the PTA medication
list
Given a prescription medication Correctly choose to either
previously entered into the PTA discontinue, flag for
medication list review with provider, or
leave the entry as is.
Given a prescription entry in the Determine whether to
PTA medication list for which the discontinue or flag for
patient is no longer taking review with provider
Given current active prescription Flag for Provider Review
entered into the PTA medication with an Order note stating.
that the patient is no longer taking Patient no longer taking
Given an expired prescription in the Discontinue with the
PTA medication list that the patient reason Medication Hx:
no longer takes Patient no longer taking
37

Research Quiz Part 2

Use Allscripts to answer questions 1 - 6
* Required
Name *

1. Name two ways to search for a patient's chart in Allscripts.

2. Under what tab could find a list of discontinued medications?

3. What type of entry in the Chart Viewer tab would contain current Warfarin/Coumadin dosing?

4. Name two types of helpful information are found by clicking the "i" icon.

5. Describe how to print a medication list from Allscripts.

6. In Allscripts progress notes, the doctor's indication that a medication has been added or
discontinued during the office visit will often be found by scrolling through the note to what section?

USE THE PAS REFERENCE BOOK MATERIALS TO ANSWER QUESTIONS 7 - 14

7. How late does the Johnstown Good Day Pharmacy stay open during the week?

8. What is the phone number for the Larimer County Detention Center infirmary?

9. What is the phone number for Centre Avenue Health and Rehab?

10. During week days, to what department does one fax requests for medication information at the
Cheyenne VA?

11. What is the extension Medical Unit nurses' station?

12. What color are the pages on which list the Third Party (insurance) help desk numbers are printed?
38

13. What is the street address for the hospital?

14. What is the item number for the fish oil capsule we select if a patient does not know the dose
taken at home?
39
Navigating Allscripts Checklist
Given
Given a patient name and date
of birth
Given a patient name and date
of birth
From the medication tab in
Allscripts
From the medication tab in
Allscripts
Given a patient name and date
of birth
From the Chart view tab in
Allscripts
From the Allscripts Chart View
sorted by encounter
From the Allscripts Chart View
From the most recent anti-
coagulation encounter in
Allscripts
From the Allscripts Chart View
Open patient chart in Allscripts
PAS Name
Observer Name
Performance Completed Date
Open the patient chart in
Allscripts
Open the patient's medication
list in Allscripts
Print the medication list
Open the discontinued
medications
Open the Chart View tab in the
patient's chart in Allscripts
Sort the list by encounter to
determine the most recent
encounter with an Allscripts
provider
Resort the list by Section by
Subsection
Scroll down to find the Anti-
coagulation subsection
Copy the Coumadin/warfarin
dosing schedule
Open most recent encounter
notes and find the plan of care
from that visit
Locate the pharmacy
information on file
40

Research Quiz Part 2

Use Allscripts to answer questions 1 - 6

* Required

Name *

1. Name two ways to search for a patient's chart in Allscripts.

2. Under what tab could find a list of discontinued medications?

3. What type of entry in the Chart Viewer tab would contain current Warfarin/Coumadin dosing?

4. Name two types of helpful information are found by clicking the "i" icon.

5. Describe how to print a medication list from Allscripts.

6. In Allscripts progress notes, the doctor's indication that a medication has been added or discontinued during
the office visit will often be found by scrolling through the note to what section?

USE THE PAS REFERENCE BOOK MATERIALS TO ANSWER QUESTIONS 7 - 14

7. How late does the Johnstown Good Day Pharmacy stay open during the week?

8. What is the phone number for the Larimer County Detention Center infirmary?
41

9. What is the phone number for Centre Avenue Health and Rehab?

10. During week days, to what department does one fax requests for medication information at the Cheyenne
VA?

11. What is the extension Medical Unit nurses' station?

12. What color are the pages on which list the Third Party (insurance) help desk numbers are printed?

13. What is the street address for the hospital?

14. What is the item number for the fish oil capsule we select if a patient does not know the dose taken at
home?
42

Researching and Entering Medication Information Review

Performance Assessment

An Experienced PAS will assist you in selecting a current patient from the list in the EPIC Hyperspace
Environment and observe your process.

You will:

A. Print the Medication Reconciliation Report for that Patient and research patient information from all
available relevant sources making notes as you go.

B. In EPIC Non-Prod SME environment accurately update a fake patient chart using the list compiled from your
research according to the Guiding Principles.

C. Document your work in both electronic (SME) and hard copy form.
43

Experienced PAS Instructions for Lesson 5

Research before beginning with new PAS to find a patient who has information in more than one place for
example Allscripts in addition to EPIC. Ideally this patient would have 8-15 medications to enter. If not you
play patient and list some additional meds.

The New PAS has not yet had the lesson on interviewing the patient or calling the pharmacy. This assessment
is to determine if the new PAS has and can use knowledge of resources and entering medications properly.
44

Researching and Entering Medication Information Review

Performance Assessment Rubric

Unsatisfactory 0 Needs Revision 1 Satisfactory 2 Score

A. Use of PAS does not make use PAS makes insufficient PAS makes appropriate use
Resources of appropriate relevant use of relevant of relevant resources to
resources to research resources to research research pertinent patient
pertinent patient pertinent patient information.
information. information.
B. Update PTA PAS has missing or PAS enters all PAS appropriately enters
Med List wrong information medications but with PTA meds into SME
and/or does not use PAS errors in using the environment according to
process or guiding guiding principles and PAS process and guiding
principles. PAS process. principles.
C. PAS does not document PAS documents work PAS appropriately
Documentation work in either Progress but with insufficient documents work in
Note or Packet or both. detail. Progress Note and in hard
copy packet.
45

Interviewing the Patient Checklist PAS Name

Observer Name Date

Given Performance Yes No N/A
At the Introduce yourself and explains reason for visit
beginning of Verify you have the correct patient
the interview
During the Ask patient to state all pharmacies used to fill their
interview current medications
Ask which pharmacy they would like any new
prescriptions from the hospital to be sent.
For short term Ask when the patient started the medication
medications and/or how many doses they have already taken
like antibiotics
and prednisone
Patient's own Copy down name, dose, frequency, date filled, and
prescription pharmacy information, and OTC name and dose
and OTC
medication
bottles
List of Review medications with patient or other
medications knowledgeable person to confirm what and how
from all the patient has been taking each one.
available Ask when each medication was last taken.
sources
Before ending Use the BEDC checklist to be sure that all
the interview medications the patient is currently taking is
included in their list
46

Verification Call Checklist PAS Name

Observer Name Date

Instructions: Observe the PAS during a verification call to a pharmacy. Look for each of the following actions.
Check Yes if the action is present. Check No if the action is not present. Check N/A if the action does not
apply.
Given Performance Yes No N/A
List of PTA Verify the name dose and frequency with pharmacy, PCP,
Medications insurance company, etc.
Name, DOB, Interview pharmacy personnel to verify PTA medication
name of information noting any discrepancies
pharmacy
After Take down or confirm from the current list the name,
identifying dose, and frequency of current active medications being
patient name, sure that the form (immediate release, extended release,
date of birth, etc.) is accurate
etc. with
pharmacy
For short term Ask the number of days to be taken and when the patient
medications picked up the medication
like antibiotics
and prednisone
Before ending Ask if there are any other medications that seem current
interview that have not been discussed.
47

PAS PTA Medication List Checklist PAS Name

Observer Name Date
Instructions: Experienced and New PAS use this checklist as a guideline to remember key components of the
PAS process.
Not Missing (0) Incomplete or Present
applicable with errors according to
(1) standard
practice (2)
Last Taken Times
Research patient information
Obtained information from notes in
previous visits
Obtained information from Allscripts
Obtained information from other
sources
Documentation of pharmacy
Medications entered into EPIC
Patient MAR from facility present in file.
Documentation of discrepancy between
how medication is prescribed and how
patient takes.
Documentation of special scenarios
Proper use of Discontinue Medications
Proper use of Flag for Removal
Notation of Informant
Verification Progress Note
Dr. Jump with discrepancy
Dr. Jump without discrepancy
Completed Final Medication
Reconciliation Report
48

Putting It All Together Performance Assessment Directions

Task: You will complete the entire PAS process according to MM 31 and use guiding principles for special
scenarios. You be shadowed by a peer and a rubric will be used to measure level of competency.
A. Use of resourcesuse any or all of the following that are available and appropriate for the given patient.
EPIC
Allscripts
PAS Reference Book

B. Interview the patient or other knowledgeable person to ascertain the following:

Introduce yourself and explain your purpose
Confirm patient name and date of birth
Obtain/confirm pharmacy information
Obtain/confirm patient list of medications
Obtain last taken times
Use BEDC checklist to make sure nothing has been missed

C. Verify prescription information with prescription benefits, red box, pharmacy, provider, insurance

companies etc.

D. Update PTA Med List in EPIC using the guiding principles and Policy MM31 as a guide including:
Correct drug
Last taken time
Informant
Progress Note
Med List Status
Proper use of order notes and instructions

E. Collect and file all paperwork associated with this patient's encounter
49
Putting It All Together Task Rubric
Peer Observer Name
A. Use of Resources
B. Interviewing the Patient
C. Verify prescription
Information
D. Update PTA Med List in
Epic
E. Documentation
PAS Name
Date
Does Not Meet Standard Minimally Competent Competent Highly Competent Score/Level
Value: 0.00 Value: 1.00 Value: 2.00 Value: 3.00
The PAS made insufficient The PAS used limited The PAS appropriately used an The PAS used appropriately used
use of relevant resources to number of relevant adequate number of relevant substantial number of relevant
research pertinent patient resources to research resources to research patient resources to research pertinent
information and verify pertinent patient information pertinent patient patient information and verify
prescription medications. information and verify information and verify prescription prescription medications.
prescription medications. medications.
The PAS failed to interview The PAS did not complete The PAS completed most of the The PAS completed all the
the patient. an adequate number of the components of the patient components of the patient
components of the patient interview. interview.
interview.
The PAS failed to verify the Does not apply Does not Apply The PAS verified the medication
medication information information with all the means
with all the means at hand. at hand.
The PAS failed to update The PAS updated the EHR The PAS adequately updated the The PAS appropriately updated
the Electronic Health with numerous variations EHR with minimal variation from the Electronic health record
Record in the PAS process and PAS process and guiding principles. according to the standard
guiding principles. practice and guiding principles.
The PAS failed to document The PAS documented The PAS adequately included all The PAS appropriately included
work in the EHR and hard limited relative relative documentation in both the all relative documentation in
copy files documentation in either EHR and hard copy form. both the EHR and hard copy
the EHR or hard copy form. form.
50

HANDOUTS
51

PAS Shadow Reflection Form

* Required

What is your name, and who did you shadow?

1. How did PAS know the patient's list needed to be done? How did s/he indicate that they were
taking ownership of this list in the EPIC? *

2. How did PAS prepare before going to speak to the patient? What resources did the PAS use? *

3. Patient Interview: Describe what you observed during each portion of the patient interview. *

4. Describe what you observed when the PAS was verifying the medication information. *

5. What steps were taken after the medication information was verified? *
52

6. List any other observations or questions you may have after observing the PAS.
53

EPIC Guided Practice

Instructions: This exercise will guide you through the EPIC SME environment to help you become more
familiar with the screens, buttons, icons, etc. It is intended to be followed in sequence. If you cannot
find an item asked for, try going back to a previous step and work your way through again looking for
any possible steps missed. For convenience you may print the form, but please SUBMIT YOUR ANSWERS
ONLINE.

To open the practice application from VIC, click on:

Applications --> AppWeb2-->Epic Non-Prod-->Epic SME

User id: rxpas

Password: Uchtest1!
Department: MCR Pharmacy

This will open your dashboard. To navigate back to it, click on the 1st tab on the left under the
EPIC button on the top left hand side of the screen
* Required

What are the other 2 tabs beside the dashboard tab.?

Hover to discover...

From the Dashboard, click on the ED Track Board link. What is the name of the person who is
about to be admitted? Who is about to be discharged?

Use the legend.

Open one of the patients charts. (Double click on patients name.) What is the name of the
activity for this default screen?

Look at the buttons on the left of the screen

List the names of the other Activity tabs on the left hand side of this screen:
54

Click on each of the activity buttons and notice what type of information is available there.
Which activity would you select to find the name of the patients family members?

Close the patient chart by clicking on the X on the tab near the top with the patients name.
What screen do you see now?

Close the Ed Track Board. What screen do you see now?

Click on Patient Station (3 to the right of the EPIC button). What is the title of the dialogue box
that pops up?

List all the criteria that may be used to search for a patient.

Click on the Recent Patients tab. Click patient Fresh, Comments. What is the default activity? *

Activities are the buttons on the left side of the screen

55

What other activities tabs are present on this screen?

Make sure that the Admission Encounter is highlighted and click the Open Chart button which is
located about midway down the screen. What is the name of the default activity?

Notice that there are navigation arrows between the Patient name and the Patient Summary
activity tab.

Complete each of the following steps

Check the box when complete

o Close the Patient Chart

o Click on the Patient Lists icon located 5 to the right of the EPIC button
o Expand the Medical Center of the Rockies folder
o From there, expand the Pharmacy Admission Specialist folder.
o Open the ALL Patients folder
o Sort the list by Med List Status
o Open patient, Wipper, Mike (the patient summary will open.)
o Print the Medicaiton Reconciliation Report
o Click on the Admission activity
o Make the Admission (PAS) Navigator screen larger by clicking the "Resize" button
near the top of the right hand side of the screen.
o Click again to return it to the default state.
o Use the scroll bar to see the types of information available on this screen

Click on the Med Rec Status link within the list below PAS Navigator. Have the patients Prior to
Admissions meds been reviewed? How can you tell?
56

Click on the Review PTA Meds in the PAS Navigator. Notice that the medication list is by default
listed alphabetically. What are the other options for sorting the PTA Meds list?

Find the Med List status. What are the five options? *

Check each box below as you complete the activity.

o Close the patient's chart

o Click on the Patient Station icon to open the Patient Lookup dialogue box.
o Click on the Recent Patient tab.
o Select and open a patient chart.
o Make sure a hospital encounter is highlighted and click accept.

What is the name of the default report in the Patient Summary?

What other reports are available in this activity?

57

Check each box below as you complete the activity.

o Click on the Chart Review Activity.

o Select the most recent Hospital Admission Encounter.
o Locate and open the Media tab within the chart review activity.The media tab will
contain the scanned image of the patient's insurance card if available.

There is a Notes activity and a notes tab within the Chart Review Activity

o Open the Notes tab within the Chart Review Activity

o Now Open the Notes activity
o If there are no notes, click on "Create in Notewriter" and write a work appropriate
note of your choice.
o If there is already a note present, open it and read the contents

Open the medications activity. Click on the Encounter tab withing the Medications activity.
What are the three sections on this screen?

Open the Demographic activity and list three types of information listed on the default tab.
58

Open the PAS Navigator by clicking on the Admission activity button. Within the PAS Navigator,
click on Review PTA Meds. List four areas within this section which can be updated:

o Change the Med List Status to In Progress

o Select a pharmacy from the option search Cherry Creek. Select (highlight) the entry
and click Accept. Click accept again to exit the dialogue box. This will be the default
pharmacy for the patient and will be the one that will receive any prescriptions that are
electronically sent from the hospital.
o Click in the box that says Add Prior to Admission Med enter lisin 10-->enter.
Select (highlight) the Lisinopril 10 mg tablet. Click Accept. Click Accept again.
o Change the Med List to Ready for Provider.

Click Mark As Reviewed. What changes do you see on the screen? *

o Click on Med Rec Status in the PAS navigator. You will see information on Prior to
Admission Meds Needing Review
59

Criteria for Creating a Personal Patient List in EPIC

After logging in to EPIC, select the Patient Lists from the top of the screen.

Click the Create button near the top left of the screen.

Click on "My List"

In the dialogue box type "Current Patients" in the Name field.

From the "Available Columns" listed under Layout you will highlight and then click "Add" for each of the
following categories. (The column name will move from Available on the left to Selected on the right.)

Patient Name/Sex/Age
Room/Bed
Admission Date
Admission Time
Med List Status
MRN
Med Review Date
Med Review User
Patient Class

Once you have these columns moved into the Selected field, you can move them up and down in the
list by highlighting the name you want to move and click the up or down arrow to the right of the box.

When you have things the way you want them, click accept.

The next step is to select the units you want to pull from to populate the list. In the same screen expand
the Poudre Valley Hospital folder. Then expand the Units folder. Drag the following units up to your
newly created list:

Medicine
ICU
Telemetry
Neu Med Surg
Surgical
Oncology
Ortho
Pediatric
PACU
60

ADDING A PTA MEDICATION

1. Click on a patients name to open the chart. (You will see the Medication Reconciliation
Form on the Patient Summary tab).

2. Click on the Admission tab. This will open the PAS Admission Navigator.

3. Click on Review PTA Meds

4. If you have not already done so, change the Med List Status to In Progress

5. In the Add Prior to Admission Med field near the top of your screen, search the med
you want to enter by typing part of the name and the dose if you know it and press
ENTER. Ex: lisin 10 this will bring up a list of choices from the Preferences List.

6. Scroll down or click on the correct choice (if not already highlighted in blue) and click
Accept. (Or press ENTER)

7. Read through the entry that is defaulted in the Order Composer and make any
necessary changes in dose and frequency.

8. Once the entry is correct, click Accept or press Alt A. This will add the new Medication to
the list and bring the cursor back to the Add Prior to Admission Med field. (Notice the
red check mark in the box under the last taken times. This indicates that the patient is
currently taking the medication. If you click the red check mark it will disappear
indicating that the patient is not currently taking the medication.)

9. You will need to choose a last taken time from the list or you may put a specific date and
time in the appropriate boxes. This may be done each time you enter a new med or
when the entire list is completed.

Medications that do not appear on the Preferences List:

1. When you search for a med and your results will say No items found, click the
Database Lookup Tab.

2. Example: Try searching for Cinnamon. Once you click on the Database Lookup tab, you
should get several options. Pick the Cinnamon Bark-Chromium Picolinate 500mg-100mg
and click accept. Patient takes 1 capsule daily. Fill in that info in the order composer and
click accept.
61

Medications Not Found or Unidentified by Patient:

If the medication cannot be found in the system, or the patient doesnt know the name of the
med:

Type Help in the Add Prior to Admission Med field and press ENTER. You will get a few
options including Unknown to Patient and Unable to Find.

1. Use Unable to Find if the patient can tell you which medication hes taking, but you
cant find it in the system. Click accept. The order composer will show UNABLE TO FIND
and right below that is Med Name: ***

2. Fill out the dose, route and frequency.

3. Click on the Med Name: *** link next to the instructions. This will open a box in which
to write more instructions.

4. Replace the *** with the name of the medication.

5. Click Accept when all info is entered correctly for the medication.

Completing the Review:

A. Be sure you have indicated the last taken by either selecting one of the buttons or
putting the date in the box under Time. Also notice the Mark Unselected Today and
Mark Unselected Yesterday buttons. This will allow you to indicate today or yesterday
as the last taken time for all meds you have not already marked.

B. You can leave a comment concerning the medication by clicking on the sheet of paper
icon and typing the note and clicking accept.

C. Additional instructions may be added by clicking on the click to add text link next to
Instructions: in the order composer.

D. Once the list is as complete as you can get it, Click Mark as Reviewed
62
Category Scenario
Not enough information Patient unaware of dose; unable
to confirm dose with any other
resources
Patient only knows a little
information about a pill (i.e. green
pill daily)
Product not in Epic Unable to find exact product
match.
Over the Counter Patient doesnt know the salt form
Medications or dose. (Examples: Calcium,
Magnesium, Iron)
Patient is using an OTC medication
on an as needed basis.
PRN Medications Patient takes medication on an as
needed basis
Various Dosing Schedule Patient takes a medication on a
various dosing schedule, but uses
only 1 tablet strength. For
example: warfarin 3 mg three
times a week and 4 mg 4 days a
week, or patient takes 20 mg in
AM and 40 mg at HS.
Doses with Multiple 2 different tablet used to make up
Strengths a dose
PAS Action Comments
Choose the generic entry in Epic under Database Lookup. Once dose is known, the Valerian PO
Ex. Valerian PO should be removed and the appropriate
product with the correct strength used in
Epic
Use Unknown to Patient in Epic and fill in as much
information as possible so that someone can pick up from
there and enter the information once the drugs identity is
known.
Type in Unable to Find in Epic and fill in known
information.
Use formulary item from our list if appropriate. Type Formulary item; home dose
unknown as an order note.
Fill in PRN indication(s) and all other known information. If Type Formulary item; home dose
product is listed on our OTC list use that information unless unknown as an order note.
the patient specifies how they have been taking it. If it is not
on the formulary list, ask the patient the dose and frequency
they use and fill out as completely as possible.
Enter reason for prn indication. Use check boxes as If Clinic or RX, dont change anything or add
appropriate, and if one is not correct, type in indication. an indication to the med entry. Enter the
reason for use in an Order Note
Make 2 separate entries for each dose. Choose the product If you use part of the dosing and the
with the appropriate tablet strength (the tablet the patient remainder in the comments, it doesnt flow
uses at home). When given the choice for dose, route, correctly if the MD uses the entry to
frequency, choose Click to add text and write the prescribe the drug and retail pharmacies
days/time of day the patient takes in the Sig line. cant fill it.
*This only applies if the patient uses 1
dosage form for making their total dose. If
a patient has 2 different table strengths,
use the appropriate entries.
**Remember to ALWAYS use patient
friendly, clear directions!
On each entry, use the appropriate dose, route, and
frequency buttons, and then write in the instructions of the
first medication to take with the 2nd medication for total
dose. Example: Labetalol 100mg BID (using the buttons); In
instructions write: Take with 300mg tablet to total dose of
400mg. Do the appropriate documentation with the
second drug.
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Category Scenario
Insulin Insulin sliding scales
Antibiotics Patient is taking a short course of
antibiotics (PO, IV, IM, etc.)
Facility administered Heparin and saline flushes that are
medications admin in clinic are showing up on
patients list.
Medical Supplies Patient has a medical supply on their
home PTA medications list.
Examples: lancets, home oxygen,
walker, compression stockings
RX on hold/not being Patient has RX but hasnt started
used taking yet. Medications the patient
stopped taking but the prescriber
thinks they should be taking.
Medications that are being held for a
procedure but will be resumed
afterward.
Prescription Patient is taking a prescription
Medications that arent medication they arent prescribed to
for the patient take (i.e. a spouses or other family
members)
Patient Taking
Prescription differently
then Entered in Epic
MD Directed Change on Owned by UCH Pharmacy
an RX that is Live in Epic
Rx is owned externally, or was
initially patient reported
Pt states they are taking PAS unable to verify med
a unverified medication.
PAS Action Comments
Write sliding scale in instructions completely, using
patient friendly language.
Fill out dose, route, and frequency. Write into the
instructions section the days supply and when the drug
started and/or when it is expected to finish.
Use smart text .pvhpasfacilitymednote and fill out the
template with location of facility, source of the
information, and names of any meds taken within last 24
hours of admission to PVH (names only)
If no longer taking, discontinue from lists. Same rules as If it is a recent RX and is UCH owned, Flag
other medications apply. for Removal and enter an order note
describing issue.
Write in the comments that medication not being
currently used. Document time of last dose as Not
Taking and comment why it is still on profile in Order
Notes
Enter the medication as you normally would. Then in the
Order Notes sections write: Note: This is not prescribed
for the patient; its from
Leave RX as entered. Write in Order Note how the patient
is actually using the medication.
Flag the original for removal and comment in an Order
Note why it is flagged. Enter a separate entry of how the
patient is taking the medication d write in an order note
that MED directed this change in therapy and that patient
may need a new RX upon discharge.
Update the information to reflect what the change is and
how the patient it now taking it.
Enter medication the way the patient states Write Order Note stating Unable to verify.
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65

Researching in EPIC Discussion Guide

Instructions for experienced PAS:

Ask, How do you think each of the following tools might be beneficial when looking for
information to complete the PTA medication list? Have new PAS navigate to each area. Discuss
possible purpose and scenarios. Elicit feedback.

o Notes Activity
Progress Notes
PAS
Other Providers
H & P physician notes
ED Notes
Case Manager notes
o Chart Review Activity
Previous encounters
After Visit Summary (AVS)
Medication History
Infusion Appointments
Anticoagulation
Clinic appointments
Pre Admission Appointments
Notes tab
Media tab
o Demographics Activity
o Clinical Archive
o Admission Activity
Reconciled Medication Dispenses
Verify Rx Benefits
Rx Snapshot
Med Rec StatusDr. orders
o Medications Activity
Current
History
Facility administered meds
Prescriptions (PTA)
What was discontinued, date, reason
Dates meds were added to record
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Allscripts Discussion Guide and Video Link

A Brief Description
Allscripts
o Allscripts is the software application used by many PVHS doctors and clinics
including the Heart Center of the Rockies (important location for monitoring
warfarin patients). PAS may be able to locate significant information in here
which is especially useful after offices close for the day.

A video demonstration for logging in and some useful areas of Allscripts is located here:

Allscripts Video (Ctrl + Click to access). Be sure to maximize the screen for better viewing.

Using Allscripts

Double click on Allscripts icon on desktop.

Log in using your usual ID and password.
If no patient is active, you can search for them by Last, First name.
Once a patient record appears, notice the horizontal Clinical Toolbar the toolbar has a
string of icons including a heart and a chemistry beaker. PAS does not want to touch
anything in this Clinical toolbar.
o On some systems, there is an X in the upper right corner of the toolbar. If you
see an X, click it to close the toolbar.
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o If there is no X, be sure that you do not click on anything in the toolbar.

Useful Areas (below the Clinical Toolbar in above screen shot)

o Chart Viewer the chart viewer gives you access to physician notes from office
visit. You can sometimes find medication information in these notes.
1. View All by Sections by Subsections: will separate files into Notes,
Diagnostics, etc. You can open any by clicking on the icon located on the
line and directly in front of the heading
2. View All by Encounterwill separate all entries in reverse chronological
order. This is helpful to quickly determine how long it has been since an
entry/encounter was entered into Allscripts. It is also helpful when trying
to find a note for a specific date.
3. View All by Specialty: This will divide files into sections such as
Cardiology, Nephrology, etc. This is a useful view if searching for the
latest Warfarin/Coumadin dosing info from the Heart Center of the
Rockies (HCOR). You can open the file and print off the dosing info to
attach to your final report.
4. View All by Notes: This lists physician notes from various visits.
Sometimes doctors maintain lists of patients meds.
o Meds the tab, located two to the right of the Chart Viewer, may reveal info
specifically related to the patients medications. A list of the medications may be
printed by right-clicking in the med list, scrolling down in the dialogue box until
you see print medication list. When you click print list another box will pop up.
Click preview then click print at the bottom of the next screen.
68

o Orders this box, located further to the right, may offer info. You can use the
pull down arrow to request to see All Orders.

Select a Different Patient

o Directly below the patients name, (Test, October in screen shot), there is an
option to Select Patient. Click on it to get an option to Search. Then, you can type
in a new Patients Last name, First name to obtain their record.

Find Info on Patient i.e. Demographics, Rx Benefit Plans, Pharmacies used

o Immediately to the right of the Select Patient option, there is a blue i. Click on
the information icon and it will expand the display. Scroll down, and you may
find info listing the patients pharmacy and/or mail order pharmacy. If the
hospitalized patient cannot communicate, this may give you a clue of where to
start investigating.
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PAS Reference Book Discussion Guide

The PAS Reference Book was initially created as a place to store the various items of reference that had
been previously posted about the PAS office. As time when by more reference tools have been created.
Other tools are now available electronically as part of EPIC. However, there are many times when a
phone number or other piece of information is needed that is not available in EPIC.

As you go through the PAS Reference Book with the experienced PAS, notice that many updates are
hand written. We often come across helpful information as we go about our business. It is helpful to
make note of these in the book. Eventually this updates will be added and new pages will be printed on
which to write yet more helpful information.

There are many helpful sections in the book. Some of the most commonly used sections are:

Pharmacy Hours Pagecontains the hours of operation for many of the local pharmacies.

Yellow phone number sectionthese pages contain many of the numbers that are now
available in EPIC for pharmacies, but there are also local numbers that are helpful for gathering
information such as the Prescription Assistance Program, the Larimer County Detention Center
infirmary, and the NPI and DEA numbers for PVH as well as UCH North contact information.

In addition the process for requesting medication information from the Cheyenne and Denver
VA is located on the last two pages of this section.

Blue Assisted Living pagesthis table contains contact information for many of the skilled
nursing facilities that serve our area.

OTC Formulary listthere are 2 tables that help us select formulary items for common OTCs
when the patient does not know their dose. One table contains the meds recommended for adults, and
there is another pediatric table. These tables should be in the PAS Reference Book, but may also be
located in the hanging files at the workstations in the PAS office.
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Video/Presentation Links

SME Video http://screencast.com/t/cSYwM6jIC2

Allscripts Video http://screencast.com/t/BxJW2zIOY
Interviewing the Patient Video http://youtu.be/P8UIVDDi2yE
Discontinuing Medication Decision Power Point
https://drive.google.com/file/d/0B6uvxZjHnCVbS2dMTkt2dm91bkk/edit?usp=sharing
71

References

Using medication reconciliation to prevent errors (2006). Retrieved from:

http://www.jointcommission.org/sentinel_event_alert_issue_35_using_medication_reconciliati
on_to_prevent_errors/

Perica,K. (2014, January) Presentation Removal of Meds Power Point presentation at the
meeting of the Electronic Health Record Specialists of Poudre Valley Hospital, Fort Collins, CO

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