1. A complaint about Paml accuracy is received, how do you track who has modified the Paml? Each time the Paml is modified, a document is sent to StarPanel titled Pre-Admission Medication List. That author of the document will be the person who modified the list. Type Pre- Admission in the All document title search to get a listing of all the Paml modifications (HINT: typing in Paml will not work for the search). See screen shot below.

Reconciling provider:There is currently not a way to tell from the viewing the Paml application or from Starpanel who the provider was that reconciled the meds. This information must be requested from the EDW. If you need this information, you can make the request to Byron Lee and please copy Jay Morrison, Karen and Gwen on the request. You will not likely get the request for this often, but may need it in the event that a JCAHO Surveyor were to ask-please let them know the urgency of the request.

2. How to respond to the complaint: Here are sample letters that you may consider using in your response to the users. You will need to modify the text to make it appropriate to the situation that you are investigating. You will find the 2 ppts for end user education on the V: drive.

Dr. John Doe –

Thank you for reporting the problem with Preadmission Medication List documentation. I understand from the information provided when you reported the problem to the Help Desk that you had concerns that the admitting nurse had failed to capture a complete and accurate medication history. I have investigated and found that:

(omit the one that is not correct)

  • The medication list documented on admission had been updated since the most recent prior Medication List (done done in the Clinic on _____) (date/time) indicating that some efforts had been made to update the medication information
  • The medication list was identical to that done during the most recent clinic visit (in July 2007). This is not proof that the list was not reviewed/updated but does warrant some follow-up. I have therefore provided the nurse and his/her manager some instructions on the Medication Reconciliation Policy and how to document the PreAdmit Medication List.

Because patient condition, presence or absence of family members, and access to the patient during the sometimes chaotic admission process can impact the ability to collect a medication history, there are often legitimate reasons that the initial PAML list that is generated may be less than complete, regardless of who documents the list. Because of this, the process is deliberately set up as a team process. The admitting nurse has responsibility to document a medication history and physicians and other members of the team have responsibility to review and verify that information and to add to the PAML list when additional information becomes available.

We have achieved the best outcomes when team members partner together to complete this important work. If you have concerns about the team work surrounding this joint responsibility on a specific unit, we strongly encourage you to talk directly with the Manager on that unit. They will be in a position to identify workflow inefficiencies, communication gaps, personnel issues, and other barriers interfering with achievement of the desired outcome – safe, high quality care for the patient.

Again, thank you for sharing your concern and for demonstrating your commitment to safe patient care.

Your name, title

Systems Support Services

Nancy Nurse –(manager would be cc’d on this)

I am following up on a report of a problem involving completion of a Preadmission Medication List (PAML) on mm/dd/year for patient’s MR # was xxxxxxxxx . In investigating the report, I have checked StarPanel and found that the most recent Medication List documented prior to the date that PAML was documented was done on mm/dd/year. The PAML list documented recently was identical to that earlier list. It is possible that the patient is still taking exactly the same medications they were on XX months/years ago but when we see a PAML that is identical to an earlier Medication List, this can also be an indicator that the person who documented the PAML was unclear on the process for documenting the medication history. In case this might be the case, I have attached a short module that explains the correct way to collect and document the PAML. If this was a case in which the PAML and an earlier Medication List were appropriately identical, I hope you will not be offended. Only those directly involved in the care of this patient can fully know this information and our role is to ensure that staff have the training and support they need to use our clinical systems efficiently and effectively to ensure safe, high quality care for our patients.

I also want to share how the PAML is used to increase the safety of medication management. Medication Reconciliation is one of the best practices identified to ensure that patients get the meds they are supposed to get, don’t get ones they should not be taking, and to help the team identify and address unsafe interactions between medications. Medications are reconciled on admission, with each change in level of care or service, following significant medical & surgical procedures, and at the time of discharge. This practice ensures that meds that must be stopped or started due to hospitalization are addressed with changes in condition and then again prior to discharge to ensure the patient returns home with accurate information about what drugs to keep taking, stop taking, and which ones have changes in dose or other directions for use compared to they way they were taking them prior to admission.

Thanks for taking the time to review this information. If you have any questions about use of the PAML tool, please let me know and I’ll try my best to answer them or arrange for someone to assist you in person.

Your name, title

Systems Support Services