What does it mean if you see orders under the heading Unreconciled Transfer Orders

Definition

Experience from hundreds of organizations has shown that poor communication of medical information at transition points is responsible for as many as 50 percent of all medication errors in the hospital and up to 20 percent of adverse drug events (ADEs). Each time a patient moves from one setting to another, clinicians should compare previous medication orders with new orders and plans for care and reconcile any differences. If this process does not occur in a standardized manner designed to ensure complete reconciliation, medication errors may lead to adverse events and harm.

Organizations can evaluate how well their own processes work by collecting data on the percentage of unreconciled medications. Teams should measure the percentage of unreconciled medications to see if the changes they are testing and implementing in reconciliation processes are leading to improvement.

Formula 
The numerator is the number of unreconciled medications (note that this is medications, not doses). If a medication is omitted in the orders without explanation, it is unreconciled, so your evaluation should not be based on orders alone. For example, if a medication is omitted, check the progress notes for a documented reason; if a legitimate reason for not ordering the medication is found, such as the patient is toxic from too much of the drug, then it would be considered reconciled.

The denominator is the total number of medications ordered for patients in the sample. This would include all medications ordered previously (e.g., from home medication list or MAR prior to transfer or discharge) and all medications ordered at transition (admitting or transfer orders or discharge instructions) in the reviewed sample of charts. Note: Over-the-counter (OTC) and herbal medications are not to be counted in the denominator when first starting this process. The recommended approach is to reconcile prescription medications first and once a good process is in place, then add OTC, herbals and other medications.

Goal
Reduce the percent of unreconciled medications in your area of focus (admission, transfer, or discharge) by 75 percent (or to zero). It is anticipated that each organization will ultimately address all three areas related to reconciliation (admission, transfer, and discharge). It is best to start with admission reconciliation.

Data Collection Plan
Summarize and report monthly.

Sample Graph

What does it mean if you see orders under the heading Unreconciled Transfer Orders

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LIVE 3.10.20:

Nurses currently see providers’ Unreconciled Orders in their Signed and Held Orders view. This is in addition to the Signed and Held Orders they may be responsible for releasing in their phase of care:

What does it mean if you see orders under the heading Unreconciled Transfer Orders

When nurses attempt to release ONLY the appropriate Signed and Held orders for their phase of care the alert seen below will fire. The nurse has to select “Continue” in order to move forward with releasing the appropriate Signed and Held orders:

What does it mean if you see orders under the heading Unreconciled Transfer Orders

The Unreconciled Orders subsequently disappear from the nurse’s view:

What does it mean if you see orders under the heading Unreconciled Transfer Orders

This was causing confusion and making some nurses hesitant to release the appropriate Signed and Held Orders for fear of losing the other orders. It has been decided that these orders will be removed from the nurse’s view. It is the provider’s responsibility to reconcile orders when patients move through different phases of care. We want to streamline and simplify the Signed and Held Order process, as much as possible, so nurses have the orders they need to best care for their patients.

What does it mean if orders are categorized as unreconciled transfer orders?

What does it mean if you see orders under the heading Unreconciled Transfer Orders. The physician did not review these orders. Contact physician to complete reconciliation. - Orders Team.

Which section of the Transfer Navigator is used to review all the orders for a patient?

If a patient has orders that need to be released, they can be viewed in the Patient Summary activity, on the Index report, under Signed and Held Orders. They can also be reviewed in the Order Review activity, or from the Signed/Held Orders section of a navigator.

What does it mean when you acknowledge an order in epic?

Acknowledging new orders means the order has been carried out.

Where can you find required documentation for your shift in epic?

All documentation you need for your shift is in the BLACK DOWNTIME BOX found on your unit. They can also be found on the documentation website. All orders received during downtime must be entered into Epic using the Ordered During Downtime order mode. All LDAs placed need to be added after Epic comes back up.