Patient Safety Update
PAML Links to Order Entry
In response to requests of clinicians, BWH and Partners Information Systems linked the electronic medication reconciliation process or PAML (pre-admission medication list) with BWH’s Order Entry (OE) system. At the end of May, patients’ medications in the PAML were seamlessly moved into admission medication orders.
“Thanks go to our IS and Patient Safety teams for their diligent work on this project during the last nine months to make this work efficiently while protecting our patients,” Andy Whittemore, MD, BWH’s chief medical officer, said.
In order to be compliant with the Joint Commission, a patient’s home medication list must be reviewed with the patient and reconciled when that patient is admitted to the hospital, transferred or discharged.
The process of signing the PAML and checking “PAML Creation Complete” is the step that represents the intent of medication reconciliation and will lead you to the PAML to OE connection. To get to this step, the ordering clinician needs to do the following:
1. Build the PAML and review the meds with the patient
2. Choose a planned action on admission for each home medication (such as continue as written, continue at different dose/freq, same or different route, continue at different route +/-dose /freq, discontinue, substitute, hold on admission or uncertain). Page the pharmacist if you need help in verifying any of the medications.
3. Sign the PAML and check “PAML Creation Complete.” This step brings you to the option “PAML to OE.” Your planned actions on admission from the PAML carry the appropriate fields into the OE system for your review. The original PAML entry and planned action will appear on the bottom of the screen as a reminder. You can decide to make changes in OE but there is no need to go back to change the PAML. The pharmacist will change it to reflect your order.
There is no change to the discharge medication reconciliation process. For more details on the PAML to OE connections, please see PAML tip sheet, which is available in the Partners Handbook.
If you have any questions regarding this change, contact any of the following members of the implementation team: Tejal Gandhi, MD; Jeff Schnipper, MD; or Erin Graydon-Baker.