For staff: New in Epic - pharmacists pending TTOs for medical review

A change is being made in Epic on Tuesday 26 January which will allow ward-based pharmacists to pend TTOs, like doctors and specialist nurses currently do, within the discharge navigator in Epic.

This should help to improve patient flow and assist staff with the timely discharge of patients.

Below are the key actions to help pharmacists and consultants/doctors/specialist nurses to understand this new workflow:


Pharmacist key actions:

  1. Within the ‘Discharge’ activity tab in Epic, open the ‘Med Rec’ section of the TTO tab.
  2. Work through the med rec list and reconcile orders according to the published standard operating procedure (SOP).
  3. Move to Review and Sign. Review and Sign will show the medications that are to be prescribed, stopped and any new medications that you have ordered.
  4. At this point you can Pend the changes for review by a consultant/doctor.


Consultant/doctor/specialist nurse key actions:

When performing discharge TTO/Order Rec you will be able to ‘pend’ the orders to be reviewed and finalised later, instead of signing immediately – by clicking the ‘Pend’ button instead of the ‘sign’ button. To access these orders later, follow the steps below:

1.  When you enter the TTO/Order Rec section of the Discharge Navigator, a box will appear stating that there are pended reconciliation changes that have been made by a pharmacist or fellow specialist nurse/doctor. You can either:

‘Manage this unsigned work’
Allows you to view the changes that have been pended and continue, modify or edit the changes.

‘Delete this unsigned work’
This removes all changes made by the pharmacist

This warning box will close, Med Rec will open and you won’t be able to see any of the changes made by the pharmacist. If you now close the patient’s chart and open it again you will be able to retrieve the pharmacist’s work.  If you do make reconciliation decisions you can then choose to Sign or Pend the med rec. If you Pend, this will supersede the previously pended changes.

2.  Identifying unsigned orders early - you can add a column to ‘My Patient Lists’ that will show pended med rec. This is the “unsigned Order Rec Orders” column. 

A tip sheet for consultant/doctors explaining the full process is available here  - you will have to log into the My eHospital website to view this tip sheet. This tip sheet is also searchable within the Education Library (via the My eHospital link within Epic) - search 'tip sheets' by 'IPD - EpicCare IP Doctor' and you'll see the tip sheet entitled 'Pharmacy pending TTO meds' listed.