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Enhancing Medication Labeling and Error Prevention in Inpatient Pharmacy Services

This document outlines the strategies employed to improve the consistency and accuracy of medication dosing information displayed on Pyxis machines at North Country Health Services. It discusses the integration of customized label comments, user prompts for dosage units, and error-reduction measures such as real-time feedback in medication dosing calculations. The collaboration between pharmacy and nursing teams is highlighted, aiming to ensure clarity in prescriptions, minimize potential errors, and enhance patient safety through efficient label management.

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Enhancing Medication Labeling and Error Prevention in Inpatient Pharmacy Services

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  1. Defaulting PHA Inpatient Label Comments Based on Dose Herb Bromenshenkel RPh North Country Health Services

  2. Pyxis screen

  3. North Country Health Services

  4. Pharmacy Information • MEDITECH Magic since 1990 • Pyxis machines in all areas • No inpatient cart fill • Meds loaded and unloaded as needed • Custom load reports • Manual MAR, Not generated by MEDITECH

  5. Pyxis Information • First line of label comments flows to Pyxis machine and displays for nurse • Dose is not always the same unit stored in Pyxis • 2 tabs • ½ tabs • Injections: Solumedrol 80 mg (1.28 ml)

  6. Pharmacy Enters Label Comments • To aid nursing, pharmacy would enter dose comments in line 1 of label comments. • Pharmacy tried for standard format: • Examples: • Dose: 1.28 ML = 80 MG • Solumedrol 80mg (125 mg/2 ml) • Dose: 1.5 TABS X 40 MG = 60 MG • Furosemide 40 mg tab

  7. Problems with Pharmacy Entry • Format not consistent • Goal was for nurse to see volume or number of tabs before size of product • I.e.: Dose: 1.5 TABS x 40 MG = 60 mg • vs.: Dose: 40 mg x 1.5 Tabs = 60 mg • Possibility for error due to calculation or typo

  8. Solution • Rule determines if dose is different than dispensing size. • If different: • Rule calculates dose string • Rule prompts user with string • User specifies if rule sets first line in label comments • Customized post live • No messages for: Senokot 2 tabs • Dose 1 x 2 TABS = 2 TABS

  9. What Displays • Varies if tabs/caps versus liquids/injections • Tabs/Caps: • *Dose: 0.5 TABS X 20 MG = 10 MG • *Dose: 2 TABS X 20 MG = 40 MG • Liquids/Injections: • *Dose: 1.28 ML = 80 MG • We put an “*” to indicate which ones computer set (quality assurance)

  10. Actual Display

  11. Key Points • Rule only sets comment if user selects “Y” • If comments exist, they are moved down 1 line • What it is going to be does not display unless user enter/Edit label comments • Once user enters “Y” at Edit label Comments, set comments display • If doing multiple dose edits on same rx, best to exist and come in and make one change • Have done, without problems

  12. When Select Edit Label Comments

  13. Other Examples:

  14. Setup

  15. Computer Set • One Rule • Numerous Custom Keywords • Most keywords pull simple data • Two keywords more extensive • Determines units/dose • Runs report to set Label Comments • Keyword used in rule runs NPR report which puts the comments into the data structure

  16. Simple Keywords • z label.comment.1 • @label.comment[1] • z dose.and.unit • @PHA.RX.dose.and.unit • Z drug.order.size • @PHA.DRUG.order.size[@med] • Z drug.order.unit • @PHA.DRUG.order.unit[@med]

  17. More Complex Keywords #1 • z disp.form.p.dose.un IF{@dose^V1, @PHA.DRUG.order.unit[@med]^V1A, @PHA.DRUG.order.size[@med]^V2, @PHA.DRUG.dispense.size[@med]^V3, @PHA.DRUG.strength.amt1[@med]^ST1, @PHA.DRUG.strength.amt2[@med]^ST2, @PHA.DRUG.dispense.unit[@med]^VU, @PHA.DRUG.dispense.form[@med]^VF, @PHA.DRUG.admin.form[@med]^AF, IF{(V2=V3)&(AF'=V1A) 1, IF{V2'=V1 1, V1:10D/V2^VR, VR:3D^VR, %Z.strip.trailing.zeros(VR)^MSDOSE, "*Dose: "_MSDOSE_" "_VF_"S X "_V3_" "_V1A_" = "_V1_" "_V1A^/Z.INFO}; IF{(AF'=V1A) 1, ST1:10D/ST2^CON, %Z.strip.trailing.zeros(CON)^CON, V1:10D/CON^VR, VR:3D^VR, %Z.strip.trailing.zeros(VR)_" "_VU^MSDOSE, "*Dose: "_MSDOSE_" = "_V1_" "_V1A^/Z.INFO};1;1}}

  18. More Complex Keyword #2 • z set.lab.com.1.4 • %PHA.RX.zcus.hab.rule.label.comment.1.4.M.ck(urn); • Rule runs report which files data to data structure

  19. Report

  20. Report Macro – Copy/Paste IF{/RULE.EVAL="REFILL"!(/RULE.EVAL="TXN") ^?;^/}^q, @Chg.prefix(PHA.RX,?,[q]), IF{/RULE.EVAL="REFILL"!(/RULE.EVAL="TXN") ^:;^/}^c, @Chg.prefix(PHA.RX,:,[c]), /patient^patient,/urn^urn, /PHA.REF.urn^PHA.REF.urn,/med^med,@t.med.rule^med.rule,/txn.date^txn.date,/txn.q^txn.q, /Z.INFO^LAB1, IF{/TR[urn]CM[1]$5="*Dose" LAB1^/TR[urn]CM[1]; /TR[urn]CM[4]^/TR[urn]CM[5],/TR[urn]CM[3]^/TR[urn]CM[4],/TR[urn]CM[2]^/TR[urn]CM[3], /TR[urn]CM[1]^/TR[urn]CM[2], LAB1^/TR[urn]CM[1]},1;

  21. Actual Rule

  22. Rule Code to Copy/Paste [f z label.comment.1]^LAB1, [f z dose.and.unit]^DOSEU, [f z drug.order.size]_" "_[f z drug.order.unit]^ORDD, IF{DOSEU=ORDD 1; [f rx dose]^CDOSE, [f rx start date]^STK, [f rx pt type]^PTY, [f rx ord type]^OTY, IF{STK_.=.!(PTY="OUT")!(CDOSE=0)!(OTY'="M") 1; IF{[f rx dose]=0&(OTY'="M") 1; [f z disp.form.p.dos.un]^INFO, IF{INFO=1!(INFO=LAB1)!(INFO_.=.) [f rx ok]; ("Set Internal Label Comments to:"_INFO)^ASK, IF{1'=[f rx yes/no](ASK) 1;[f z set.lab.com.1.4]}}};1}};

  23. Where activated - CDP

  24. Questions Herb Bromenshenkel RPH hbromenshenkel@nchs.com 218-333-5527

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