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Robin Bartlett, PharmD Carla Stearle, PharmD June 2010

Pharmacy Data Management (PDM). Robin Bartlett, PharmD Carla Stearle, PharmD June 2010. Course Objectives. Describe and Manage PDM Menu Options Interaction between options Proper set up Identify common pharmacy issues in EHR. Overview. Pharmacy Data Management Set Up

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Robin Bartlett, PharmD Carla Stearle, PharmD June 2010

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  1. Pharmacy Data Management (PDM) Robin Bartlett, PharmD Carla Stearle, PharmD June 2010

  2. Course Objectives • Describe and Manage PDM • Menu Options • Interaction between options • Proper set up • Identify common pharmacy issues in EHR

  3. Overview • Pharmacy Data Management Set Up • The baseline for how well medication management will work for all disciplines. • Impacts all disciplines • Providers • Nurses • Pharmacy • Technicians • Clerks

  4. Menu OptionsPharmacy Data Management Menu CMOP Mark/Unmark (Single Drug) Dosages ... Drug Enter/Edit Edit Orderable Items Drug Interaction Management ... Electrolyte File (IV) Lookup into Dispense Drug File Medication Instruction File Add/Edit Medication Route File Enter/Edit Orderable Item Management ... Orderable Item Report Drug Text Enter/Edit Pharmacy System Parameters Edit Standard Schedule Edit Synonym Enter/Edit

  5. Dosages • Enter/Edit Dosages • Possible Dosages • Tablets and Capsules • Auto Created • Can add/edit • Enter Package use Inpatient and/ or Outpatient (if allowed) • Local Possible Dosages • All other drugs ie creams, susp, MDIs • Add/edit individual (local) dosages • Enter Package use Inpatient and/or Outpatient

  6. Adding New Dosages • Dosages are ONLY for Single Entity tablets and capsules PDM Dosages  Dosages Enter/Edit Select Drug: HALOPERIDOL 10MG TAB CN709 Strength from National Drug File match => 10 MG Strength currently in the Drug File => 10 MG Edit Strength? N// Strength => 10 Unit => MG Select DISPENSE UNITS PER DOSE: ?? Choose from: 1 10 IO 2 20 IO Select DISPENSE UNITS PER DOSE: 3 Are you adding '3' as a new POSSIBLE DOSAGES (the 3RD for this DRUG)? No//Y Enter an 'I' for Inpatient, 'O' for Outpatient, 'IO' for both. PACKAGE: IO Strength => 10 Unit => MG • Don’t add LPDs to get more choices for single entity tablets & capsules • Won’t be selectable (even though you will be able to add them) • Dosages can not be imprecise i.e. 1-2 tablets (LPDs can) • Don’t use a leading 0 for fractions of a dispense unit • i.e. ½ tablet would be .5 NOT 0.5 Never edit the strength here! Automatically created when drug was matched to the NDF

  7. Adding Local Possible Dosages • For all other Drugs LPDs apply • Even in they have dosages associated with them • PDM Dosages Dosages Enter/Edit • Enter past the Dosages section if it appears • Add any LPDs you will want to use in the Sigs • Include • article if needed (A, THE) • Quantity (1, 2 etc.) • Noun (TABLET, CAPSULE, SUPPOSITORY, ML) • Delete superfluous LPDs • 2 suppositories etc. What you type is what you get – Abbreviations do NOT expand MG do NOT calculate

  8. Adding LPDs PDM Dosages  Dosages Enter/Edit Select Drug: 2432 ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB CN103 This entry is marked for the following PHARMACY packages: Outpatient Select LOCAL POSSIBLE DOSAGE: ? Answer with LOCAL POSSIBLE DOSAGE Choose from: 1 CAPSULE IO 2 CAPSULES IO You may enter a new LOCAL POSSIBLE DOSAGE, if you wish (1-60 characters in length) Select LOCAL POSSIBLE DOSAGE: 1-2 CAPSULES Are you adding '1-2 CAPSULES' as a new LOCAL POSSIBLE DOSAGE (the 3RD for this DRUG)? No// Y LOCAL POSSIBLE DOSAGE: 1-2 CAPSULES// PACKAGE: IO Can select specific Drugs with the IEN (# column from the NSYN report) Include number, noun, and article (if needed)

  9. Deleting Dosages PDM Dosages  Dosages Enter/Edit Select Drug: 1457 NITROGLYCERIN 0.4MG TAB,S.L CV250 Strength from National Drug File match=> 0.4 MG Strength currently in the Drug File => 0.4 MG Edit Strength? N// Strength => 0.4 Unit => MG Select DISPENSE UNITS PER DOSE: ?? Choose from: 1 0.4 IO 2 0.8 IO Select DISPENSE UNITS PER DOSE: 2 DISPENSE UNITS PER DOSE: 2// @ SURE YOU WANT TO DELETE THE ENTIRE '2' DISPENSE UNITS PER DOSE? Y Select DISPENSE UNITS PER DOSE: . PACKAGE: IO Strength => 0.4 Unit => MG Enter/Edit Local Possible Dosages? N // Select Drug:

  10. Deleting LPDs PDM Dosages  Dosages Enter/Edit Select Drug: 1595 BISACODYL 10MG SUPP,RTL Strength from National Drug File match=> 10 MG Strength currently in the Drug File => 10 MG Edit Strength? N// Strength => 10 Unit => MG Select DISPENSE UNITS PER DOSE: ?? Choose from: 1 10 IO 2 20 IO Select DISPENSE UNITS PER DOSE: Select LOCAL POSSIBLE DOSAGE: ? Answer with LOCAL POSSIBLE DOSAGE Choose from: 1 Suppository IO 2 Suppositories IO LOCAL POSSIBLE DOSAGE : 2// @ SURE YOU WANT TO DELETE THE ENTIRE '2 SUPPOSITORIES‘ AS A LOCAL POSSIBLE DOSAGE? Y Select DISPENSE UNITS PER DOSE: . PACKAGE: IO Strength => 0.4 Unit => MG Enter/Edit Local Possible Dosages? N // Select Drug: Shows possible doses (only for Inpatient use) Ready to edit next Drug

  11. Drug Enter/Edit Key Fields • Dosages • DEA Special Handling • VA Drug Class Code • Inactive Date • Product information • Dispense Units • Order Units • NDC • Dispense Unit/Order Unit

  12. Drug Enter/Edit • Other data options inclusive with drug entry • Dosages • Orderable item • Synonym • ID packages for drug use.

  13. Look Up into Dispense Drug File • Snapshot of medication information • Cost • Synonyms • NDC • Dosages • VA Drug Class Code • Can be of use for non-pharmacy staff to look up meds (billing)

  14. Medication Instruction File • Enter/Edit common instructions • PM = Evening • AM = Morning • AP = Apply • Entered under edit orderable items

  15. Standard Files Adding Med Instructions • PDM  Medication Instruction File Add/Edit Select MEDICATION INSTRUCTION NAME: SWB NAME: SWB// SYNONYM: EXPANSION: **SHAKE WELL BEFORE USING** Replace PLURAL: INTENDED USE: IN & OUTPATIENT// MED ROUTE: Leave Blank SCHEDULE:Leave Blank

  16. Medication Route File • Enter/Edit common routes • Ophthalmic = In Affected Eyes • Topical = To Affected Area • Added under Edit Orderable Items

  17. Orderable Item Management • Edit/Enter several pertinent fields • Assign Drug Text Entry for provider viewing • Med Route • Schedule Type • Schedule • Patient Instructions • Synonym (for EHR med ordering selection)

  18. PDM  Orderable Item Management  Edit Orderable Items Select PHARMACY ORDERABLE ITEM NAME: IBUPROFEN Orderable Item -> IBUPROFEN Dosage Form -> TAB List all Drugs/Additives/Solutions tied to this Orderable Item? YES// Dispense Drugs: --------------- IBUPROFEN 200MG TAB IBUPROFEN 400MG TAB IBUPROFEN 600MG TAB IBUPROFEN 800MG TAB Are you sure you want to edit this Orderable Item? NO// YES Now editing Orderable Item: IBUPROFEN TAB Orderable Item Name: IBUPROFEN// This Orderable Item is Formulary. This Orderable Item is marked as a Non-VA Med. Select OI-DRUG TEXT ENTRY: INACTIVE DATE: DAY (nD) or DOSE (nL) LIMIT: MED ROUTE: SCHEDULE TYPE: SCHEDULE: Q6H// PATIENT INSTRUCTIONS: WF FPA// Select SYNONYM: ?? Choose from: ADVIL MOTRIN You may enter a new SYNONYM, if you wish Select SYNONYM: Lists all of the Drug File Entries that are linked to this OI Could change the OI name (for typos) Can associate drug text (dosing tables etc) with an OI. Displays in EHR for providers to review If blank will default to ORAL(can’t put ORAL in here) All non-orals must have a route entered here Leave Schedule type blank for Outpatient Can have as many as you want- Usually all Trade Names. Some sites use classes for some drugs i.e. OCP or STATINS

  19. Drug Text Enter/Edit • Enter Text that can be viewed • Enter for viewing under Orderable Item Edit • Can enter multiple texts under Orderable Item • Providers can view on EHR med order entry • Pharmacist can view on RPMS med order entry • Viewed under heading “Restriction/Guidelines” • Can cut and paste dosing tables

  20. AWP Scan Option • Separate Menu Option • Allows the scanning of medications into the Drug File • Automatically updates • Synonym • NDC • Dispense Units per Order

  21. Updating Actual Drug Costs • McKesson Web Site • Ordering • Cost Change Report • Enter Dates • RPMS Extract • Generate Report • Save

  22. Updating Actual Drug Costs • IT help to locate file • IHS Specific Pharmacy Options • IMPORT ENTRIES FROM AAC FILE • AWP Manual Update

  23. Standard Schedule Edit • Inpatient and Outpatient dosing schedule • Entered for viewing under Orderable Item Edit

  24. Standard Files Adding/Editing Schedules PDM  STANDARD SCHEDULE EDIT Select ADMINISTRATION SCHEDULE: QDAY Are you adding 'QDAY' as a new ADMINISTRATION SCHEDULE (the 14TH)? No// Y (Yes) NAME: QDAY// OUTPATIENT EXPANSION: EVERY DAY TYPE OF SCHEDULE: CONTINUOUS TYPE OF SCHEDULE: CONTINUOUS// CONTINUOUS STANDARD ADMINISTRATION TIMES: FREQUENCY (IN MINUTES): 1440// Select WARD: NAME: “MO-WED-FRI” Can force an entry by using “ ” i.e. if MO was already in the file OUTPATIENT EXPANSION: ON MONDAYS, WEDNESDAYS, AND FRIDAYS TYPE OF SCHEDULE: CONTINUOUS// DAY OF THE WEEK STANDARD ADMINISTRATION TIMES: FREQUENCY (IN MINUTES): 1440 Select WARD:

  25. New Drug Entry Exercise • Enter new drug entry • Dosages • Medication Instruction • Medication Route • Orderable Item • Drug Text • Standard Schedule

  26. Drug Enter/Edit Generic Name, Strength, dosage form GENERIC NAME: DORZOLAMIDE 2% SOL,OPH Are you adding 'DORZOLAMIDE 2% SOL,OPH' as a new DRUG (the 2632ND)? No// Y DRUG NUMBER: 85620// DRUG VA CLASSIFICATION: DRUG FSN: DRUG NATIONAL DRUG CLASS: DRUG CURRENT INVENTORY: DRUG LOCAL NON-FORMULARY: DRUG INACTIVE DATE: DRUG MESSAGE: DRUG RESTRICTION: GENERIC NAME: DORZOLAMIDE 2% SOL,OPH Replace VA CLASSIFICATION: DEA, SPECIAL HDLG: 6P NATIONAL FORMULARY INDICATOR: Not Matched To NDF LOCAL NON-FORMULARY: VISN NON-FORMULARY: Select DRUG TEXT ENTRY: Select FORMULARY ALTERNATIVE: Select SYNONYM: MESSAGE: RESTRICTION: FSN: INACTIVE DATE: Automatically assigned by FM Don’t enter manually, NDF match will add this 6=legend, 9=OTC I-IV for scheduled, need B to allow RF, P= dated item Leave blank – not seen in EHR – use OI synonym Do not use the NDC field here- Enter it further Down WILL DISPLAY TO PROVIDER ON POE- restrictions like outside Rx only, or limited to 3rd party pay Date item no longer stocked –NOT the expiration date! Never delete a Drug – Use this field to make them non-selectable

  27. WARNING LABEL: ORDER UNIT: BT DISPENSE UNIT: ML DISPENSE UNITS PER ORDER UNIT: 10 NDC: 00006-3519-36 PRICE PER ORDER UNIT: LAST PRICE UPDATE: AWP PER ORDER UNIT 7.25: AWP PER DISP UNIT is: 00007.425000 SOURCE OF SUPPLY: DISPENSING LOCATION: STORAGE LOCATION: PRICE PER DISPENSE UNIT: Do you wish to match/rematch to NATIONAL DRUG file? Yes// Deleting Possible Dosages... Match local drug DORZOLAMIDE 2% SOL,OPH ORDER UNIT: BT DISPENSE UNITS/ORDER UNITS: 10 DISPENSE UNIT: ML I will try to match NDC: 00006-3519-36 to NDF. No match on that NDC.... I will attempt to match the NDCs from your SYNONYMS. No match by Synonym NDC... now first word Match made with DORZOLAMIDE 2% SOL,OPH Now select VA Product Name 1 DORZOLAMIDE HCL 2% SOLN,OPH SOLN,OPH OP109 D0286 Enter your choice: 1 Will print with VA laser labels, Enter the #s separated by commas Container item purchased in Dose of the order unit i.e. GM, ML, TAB, CAP Must use 5-4-2 Use leading 0 if needed Automatically populated if matched based upon the NDC & Dispense Units Per Order Unit Must match to NDF to get VA Drug Class Will create multiple OIs if add new strength of Drug that had not been marched to NDF

  28. Is this a match < Reply Y, N or press return to continue > : Y • CHOOSE FROM: • 1 10 ML BOTTLE • 2 3 X 5 ML BOTTLE • 3 5 ML BOTTLE • 4 OTHER OTHER • Enter Package Size & Type Combination: 1 • Local drug DORZOLAMIDE 2% SOL,OPH • matches DORZOLAMIDE HCL 2% SOLN,OPH • PACKAGE SIZE: 10 ML • PACKAGE TYPE: BOTTLE • < Enter "Y" for yes > < Enter "N" for no > OK? : Y • LOCAL DRUG NAME: DORZOLAMIDE 2% SOL,OPH • ORDER UNIT: BT • DISPENSE UNITS/ORDER UNITS: 10 • DISPENSE UNIT: ML • VA PRODUCT NAME: DORZOLAMIDE HCL 2% SOLN,OPH • VA PRINT NAME: DORZOLAMIDE HCL 2% OPH SOLN CMOP ID: D0286 • VA DISPENSE UNIT: ML MARKABLE FOR CMOP: YES • PACKAGE SIZE: 10 ML • PACKAGE TYPE: BOTTLE • VA CLASS: OP109 ANTIGLAUCOMA,OTHER • CS FEDERAL SCHEDULE: • INGREDIENTS: DORZOLAMIDE HYDROCHLORIDE 2 % • NATIONAL FORMULARY INDICATOR: YES • NATIONAL FORMULARY RESTRICTION: • < Enter "Y" for yes, "N" for no > Is this a match ? Y Must say yes to each prompt or match will or complete

  29. You have just VERIFIED this match and MERGED the entry. • Resetting Possible Dosages.. Press Return to continue: <ENTER> • Do you want to edit Local Possible Dosages? N// Y • Strength: 2 Unit: % • Select LOCAL POSSIBLE DOSAGE: 1 DROP • Are you adding ‘1 DROPS' as a new LOCAL POSSIBLE DOSAGE (the 1ST for this DRUG)? No// Y • PACKAGE: OI Both • LOCAL POSSIBLE DOSAGE: 2 DROPS • Are you adding '2 DROPS' as a new LOCAL POSSIBLE DOSAGE (the 2ND for this DRUG)? No// Y • PACKAGE: OI Both • Select LOCAL POSSIBLE DOSAGE: • MARK THIS DRUG AND EDIT IT FOR: • O - Outpatient • U - Unit Dose • I - IV • W - Ward Stock • D - Drug Accountability • C - Controlled Substances • X - Non-VA Med • A - ALL • Enter your choice(s) separated by commas : O,X • ** You are NOW editing OUTPATIENT fields. ** • AN Outpatient Pharmacy ITEM? No// Y (Yes) • CORRESPONDING INPATIENT DRUG: • MAXIMUM DOSE PER DAY: • LOCAL NON-FORMULARY: • NORMAL AMOUNT TO ORDER: Now prompted to ad Dosage or, in this case LPDs Put in all appropriate codes, use X to allow use of upcoming Outside Rx functions. Do NOT mark for Ward stock or Controlled Substances here

  30. SOURCE OF SUPPLY: CURRENT INVENTORY: ACTION PROFILE MESSAGE (OP): MESSAGE: QUANTITY DISPENSE MESSAGE: OP EXTERNAL DISPENSE: Do you wish to mark/unmark as a LAB MONITOR or CLOZAPINE DRUG? Enter Yes or No: N ** You are NOW Marking/Unmarking for NON-VA MEDS. ** A Non-VA Med ITEM? No// Y (Yes) ** You are NOW in the ORDERABLE ITEM matching for the dispense drug. ** There are other Dispense Drugs with the same VA Generic Name and same Dose Form already matched to orderable items. Choose a number to match, or enter '^' to enter a new one. Disp. drug -> DORZOLAMIDE 2% SOL,OPH 1 DORZOLAMIDE SOLN,OPH Choose number of Orderable Item to match, or '^' to enter a new one: 1 Matching DORZOLAMIDE 2% SOL,OPH to DORZOLAMIDE SOLN,OPH Is this OK? YES// Match Complete! Now editing Orderable Item: DORZOLAMIDE SOLN,OPH FORMULARY STATUS: Clozapine always No. Can link drugs to specific lab tests (not panels) Now linking item to OI for POE

  31. If have created a Drug Text entry (dosing Table etc), can attach it to OI here Select OI-DRUG TEXT ENTRY: INACTIVE DATE: DAY (nD) or DOSE (nL) LIMIT: MED ROUTE: OPHTHALMIC// SCHEDULE TYPE: SCHEDULE: Q8H// PATIENT INSTRUCTIONS: FGL Select SYNONYM: TRUSOPT SYNONYM: TRUSOPT// Select SYNONYM: Blank = PO Expands to FOR GLAUCOMA Add Trade Names to assist providers with item selection in POE

  32. Troubleshooting • Stay Calm • Take a deep breath • Don’t yell at the providers • Don’t yell at your coworkers • It will be ok…………maybe.

  33. Problem  Missing Dosage Cause  Dosages not set up Normally expect Dosages of 1 and 2 to be automatically created when new single entity tablet is added

  34. Solution  Add Dosages • Two Tools • Drug Enter/Edit • Enter/Edit Dosages PDM Drug Enter/Edit GENERIC NAME: DIVALPROEX// DIVALPROEX 500MG VA CLASSIFICATION: DEA, SPECIAL HDLG: 6P// NATIONAL FORMULARY INDICATOR: LOCAL NON-FORMULARY: ^ST Storage Location: Do you wish to match/rematch to NATIONAL DRUG file? Yes// <enter> Deleting Possible Dosages... Match local drug DIVALPROEX 500MG (DELAYED RELEASE) ORDER UNIT: BT DISPENSE UNITS/ORDER UNITS: 1 DISPENSE UNIT: TAB I will try to match NDC: 00074-6154-13 to NDF. No match on that NDC.... 1 DIVALPROEX NA 500MG TAB,EC TAB,EC (DELAYED RELEASE) CN400 D0566 Enter your choice: 1 Is this a match < Reply Y, N or press return to continue > : Y CHOOSE FROM: 1 100 BOTTLE 2 100 UNIT DOSE 3 500 BOTTLE 4 OTHER OTHER Enter Package Size & Type Combination: 1 Not Matched To NDF

  35. Do you wish to match/rematch to NATIONAL DRUG file? Yes// <enter> Deleting Possible Dosages... Match local drug DIVALPROEX 500MG (DELAYED RELEASE) ORDER UNIT: BT DISPENSE UNITS/ORDER UNITS: 1 DISPENSE UNIT: TAB I will try to match NDC: 00074-6154-13 to NDF. No match on that NDC.... 1 DIVALPROEX NA 500MG TAB,EC TAB,EC (DELAYED RELEASE) CN400 D0566 Enter your choice: 1 Is this a match < Reply Y, N or press return to continue > : Y CHOOSE FROM: 1 100 BOTTLE 2 100 UNIT DOSE 3 500 BOTTLE 4 OTHER OTHER Enter Package Size & Type Combination: 1 Local drug DIVALPROEX 500MG (DELAYED RELEASE) matches DIVALPROEX NA 500MG TAB,EC PACKAGE SIZE: 100 PACKAGE TYPE: BOTTLE < Enter "Y" for yes >< Enter "N" for no > OK? : Y LOCAL DRUG NAME: DIVALPROEX 500MG (DELAYED RELEASE) ORDER UNIT: BT DISPENSE UNITS/ORDER UNITS: 1 DISPENSE UNIT: TAB Run Through NDF Match to get to Dosages

  36. Editing Dosages with Enter/Edit Dosages PDM Dosages  Dosages Enter/Edit Select Drug: DIVALPROEX 500MG (DELAYED RELEASE) CN400 00074-6154-13 This entry is marked for the following PHARMACY packages: Outpatient DIVALPROEX 500MG (DELAYED RELEASE) Inactive Date: This drug has the following Local Possible Dosages: 500MG PACKAGE: OI 1000MG PACKAGE: OI Do you want to merge new Local Possible Dosages? Y// NO Select LOCAL POSSIBLE DOSAGE: 1 TABLET Are you adding '1 TABLET' as a new LOCAL POSSIBLE DOSAGE (the 4TH for this DRUG)? No// Y (Yes) LOCAL POSSIBLE DOSAGE: 1 TABLET// PACKAGE: OI Both Strength: 500 Unit: MG Select LOCAL POSSIBLE DOSAGE: 2 TABLETS Are you adding '2 TABLETS' as a new LOCAL POSSIBLE DOSAGE (the 5TH for this DRUG)? No// Y (Yes) LOCAL POSSIBLE DOSAGE: 2 TABLETS// PACKAGE: OI Both These LPDs will expand correctly

  37. Dosages Now Appear

  38. Problem Missing Schedule Pt. Instructions Default schedule is not set Patient Instructions are missing

  39. Solution Edit The Orderable Item PDM  Orderable Item Management  Edit Orderable Items • Orderable Item -> DIVALPROEX • Dosage Form -> TAB,EC (DELAYED RELEASE) • Dispense Drugs: • --------------- • DIVALPROEX 500MG (DELAYED RELEASE) • Are you sure you want to edit this Orderable Item? NO// YES • Now editing Orderable Item: • DIVALPROEX TAB,EC (DELAYED RELEASE) • Orderable Item Name: DIVALPROEX// • This Orderable Item is Formulary. • This Orderable Item is marked as a Non-VA Med. • Select OI-DRUG TEXT ENTRY: • INACTIVE DATE: • DAY (nD) or DOSE (nL) LIMIT: • MED ROUTE: • SCHEDULE TYPE: • SCHEDULE: DAILY • Outpatient Expansion: • EVERY DAY • PATIENT INSTRUCTIONS: TPS • TO PREVENT SEIZURES • SYNONYM: DEPAKOTE

  40. Schedule is defaulted for the quick order now Patient Instructions are now an option and the provider can decide to leave them on the final drug label or uncheck the box

  41. Problem  QO Defaults not set • Days Supply • Quantity • Pick up • Default Dosage • Clinical Indication • Refills

  42. Solution  Edit the Quick Order NAME: PSOZ DIVALPROEX (DEPAKOTE) 500MG (2X250MG) (DELAYED RELEASE) DISPLAY TEXT: Divalproex (Depakote) 500mg BEDTIME (DELAYED RELEASE) VERIFY ORDER: YES// DESCRIPTION: No existing text Edit? NO// ENTRY ACTION: Medication: DIVALPROEX TAB,SA,24HR (EXTENDED RELEASE) // Complex dose? NO// Dose: 2 TABLETS 250MG// Route: ORAL// Schedule: DAILY// Patient Instructions: TO PREVENT SEIZURES Include Patient Instructions in Sig? YES// Chronic Med?YES// Days Supply: 30// Quantity (TABLET): 60// Refills (0-11): 11// Pick Up: WINDOW// Priority: ROUTINE// Comments: No existing text Edit? No// (No) ----------------------------------------- Medication: DIVALPROEX TAB,SA,24HR (EXTENDED RELEASE) 250MG Instructions: 2 TABLETS 250MG ORAL DAILY Patient Instructions: TO PREVENT SEIZURES Days Supply: 30 Quantity (TABLET): 60 Refills (0-11): 11 Pick Up: WINDOW Priority: ROUTINE ------------------------------------------------------------------------------- (P)lace, (E)dit, or (C)ancel this quick order? PLACE//

  43. Problem Providers sending orders that can’t be finished electronically Pop up boxes can display messages to remind providers of various dosage forms, hard copy’s must be signed, etc This currently only appears if the provider EDITS the quick order! Request for fix has been submitted.

  44. Solution Add a message for the Drug GENERIC NAME: MORPHINE 15MG SR TAB Replace VA CLASSIFICATION: CN101// DEA, SPECIAL HDLG: 2AP// NATIONAL FORMULARY INDICATOR: YES LOCAL NON-FORMULARY: VISN NON-FORMULARY: Select DRUG TEXT ENTRY: Select FORMULARY ALTERNATIVE: Select SYNONYM: MESSAGE: MUST have Hand Signed Hard Copy to Process!!! RESTRICTION: INACTIVE DATE: WARNING LABEL: 1,8,18,20// ORDER UNIT: BT// Careful not to create too many pop-ups – Will irritate providers

  45. Problem Order does not have a dispense Drug Cause Provider entered an unrecognized Dose

  46. Problem  Ordered Dosage does not expand as expected Cause  * Provider manually entered the dosage* Need additional Dosages set up for drug or won’t expand for label PATIENT STATUS: OUTPATIENT// OUTPATIENT DRUG: PYRAZINAMIDE 500MG TAB (ST) ...OK? Yes// Now doing order checks. Please wait... VERB: TAKE Available Dosage(s) 1. 500MG Select from list of Available Dosages, Enter Free Text Dose or Enter a Question Mark (?) to view list:

  47. Solution: Edit Dosages • PDM Dosages  Dosages Enter/Edit • Select Drug: PYRAZINAMIDE 500MG TAB (ST) AM500 • This entry is marked for the following PHARMACY packages: • Outpatient • Non-VA Med • This drug can have Possible Dosages, but currently does not have any. • Create Possible Dosages for this drug? N// YES • Resetting Possible Dosages.. • Strength from National Drug File match => 500 MG • Strength currently in the Drug File => 500 MG • Edit Strength? N// • Strength => 500 Unit => MG • Select DISPENSE UNITS PER DOSE: 2 1000 IO • Are you adding ‘2' as a new POSSIBLE DOSAGES (the 2nd for this DRUG)? No// Y • DISPENSE UNITS PER DOSE: 2// • PACKAGE: IO// • Strength => 500 Unit => MG • Select DISPENSE UNITS PER DOSE: 3 • Are you adding '3' as a new POSSIBLE DOSAGES (the 3RD for this DRUG)? No// Y • Dosage = 1500MG • POSSIBLE DOSAGES DOSE: 1500// (No Editing) • DISPENSE UNITS PER DOSE: 3// • PACKAGE: OI • Strength => 500 Unit => MG • Select DISPENSE UNITS PER DOSE: Add in the required dosages (either POSSIBLE DOSAGES OR LOCAL POSSIBLE DOSAGES)

  48. TIP: Must re-edit the QO to link the new Dosage • Select QUICK ORDER NAME: PSOZ PZA 1500MG QDAY • NAME: PSOZ PZA 1500MG QDAY Replace • DISPLAY TEXT: PZA 1500MG QDAY// • VERIFY ORDER: YES// • DESCRIPTION: • No existing text • Edit? NO// • Medication: PYRAZINAMIDE TAB // • Complex dose? NO// • Dose: 1500MG// @ • Re-check for the new dosages you just added

  49. New Dosages are now selectable

  50. I don’t think so! Problem: Incorrect Routes

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