5 th annual pbm pharmacy informatics conference
Download
1 / 45

5 th Annual PBM Pharmacy Informatics Conference - PowerPoint PPT Presentation


  • 244 Views
  • Uploaded on

5 th Annual PBM Pharmacy Informatics Conference. Are You Ready for MOCHA V 2.0?. Jim Hewins, Kansas City MO Dionne Roney, Charleston SC. DATE/MONTH 2012. MOCHA 2.0 Objectives. Discuss the timeline the sites will need to consider prior to implementing MOCHA V 2.0

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' 5 th Annual PBM Pharmacy Informatics Conference' - xander-whitaker


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
5 th annual pbm pharmacy informatics conference

5th Annual PBM Pharmacy Informatics Conference

Are You Ready for MOCHA V 2.0?

Jim Hewins, Kansas City MO

Dionne Roney, Charleston SC

DATE/MONTH 2012


Mocha 2 0 objectives
MOCHA 2.0 Objectives

  • Discuss the timeline the sites will need to consider prior to implementing MOCHA V 2.0

  • Explain the tasks that need to be completed prior to implementing MOCHA V 2.0

  • Describe the setup for doses to enable the dose checks to occur properly

  • Explain how to trouble shoot problem order checks


Types of dosage information
Types of Dosage Information

  • Max single dose – this is the individual dose amount, whether it is given once a day or 24 times a day

  • Total daily dose – Dose x Frequency (per 24h)

  • General Dosage Range – Is provided when there is a problem with the order and dosage checks cannot be performed


Mocha 2 0 four increments
MOCHA 2.0 – four increments

  • Increment A - Maximum single dose check for simple and complex medication orders. First increment to be released

  • Increment B - Daily dose range check. Includes general dosing information when a dosing check cannot be performed – simple orders only

  • Increment C - Daily dose range for complex orders. Includes general dosing information when a dosing check cannot be performed

  • Increment D - TBD


Mocha 2 0
MOCHA 2.0

  • Both Outpatient Pharmacy and Inpatient Medications

  • Provides error messages with reasons at the order level when a Maximum Single Dose Order Check cannot be performed for Pharmacy users

  • Provides a generic error message at the order level when Maximum Single Dose Order Check cannot be performed for CPRS users

  • Adds a check during installation to see if Pre-Release setup work has been completed (PSS*1*129 & PSS*1*147, PRE v0.5 PRE-RELEASE patches).


Mocha 2 01
MOCHA 2.0

  • Adds new fields to the Administration Schedule file (#51.1)

  • Modify Standard Schedule Edit (PSS Schedule Edit) option to allow editing of the new dosing exclusion fields

  • Modify Administration File Report (PSS Schedule Report)

  • Apply the ‘all Dosage Checks exclusion’ for a schedule when processing outpatient and inpatient medication orders

  • Creates a new Pharmacy Data Management (PDM) option called Lookup Dosing Check Info for Drug

  • Adds new entries to the VistA DOSE UNIT file (51.24)


Cprs versus vista order checks
CPRS versus Vista Order Checks

Maximum Single Dose Check could not be performed for Drug: IPRATROPIUM BROMIDE 17MCG 200D ORAL INHL

Reason: No dosing information found in database.


Dose warning for single ingredient drug
Dose Warning for Single Ingredient Drug

Order details:

Orderable Item: METFORMIN HCL TAB,ORAL

Dosage Ordered: 3000 (MG)

Dispense Units: 3

Noun: TABLETS

Route: ORAL (BY MOUTH)

Schedule: BID-WF

Dose warning text:

METFORMIN HCL 1000MG TAB: Single dose amount of 3000 MILLIGRAMS exceeds the maximum single dose amount of 1000 MILLIGRAMS.


Dose warning for multi ingredient drug
Dose Warning for Multi-Ingredient Drug

Order details:

Orderable Item: HYDROCHLOROTHIAZIDE/LISINOPRIL

Dosage Ordered: 5 TABLETS

Route: ORAL (BY MOUTH)

Schedule: QAM

SIG: TAKE 5 TABLETS BY MOUTH EVERY MORNING FOR BLOOD PRESSURE

Dose warning text:

HCTZ 12.5/LISINOPRIL 20MG TAB: Single dose form amount of 5 TABLET(S)

exceeds the maximum single dose form amount of 4 TABLET(S).


Dose checks calculations dependent on body surface area or weight data
Dose Checks Calculations Dependent on Body Surface Area or Weight Data

Patient data:

DOB: SEP 6,1946 (65)

Ht(cm): 129.54 (03/13/2012)

Wt(kg): 64.04 (03/14/2012)

Dose warning text:

ENOXAPARIN 150MG/ML INJ SYRINGE 1ML: Single dose amount of

150 MILLIGRAMS exceeds the maximum single dose amount of 105.66

MILLIGRAMS.


Factors used to derive a recommended dose
Factors Used to Derive Weight Dataa Recommended Dose

  • Patient Age

  • Height/Weight/BSA (when applicable)

  • Dose Form

  • Dose Unit

  • Medication Route

  • Frequency

  • Duration

  • Rate


Factor patient age
Factor: Patient Age Weight Data

  • Recommended doses vary according to a patient’s age

  • FDB stores dose data according to patient age

  • Doses are not always established and available for a certain age, but this is more common with pediatric dosing than geriatric dosing


Factor patient height weight bsa
Factor: Patient Height, Weight, BSA Weight Data

  • Calculated doses for specific drugs are done when a weight or BSA value is relevant in the determination of an appropriate dose

  • Some drug dosages are only weight/BSA dependent for specific age groups (i.e. weight may be relevant on a 90 year old, but not on a 50 year old


Factor dose form
Factor: Dose Form Weight Data

  • Doses are stored differently based on the drug’s dosage form (i.e. oral, IV, transdermal)

  • Some dosage forms are excluded from dosing order checks (i.e. creams, ointments)


Dose check exclusions
Dose Check Exclusions Weight Data

  • Supplies (bandages, syringes)

  • Compounded items not matched to NDF

  • Large volume IV solutions – non Premix

  • Items that don’t require a dose check, but that have a dosage form that does generate checks

  • Drugs with excluded dosage forms (i.e.. creams, ointments) but, the exclusion can be overridden at the NDF level




Factor dose units
Factor: Dose Units Weight Data

  • The dose unit on an order must either match the unit that FDB has stored, or else be able to convert to that unit.

  • If the dose unit does not match the FDB dose unit, then the order check will not occur and an error message will display


Dose units for single ingredient drugs
Dose Units for Single Ingredient Drugs Weight Data

  • Generally used for single ingredient drugs that are administered via po, SC, or IM

  • The most common type of dose unit (mg, gm, units)

  • Possible types of FDB Dose Unit Conversions

    • Metric conversions – wide range (i.e.. mcg to mg)

    • Numeric conversions between standard units and metric units (i.e. Cm to In, Oz to Tsp, Tsp to mL, MMU to IU)


Dose units continued
Dose Units (continued) Weight Data

  • Dose form type units – Used for non-po solids (patches, inhalers), multi-ingredient drugs

  • FDB selects the type of dose units for an item

    • Patch dose unit is “ 1 patch”, rather than 75mcg

    • Inhaler dose units are variable and include inhalations, sprays, puffs, etc. Currently, they sometimes also include metric doses.


Non standard doses
Non-Standard Doses Weight Data

  • Fractional doses – no problem

  • Free-text doses – different assumptions in CPRS versus. backdoor, because of the way that a dispense drug is selected in each package

  • The pharmacy packages can perform some sophisticated auto-population logic for free-text doses (i.e. three and one-half tablets = 3.5 tablets). If a match cannot be determined, then no order check will be performed



Factor medication route
Factor: Medication Route Weight Data

  • If a medication route is not accurately mapped, then a dose check will not occur

  • FDB Doses are tied to specific routes (IV versus IM), error messages will display if an invalid route is selected

  • Sometimes FDB is too limiting with its expected med route.

    • Patches – must be transdermal not topical

    • Inhalers – Nebulization versus Inhalation; Oral Inhalation versus Oral

      (Albuterol Solution)


Medication route issues
Medication Route Issues Weight Data

Maximum Single Dose Check could not be performed for Drug: DIGOXIN (LANOXIN) 0.25MG TAB

Reason(s): Invalid or Undefined Dose Route


Medication route issues1
Medication Route Issues Weight Data

NAME: NEBULIZATION//

Already mapped to:

Stnd Route: 'INHALATION' FDB Route: 'INHALATION‘

Order Check Returned:

Maximum Single Dose Check could not be performed for Drug: ALBUTEROL 0.5%

(MULTI-DOSE) INHL SOLN

Reason: No dosing information specific to maximum single dose is

available from the database.

Local Route: 'NEBULIZATION' has been remapped to

Stnd Route: 'NEBULIZATION' FDB Route: 'NEBULIZATION‘

Order Check Returned:

ALBUTEROL 0.5% (MULTI-DOSE) INHL SOLN: Single dose form amount of 3

MILLILITERS exceeds the maximum single dose form amount of 2 MILLILITERS.


Factor frequency
Factor: Frequency Weight Data

  • Used to calculate a total daily dose

  • Two new fields were created in file 51.1

    • EXCLUDE FROM ALL DOSING CHECKS:

    • EXCLUDE FROM DAILY DOSE CHECK:


Iv orders
IV Orders Weight Data

  • IV orders based on various business rules, the single dose amount (SDA) and Dose Unit (DU) could be derived from

    • IV solution volume

    • IV Additive strength/unit

    • Infusion Rate

    • Calculated via a formula


Iv orders continued
IV Orders (continued) Weight Data

IV Orders


Iv orders continued1
IV orders (continued) Weight Data

  • Intermittent Order:

    • Cefazolin 10 gms in Dextrose 5% 100 ml IVPB over 60 minutes q12h

      • Single dose amount: 10

      • Drug unit: grams

  • Intermittent Order marked as Premix:

    • Cefazolin 10 gms in Dextrose 5% 500 ml IVPB over 60 minutes q12h

    • Single dose amount: 500

    • Drug unit: milliliters


Iv orders continued2
IV orders (continued) Weight Data

  • Continuous Order marked as Premix:

    • Cefazolin 10 gms in Dextrose 5% 500 ml IV at 100 ml/hr

    • No dosing information in FDB

  • Continuous Order marked as Premix:

    • Heparin 20,000 units in 500 ml 42ml/hr


Iv orders continued3
IV Orders (continued) Weight Data

If the Drug can be administered via a ‘CONTINUOUS’ FDB Dose Route, the single dose amount shall be derived using the following formula:

Single Dose Amount/Dose Rate =

(IV Additive Strength & Unit/Volume of IV Solution) * Infusion rate (ML/HR)

Example: (20000Units/500ML) * 42ML/HR = 1680 Units/HR

Single Dose Amount = 1680

Dose Units = Units (FDB EQUIVALENT is UNIT(S))

Dose Rate Unit = HOUR


Free text infusion rates
Free Text Infusion Rates Weight Data

  • If the infusion rate is in the free text format of ‘XML/[email protected]

    • ‘X’ = single dose amount

    • The FDB equivalent of ‘ML’ shall be sent to the interface for the Dose Unit

    • Applies to CPRS and Pharmacy backdoor

  • Continuous Order marked as Premix:


Free text infusion rates con t
Free Text Infusion Rates con’t Weight Data

  • If the infusion rate in the format ‘XY/P/[email protected]’ or ‘X<space>Y/P/[email protected]

    • ‘X’ shall represent the numeric dose

    • ‘Y’ shall represent the dose unit

    • ‘P’ shall represent a patient parameter

      • If the values for ‘P’ are ‘KG’ or ‘M2’, the software will multiply the parameter value for the patient by the numeric dose to calculate the single dose amount sent into the interface

    • ‘R’ shall represent the dose rate unit/duration rate

      • If the values for ‘R’ are ‘MIN’, ‘HR’ or ‘DAY’, the software shall set the Dose Rate Unit/Duration Rate equal to ‘MINUTE’, ‘HOUR’ or ‘DAY’ respectively.

    • ‘N’ shall represent a numeric value

  • Applies to CPRS entered order only



Free text infusion rate example
Free Text Infusion Rate Example Weight Data

  • Free Text Infusion rate:

    • Dobutamine 1000 in 250 ml Premix IV at 42 mcg/kg/[email protected]

    • Pt 129.09 kg

    • Finishing it in Vista

      Backdoor Vista:

      Rate: 42mcg/kg/min ml/hr


What do i need to do
What do I need to do? Weight Data

  • Local Medication Route Mapping

    • As you are changing medication routes, remember to check orderable items as well as CPRS quick orders that may be using old/invalid medication routes

  • Local Possible Dosage Setup

    • FDB uses dose units to calculate and match a dose from their database.

    • Review Local Possible Dosages Report (PSS LOCAL POSSIBLE DOSAGES ) option to verify

    • Populate the dose Unit and corresponding Numeric Dose field

  • Frequency Review

  • Enter/Edit Additive Frequency for IV Additives


Local possible dosage report
Local Possible Dosage Report Weight Data

(10167) TESTOSTERONE (ANDROGEL) 1% 2.5GM/PKT GEL *N/F*

INJECTION, THEN PATCH, THEN GEL

Strength: Units: Application Package: XOUN

Local Possible Dosages:

ONE PACKET (2.5 GMS)

Numeric Dose: Dose Unit: Package: IO

VA PRODUCT MATCH: TESTOSTERONE (ANDROGEL) 1% 2.5GM/PKT GEL,TOP


Error message local possible dose
Error Message – Local Possible Dose Weight Data

Dosing Checks could not be performed for Drug: TESTOSTERONE (ANDROGEL) 1%

2.5GM/PKT GEL

Reason: No dosing information found in database.

Dosing Checks could not be performed for Drug: TESTOSTERONE (ANDROGEL) 1%

2.5GM/PKT GEL

Reason(s): Free Text Dosage could not be evaluated


Fixing local possible dose
Fixing Local Possible Dose Weight Data

TESTOSTERONE (ANDROGEL) 1% 2.5GM/PKT GEL *N/F* Inactive Date:

This drug has the following Local Possible Dosages:

ONE PACKET (2.5 GMS) PACKAGE: IO

BCMA UNITS PER DOSE:

NUMERIC DOSE: DOSE UNIT:

Do you want to merge new Local Possible Dosages? Y// NO

Strength: 1 Unit: %

Select LOCAL POSSIBLE DOSAGE: ONE PACKET (2.5 GMS) IO

LOCAL POSSIBLE DOSAGE: ONE PACKET (2.5 GMS) Replace

PACKAGE: Both//

BCMA UNITS PER DOSE:

DOSE UNIT: GMS GRAM(S)

NUMERIC DOSE: 2.5

Strength: 1 Unit: %


Dosage unit for inhaler
Dosage Unit for Inhaler Weight Data

IPRATROPIUM BROMIDE 17MCG 200D ORAL INHL

1 PUFF NUMERIC DOSE: 17 DOSE UNIT: MICROGRAM(S)

Order Check Returned:

Maximum Single Dose Check could not be performed for Drug: IPRATROPIUM

BROMIDE 17MCG 200D ORAL INHL

Reason: No dosing information found in database.

IPRATROPIUM BROMIDE 17MCG 200D ORAL INHL

1 PUFF NUMERIC DOSE: 1 DOSE UNIT: INHALATION(S)

Order Check Returned:

IPRATROPIUM BROMIDE 17MCG 200D ORAL INHL: Single dose form amount of 12

PUFF(S) exceeds the maximum single dose form amount of 8 PUFF(S).


What happens if you can t figure out the dosage unit
What happens if you can’t figure out the dosage unit? Weight Data

Dispense Drug: FENTANYL 50 MCG/HR PATCH

Local Possible Dose: 50 MCG/HR (1 PATCH) Dose Unit: Micrograms

Schedule: q72h Numeric Dose: 50

Route: Topical

Order Check Text:

PECS Information:


Dosepacks
Dosepacks Weight Data

Dispense Drug: METHYLPREDNISOLONE 4MG TAB DOSEPAK,21

Local Possible Dose: TABLET(S) Dose Unit: Each

Schedule: As Directed Numeric Dose: 1

Route: Oral

PECS Information:


No information in pecs
No information in PECS Weight Data

Dispense Drug: MAGNESIUM CITRATE LIQUID 300ML

Local Possible Dose: 300 Dose Unit: Milliliters

Schedule: Once Numeric Dose: 300

Route: Orally

Order Check Text:


Review and update
Review and Update Weight Data

  • Unmatched drug file entries

  • DEA/Special handling field

  • Med route mappings

  • Orderable item medication route defaults for potentially problematic dosage forms

  • Local Possible Doses

  • Edit any quick orders that might be affected

  • Process for staff to report any issues and error messages

  • CPRS Parameters – as of right now, dosing is an order check that can be turned off. This may become mandatory in the future or you may want to make it mandatory at your site.


Questions
QUESTIONS? Weight Data

Please use the Q&A Function on Live Meeting

OR

Email: [email protected]

[email protected]


ad