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Crime Scene: The route of “IM” is not available

Crime Scene: The route of “IM” is not available. Police Report: Provider wants to order a one-time dose of Ceftriaxone to be given “IM” but that route is not available. Crime Scene: The route of “IM” is not available. Solution: RPMS PDMDosagesDosage Form File Enter/Edit

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Crime Scene: The route of “IM” is not available

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  1. Crime Scene:The route of “IM” is not available • Police Report: • Provider wants to order a one-time dose of Ceftriaxone to be given “IM” but that route is not available

  2. Crime Scene:The route of “IM” is not available • Solution: RPMSPDMDosagesDosage Form File Enter/Edit ************************************************** Select DOSAGE FORM NAME: INJ,SOLN 1 INJ,SOLN 2 INJ,SOLN,SA CHOOSE 1-2: 1 INJ,SOLN NAME: INJ,SOLN Select MED ROUTE FOR DOSAGE FORM: IV PIGGYBACK// INTRAMUSCULAR 1 INTRAMUSCULAR IM Are you adding 'INTRAMUSCULAR' as a new MED ROUTE FOR DOSAGE FORM (the 4TH for this DOSAGE FORM)? No// YES

  3. Crime Scene:The route of “IM” is NOW available

  4. Crime Scene: Pharmacist wishes to finish a pending IV piggyback order, but the option to finish it as an IV isn’t there?!?! DC Discontinue FL Flag ED Edit FN Finish Select Item(s): Next Screen// FN Finish COMPLETE THIS ORDER AS IV OR UNIT DOSE? IV// This prompt is missing!

  5. Crime Scene: Finishing IV piggyback orders • Solution: The Medication Routes File Select MEDICATION ROUTES NAME: IVPB IV PIGGYBACK IVPB NAME: IV PIGGYBACK// ABBREVIATION: IVPB// PACKAGE USE: ALL PACKAGES// OUTPATIENT EXPANSION: IVPB// OTHER LANGUAGE EXPANSION: IV FLAG: YES//

  6. Many different scenarios…..

  7. Crime Scene: Solution/Additive not Available when making an “IV Medication” Quick Order • Pharmacist is building an IV Quick Order for SODIUM CHLORIDE 0.9% with 40MEQ KCL When building the quick order the Solution isn’t listed Select QUICK ORDER NAME: PSIVZ SODIUM CHLORIDE 0.9% W/40MEQ KCL NAME: PSIVZ SODIUM CHLORIDE 0.9% W/40MEQ KCL Replace DISPLAY TEXT: KCL 40mEq in 0.9% NS Replace VERIFY ORDER: YES// DESCRIPTION: No existing text Edit? NO// Solution: SODIUM CHLORIDE 0.9% W/40MEQ KCL ?? Enter a base solution for this order.

  8. AN IV ITEM? Yes// Y (Yes) Edit Additives or Solutions: Select one of the following: A ADDITIVES S SOLUTIONS Enter response: SOLUTIONS Select IV SOLUTIONS PRINT NAME: SODIUM CHLORIDE CHOOSE 1-15: 15 SODIUM CHLORIDE 0.9% 40MEQ KCL 1000 ML PRINT NAME: SODIUM CHLORIDE 0.9% 40MEQ KCL Replace PRINT NAME {2}: GENERIC DRUG: SOD. CHL. 0.9% W/ 40MEQ KCL 1000ML (INJ) VOLUME: 1000 ML// Select ELECTROLYTES: CHLORIDE// ELECTROLYTES: CHLORIDE// CONCENTRATION: .04 MEQ/ML// Select ELECTROLYTES: Select SYNONYM: DRUG INFORMATION: No existing text Edit? NO// AVERAGE DRUG COST: .01679// INACTIVATION DATE: USED IN IV FLUID ORDER ENTRY: NO// Edit Additives or Solutions: CHANGE TO YES

  9. Crime Scene: Solution/Additive not Available when making an “IV Medication” Quick Order • When should the Prompt “Used in IV Fluid Order Entry” be Marked “Yes” • All Additives and Solutions that are Continuous/Intermittent IV Infusions • Typically Large Volume Admixtures • Not Scheduled IVPBs

  10. Crime Scene: Unable to Transfer from “Inpatient to Outpatient”

  11. Crime Scene: Unable to Transfer from “Inpatient to Outpatient” • Solution • One Orderable Item is required for both the Bulk Outpatient Dispense Drug and the Unit Dose Inpatient Dispense Drug ************************************************************* Orderable Item -> CITALOPRAM Dosage Form -> TAB Dispense Drugs: --------------- CITALOPRAM 40MG TAB CITALOPRAM 20MG TAB CITALOPRAM 20MG U/D TAB CITALOPRAM 10MG TAB

  12. Crime Scene: Transfer to Outpatient Dialog (Setting Defaults) • Police Report: Why are the fields “Pick Up” and “Refills” not filled in?

  13. Crime Scene: Transfer to Outpatient Dialog (Setting Defaults) • Solution: There is none! • No default exists in the inpatient order file to convert data when transferring from inpatient to outpatient • Old VA Function? • Computer fills in what it can from the inpatient order • Provider must fill in the information upon ordering the medication

  14. Crime Scene: Units Per Dose (U/D) in the Dispense Drug Field Inaccurate • Scenario: • An inpatient is on Carvedilol 6.25mg PO BID • Computer wants to use ½ tablet of Carvedilol 12.5mg Unit Dose as the dispense drug • Pharmacy has Carvedilol 6.25mg Unit Dose tablets available in the Omni-Cell/Pyxis • Why is this happening?

  15. Crime Scene: Units Per Dose (U/D) in the Dispense Drug Field Inaccurate DEMO,PATIENT INPATIENT Ward: 2S MED/ CWA HRN: 999997 Room-Bed: Ht(cm): 152.40 01/12/2010 DOB: 05/19/50 (59) Wt(kg): 114.55 02/05/2010 (1)Orderable Item: CARVEDILOL TAB Instructions: (2)Dosage Ordered: 6.25MG (3)Start: 02/10/10 21:00 (4) Med Route: ORAL (5) Stop: 05/21/10 16:00 (6) Schedule Type: CONTINUOUS (8) Schedule: BID (9) Admin Times: 0900-2100 (10) Provider: STEARLE,CARLA D DURATION: (11) Special Instructions: (12) Dispense Drug U/D Inactive Date CARVEDILOL 12.5MG TAB U/D 0.5

  16. Crime Scene: Units Per Dose (U/D) in the Dispense Drug Field Inaccurate • Solution: Check the Possible Dosages in Drug Enter/Edit • Unit Dose Entries should typically only have one possible dosage • Carvedilol 6.25mg U/D • Possible Dosage: 6.25mg=1 tablet • Carvedilol 12.5mg U/D • Possible Dosage: 12.5mg=1 tablet

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