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Defaulting PHA Inpatient Label Comments Based on Dose. Herb Bromenshenkel RPh North Country Health Services. Pyxis screen . North Country Health Services. Pharmacy Information. MEDITECH Magic since 1990 Pyxis machines in all areas No inpatient cart fill Meds loaded and unloaded as needed

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defaulting pha inpatient label comments based on dose

Defaulting PHA Inpatient Label Comments Based on Dose

Herb Bromenshenkel RPh

North Country Health Services

pharmacy information
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
pyxis information
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)
pharmacy enters label comments
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
problems with pharmacy entry
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
solution
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
what displays
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)
key points
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
computer set
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
simple keywords
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]
more complex keywords 1
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}}

more complex keyword 2
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
report macro copy paste
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;

rule code to copy paste
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}};

questions
Questions

Herb Bromenshenkel RPH

hbromenshenkel@nchs.com

218-333-5527