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Pharmacy Data Management Associated Files. July 2012. Course Objectives.

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course objectives
Course Objectives
  • Examine the need for complete and accurate support files in an information system. Determine the benefits from efficient functioning and the risks associated with errors. Defend the notion that time spent configuring the drug file properly will save time and effort in other uses of the medical information system.
  • Explain national standards as they relate to medications and drug files: consider ISMP recommendations for Sound Alike/Look Alike medications and abbreviations forbidden by national standards bodies such as The Joint Commission or ISMP and recommend an implementation plan.
  • Recognize how an order is constructed in the system (schedule, dosage form, etc.) and the interrelationship between supporting files. Defend the reasons for the way inpatient and outpatient pharmacy quick orders are built and used.
menu options
Menu Options

Dosages ...

Drug Enter/Edit

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

Formulary Information Report

Drug Text Enter/Edit

Drug Text File Report

Pharmacy System Parameters Edit

Standard Schedule Edit

Synonym Enter/Edit

Controlled Substances/PKI Reports…

dosages file
Dosages File
  • The following options are available:
    • Auto Create Dosages
    • Dosage Form File Enter/Edit
    • Enter/Edit Dosages
    • Most Common Dosages Report
    • Noun/Dosage Form Report
    • Review Dosages Report
dosage form file enter edit
Dosage Form File Enter/Edit
  • Need to go to Dosages Menu to find it
  • Edits here affect every drug with that dosage form!
  • Can associate one or more routes
  • Can change the verb
  • Must remove the prepositions
  • Can edit the nouns
dosage form file cont
Dosage Form File, cont.

NAME: TAB Comes from matching; do not edit

Select MED ROUTE FOR DOSAGE FORM: ORAL// Can have more than one

VERB: TAKE// This will be on the label, so should be patient friendly

OTHER LANGUAGE VERB: Leave Blank!

PREPOSITION:Leave Blank!

OTHER LANGUAGE PREPOSITION: Leave Blank!

Select NOUN: TABLET(S)//

Can have more than one, will have doses of 1 and 2 of most noun(s) here created

NOUN: TABLET(S)//

OTHER LANGUAGE NOUN: Leave Blank!

PACKAGE: Both// Usually both

Select NOUN:

CONJUNCTION:

Not usually used, but might be for topicals that have a %strength

dosage form file cont1
Dosage Form File, cont.

NAME: INHL,ORAL

Select MED ROUTE FOR DOSAGE FORM: ORAL//

VERB: INHALE//

OTHER LANGUAGE VERB:

PREPOSITION:

OTHER LANGUAGE PREPOSITION:

Select NOUN: PUFF(S)//

NOUN: PUFF(S)//

OTHER LANGUAGE NOUN:

PACKAGE: Both//

Select NOUN:

CONJUNCTION:

dosage form file cont2
Dosage Form File, cont.

NAME: OPHTHALMIC,CRC

Select MED ROUTE FOR DOSAGE FORM: IN BOTH EYES//

VERB: PLACE//

OTHER LANGUAGE VERB:

PREPOSITION:

OTHER LANGUAGE PREPOSITION:

Select NOUN:

CONJUNCTION:

dosages
Dosages
  • Enter/Edit Dosages
    • Possible Dosages
      • Single entity tablets & capsules, and some other single entity agents
      • Auto Creation
        • Creates 1 and 2 (units)
        • May have to edit if 2 is inappropriate or add more dosages
      • 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
adding new dosages
Adding New Dosages
  • Dosages are onlyfor 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//

Rarely edit the strength here! Some apparent utility with very select IV push drugs when used with automated systems such as Pyxis – but may change with BCMA.

Strength => 10 Unit => MG

Select DISPENSE UNITS PER DOSE: ??

Choose from:

1 10 IO

2 20 IO

Automatically created when drug was matched to the NDF. Does not mean they make sense so review (e.g., 1600 mg of ibuprofen)

adding new dosages cont
Adding New Dosages (cont.)

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 zero for fractions of a dispense unit
    • i.e. ½ tablet would be .5 NOT 0.5
deleting inappropriate dosages
Deleting Inappropriate Dosages

The system automatically generates 1 and 2 on single entity solid oral dosage forms. Sometimes 2 is inappropriate.

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

deleting inappropriate dosages1
Deleting Inappropriate Dosages

Select DISPENSE UNITS PER DOSE:

PACKAGE: IO

Strength => 0.4 Unit => MG

Enter/Edit Local Possible Dosages? N //

Select Drug:

adding local possible dosages
Adding Local Possible Dosages
  • For all other Drugs LPDs apply
    • **Even if 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)
      • What you type is what you get – Abbreviations do NOT expand MG do NOT calculate
      • Avoid “Teaspoonful”, “Tablespoonful”, etc., (Use “ML”)
        • Evidence suggests this leads to medication errors
    • Delete Superfluous LPDs
      • 2 suppositories etc.
adding lpds
Adding LPDs

PDM > Dosages > Dosages Enter/Edit

Select Drug: 2432 ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB CN103Can select specific Drugs with the IEN (# column from the NSYN report)

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)Include number, noun, and article (if needed)

adding lpds1
Adding LPDs

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

deleting lpds
Deleting LPDs

PDM > Dosages > Enter/Edit Dosages

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: ?

deleting lpds1
Deleting LPDs

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: Ready to edit next Drug

look up into dispense drug file
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)

medication instruction
Medication Instruction

Select MEDICATION INSTRUCTION NAME: ??

Choose from:

(M) (MUST SEE PROVIDER FOR MORE REFILLS)

A/A **AVOID ALCOHOL**

AH **AVOID ALCOHOL**

AOOH AT ONSET OF HEADACHE

DD **DOSE DECREASED** Generally for patient instructions

DIN **DOSE INCREASED** Not for schedules (BID, Q12H, etc.).

Those go in standard schedules

FALL FOR ALLERGIES

FAN FOR ANXIETY

FAR FOR ARTHRITIS

FAS FOR ASTHMA

FAX FOR ANXIETY

FBC FOR BIRTH CONTROL

medication instruction cont
Medication Instruction (cont.)

FBP FOR HIGH BLOOD PRESSURE

FBR FOR BREATHING

FCA FOR CALCIUM

FCH FOR CHOLESTEROL CONTROL

FCIRC FOR CIRCULATION

NAME: FFL// The abbreviation you will use

SYNONYM: If you want more than one abbreviation

EXPANSION: FOR FLUID// How it will look on labels and reports

PLURAL: Not usually used

INTENDED USE: OUTPATIENT ONLY// Inpatient, Outpatient, or both

FREQUENCY (IN MINUTES): No longer needed

medication instruction cont1
Medication Instruction (cont.)

NAME: AH//

SYNONYM:

EXPANSION: **AVOID ALCOHOL**//

PLURAL:

INTENDED USE: OUTPATIENT ONLY//

FREQUENCY (IN MINUTES):

NAME: WF//

SYNONYM: WFM//

EXPANSION: WITH FOOD OR MILK//

PLURAL:

INTENDED USE: IN & OUTPATIENT//

FREQUENCY (IN MINUTES):

medication instruction file
Medication Instruction File
  • Enter or Edit common instructions
    • PM = Evening
    • AM = Morning
    • AP = Apply

Used in the EDIT ORDERABLE ITEMS option

medication routes
Medication Routes

Select MEDICATION ROUTES NAME: ??

Choose from:

BLOOD TEST

BUCCAL BUCC

BUCCAL DENTAL INFILTRATION BUCCDENTIF

BUCCAL ORAL BUCCORAL

BUCCAL SUBLINGUAL BUCCSL

BY MOUTH BYMO

CATHETER

CAUDAL BLOCK CAUD

CAUDAL EPIDURAL CAUDED

CAUDAL EPIDURAL MISCELLANEOUS CAUDED MISC

CAUDAL SUBCUTANEOUS INFILTRATI CAUDSC IF

CHEW CHEW

medication routes cont
Medication Routes, cont.

DEEP IM

DENTAL DENT

DENTAL INFILTRATION DENTIF

DENTAL INTRAMUSCULAR DENTALIM

DENTAL ORAL DENTORAL

DENTAL ORAL TOPICAL DENTORALTOP

DENTAL SUBCUTANEOUS DENTSC

NAME: ORAL// Full name

ABBREVIATION: PO//Abbreviation used in prescriptions

PACKAGE USE: ALL PACKAGES//

”National Drug File Only” will hide it from use locally

OUTPATIENT EXPANSION: BY MOUTH//

Include preposition, will show on label

OTHER LANGUAGE EXPANSION: Leave Blank!

medication routes cont1
Medication Routes, cont.

IV FLAG: mark “yes” if will process in the IV Package in RPMS

NAME: TOPICAL//

ABBREVIATION: TOP//

PACKAGE USE: ALL PACKAGES//

OUTPATIENT EXPANSION: TO AFFECTED AREA//

OTHER LANGUAGE EXPANSION:

IV FLAG:

NAME: OPHTHALMIC//

ABBREVIATION: OPH//

PACKAGE USE: ALL PACKAGES//

OUTPATIENT EXPANSION: INTO AFFECTED EYE(S) Replace

OTHER LANGUAGE EXPANSION:

IV FLAG:

medication route file
Medication Route File
  • Enter or Edit common routes:
    • Ophthalmic = In Affected Eyes
    • Topical = To Affected Area
  • The most common route (just one) can be added under “Edit Orderable Items.”
  • Routes can be tied to Dosage Forms:
    • So that only certain ones show in the EHR for a given Dosage Form (so providers can’t choose “IV” for an oral tablet, for example).
    • This can be helpful, but editing can also have unintended consequences.
orderable item management
Orderable Item Management
  • Edit or Enter several pertinent fields:
    • Drug Text Entry for provider viewing if desired
    • Med Route
    • Schedule Type:
      • Can cause problems. Best to leave blank, especially for drugs used in inpatient.
    • Schedule
    • Patient Instructions
    • Synonym (for EHR med ordering selection)
edit orderable items
Edit Orderable Items

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//

Lists all of the Drug File Entries that are linked to this OI

Dispense Drugs:

---------------

IBUPROFEN 200MG TAB

IBUPROFEN 400MG TAB

IBUPROFEN 600MG TAB

IBUPROFEN 800MG TAB

edit orderable items cont
Edit Orderable Items (cont.)

Are you sure you want to edit this Orderable Item? NO// YES

Now editing Orderable Item:

IBUPROFEN TAB

Orderable Item Name: IBUPROFEN//Could change the OI name (for typos)

This Orderable Item is Formulary.

This Orderable Item is marked as a Non-VA Med.

Select OI-DRUG TEXT ENTRY:

Can associate drug text (dosing tables etc.) with an OI.

Displays in EHR for providers to review.

INACTIVE DATE:

DAY (nD) or DOSE (nL) LIMIT:

edit orderable items cont1
Edit Orderable Items (cont.)

MED ROUTE: If blank will default to ORAL (can’t put ORAL in here) All non-orals must have a route entered here.

SCHEDULE TYPE: Leave Schedule type blank for Outpatient.

SCHEDULE: Q6H//

PATIENT INSTRUCTIONS: WF FPA//

Select SYNONYM: ??

Choose from:

ADVIL

MOTRIN

You may enter a new SYNONYM, if you wish

Select SYNONYM: Can have as many as you want- Usually all Trade Names.

Some sites use classes for some drugs i.e. OCP or STATINS.

drug text enter edit
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
    • Drug Texts longer than one line are viewed under heading “Restriction/Guidelines”
    • Can cut and paste dosing tables if they are in text format
    • Recommended over using Drug Message
    • Details are in the “Drug Text creation editing and usage” power-point
standard schedule
Standard Schedule

Select Pharmacy Data Management Option: standard Schedule Edit

Select ADMINISTRATION SCHEDULE: ??

Choose from:

(5) TIMES/DAY 0700-1000-1300-1600-1900

3PM 1500

AC 0700-1100-1600

AC BID 0700-1630

AC TID 0700-1130-1630

AC&HS 0630-1130-1630-2100

ACCU-CHEK AC&HS 0630-0632-1130-1131-1630-1631-2100-2101

BB 0700

BDA

BID 1000-2200

BID (DIURETIC) 0700-1500

BID (HYPOGLYCEMIC) 0700-1500

BID (INSULIN) 0700-0701-0702-1630-1631-1632

standard schedule cont
Standard Schedule (cont.)

BIW

BL 1100

BS 1630

DAILY 1000

NAME: TID// The “shortcut” abbreviation

OUTPATIENT EXPANSION: THREE TIMES A DAY//How it looks in the Rx

OTHER LANGUAGE EXPANSION: Leave Blank!

TYPE OF SCHEDULE: CONTINUOUS//Cont, day of week, or one-time

STANDARD ADMINISTRATION TIMES: 1000-1500-2200//

Not needed if not inpatient at your facility

FREQUENCY (IN MINUTES): 480//

Minutes between doses, calculated as if split evenly through a 24 hour day

standard schedule cont1
Standard Schedule (cont.)

Select WARD:

Not needed if not inpatient at your facility

NAME: WEDNESDAY//

OUTPATIENT EXPANSION: EVERY WEDNESDAY//

OTHER LANGUAGE EXPANSION:

TYPE OF SCHEDULE: DAY OF THE WEEK//

STANDARD ADMINISTRATION TIMES: 1000//

Select WARD:

NAME: ONCE//

OUTPATIENT EXPANSION: ONCE//

OTHER LANGUAGE EXPANSION:

TYPE OF SCHEDULE: ONE-TIME//

standard schedule edit
Standard Schedule Edit
  • Inpatient and Outpatient dosing schedule:
    • Sets administration times for standard schedules, e.g., Daily=0900.
    • Inpatient schedules should match facility administration policy.
    • Obsolete schedules should be deleted.
    • Used in the EDIT ORDERABLE ITEMS option.
putting it all together
Putting it all together
  • With drug file entry, creates a prescription and (if using) a label
  • So…where are the nouns, verbs, and routes seen?