July 2012

Pharmacy Data ManagementPharmacy Data ManagementAssociated FilesAssociated Files

• 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.

Course Objectives

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 FileThe 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

• Need to go into “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.NAME: TAB comes from matching, do not editSelect MED ROUTE FOR DOSAGE FORM: ORAL// can have more than

one hereVERB: TAKE// this will be on the label, so should be patient friendlyOTHER 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 bothSelect NOUN:CONJUNCTION: not usually used, but might be for topicals that have a

%strength

Dosage Form File, cont.NAME: INHL,ORALSelect 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, 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 • 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• Dosages are ONLY for Single Entity tablets and capsules

PDM Dosages Dosages Enter/EditSelect Drug: HALOPERIDOL 10MG TAB CN709

Strength from National Drug File match => 10 MGStrength currently in the Drug File => 10 MG

Edit Strength? N// Strength => 10 Unit => MGSelect 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

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.

Automatically created when drug was matched to the NDF

DOES NOT mean they make sense so review (i.e 1600 mg of ibuprofen)

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/EditSelect 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? YSelect DISPENSE UNITS PER DOSE: .PACKAGE: IO

Strength => 0.4 Unit => MGEnter/Edit Local Possible Dosages? N //Select Drug:

• 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)– Avoid “Teaspoonful”, “Tablespoonful”, etc (Use “ML”)

» Evidence suggests this leads to medication errors

• Delete superfluous LPDs– 2 suppositories etc.

Adding Local Possible Dosages

What you type is what you get – Abbreviations do NOT expand MG do

NOT calculate

Adding LPDsPDM Dosages Dosages Enter/EditSelect Drug: 2432 ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB

CN103This 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// YLOCAL 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)

PDM Dosages Enter/Edit DosagesSelect 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? YSelect DISPENSE UNITS PER DOSE: .PACKAGE: IO

Strength => 0.4 Unit => MGEnter/Edit Local Possible Dosages? N //Select Drug:

Ready to edit next Drug

Deleting LPDs

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 InstructionSelect MEDICATION INSTRUCTION NAME: ??Choose from:(M) (MUST SEE PROVIDER FOR MORE REFILLS)A/A **AVOID ALCOHOL**AH **AVOID ALCOHOL**AOOH AT ONSET OF HEADACHEDD **DOSE DECREASED**DIN **DOSE INCREASED**FALL FOR ALLERGIESFAN FOR ANXIETYFAR FOR ARTHRITISFAS FOR ASTHMAFAX FOR ANXIETYFBC FOR BIRTH CONTROLFBP FOR HIGH BLOOD PRESSUREFBR FOR BREATHINGFCA FOR CALCIUMFCH FOR CHOLESTEROL CONTROLFCIRC FOR CIRCULATION

• Generally for patient instructions• Not for schedules (BID, Q12H, etc)

– Those go in standard schedules

Medication Instruction, cont.NAME: FFL// the abbreviation you will useSYNONYM: if you want more than one abbreviationEXPANSION: FOR FLUID// how it will look on labels and reportsPLURAL: not usually usedINTENDED USE: OUTPATIENT ONLY// Inpatient, Outpatient, or bothFREQUENCY (IN MINUTES): no longer needed

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

• Enter/Edit common instructions– PM = Evening– AM = Morning– AP = Apply

• Used in the EDIT ORDERABLE ITEMS option

Medication RoutesSelect 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 DEEP IM DENTAL DENT DENTAL INFILTRATION DENTIF DENTAL INTRAMUSCULAR DENTALIM DENTAL ORAL DENTORAL DENTAL ORAL TOPICAL DENTORALTOP DENTAL SUBCUTANEOUS DENTSC

Medication Routes, cont.NAME: ORAL// full nameABBREVIATION: PO//abbreviation used in prescriptionsPACKAGE USE: ALL PACKAGES// ”National Drug File Only” will hide it from use

locallyOUTPATIENT EXPANSION: BY MOUTH// include preposition, will show on labelOTHER LANGUAGE EXPANSION: LEAVE BLANK!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) ReplaceOTHER LANGUAGE EXPANSION:IV FLAG:

Medication Route File• Enter/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

• Edit/Enter several pertinent fields– Assign Drug Text Entry for provider viewing if

desired

– Med Route

– Schedule Type*

– Schedule

– Patient Instructions

– Synonym (for EHR med ordering selection)

*Can cause problems. Best to leave blank, especially for drugs used in inpatient.

PDM Orderable Item Management Edit Orderable Items

Select PHARMACY ORDERABLE ITEM NAME: IBUPROFEN Orderable Item -> IBUPROFEN

Dosage Form -> TABList all Drugs/Additives/Solutions tied to this Orderable Item? YES//

Dispense Drugs:---------------IBUPROFEN 200MG TABIBUPROFEN 400MG TABIBUPROFEN 600MG TABIBUPROFEN 800MG TAB

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

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 ScheduleSelect 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 BIW BL 1100 BS 1630 DAILY 1000

Standard Schedule, cont.NAME: TID// the “shortcut” abbreviationOUTPATIENT EXPANSION: THREE TIMES A DAY// how it looks in the RxOTHER LANGUAGE EXPANSION: LEAVE BLANK!TYPE OF SCHEDULE: CONTINUOUS// Cont, day of week, or one-timeSTANDARD ADMINISTRATION TIMES: 1000-1500-2200// not needed if not

inpatient at your facilityFREQUENCY (IN MINUTES): 480// minutes between doses, calculated as if split

evenly through a 24 hour daySelect 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

• Inpatient and Outpatient dosing schedule– Sets administration times for standard

schedules, ie. 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

• With drug file entry, creates a prescription and (if using) a label

• So…where are the nouns, verbs, and routes seen?

Dosage Form

Routes: Only routes you have linked to the dosage

form show here

Standard Schedules

Medication Instructions, shows expanded in EHR

Verb (in the dosage form file)

Noun (in the dosage form file)

DEMO,PATIENT INFANT 99990TAKE ONE (1) CAPSULE BY MOUTH THREE TIMES A DAY FOR INFECTION TREATMENT; TAKE UNTIL FINISHED MRx0

AMOXICILLIN 250MG CAP #30 CAPRx 1337617 MAMNPROVIDER,M CHM 8-09-10

Verb (from

Dosage form file)

Noun (from

Dosage form file)

Route (note preposition in the route expansion, not in the field “preposition”)

Standard schedule, expanded