Managing Pharmacy Drug Data Optimizing Pharmacy Data Management Mary Ann Niesen, Pharm.D.

Adding a new drug Follow standardized format: Generic name, strength, form Albuterol 90mcg/spray MDI Clopidogrel 75mg Tab Be sure to fill out key fields: DEA code, order unit, dispense unit, dispense units/order unit, NDC, etc.

National Drug File Match through the drug entry screen If unable to match, manually assign a VA Drug class code. This is required for correct functioning of doses, allergy checks, CRS taxonomies, etc. May need matches verified and merged if the user does not have correct keys.

Dosages/Local dosages Review or add dosages/local dosages Dosages = tied to National Drug File Entry of mg strength is translated to number of tablets on label Can add or delete these as needed Local Dosages = entered locally Literal text will be displayed on label Can have both but will not work well with EHR

Misc. Fields by Type of use Mark drug as appropriate: Inpt, outpt, controlled, unit dose, non-VA, etc. Quantity disp. message will display in EHR when dose is chosen (and in Pharmacy package back-end processing) so provider knows what size tube/bottle/package to prescribe. Drug can be tied to a lab test (not a panel!) for checking during data entry (Simvastatin and AST).

Orderable items These are the “basic” building blocks for all orders, not just pharmacy. For Pharmacy, these should be drug and form WITHOUT strength. Exception—insulin needs type included (“regular insulin”, not “insulin”) Choose form carefully! Can set some defaults—route, schedule, text, etc.

Update an existing drug Update fields as needed, instead of entering new drug Inactivate drugs no longer in use NEVER delete a drug! Re-activate if needed Make sure NDC and bottle size match Re-match to National Drug File if needed (but will need to re-do dosages changes)

Nouns and verbs Nouns and verbs relate the dosage form and the dose to the instructions printed on the label: In Take 1 tablet every 6 hours “take” is the verb and “tablet” is the noun In Shake well and give 5 ml 3 times a day “shake well and give” is the verb and “ml” is the noun

Routes Routes are tied to dosage forms and/or orderable items Some routes are unnecessary and can be marked as National package only Routes can be added—“topical body” for permethrin cream PO is the default route

Standard Schedules Continuous, One-time, or Day of week Include a time interval (in minutes) Allow for calculation of quantity based on dose and days supply for most drugs In back-end prescription processing, can still use old “medication instructions” but only standard schedules show in EHR.

Dosages Dosage vs Local Possible Dosage Dosages can be tied to inpt, outpt, or both Some dosage forms have Dosages that can only be tied to inpt—must still make Local possible dosages for outpt use How to handle doses of “1-2 tablets”? If Dosages exist, cannot “see” local possible dose in EHR

Dosage Forms A National File Form chosen when matching to orderable item Can be confusing XR vs ER vs SR, etc. May need to edit verbs Reconsitutable oral powder was “mix and take” changed to “shake well and give”

Drug/Orderable item text Can be tied to individual drug or to orderable item Can be prepared in word processing application then cut and pasted into RPMS Will cause a link to show in the order dialog box in EHR (and additional question in Pharmacy package) Used for pediatric dose charts, restrictions, or special instructions

Importance of good PDM setup Essential for trouble free use of POS, Adverse Reaction Tracking, EHR Allergy checks may not trigger if VA drug class not entered Drug will not be billed if NDC doesn’t match package size Many CRS (GPRA) taxonomies based on VA drug class or NDC…