Steve Bowman R.Ph. Information Systems Consulting Pharmacy Data Management

Describe the PDM –Environment –Terminology –Tools Tips for proper set up & maintenance Identify common pharmacy problems in EHR Review solutions Course Objectives

Proper pharmacy package configuration Foundation for E.H.R. Crucial to successful P.O.E Impacts all disciplines Providers Nurses pharmacy Overview

Configuration Files More than just the Drug file – 6 files involved Each file is responsible for the components required to –Build Sigs in the prescription processing –Interface correctly with other RPMS components Point of Sale (POS) Physician Order Entry (POE)

Configuration Files

PDM Tools Standard Files (Schedules, Routes, Pt. Instructions) SIG Defaults

Terminology - Routes The Medication Route file –Must contain all routes that a site wants to use on their Rx labels Standard List in Appendix A of Pharmacy 5-7 Handbook Forbidden Abbreviations must be modified or deleted –AU, AS, OU, OS etc. –Use Med Route/Instructions Table Maintenance option on PDM to set up –Outpatient Expansion field  Text that will print on the label Includes any prepositions needed for I.E. ORAL, should be BY MOUTH instead of MOUTH –Delete all prepositions from the Dosage Form File –Package Use field  ALL (inpatient & outpatient) Two types of routes –Routes – that are associated with Dosage Forms (only used for Oral drugs) –Default routes – that are associated with Pharmacy Orderable Items (for all non-orals) –If a Drug has a Default Route that is what appears on the label (the routes column is ignored) –All non Oral drugs need a default route manually entered for them even if they have what appears to be an appropriate entry in the Route column (NSYN) Drugs/Orderables can only have one route value associated with them e.g. Ophthalmic drops would default to Affected Eye(s) but could manually change to Left or right eye as needed Can manually change a route during prescription processing or in Quick Order Creation

PDM  Med. Route/Instructions Table Maintenance ADDING MEDICATION ROUTES Select Pharmacy Data Management Option: Med. Route/Instructions Table Maintenance Select MEDICATION ROUTES NAME: TOPICAL SOAK Are you adding 'TOPICAL SOAK ' as a new MEDICATION ROUTES (the 250TH)? No// Y MEDICATION ROUTES ABBREVIATION: NAME: TOPICAL SOAK// ABBREVIATION: PACKAGE USE: ALL ALL PACKAGES OUTPATIENT EXPANSION: IN WATER, SOAK THE AFFECTED AREA Would you like to update the Dosage Form file? Y// NO

The Administration Schedule file –Must contain all schedules that a site wants to use on their Rx labels Standard List in Appendix A of Pharmacy 5-7 Handbook Must Delete/Edit forbidden Abbreviations –QOD, QD, etc. –Use Standard Schedule Edit on PDM to set up –Key Fields Outpatient Expansion  Text that will print on the label Type of Schedule –CONTINUOUS takes place on a regular basis i.e. 'three times a day' or 'once every two days' –DAY OF THE WEEK takes place only on specific days of the week »should have admin times (If not, the start time of the order is used) »Name must be in the form of 'MO-WE-FR‘ (first 2 letters of the day) –ONE-TIME takes place once only at a specific date and time. Frequency  # of times dose will be given per day divided into 1440 minutes »BID = 1440/2 = 720 TID = 1440/3 = 480 »Used to calculate quantity dispensed Standard Administration Times  Used for Inpatient »i.e Terminology – Standard Schedules

ENTERING SCHEDULES PDM  STANDARD SCHEDULE EDIT Select ADMINISTRATION SCHEDULE: QDAY Are you adding 'QDAY' as a new ADMINISTRATION SCHEDULE (the 14TH)? No// Y (Yes) NAME: QDAY// OUTPATIENT EXPANSION: EVERY DAY TYPE OF SCHEDULE: CONTINUOUS TYPE OF SCHEDULE: CONTINUOUS// CONTINUOUS STANDARD ADMINISTRATION TIMES: FREQUENCY (IN MINUTES): 1440// Select WARD: NAME: “MO-WED-FRI” OUTPATIENT EXPANSION: ON MONDAYS, WEDNESDAYS, AND FRIDAYS TYPE OF SCHEDULE: CONTINUOUS// DAY OF THE WEEK STANDARD ADMINISTRATION TIMES: FREQUENCY (IN MINUTES): 1440 Select WARD: force an entry by using “ ” i.e. if MO was already in the file

The Medication Instructions file –Only used by the outpatient module –Contains abbreviations for patient information that appears at the end of the Rx label i.e FPA  FOR PAIN TWF  TAKE WITH FOOD Standard List in Appendix A of Pharmacy 5-7 Handbook –Use Medication Instruction File Add/Edit on PDM menu –Key Fields Medication Instruction Name  The abbreviation Expansion  Text that will print on the label Package Use  ALL (inpatient & outpatient) Leave other fields blank (Synonym, Med Route, Schedule) Terminology – Medication Instructions

PDM > Medication Instruction File Add/Edit Adding Med Instructions Select MEDICATION INSTRUCTION NAME: SWB NAME: SWB// SYNONYM: EXPANSION: **SHAKE WELL BEFORE USING** Replace PLURAL: INTENDED USE: IN & OUTPATIENT// MED ROUTE: Leave Blank SCHEDULE: Leave Blank

Two Uses –Drug File– Quick Codes  Not seen in EHR for use by Pharmacy to select drugs quickly Use Drug Enter/Edit to add/modify the Synonym(s) –If enter Trade Name type here it does NOT show up in EHR –Do NOT enter the NDC here use NDC field further down –Pharmacy Orderable Item File (trade names) for use by Providers to select meds in POE/EHR Use Edit Orderable Items to add/modify the Synonym(s) field Terminology – Synonyms

Correct setup & maintenance is critical for successful POE Two Types –Dosages Single entity tablets & capsules Comprised of - Strength – Dispense Units – Package Use A dosage of 1 and 2 is automatically created when adding new items with Drug Enter/Edit –Must manually add any others i.e..5, 3, 4 etc. –PDM  Dosages  Dosages Enter/Edit –Local Possible Dosages (LPDs) All other Drug file entries Combination drugs (tabs & Caps)Liquids (suspensions, syrups, solutions) Drugs with % strengthsOphthalmics/Otics InhalersTopicals Rectal/VaginalInjections Comprised of - Quantity – Noun – Package Use –Should include article where needed for label »A THIN LAYER or THE ENTIRE CONTENTS Must enter these in manually –PDM  Dosages  Dosages Enter/Edit won't display for drugs that use Dosages –i.e. single Entity tablets and capsules Terminology – Dosages

Adding New Dosages ONLY for 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// Strength => 10 Unit => MG Select 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 Never edit the strength here! Were automatically created when drug was matched to the NDF

For all other Drugs LPDs apply Even in 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) Delete superfluous LPDs –2 suppositories etc. Adding Local Possible Dosages What you type is what you get – Abbreviations are NOT expanded

Adding LPDs PDM  Dosages  Dosages Enter/Edit Select Drug: 2432 ACETAMINOPHEN/BUTALBITAL/CAFFEINE TAB CN103 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) 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 Can select specific Drugs with the IEN (# column from the NSYN report) Include number, noun, and article (if needed)

Deleting Dosages & LPDs DOSAGES 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: IO IO Select DISPENSE UNITS PER DOSE: 2 DISPENSE UNITS PER DOSE: SURE YOU WANT TO DELETE THE ENTIRE '2' DISPENSE UNITS PER DOSE? Y Select DISPENSE UNITS PER DOSE:. PACKAGE: IO Strength => 0.4 Unit => MG Enter/Edit Local Possible Dosages? N // Select Drug:

LPDs PDM  Dosages  Dosages Enter/Edit 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: ? Answer with LOCAL POSSIBLE DOSAGE Choose from: 1 SuppositoryIO 2 SuppositoriesIO LOCAL POSSIBLE DOSAGE : 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: Shows possible doses (only for Inpatient use) Ready to edit next Drug

Associated with Orderable Items Dosage Form File holds –Nouns –Verbs –Routes –Prepositions PDM  Dosages  Dosage Form File Enter/Edit Delete prepositions –when sigs have double prepositions i.e. BY BY MOUTH Delete inappropriate routes Modify missing or incorrect verbs or nouns PDM  Orderable Item Maintenance  Dispense Drug/Orderable Item Maintenance To change an incorrect dosage form for an orderable Item Terminology – Dosage Form Defaults for Orderable items to build SIGS Must all be deleted (are included in routes)

Changing Incorrect Dosage Forms If Orderable Item has an incorrect dosage Form –Nouns, verbs will be wrong in SIGS –Must rematch the dispense drug to a different orderable item or create a new one –Use the Dispense Drug/Orderable Item Maintenance option Example  ASPIRIN 325MG TAB,EC matched to dosage form TAB want it matched to TAB,EC PDM  Orderable Item Maintenance  Dispense Drug/Orderable Item Maintenance Select DISPENSE DRUG: ASPIRIN 325MG TAB,EC ASPIRIN 325MG E.C. TAB is already matched toASPIRIN TAB Do you want to match to a different Orderable Item? NO// YES Choose Dosage Form: TAB,EC 1 TAB,EC 2 TAB,EC (DELAYED RELEASE) CHOOSE 1-2: 1 TAB,EC Dose Form -> TAB,EC Match to another Orderable Item with same Dosage Form? NO// Dosage Form -> TAB,EC Dispense Drug -> ASPIRIN 325MG E.C. TAB Orderable Item Name: ASPIRIN 325MG Matching ASPIRIN 325MG E.C. TAB to ASPIRIN 325MG TAB,EC Is this OK? YES// Match Complete! Now editing Orderable Item: ASPIRIN 325MG TAB,EC FORMULARY STATUS:

Deleting Inappropriate Routes (associated with Dosage Forms) PDM  Dosages  Dosage Form File Enter/Edit –Edit the MED ROUTE FOR DOSAGE FORM field –Delete those that you don’t want Select DOSAGE FORM NAME: INJ Select MED ROUTE FOR DOSAGE FORM: SUBCUTANEOUS// ? Answer with MED ROUTE FOR DOSAGE FORM Choose from: INTRAVENOUS INTRAMUSCULAR SUBCUTANEOUSNASAL Select MED ROUTE FOR DOSAGE FORM: SUBCUTANEOUS// NASAL MED ROUTE FOR DOSAGE FORM: SURE YOU WANT TO DELETE THE ENTIRE MED ROUTE FOR DOSAGE FORM? Y Select DOSAGE FORM NAME:

Some verbs in the DF file were missing or incorrect Recommended additions/modifications –Appendix B of Handbook –Use Dosage Form File Enter/Edit NAME: PWDR,RENST-ORAL Select MED ROUTE FOR DOSAGE FORM: ORAL// VERB: DISSOLVE// SHAKE WELL AND GIVE OTHER LANGUAGE VERB: PREPOSITION: SURE YOU WANT TO DELETE? Y OTHER LANGUAGE PREPOSITION: Select NOUN: CONJUNCTION: Prepositions should all have been deleted with a Fileman Loop/Delete prior to conversion to 7.0 Changing/Adding Verbs & Deleting Prepositions All Prepositions must be deleted from the DF file

Pharmacy Orderable Items The pivotal file for POE/EHR –Quick orders are created from this file –Contains all of the defaults for SIGs (except dosages) –Providers select items from this file to create orders if no QO PDM  Orderable Item Management  Edit Orderable Items to edit/add: Name Drug Text Inactive Date Route Schedule Pt. Instructions Synonyms These values show up when creating QOs or when Providers select meds w/o a QO

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// Dispense Drugs: IBUPROFEN 200MG TAB IBUPROFEN 400MG TAB IBUPROFEN 600MG TAB IBUPROFEN 800MG TAB Are you sure you want to edit this Orderable Item? NO// YES Now 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 wish Select 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

The Fileman Searches Menu KIDS file –azpdrug0141.k –Site Manager install Assign AZPSCBDRUGSEARCH option as a secondary Menu or add it to PDM Used to assess and the status of Pharmacy support file configuration –Pharmacy Orderable Items –Routes –Med Instructions –Schedules

Create a HyperTeminal Connection Click Start on your Windows Taskbar Click All Programs Click Accessories Click Communications Double Click HyperTerminal A connection Description window should appear - type in RPMS where it asks for a description-click the Next button In the Connect to window - go to the connect using dropdown and switch to TCP/IP Type the IP address for your RPMS server YYY.ZZ in the Host address box - click OK. Save a shortcut Icon for this on your Desktop

How to Screen Capture an RPMS Report Select report to print At the DEVICE prompt enter in 0 to print to screen and any formatting needed Above example is for 80 columns & rows Before hitting the enter key Select Transfer  Capture  name the file & where to save it

Once the report completes Choose Transfer  Stop  Hit Enter after doing these

Formatting a captured report Open MS Excel –Choose the DATA dropdown  GET EXTERNAL DATA  IMPORT TEXT FILE At FILES OF TYPE, select ALL FILES Go to the directory where you saved the file, click to open

The Text Import Wizard will open Select Fixed with Click Next Move the Break lines to set up correct columns Click Finish

For Routes, Schedules, & Med. Instructions Can quit or use Auto-format to make it easier to read Highlight the entire Sheet and choose Format  then auto-format Click – OK on the IMPORT DATA screen Select one that will help make the lines easier to read (I like List 1 or 3D Effects 2) - Click OK

Format an RPMS Report in Excel MEDICATION ROUTESOUTPATIENT EXPANSION BLOOD TESTFOR BLOOD TESTING BLOOD TEST DEVICETO MONITOR GLUCOSE BLOOD TEST SOLN, GLUCOSEIN BLOOD GLUCOSE MONITOR BOTH EARSINTO BOTH EARS BOTH EYESINTO BOTH EYES BUCCALBETWEEN CHEEK AND GUM UNTIL DISSOLVED BUCCAL ORALBETWEEN THE CHEEK & GUM ON EACH SIDE OF BUCCAL_ORALTO AFFECTED AREA ON CHEEK OR GUM CHEST WALLTO THE CHEST WALL CONDOMFOR CONTRACEPTIVE PURPOSES CONTROL SOLUTIONIN METER DENTALTO GUMS & TEETH AS DIRECTED DENTAL ORAL TOPICALTO AFFECTED GUMS DENTAL RINSEFOR 30 SECONDS & SPIT OUT DENTAL SWISHAROUND IN MOUTH FOR 30 SECONDS & SPIT DENTAL TOPICALTO GUMS DENTAL TOPICAL BUCCALTO AFFECTED AREAS ON CHEEKS OR GUMS DISINTIGRATING_ORALON THE TONGUE DISINT_ORALBY MOUTH EACH_ORALINTO EACH SIDE OF THE MOUTH ENEMA,RTLINTO THE RECTUM GRANULES_ORALIN WATER AND DRINK

For Pharmacy Orderables (NSYN report) Need to do more formatting Select the Print Preview Icon to get to the page layout screens Click on Setup, then Select Landscape, Select the Margins tab Set left, right, top, and bottom margins to.01 and the header and footer to zero. then click OK and then close the Page set up page to return to the main spreadsheet

From the View dropdown Select Page Break Preview and move the dotted line to the right of the Pt. Instructions column. Then go back to View and select Normal Can then choose to –Center Columns –Auto-format as with Routes etc. –Split window

Troubleshooting

Problem  Missing Dosage

GENERIC NAME: DIVALPROEX// DIVALPROEX 500MG (DELAYED RELEASE) VA CLASSIFICATION: DEA, SPECIAL HDLG: 6P// NATIONAL FORMULARY INDICATOR: Not Matched To NDF LOCAL NON-FORMULARY: VISN NON-FORMULARY: Select DRUG TEXT ENTRY: Select FORMULARY ALTERNATIVE: Select SYNONYM: MESSAGE: RESTRICTION: FSN: INACTIVE DATE: WARNING LABEL: ORDER UNIT: TA ORDER UNIT: BOTTLE BT BOTTLE DISPENSE UNIT: TAB DISPENSE UNITS PER ORDER UNIT: 1 NDC: PRICE PER ORDER UNIT: LAST PRICE UPDATE: SEP AWP PER ORDER UNIT: AWP PER DISP UNIT is SOURCE OF SUPPLY: DISPENSING LOCATION: STORAGE LOCATION: PRICE PER DISPENSE UNIT: Dosages can be setup in one of places: Enter Edit Drug (EDRG) Dosages Enter/Edit Solution  Enter/Edit Drug or Dosages Enter/Edit

Do you wish to match/rematch to NATIONAL DRUG file? Yes// (Yes) Deleting Possible Dosages... Match local drug DIVALPROEX 500MG (DELAYED RELEASE) ORDER UNIT: BT DISPENSE UNITS/ORDER UNITS: 1 DISPENSE UNIT: TAB I will try to match NDC: to NDF. No match on that NDC.... I will attempt to match the NDCs from your SYNONYMS. No match by Synonym NDC... now first word Match made with DIVALPROEX 500MG (DELAYED RELEASE) Now select VA Product Name 1 DIVALPROEX NA 500MG TAB,EC TAB,EC (DELAYED RELEASE) CN400 D0566 Enter your choice: 1 Is this a match : Y CHOOSE FROM: BOTTLE UNIT DOSE BOTTLE 4 OTHER OTHER Enter Package Size & Type Combination: 1 Local drug DIVALPROEX 500MG (DELAYED RELEASE) matches DIVALPROEX NA 500MG TAB,EC PACKAGE SIZE: 100 PACKAGE TYPE: BOTTLE OK? : Y

LOCAL DRUG NAME: DIVALPROEX 500MG (DELAYED RELEASE) ORDER UNIT: BT DISPENSE UNITS/ORDER UNITS: 1 DISPENSE UNIT: TAB VA PRODUCT NAME: DIVALPROEX NA 500MG TAB,EC VA PRINT NAME: DIVALPROEX 500MG EC(DELAYED RELEASE) TAB CMOP ID: D0566 VA DISPENSE UNIT: TAB MARKABLE FOR CMOP: YES PACKAGE SIZE: 100 PACKAGE TYPE: BOTTLE VA CLASS: CN400 ANTICONVULSANTS CS FEDERAL SCHEDULE: INGREDIENTS: NATIONAL FORMULARY INDICATOR: YES NATIONAL FORMULARY RESTRICTION: Is this a match ? Y You have just VERIFIED this match and MERGED the entry. Resetting Possible Dosages.. Press Return to continue: Just a reminder...you are editing DIVALPROEX 500MG (DELAYED RELEASE). LOCAL POSSIBLE DOSAGES: Do you want to edit Local Possible Dosages? LOCAL POSSIBLE DOSAGES: PACKAGE: IO

Do you want to edit Local Possible Dosages? N// YES Strength: 500 Unit: MG Select LOCAL POSSIBLE DOSAGE: 500MG Are you adding '500MG' as a new LOCAL POSSIBLE DOSAGE (the 2ND for this DRUG)? No// Y (Yes) LOCAL POSSIBLE DOSAGE: 500MG// PACKAGE: ? Enter an 'I' for Inpatient, 'O' for Outpatient, 'IO' or 'OI' for both. PACKAGE: OI Both Strength: 500 Unit: MG Select LOCAL POSSIBLE DOSAGE: 1000MG Are you adding '1000MG' as a new LOCAL POSSIBLE DOSAGE (the 3RD for this DRUG)? No// Y (Yes) LOCAL POSSIBLE DOSAGE: 1000MG// PACKAGE: OI Both Strength: 500 Unit: MG

Select IHS Kernel Option: ^DOSAGEs Auto Create Dosages Dosage Form File Enter/Edit Enter/Edit Dosages Most Common Dosages Report Noun/Dosage Form Report Review Dosages Report Select Drug: DIVALPROEX 500MG (DELAYED RELEASE) CN This entry is marked for the following PHARMACY packages: Outpatient DIVALPROEX 500MG (DELAYED RELEASE) Inactive Date: This drug has the following Local Possible Dosages: 500MG PACKAGE: OI 1000MG PACKAGE: OI Do you want to merge new Local Possible Dosages? Y// NO Select LOCAL POSSIBLE DOSAGE: 1 TABLET Are you adding '1 TABLET' as a new LOCAL POSSIBLE DOSAGE (the 4TH for this DRUG)? No// Y (Yes) LOCAL POSSIBLE DOSAGE: 1 TABLET// PACKAGE: OI Both Strength: 500 Unit: MG Select LOCAL POSSIBLE DOSAGE: 2 TABLETS Are you adding '2 TABLETS' as a new LOCAL POSSIBLE DOSAGE (the 5TH for this DRUG)? No// Y (Yes) LOCAL POSSIBLE DOSAGE: 2 TABLETS// PACKAGE: OI Both

Missing route Drug is missing a verb & noun

Select IHS Kernel Option: ^dosages Auto Create Dosages Dosage Form File Enter/Edit Enter/Edit Dosages Most Common Dosages Report Noun/Dosage Form Report Review Dosages Report Select Dosages Option: DOSAGE Form File Enter/Edit Select DOSAGE FORM NAME: TAB 1 TAB 2 TAB,BUCC,SA 3 TAB,BUCCAL 4 TAB,CHEWABLE 5 TAB,CHEWG GUM 6 TAB,CR 7 TAB,EC 8 TAB,EC (DELAYED RELEASE) 9 TAB,EC,SA 10 TAB,EFFERVSC Press to see more, '^' to exit this list, OR CHOOSE 1-10: 8 Next you will need to go to the “DOSAGE FORM FILE ENTER/EDIT “ Menu under the “DOSAGES” Menu Type in the dosage form tied to your drug

Select MED ROUTE FOR DOSAGE FORM: ORAL 1 ORAL PO 2 ORAL (TOPICAL) PO TOPICAL 3 ORAL GASTRIC TUBE OG TUBE 4 ORAL INHALATION ORALINHL 5 ORAL INHALATION INHL(PO) Press to see more, '^' to exit this list, OR CHOOSE 1-5: 1 ORAL PO Are you adding 'ORAL' as a new MED ROUTE FOR DOSAGE FORM (the 1ST for this DOSAGE FORM)? No// Y (Yes)

Select MED ROUTE FOR DOSAGE FORM: VERB: TAKE OTHER LANGUAGE VERB: PREPOSITION: BY OTHER LANGUAGE PREPOSITION: Select NOUN: TABLET(S)// NOUN: TABLET(S)// OTHER LANGUAGE NOUN: PACKAGE: Both// Select NOUN: CONJUNCTION Add verb Add noun Remove Preposition

The route is now working Verb “take” has been added to the drug dosage form file and automatically populates the quick order dialog box. Note the noun does not appear until a dose has been selected.

Select VA FileMan Option: Search File Entries This handy search will find all the drugs missing a route OUTPUT FROM WHAT FILE: DRUG// DOSAGE FORM (291 entries) -A- SEARCH FOR DOSAGE FORM FIELD: MED ROUTE FOR DOSAGE FORM (multiple) -A- SEARCH FOR DOSAGE FORM MED ROUTE FOR DOSAGE FORM SUB-FIELD:.01 MED ROU TE FOR DOSAGE FORM -A- CONDITION: NULL -B- SEARCH FOR DOSAGE FORM MED ROUTE FOR DOSAGE FORM SUB-FIELD: -B- SEARCH FOR DOSAGE FORM FIELD: IF: A// MED ROUTE FOR DOSAGE FORM NULL DO YOU WANT THIS SEARCH SPECIFICATION TO BE CONSIDERED TRUE FOR CONDITION -A- 1) WHEN AT LEAST ONE OF THE 'MED ROUTE FOR DOSAGE FORM' MULTIPLES SATISF IES IT 2) WHEN ALL OF THE 'MED ROUTE FOR DOSAGE FORM' MULTIPLES SATISFY IT 3) WHEN ALL OF THE 'MED ROUTE FOR DOSAGE FORM' MULTIPLES SATISFY IT, OR WHEN THERE ARE NO 'MED ROUTE FOR DOSAGE FORM' MULTIPLES CHOOSE 1-3: 1// 3

STORE RESULTS OF SEARCH IN TEMPLATE: SORT BY: NAME// START WITH NAME: FIRST// FIRST PRINT FIELD: NAME THEN PRINT FIELD: Heading (S/C): DOSAGE FORM SEARCH// DEVICE: HOME

Default schedule is not set Patient Instructions are missing

Edit Orderable Items Dispense Drug/Orderable Item Maintenance Orderable Item/Dosages Report Patient Instructions Report Select Orderable Item Management Option: EDIT Orderable Item -> DIVALPROEX Dosage Form -> TAB,EC (DELAYED RELEASE) Dispense Drugs: DIVALPROEX 500MG (DELAYED RELEASE) Are you sure you want to edit this Orderable Item? NO// YES Now editing Orderable Item: DIVALPROEX TAB,EC (DELAYED RELEASE) Orderable Item Name: DIVALPROEX// 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: DAILY Outpatient Expansion: EVERY DAY PATIENT INSTRUCTIONS: TPS TO PREVENT SEIZURES SYNONYM:

Schedule is defaulted for the quick order now Patient Instructions are now an option and the provider can decide to leave them on the final drug label or uncheck the box

NAME: PSOZ DIVALPROEX (DEPAKOTE) 500MG (2X250MG) (DELAYED RELEASE) Replace DISPLAY TEXT: Divalproex (Depakote) 500mg BEDTIME (DELAYED RELEASE) Replace VERIFY ORDER: YES// DESCRIPTION: No existing text Edit? NO// ENTRY ACTION: Medication: DIVALPROEX TAB,SA,24HR (EXTENDED RELEASE) // Complex dose? NO// Dose: 2 TABLETS 250MG// Route: ORAL// Schedule: DAILY// Patient Instructions: TO PREVENT SEIZURES Include Patient Instructions in Sig? YES// Chronic Med?YES// Days Supply: 30// Quantity (TABLET): 60// Refills (0-11): 11// Pick Up: WINDOW// Priority: ROUTINE// Comments: No existing text Edit? No// (No) Medication: DIVALPROEX TAB,SA,24HR (EXTENDED RELEASE) 250MG Instructions: 2 TABLETS 250MG ORAL DAILY Patient Instructions: TO PREVENT SEIZURES Days Supply: 30 Quantity (TABLET): 60 Refills (0-11): 11 Pick Up: WINDOW Priority: ROUTINE (P)lace, (E)dit, or (C)ancel this quick order? PLACE//

Pop up boxes can display messages to remind providers of various dosage forms, hard copy’s must be signed, etc This currently only appears if the provider EDITS the quick order! Request for fix has been submitted.

GENERIC NAME: MORPHINE 15MG SR TAB Replace VA CLASSIFICATION: CN101// DEA, SPECIAL HDLG: 2AP// NATIONAL FORMULARY INDICATOR: YES LOCAL NON-FORMULARY: VISN NON-FORMULARY: Select DRUG TEXT ENTRY: Select FORMULARY ALTERNATIVE: Select SYNONYM: MOR15// SYNONYM: MOR15// INTENDED USE: QUICK CODE// NDC CODE: Select SYNONYM: MESSAGE: MUST have hand signed copy to process!!! Replace RESTRICTION:

Objects can be imported into comment field too

Solution: If you really want this option, you’ll have to change all POSSIBLE DOSAGES to LOCAL POSSIBLE DOSAGES. Then you can customize them to look like this: 1 TABLET 2 TABLETS 1-2 TABLETS

EOI Edit Orderable Items DDOI Dispense Drug/Orderable Item Maintenance Orderable Item/Dosages Report Patient Instructions Report

Orderable Item -> IBUPROFEN Dosage Form -> TAB Dispense Drugs: IBUPROFEN 400MG TAB 30'S JAN 19, 2006 IBUPROFEN 400MG TAB BULK IBUPROFEN 800MG TAB BULK IBUPROFEN 800MG TAB 100'S IBUPROFEN 400MG TAB 100'S JAN 19, 2007 IBUPROFEN 200MG TAB 24'S MAY 06, 2007 IBUPROFEN 200MG TAB 50'S Are you sure you want to edit this Orderable Item? NO// y YES Tip: Minimize the NDCs and package sizes of your drugs. Alternately, you can separate them into different orderable items, but this can create other problems.

Auto Create Dosages Dosage Form File Enter/Edit Enter/Edit Dosages Most Common Dosages Report Noun/Dosage Form Report Review Dosages Report Then make sure you add in the dosages you want either by using either “POSSIBLE DOSAGES” OR “LOCAL POSSIBLE DOSAGES”

Select QUICK ORDER NAME: PSOZ PZA 1500MG QDAY NAME: PSOZ PZA 1500MG QDAY Replace DISPLAY TEXT: PZA 1500mg qday// VERIFY ORDER: YES// DESCRIPTION: No existing text Edit? NO// Medication: PYRAZINAMIDE TAB // Complex dose? NO// Dose: 1500MG//  delete this using sign, then re-check for the new dosages you put in on the last slilde

This list is from the “ALL OTHER MEDS” list from the quick order entry menu in the EHR GUI

EOI Edit Orderable Items DDOI Dispense Drug/Orderable Item Maintenance Orderable Item/Dosages Report Patient Instructions Report

Select OI-DRUG TEXT ENTRY: INACTIVE DATE: DAY (nD) or DOSE (nL) LIMIT: MED ROUTE: SCHEDULE TYPE: PRN// SCHEDULE: TID PRN// PATIENT INSTRUCTIONS: TWF// Select SYNONYM: ? Answer with SYNONYM Choose from: I 25 I-25 I25 INDOCIN

We don’t want this injected IV, do we?

Auto Create Dosages Dosage Form File Enter/Edit Enter/Edit Dosages Most Common Dosages Report Noun/Dosage Form Report Review Dosages Report Select Dosages Option: DOSAGE Form File Enter/Edit

Select DOSAGE FORM NAME: inj 1 INJ 2 INJ (IN OIL) 3 INJ,CONC 4 INJ,CONC, W/BUF 5 INJ,CONC-SOLN 6 INJ,FROZEN 7 INJ,LYPHL 8 INJ,PWDR 9 INJ,REPOSITORY 10 INJ,SOLN 11 INJ,SOLN,SA 12 INJ,SUSP 13 INJ,SUSP,SA 14 INJ,SUSP-DRY,SA 15 INJ/IMPLANT Press to see more, '^' to exit this list, OR CHOOSE 1-15:

Select DOSAGE FORM NAME: INJ,SUSP NAME: INJ,SUSP Select MED ROUTE FOR DOSAGE FORM: INTRAVENOUS// ? Answer with MED ROUTE FOR DOSAGE FORM Choose from: INTRAVENOUS INTRAMUSCULAR You may enter a new MED ROUTE FOR DOSAGE FORM, if you wish Screen prevents selection of any NDF-Only Med Route. Answer with MEDICATION ROUTES NAME, or ABBREVIATION Do you want the entire MEDICATION ROUTES List?

Have 1 person making quick orders if possible Limit drug file access to a few trusted people Conduct random quick order checks Use your colleagues for input Subscribe to the IHSRX Listserv!

Resources FTP Site ftp://ftp.ihs.gov/rpms/Pharmacy%205-7 Specific questions regarding drug file preparation addressed to Steve Bowman,

EHR web site:

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