1. June 2011 Pharmacy Data Management/Drug Databases

2. Describe how technology can impact patient safety Identify and discuss common risks and/or unintended consequences encountered when implementing medication management supporting systems. Outline the approach to training, implementation, and maintenance of the drug database Recognize the potential impact of Institute of Medicine (IOM) recommendations and available medication management technologies on patient safety Ensure that transfer of medication orders to outpatient is appropriate Create inpatient medication quick orders Recognize the potential impact of the Institute of Medicine (IOM) recommendations for the use of “Short Man” and “Tall Man” in designing Medication Orders Course Objectives

3. Describe and Manage PDM –Menu Options –Interaction between options Proper set up Identify common pharmacy issues in EHR Course Objectives

4. Pharmacy Data Management Set Up The baseline for how well medication management will work for all disciplines. Impacts all disciplines Clerks Technicians Providers Nurses Pharmacy Overview

5. 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 Drug Text Enter/Edit Drug Text File Report Pharmacy System Parameters Edit Standard Schedule Edit Synonym Enter/Edit

6. Dosages Enter/Edit Dosages –Possible Dosages Single entity tablets & capsules, and some other single entity agents Auto Created 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 Enter Package use Inpatient and/or Outpatient

7. Drug Enter/Edit Some Important Fields to Populate –DEA Special Handling –VA Drug Class Code –Dispense and Order Units –Pricing –NDC

8. Drug Enter/Edit Other data options inclusive with drug entry –Dosages –Orderable item –Synonym –ID packages for drug use.

9. 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)

10. Medication Instruction File Enter/Edit common instructions –PM = Evening –AM = Morning –AP = Apply Entered under edit orderable items

11. 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

12. 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)

13. 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 –Viewed under heading “Restriction/Guidelines” –Can cut and paste dosing tables

14. AWP Scan Option Separate Menu Option –Allows the scanning of medications into the Drug File –Automatically updates Synonym NDC Dispense Units per Order

15. Standard Schedule Edit Inpatient and Outpatient dosing schedule Entered for viewing under Orderable Item Edit

16. Tall-Man Naming Conventions ISMP Patient Safety Guidelines Uses strategically placed capital letters (Tall) to differentiate between confusing drug names Drug generic name, Orderable item name, Quick order display name, IV additive and IV solution print names all need to conform to guidelines Drugs and orderable items using Tall-Man convention need a synonym in ALL CAPS http://www.ismp.org/Tools/tallmanletters.pdf

17. New Drug Entry Exercise Enter a new drug –Dosages –Medication Instruction –Medication Route –Orderable Item –Drug Text –Standard Schedule –Tall-Man Naming Convention