1. July 2012 Pharmacy Data Management/Drug Databases 1

2. 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. 2

3. Technology: A Double-Edged Sword As pharmacy computer systems have evolved they have automated more functions and relieved the pharmacist of much mental work: Allergy and drug interaction checks Improved legibility of paperwork Better record keeping Electronic prescription transmission Over time people become dependent on the technology and use their clinical skills less or users with fewer clinical skills assume roles because the technology “has their back”: Missing interactions because the computer didn’t throw a flag Technicians assigned more complex duties using the computer But if the programs are not set up properly errors can result. 3

4. Making Technology Trustworthy Garbage In Garbage Out The key here is training: It’s important that whoever sets up and/or maintains the system is clinically and technically qualified. It’s important that whoever operates the system is also aware of the performance of the system and can detect errors such as missed allergies or unmatched drugs. It’s also important that the organization develops and implements a functional feedback mechanism so that system managers are made aware of errors found by users. 4

5. Pharmacy Data Management A set of programs that configure elements used in medication orders and prescriptions: Controls how medications are managed throughout the entire health operation Impacts all disciplines: Clerks Technicians Providers Nurses Pharmacy 5

6. 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… 6

7. Drug Enter/Edit Some Important Fields to Populate DEA Special Handling VA Drug Class Code Synonym(s) Order Units Dispense Units Dispense Units per Order Unit Dispense Unit NCPDP Code NDC Pricing 7

8. Drug Enter/Edit Other data options inclusive with drug entry Dosages Make sure they are appropriate Enter Package use: Inpatient Outpatient Non-VA IV ADDITIVES or IV SOLUTIONS Orderable item Schedule Synonym(s) 8

9. IV Additives and Solutions Select drug through DRUG ENTER/EDIT. Walk through questions until this prompt: MARK THIS DRUG AND EDIT IT FOR: Choose “I” AN IV ITEM? Yes// (Yes) Edit Additives or Solutions: Select one of the following: A ADDITIVES S SOLUTIONS Details are in the “PDM IV Additive and Solutions” PowerPoint. 9

10. Importance of the Orderable Item Is what the provider sees or “orders” in EHR Synonyms – help provider find the drug Multiple dispense drugs typically linked to one Orderable Item (OI): OI = Lisinopril Tab Dosage form set by matching to the NDF and can’t be edited All Lisinopril strengths link to this OI Is what the quick-order is built upon If the OI changes, the QO must be updated What prints on the cgMAR for Inpatient Ambiguous orders for drugs with LPDs 10

11. ISMP Patient Safety Guidelines Flagging High Risk/High Alert medications Barring use of error-prone abbreviations Tall Man lettering 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 HOWEVER, it is recommended to keep the dispense drug name in ALL CAPS at this time due to RPMS enhancements being made to accommodate these changes Drugs and orderable items using Tall-Man convention need a synonym in ALL CAPS http://ismp.org/Tools/tallmanletters.pdf 11

12. Drug Enter/Edit Exercise – Enter a new drug: Pharmacy Data Management: Drug Enter/Edit Tall-Man Naming Convention Refer to script 12