1. Crime Scene: The route of “IM” is not available Police Report: – Provider wants to order a one-time dose of Ceftriaxone to be given “IM” but that route is not available

2. Crime Scene: The route of “IM” is not available Solution: RPMS  PDM  Dosages  Dosage Form File Enter/Edit ************************************************** Select DOSAGE FORM NAME: INJ,SOLN 1 INJ,SOLN 2 INJ,SOLN,SA CHOOSE 1-2: 1 INJ,SOLN NAME: INJ,SOLN Select MED ROUTE FOR DOSAGE FORM: IV PIGGYBACK// INTRAMUSCULAR 1 INTRAMUSCULAR IM Are you adding 'INTRAMUSCULAR' as a new MED ROUTE FOR DOSAGE FORM (the 4TH for this DOSAGE FORM)? No// YES

3. Crime Scene: The route of “IM” is NOW available

4. Crime Scene: Pharmacist wishes to finish a pending IV piggyback order, but the option to finish it as an IV isn’t there?!?! DC Discontinue FL Flag ED Edit FN Finish Select Item(s): Next Screen// FN Finish COMPLETE THIS ORDER AS IV OR UNIT DOSE? IV// This prompt is missing !

5. Crime Scene: Finishing IV piggyback orders Solution: The Medication Routes File Select MEDICATION ROUTES NAME: IVPB IV PIGGYBACK IVPB NAME: IV PIGGYBACK// ABBREVIATION: IVPB// PACKAGE USE: ALL PACKAGES// OUTPATIENT EXPANSION: IVPB// OTHER LANGUAGE EXPANSION: IV FLAG: YES//

6. Many different scenarios….. IV Flag in the Medication Routes File Dispense Drug’s Application Use Which Order View screen will be displayed to the user Special Processing IV None IVUnit Dose Prompt User to Finish Order as IV or Unit Dose IVIV and Unit DoseIVPrompt User to Finish Order as IV or Unit Dose Non-IVIV Prompt User to Finish Order as IV or Unit Dose Non-IVUnit Dose None Non-IVIV and Unit DoseUnit DosePrompt User to Finish Order as IV or Unit Dose

7. Crime Scene: Solution/Additive not Available when making an “IV Medication” Quick Order Pharmacist is building an IV Quick Order for SODIUM CHLORIDE 0.9% with 40MEQ KCL When building the quick order the Solution isn’t listed Select QUICK ORDER NAME: PSIVZ SODIUM CHLORIDE 0.9% W/40MEQ KCL NAME: PSIVZ SODIUM CHLORIDE 0.9% W/40MEQ KCL Replace DISPLAY TEXT: KCL 40mEq in 0.9% NS Replace VERIFY ORDER: YES// DESCRIPTION: No existing text Edit? NO// Solution: SODIUM CHLORIDE 0.9% W/40MEQ KCL ?? Enter a base solution for this order.

8. AN IV ITEM? Yes// Y (Yes) Edit Additives or Solutions: Select one of the following: A ADDITIVES S SOLUTIONS Enter response: SOLUTIONS Select IV SOLUTIONS PRINT NAME: SODIUM CHLORIDE CHOOSE 1-15: 15 SODIUM CHLORIDE 0.9% 40MEQ KCL 1000 ML PRINT NAME: SODIUM CHLORIDE 0.9% 40MEQ KCL Replace PRINT NAME {2}: GENERIC DRUG: SOD. CHL. 0.9% W/ 40MEQ KCL 1000ML (INJ) VOLUME: 1000 ML// Select ELECTROLYTES: CHLORIDE// ELECTROLYTES: CHLORIDE// CONCENTRATION:.04 MEQ/ML// Select ELECTROLYTES: Select SYNONYM: DRUG INFORMATION: No existing text Edit? NO// AVERAGE DRUG COST:.01679// INACTIVATION DATE: USED IN IV FLUID ORDER ENTRY: NO// Edit Additives or Solutions: CHANGE TO YES

9. Crime Scene: Solution/Additive not Available when making an “IV Medication” Quick Order When should the Prompt “Used in IV Fluid Order Entry” be Marked “Yes” – All Additives and Solutions that are Continuous/Intermittent IV Infusions Typically Large Volume Admixtures – Not Scheduled IVPBs

10. Crime Scene: Unable to Transfer from “Inpatient to Outpatient”

11. Solution – One Orderable Item is required for both the Bulk Outpatient Dispense Drug and the Unit Dose Inpatient Dispense Drug ************************************************************ * Orderable Item -> CITALOPRAM Dosage Form -> TAB Dispense Drugs: --------------- CITALOPRAM 40MG TAB CITALOPRAM 20MG TAB CITALOPRAM 20MG U/D TAB CITALOPRAM 10MG TAB

12. Crime Scene: Transfer to Outpatient Dialog (Setting Defaults) Police Report: Why are the fields “Pick Up” and “Refills” not filled in?

13. Crime Scene: Transfer to Outpatient Dialog (Setting Defaults) Solution: There is none! – No default exists in the inpatient order file to convert data when transferring from inpatient to outpatient – Old VA Function? – Computer fills in what it can from the inpatient order – Provider must fill in the information upon ordering the medication

14. Crime Scene: Units Per Dose (U/D) in the Dispense Drug Field Inaccurate Scenario: – An inpatient is on Carvedilol 6.25mg PO BID – Computer wants to use ½ tablet of Carvedilol 12.5mg Unit Dose as the dispense drug – Pharmacy has Carvedilol 6.25mg Unit Dose tablets available in the Omni-Cell/Pyxis – Why is this happening?

15. DEMO,PATIENT INPATIENT Ward: 2S MED/ CWA HRN: 999997 Room-Bed: Ht(cm): 152.40 01/12/2010 DOB: 05/19/50 (59) Wt(kg): 114.55 02/05/2010 (1)Orderable Item: CARVEDILOL TAB Instructions: (2)Dosage Ordered: 6.25MG (3)Start: 02/10/10 21:00 (4) Med Route: ORAL (5) Stop: 05/21/10 16:00 (6) Schedule Type: CONTINUOUS (8) Schedule: BID (9) Admin Times: 0900-2100 (10) Provider: STEARLE,CARLA D DURATION: (11) Special Instructions: (12) Dispense Drug U/D Inactive Date CARVEDILOL 12.5MG TAB U/D 0.5 Crime Scene: Units Per Dose (U/D) in the Dispense Drug Field Inaccurate

16. Solution: Check the Possible Dosages in Drug Enter/Edit – Unit Dose Entries should typically only have one possible dosage Carvedilol 6.25mg U/D – Possible Dosage: 6.25mg=1 tablet Carvedilol 12.5mg U/D – Possible Dosage: 12.5mg=1 tablet