1. Main Drug File Pharmacy Data Management (PDM) Urban Health Programs August 2010

2. Section Objectives Describe and manage Drug File –Menu Options –Interaction between options Demonstrate proper set up Describe how Drug File relates to EHR use

3. Overview Pharmacy Data Management set up –The baseline for how well medication management will work for users across disciplines Impacts –Providers –Nurses –MAs –Outside pharmacies (esp. with new patches/packages)

4. Pharmacy Data Management 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

5. Drug Enter/Edit Key Fields: –DEA, Special Handling –VA Drug Class –Inactive Date –Other: Dispense Unit Order Unit Dispense Units/Order Unit Dispense Unit NCPDP code NDC

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

7. Main Drug File fields GENERIC NAME: AMOXICILLIN 250MG CAP  use standard format VA CLASSIFICATION: AM111//  from NDF match DEA, SPECIAL HDLG: 6//  use “??” to see choices NATIONAL FORMULARY INDICATOR: YES  from NDF match LOCAL NON-FORMULARY: VISN NON-FORMULARY:  for VA, from NDF match Select DRUG TEXT ENTRY:  information about drug viewable in EHR Select FORMULARY ALTERNATIVE:  pops up in EHR Select SYNONYM: AMOXIL//  does not show in EHR SYNONYM: AMOXIL// INTENDED USE: TRADE NAME// NDC CODE:  NOT the main NDC code for the drug file entry Select SYNONYM: MESSAGE:  pops up in EHR, sometimes RESTRICTION:  not for IHS FSN:  no longer needed

8. Main Drug File fields, cont. INACTIVE DATE:  controls whether drug is useable or not WARNING LABEL:  not visible in most places, esp EHR ORDER UNIT: BT// DISPENSE UNIT: CAP// DISPENSE UNITS PER ORDER UNIT: 500// DISPENSE UNIT NCPDP CODE:  will be used (eventually) for e-Rx NDC: 00093-3107-05//  in 5-4-2 format PRICE PER ORDER UNIT: LAST PRICE UPDATE: AWP PER ORDER UNIT: 118.95//  will fill in if Order Unit, etc correct AWP PER DISP UNIT is 000000.23790  calculates from AWP SOURCE OF SUPPLY:  not required DISPENSING LOCATION:  not required STORAGE LOCATION:  not required PRICE PER DISPENSE UNIT:  will calculate if price per order unit entered

9. NDC field Important for National Drug File matching, CRS/GPRA, billing, ePrescribing, etc. Must be in 5-4-2 format –If NDC on bottle is not in 5-4-2, add zeros to the front of the affected section: 0409-324-01 is converted to 00409-0324-01 –NDCs from NDF are 12 digits, not 11, and without dashes—work backward to get proper number: 000409032401 is converted to 00409-0324-01 and the initial digit is discarded

10. AWP Usually used for billing Getting an AWP filled in does confirm the drug file was entered properly –Order Unit –Dispense Unit –Dispense Units per Order Unit –NDC AWP updates are sent out periodically –TaskMan task “APSA AWP AUTO QUEUE” should be running daily (not less than weekly) –Generates MailMan bulletins that usually need to be addressed

11. MailMan Bulletin examples Subj: Outpatient Pharmacy AWP Automatic Update [#12995] 02/23/10@15:04 200 lines From: OUTPATIENT PHARMACY DEVELOPER In 'IN' basket. Page 1 ------------------------------------------------------------------------------- A Pricing update was performed on your system on FEB 23,2010. The total number of records updated = 650 Listed below are the active drugs that were not updated and the error codes. Please review and correct all errors before attempting to run the manual AWP update option. Note: any 'missing 660 node' errors means that information like (ie. Reorder Level, Order Unit, Price Per Order Unit, Dispense Units Per Order unit, Price Per Dispense Unit, etc) is missing! DOPamine 400MG/250ML INJ - MISSING 660 NODE IN DRUG FILE BETHANECHOL 10MG TAB U/D - MISSING DISPENSE UNIT IN DRUG FILE ACETAMINOPHEN 120MG SUPP - DISP UNITS DON'T MATCH - Medi = 237 / Local = 12 ACYCLOVIR 200MG CAPS - NDC'S DON'T MATCH ACETAMINOPHEN 120MG SUPP - NO ACTUAL ACQUISTION PRICE FOR THIS NDC IN AWP MED-TRANSACTION FILE

12. MailMan Bulletin Fixes Missing 660 Node –explained in the message text –ignore the “reorder level” part Missing dispense unit –important part is the “dispense units per order unit” –the order unit and dispense unit flow from that –until you gain experience, knowing what to put is a bit of a guess Disp Units Don’t Match –tells you exactly what should be in the dispense units per order unit field –it will be up to you to figure out what the order unit and the dispense unit should be –“Medi” is the National file (and what you SHOULD have); “Local” is what you have there now

13. MailMan Bulletin Fixes, cont. NDC’s don’t match –an NDC in the drug file does NOT match the drug, dispense units, and package size of the item it is matched to in the National Drug File –Check the shelf for the item you actually have note that NDCs on cases *might* be different from the NDC on an individual item –OR check the NDF for an updated NDC and/or package size No Actual Acquisition price –can be ignored, as it is NOT tied to the price per order unit field –Because the error messages are grouped by type of error (all the missing NDCs will be together, etc); and because this is ALWAYS the last one in the messages, once you hit this error you can delete the rest of the messages.

14. Limit drug file access to a few trained people Limit number of staff making quick orders Conduct random quick order checks Use your colleagues for input Recommendations