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Steve Bowman R. Ph. Information Systems Consulting

Pharmacy Data Management. Steve Bowman R. Ph. Information Systems Consulting. Course Objectives. Describe the PDM Environment Terminology Tools Tips for proper set up & maintenance Identify common pharmacy problems in EHR Review solutions. Overview.

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Steve Bowman R. Ph. Information Systems Consulting

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

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

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

  4. 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)

  5. Configuration Files

  6. 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 èText 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 è 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 • 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

  7. Terminology – Standard Schedules • 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 Expansionè 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. • Frequencyè # 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. 06-10-16-22

  8. Terminology–Medication Instructions • 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 • Expansionè Text that will print on the label • Package Useè ALL (inpatient & outpatient) • Leave other fields blank (Synonym, Med Route, Schedule)

  9. Terminology – Synonyms • 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) • Used by Providers to select meds in POE/EHR • Use Edit Orderable Items to add/modify the Synonym field

  10. Terminology – Dosages • 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 % strengths Ophthalmics/Otics Inhalers Topicals Rectal/Vaginal Injections • 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

  11. Terminology – Dosage Form • Associated with Orderable Items • Dosage Form File holds • Nouns • Verbs • Routes • Prepositions • PDM Dosages Dosage Form File Enter/Edit • Delete prepositions (should all have been deleted via FM Loop Delete) • when sigs have double prepositions i.e. BY BY MOUTH • Delete inappropriate routes • Modify missing or incorrect verbs or nouns • Appendix B of Handbook (recommended verb changes) • PDM  Orderable Item Maintenance Dispense Drug/Orderable Item Maintenance • To change an incorrect dosage form for an orderable Item • i.e. from TAB to TAB,EC Defaults for Orderable items to build SIGS Must all be deleted (are included in routes)

  12. 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 in POE

  13. The Drug File Key Fields • Dosages • DEA Special Handling • VA Drug Class Code • Inactive Date • POS information • Dispense Units • Order Units • NDC • Dispense Unit/Order Unit

  14. 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

  15. Create a HyperTerminal Connection • NSYN is 380 columns • NetTerm Truncates the report • All other Reports work fine with NetTerm or TeraTerm Click Start  Programs Accessories  Communications HyperTerminal

  16. Create a HyperTerminal Connection • In connection Description window Type RPMS for a Name  Select an Icon click OK • In the Connect to window Go to the connect using dropdown and switch to TCP/IP Type the IP address for your RPMS server in the Host address box  click OK Save a shortcut Icon for this on your Desktop

  17. 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 & 99999 rows • Before hitting the enter key Select Transfer  Capture name the file & where to save it

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

  19. 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

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

  21. Click – OK on the IMPORT DATA screen • 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 Select one that will help make the lines easier to read (I like List 1 or 3D Effects 2) - Click OK

  22. 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

  23. 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

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

  25. Standard Files Adding Medication Routes • PDM èMed. 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 Include the Preposition

  26. Standard Files Adding/Editing 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: Can force an entry by using “ ”i.e. if MO was already in the file

  27. Standard Files Adding Med Instructions • PDM  Medication Instruction File Add/Edit 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

  28. Setting Up the SIG defaults • Ensure accurate orders from providers • Edit Orderable Items to add/correct • Default route (all non-orals) • Schedule • Pt. Instructions • Synonym (Trade Names – to assist providers) • Drug Enter/Edit • For Dosages/LPDs • NDF Matching • POS Fields • Dosages Enter/Edit • For Dosages/LPDs • Dosage Form Edit • To correct verbs/nouns • To remove prepositions

  29. 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

  30. Changing Incorrect Dosage Forms • If Orderable Item has an incorrect dosage Form • Nouns, verbs may be wrong in SIGS • Ensure that Drug is correctly matched to the NDF • 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 to ASPIRIN 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// <ENTER> 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// <ENTER> Match Complete! Now editing Orderable Item: ASPIRIN 325MG TAB,EC FORMULARY STATUS:

  31. Adding New Dosages • Dosages are 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 NOT0.5 Never edit the strength here! Automatically created when drug was matched to the NDF

  32. Adding Local Possible Dosages • 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. What you type is what you get – Abbreviations do NOT expand MG do NOT calculate

  33. 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)

  34. Deleting 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: 1 0.4 IO 2 0.8 IO Select DISPENSE UNITS PER DOSE: 2 DISPENSE UNITS PER DOSE: 2// @ 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:

  35. Deleting 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 Suppository IO 2 Suppositories IO LOCAL POSSIBLE DOSAGE : 2// @ 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

  36. Drug Enter/Edit Generic Name, Strength, dosage form GENERIC NAME: DORZOLAMIDE 2% SOL,OPH Are you adding 'DORZOLAMIDE 2% SOL,OPH' as a new DRUG (the 2632ND)? No// Y DRUG NUMBER: 85620// DRUG VA CLASSIFICATION: DRUG FSN: DRUG NATIONAL DRUG CLASS: DRUG CURRENT INVENTORY: DRUG LOCAL NON-FORMULARY: DRUG INACTIVE DATE: DRUG MESSAGE: DRUG RESTRICTION: GENERIC NAME: DORZOLAMIDE 2% SOL,OPH Replace 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: Automatically assigned by FM Don’t enter manually, NDF match will add this 6=legend, 9=OTC I-IV for scheduled, need B to allow RF, P= dated item Leave blank – not seen in EHR – use OI synonym Do not use the NDC field here- Enter it further Down WILL DISPLAY TO PROVIDER ON POE- restrictions like outside Rx only, or limited to 3rd party pay Date item no longer stocked –NOT the expiration date! Never delete a Drug – Use this field to make them non-selectable

  37. WARNING LABEL: ORDER UNIT: BT DISPENSE UNIT: ML DISPENSE UNITS PER ORDER UNIT: 10 NDC: 00006-3519-36 PRICE PER ORDER UNIT: LAST PRICE UPDATE: AWP PER ORDER UNIT 7.25: AWP PER DISP UNIT is: 00007.425000 SOURCE OF SUPPLY: DISPENSING LOCATION: STORAGE LOCATION: PRICE PER DISPENSE UNIT: Do you wish to match/rematch to NATIONAL DRUG file? Yes// Deleting Possible Dosages... Match local drug DORZOLAMIDE 2% SOL,OPH ORDER UNIT: BT DISPENSE UNITS/ORDER UNITS: 10 DISPENSE UNIT: ML I will try to match NDC: 00006-3519-36 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 DORZOLAMIDE 2% SOL,OPH Now select VA Product Name 1 DORZOLAMIDE HCL 2% SOLN,OPH SOLN,OPH OP109 D0286 Enter your choice: 1 Will print with VA laser labels, Enter the #s separated by commas Container item purchased in Dose of the order unit i.e. GM, ML, TAB, CAP Must use 5-4-2 Use leading 0 if needed Automatically populated if matched based upon the NDC & Dispense Units Per Order Unit Must match to NDF to get VA Drug Class Will create multiple OIs if add new strength of Drug that had not been marched to NDF

  38. Is this a match < Reply Y, N or press return to continue > : Y • CHOOSE FROM: • 1 10 ML BOTTLE • 2 3 X 5 ML BOTTLE • 3 5 ML BOTTLE • 4 OTHER OTHER • Enter Package Size & Type Combination: 1 • Local drug DORZOLAMIDE 2% SOL,OPH • matches DORZOLAMIDE HCL 2% SOLN,OPH • PACKAGE SIZE: 10 ML • PACKAGE TYPE: BOTTLE • < Enter "Y" for yes > < Enter "N" for no > OK? : Y • LOCAL DRUG NAME: DORZOLAMIDE 2% SOL,OPH • ORDER UNIT: BT • DISPENSE UNITS/ORDER UNITS: 10 • DISPENSE UNIT: ML • VA PRODUCT NAME: DORZOLAMIDE HCL 2% SOLN,OPH • VA PRINT NAME: DORZOLAMIDE HCL 2% OPH SOLN CMOP ID: D0286 • VA DISPENSE UNIT: ML MARKABLE FOR CMOP: YES • PACKAGE SIZE: 10 ML • PACKAGE TYPE: BOTTLE • VA CLASS: OP109 ANTIGLAUCOMA,OTHER • CS FEDERAL SCHEDULE: • INGREDIENTS: DORZOLAMIDE HYDROCHLORIDE 2 % • NATIONAL FORMULARY INDICATOR: YES • NATIONAL FORMULARY RESTRICTION: • < Enter "Y" for yes, "N" for no > Is this a match ? Y Must say yes to each prompt or match will or complete

  39. You have just VERIFIED this match and MERGED the entry. • Resetting Possible Dosages.. Press Return to continue: <ENTER> • Do you want to edit Local Possible Dosages? N// Y • Strength: 2 Unit: % • Select LOCAL POSSIBLE DOSAGE: 1 DROP • Are you adding ‘1 DROPS' as a new LOCAL POSSIBLE DOSAGE (the 1ST for this DRUG)? No// Y • PACKAGE: OI Both • LOCAL POSSIBLE DOSAGE: 2 DROPS • Are you adding '2 DROPS' as a new LOCAL POSSIBLE DOSAGE (the 2ND for this DRUG)? No// Y • PACKAGE: OI Both • Select LOCAL POSSIBLE DOSAGE: • MARK THIS DRUG AND EDIT IT FOR: • O - Outpatient • U - Unit Dose • I - IV • W - Ward Stock • D - Drug Accountability • C - Controlled Substances • X - Non-VA Med • A - ALL • Enter your choice(s) separated by commas : O,X • ** You are NOW editing OUTPATIENT fields. ** • AN Outpatient Pharmacy ITEM? No// Y (Yes) • CORRESPONDING INPATIENT DRUG: • MAXIMUM DOSE PER DAY: • LOCAL NON-FORMULARY: • NORMAL AMOUNT TO ORDER: Now prompted to ad Dosage or, in this case LPDs Put in all appropriate codes, use X to allow use of upcoming Outside Rx functions. Do NOT mark for Ward stock here

  40. SOURCE OF SUPPLY: CURRENT INVENTORY: ACTION PROFILE MESSAGE (OP): MESSAGE: QUANTITY DISPENSE MESSAGE: OP EXTERNAL DISPENSE: Do you wish to mark/unmark as a LAB MONITOR or CLOZAPINE DRUG? Enter Yes or No: N ** You are NOW Marking/Unmarking for NON-VA MEDS. ** A Non-VA Med ITEM? No// Y (Yes) ** You are NOW in the ORDERABLE ITEM matching for the dispense drug. ** There are other Dispense Drugs with the same VA Generic Name and same Dose Form already matched to orderable items. Choose a number to match, or enter '^' to enter a new one. Disp. drug -> DORZOLAMIDE 2% SOL,OPH 1 DORZOLAMIDE SOLN,OPH Choose number of Orderable Item to match, or '^' to enter a new one: 1 Matching DORZOLAMIDE 2% SOL,OPH to DORZOLAMIDE SOLN,OPH Is this OK? YES// Match Complete! Now editing Orderable Item: DORZOLAMIDE SOLN,OPH FORMULARY STATUS: Clozapine always No. Can link drugs to specific lab tests (not panels) Now linking item to OI for POE

  41. If have created a Drug Text entry (dosing Table etc), can attach it to OI here Select OI-DRUG TEXT ENTRY: INACTIVE DATE: DAY (nD) or DOSE (nL) LIMIT: MED ROUTE: OPHTHALMIC// SCHEDULE TYPE: SCHEDULE: Q8H// PATIENT INSTRUCTIONS: FGL Select SYNONYM: TRUSOPT SYNONYM: TRUSOPT// Select SYNONYM: Blank = PO Expands to FOR GLAUCOMA Add Trade Names to assist providers with item selection in POE

  42. Troubleshooting Order Entry problems

  43. Problem  Missing Dosage Cause  Dosages not set up Normally expect Dosages of 1 and 2 to be automatically created when new single entity tablet is added

  44. Solution  Add Dosages • Two Tools • Drug Enter/Edit • Enter/Edit Dosages PDM Drug Enter/Edit GENERIC NAME: DIVALPROEX// DIVALPROEX 500MG VA CLASSIFICATION: DEA, SPECIAL HDLG: 6P// NATIONAL FORMULARY INDICATOR: LOCAL NON-FORMULARY: ^ST Storage Location: Do you wish to match/rematch to NATIONAL DRUG file? Yes// <enter> 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: 00074-6154-13 to NDF. No match on that NDC.... 1 DIVALPROEX NA 500MG TAB,EC TAB,EC (DELAYED RELEASE) CN400 D0566 Enter your choice: 1 Is this a match < Reply Y, N or press return to continue > : Y CHOOSE FROM: 1 100 BOTTLE 2 100 UNIT DOSE 3 500 BOTTLE 4 OTHER OTHER Enter Package Size & Type Combination:1 Not Matched To NDF

  45. Do you wish to match/rematch to NATIONAL DRUG file? Yes// <enter> 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: 00074-6154-13 to NDF. No match on that NDC.... 1 DIVALPROEX NA 500MG TAB,EC TAB,EC (DELAYED RELEASE) CN400 D0566 Enter your choice: 1 Is this a match < Reply Y, N or press return to continue > : Y CHOOSE FROM: 1 100 BOTTLE 2 100 UNIT DOSE 3 500 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 < Enter "Y" for yes >< Enter "N" for no > OK? : Y LOCAL DRUG NAME: DIVALPROEX 500MG (DELAYED RELEASE) ORDER UNIT: BT DISPENSE UNITS/ORDER UNITS: 1 DISPENSE UNIT: TAB Run Through NDF Match to get to Dosages

  46. Editing Dosages with Drug Enter/Edit 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 Normally expect single entity Tabs/Caps to allow entry of Dosages (dispense Units)

  47. 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 LOCAL POSSIBLE DOSAGE: 500MG// 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 LOCAL POSSIBLE DOSAGE: 1000MG// PACKAGE: OI Both Strength: 500 Unit: MG These LPDs will not expand correctly

  48. Editing Dosages with Enter/Edit Dosages PDM Dosages  Dosages Enter/Edit Select Drug: DIVALPROEX 500MG (DELAYED RELEASE) CN400 00074-6154-13 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 These LPDs will expand correctly

  49. Dosages Now Appear

  50. Problem  Missing Verb, Route, Noun No Route Drug is missing a verb & noun Cause  Dosage Form is missing data • Check the NDF match for this item - if it’s OK – • Enter/Edit Dosage Form

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