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Defaulting PHA Inpatient Label Comments Based on Dose

Defaulting PHA Inpatient Label Comments Based on Dose. Herb Bromenshenkel RPh North Country Health Services. Pyxis screen . North Country Health Services. Pharmacy Information. MEDITECH Magic since 1990 Pyxis machines in all areas No inpatient cart fill Meds loaded and unloaded as needed

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Defaulting PHA Inpatient Label Comments Based on Dose

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  1. Defaulting PHA Inpatient Label Comments Based on Dose Herb Bromenshenkel RPh North Country Health Services

  2. Pyxis screen

  3. North Country Health Services

  4. Pharmacy Information • MEDITECH Magic since 1990 • Pyxis machines in all areas • No inpatient cart fill • Meds loaded and unloaded as needed • Custom load reports • Manual MAR, Not generated by MEDITECH

  5. Pyxis Information • First line of label comments flows to Pyxis machine and displays for nurse • Dose is not always the same unit stored in Pyxis • 2 tabs • ½ tabs • Injections: Solumedrol 80 mg (1.28 ml)

  6. Pharmacy Enters Label Comments • To aid nursing, pharmacy would enter dose comments in line 1 of label comments. • Pharmacy tried for standard format: • Examples: • Dose: 1.28 ML = 80 MG • Solumedrol 80mg (125 mg/2 ml) • Dose: 1.5 TABS X 40 MG = 60 MG • Furosemide 40 mg tab

  7. Problems with Pharmacy Entry • Format not consistent • Goal was for nurse to see volume or number of tabs before size of product • I.e.: Dose: 1.5 TABS x 40 MG = 60 mg • vs.: Dose: 40 mg x 1.5 Tabs = 60 mg • Possibility for error due to calculation or typo

  8. Solution • Rule determines if dose is different than dispensing size. • If different: • Rule calculates dose string • Rule prompts user with string • User specifies if rule sets first line in label comments • Customized post live • No messages for: Senokot 2 tabs • Dose 1 x 2 TABS = 2 TABS

  9. What Displays • Varies if tabs/caps versus liquids/injections • Tabs/Caps: • *Dose: 0.5 TABS X 20 MG = 10 MG • *Dose: 2 TABS X 20 MG = 40 MG • Liquids/Injections: • *Dose: 1.28 ML = 80 MG • We put an “*” to indicate which ones computer set (quality assurance)

  10. Actual Display

  11. Key Points • Rule only sets comment if user selects “Y” • If comments exist, they are moved down 1 line • What it is going to be does not display unless user enter/Edit label comments • Once user enters “Y” at Edit label Comments, set comments display • If doing multiple dose edits on same rx, best to exist and come in and make one change • Have done, without problems

  12. When Select Edit Label Comments

  13. Other Examples:

  14. Setup

  15. Computer Set • One Rule • Numerous Custom Keywords • Most keywords pull simple data • Two keywords more extensive • Determines units/dose • Runs report to set Label Comments • Keyword used in rule runs NPR report which puts the comments into the data structure

  16. Simple Keywords • z label.comment.1 • @label.comment[1] • z dose.and.unit • @PHA.RX.dose.and.unit • Z drug.order.size • @PHA.DRUG.order.size[@med] • Z drug.order.unit • @PHA.DRUG.order.unit[@med]

  17. More Complex Keywords #1 • z disp.form.p.dose.un IF{@dose^V1, @PHA.DRUG.order.unit[@med]^V1A, @PHA.DRUG.order.size[@med]^V2, @PHA.DRUG.dispense.size[@med]^V3, @PHA.DRUG.strength.amt1[@med]^ST1, @PHA.DRUG.strength.amt2[@med]^ST2, @PHA.DRUG.dispense.unit[@med]^VU, @PHA.DRUG.dispense.form[@med]^VF, @PHA.DRUG.admin.form[@med]^AF, IF{(V2=V3)&(AF'=V1A) 1, IF{V2'=V1 1, V1:10D/V2^VR, VR:3D^VR, %Z.strip.trailing.zeros(VR)^MSDOSE, "*Dose: "_MSDOSE_" "_VF_"S X "_V3_" "_V1A_" = "_V1_" "_V1A^/Z.INFO}; IF{(AF'=V1A) 1, ST1:10D/ST2^CON, %Z.strip.trailing.zeros(CON)^CON, V1:10D/CON^VR, VR:3D^VR, %Z.strip.trailing.zeros(VR)_" "_VU^MSDOSE, "*Dose: "_MSDOSE_" = "_V1_" "_V1A^/Z.INFO};1;1}}

  18. More Complex Keyword #2 • z set.lab.com.1.4 • %PHA.RX.zcus.hab.rule.label.comment.1.4.M.ck(urn); • Rule runs report which files data to data structure

  19. Report

  20. Report Macro – Copy/Paste IF{/RULE.EVAL="REFILL"!(/RULE.EVAL="TXN") ^?;^/}^q, @Chg.prefix(PHA.RX,?,[q]), IF{/RULE.EVAL="REFILL"!(/RULE.EVAL="TXN") ^:;^/}^c, @Chg.prefix(PHA.RX,:,[c]), /patient^patient,/urn^urn, /PHA.REF.urn^PHA.REF.urn,/med^med,@t.med.rule^med.rule,/txn.date^txn.date,/txn.q^txn.q, /Z.INFO^LAB1, IF{/TR[urn]CM[1]$5="*Dose" LAB1^/TR[urn]CM[1]; /TR[urn]CM[4]^/TR[urn]CM[5],/TR[urn]CM[3]^/TR[urn]CM[4],/TR[urn]CM[2]^/TR[urn]CM[3], /TR[urn]CM[1]^/TR[urn]CM[2], LAB1^/TR[urn]CM[1]},1;

  21. Actual Rule

  22. Rule Code to Copy/Paste [f z label.comment.1]^LAB1, [f z dose.and.unit]^DOSEU, [f z drug.order.size]_" "_[f z drug.order.unit]^ORDD, IF{DOSEU=ORDD 1; [f rx dose]^CDOSE, [f rx start date]^STK, [f rx pt type]^PTY, [f rx ord type]^OTY, IF{STK_.=.!(PTY="OUT")!(CDOSE=0)!(OTY'="M") 1; IF{[f rx dose]=0&(OTY'="M") 1; [f z disp.form.p.dos.un]^INFO, IF{INFO=1!(INFO=LAB1)!(INFO_.=.) [f rx ok]; ("Set Internal Label Comments to:"_INFO)^ASK, IF{1'=[f rx yes/no](ASK) 1;[f z set.lab.com.1.4]}}};1}};

  23. Where activated - CDP

  24. Questions Herb Bromenshenkel RPH hbromenshenkel@nchs.com 218-333-5527

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