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Medication Quick Orders

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Medication Quick Orders

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    1. 1 Medication Quick Orders Basics of Creation & Maintenance

    2. 2 Ralph H. Johnson VA Medical Center Charleston, South Carolina

    3. 3 Ralph H. Johnson VA Medical Center 98 Bed Primary, Secondary, & Tertiary Care 28 Bed Nursing Home Acute Medical, Surgical & Psychiatric Inpatient Care Primary & specialized outpatient Services Outpatient Clinics in Savannah, GA; Myrtle Beach, Beaufort, & Goose Creek, SC Affiliated with Medical University of South Carolina (88 Medical Residents

    4. 4 Steve Cagle Pharmacist – BS Pharmacy 1967 UNC-Chapel Hill School of Pharmacy 3 years US Army (Fort Sam Houston,TX/Fort Polk,LA/45th Field Hosp-Vicenza,Italy) Community Pharmacies (3) – NC VAMC Long Beach ’78-86 VAMC San Diego ’86-’88 VAMC Charleston ‘88-present Staff Pharmacist Pharmacy ADPAC Computer Applications Coordinator

    5. 5 Planning Process issues - Ward /Clinic Administered vs. Dispensed to Outpatient Pharmacy Issues: -Ward Stock/Pyxis/Pharmacy Preparation & Delivery BCMA involved -Different Dispense Drugs on Different Wards Divisional differences - Main Facility vs CBOC Manipulate Existing Quick Order vs creation of new one Menu Placement -Menu - submenus Test Menu for CACs or Test Users -create Provider Menu for major testers -create standard Provider menu + Test Menu (Copy) Process issues: -How does med arrive for end user -Pyxis stocked (floor) – UD delivery – IV Room preparation -Clinic vs Ward administered -Pre-OP on same day admission -Know or researching -May determine how much text needed on menu (exp. Teaching facility) Test Menu for Provider: ORWDX WRITE ORDERS LIST Menu for Write Orders List 1 ORZ ADD MENU BEAUFORT GUI V16 (W/TEST) 2 ORZ ADD MENU CLINICIAN GUI V14 (W/TEST) 3 ORZ ADD MENU CLINICIAN HBPC (W/TEST) 4 ORZ ADD MENU CLINICIAN PULMONARY GUI V14 W/TEST 5 ORZ ADD MENU CLINICIAN SURGERY GUI V14 (W/TEST) Process issues: -How does med arrive for end user -Pyxis stocked (floor) – UD delivery – IV Room preparation -Clinic vs Ward administered -Pre-OP on same day admission -Know or researching -May determine how much text needed on menu (exp. Teaching facility) Test Menu for Provider: ORWDX WRITE ORDERS LIST Menu for Write Orders List 1 ORZ ADD MENU BEAUFORT GUI V16 (W/TEST) 2 ORZ ADD MENU CLINICIAN GUI V14 (W/TEST) 3 ORZ ADD MENU CLINICIAN HBPC (W/TEST) 4 ORZ ADD MENU CLINICIAN PULMONARY GUI V14 W/TEST 5 ORZ ADD MENU CLINICIAN SURGERY GUI V14 (W/TEST)

    6. 6 Trial & Error Make a Test Menu for your use Give to those who help All Pharmacist Multiple Vista Sessions – copy & paste Test Menu for Meds Pharmacist Provider Menu + TestTest Menu for Meds Pharmacist Provider Menu + Test

    7. 7 My Test Menu – Pretty Chaotic 3 times this size because I purge it infrequently3 times this size because I purge it infrequently

    8. 8 Create Test Menu for Provider Very easy to copy an existing Provider Menu & add the Test Menu 5 Steps The substitute this menu for the Provider’s current menu under ORWDX WRITE ORDERS LIST Menu for Write Orders List CHOOSE 1-2: 2 ORWDX WRITE ORDERS LIST Menu for Write Orders List ORWDX WRITE ORDERS LIST may be set for the following: 2 User USR [choose from NEW PERSON] 4 Location LOC [choose from HOSPITAL LOCATION] 5 Service SRV [choose from SERVICE/SECTION] 7 Division DIV [choose from INSTITUTION] 8 System SYS [TEST.CHARLESTON.MED.VA.GOV] Enter selection: 2 User NEW PERSON Select NEW PERSON NAME: TRIAGE,DR DT 114 RESIDENT ------------ Setting ORWDX WRITE ORDERS LIST for User: TRIAGE,DR ------------ Order Dialog: ORZ ADD MENU CLINICIAN GUI V14 (W/TEST)// Very easy to copy an existing Provider Menu & add the Test Menu 5 Steps The substitute this menu for the Provider’s current menu under ORWDX WRITE ORDERS LIST Menu for Write Orders List CHOOSE 1-2: 2 ORWDX WRITE ORDERS LIST Menu for Write Orders List ORWDX WRITE ORDERS LIST may be set for the following: 2 User USR [choose from NEW PERSON] 4 Location LOC [choose from HOSPITAL LOCATION] 5 Service SRV [choose from SERVICE/SECTION] 7 Division DIV [choose from INSTITUTION] 8 System SYS [TEST.CHARLESTON.MED.VA.GOV] Enter selection: 2 User NEW PERSON Select NEW PERSON NAME: TRIAGE,DR DT 114 RESIDENT ------------ Setting ORWDX WRITE ORDERS LIST for User: TRIAGE,DR ------------ Order Dialog: ORZ ADD MENU CLINICIAN GUI V14 (W/TEST)//

    9. 9 Provider Menu w/Test

    10. 10 Search/replace orderables [ORCM SEARCH/REPLACE ORDERABLES] (SR) Identifies Quick Orders containing the Orderable Items Search for: LamiVUD 1 LamiVUDINE SOLN,ORAL 2 LamiVUDINE TAB CHOOSE 1-2: Search for: LAMIVUD 1 LAMIVUDINE ?Non-Medication Orderable Item 2 LAMIVUDINE/ABACAVIR ABACAVIR/LAMIVUDINE TAB 3 LAMIVUDINE/ZIDOVUDINE TAB 4 LAMIVUDINE/ZIDOVUDINE/ABACAVIR TAB *Search/replace orderables [ORCM SEARCH/REPLACE ORDERABLES] (SR) -Primary Search funciton -entire ORDERABLE ITEM FILE =some are not Pharmacy OI if no Dosage Form behind entry -Caution: Tallman Lettering affects search -Naming conventions in #50.7 -- PHARMACY ORDERABLE ITEM FILE -Routine: Lookup into Dispense Drug File [PSS LOOK] *Search/replace orderables [ORCM SEARCH/REPLACE ORDERABLES] (SR) -Primary Search funciton -entire ORDERABLE ITEM FILE =some are not Pharmacy OI if no Dosage Form behind entry -Caution: Tallman Lettering affects search -Naming conventions in #50.7 -- PHARMACY ORDERABLE ITEM FILE -Routine: Lookup into Dispense Drug File [PSS LOOK]

    11. 11 Personal Quick Orders Naming conventions – -Numerous people over time using different techniques -Hard to go back and clean up – good if you can -ZZ** -PSIN = Inpatient Medications = Units Dose Medications with CPRS v27Naming conventions – -Numerous people over time using different techniques -Hard to go back and clean up – good if you can -ZZ** -PSIN = Inpatient Medications = Units Dose Medications with CPRS v27

    12. 12 Lookup into Dispense Drug File [PSS LOOK] Useful Routine: Lookup into Dispense Drug File [PSS LOOK] Ward to Ward variation – BCMA specific for a Dispense DrugUseful Routine: Lookup into Dispense Drug File [PSS LOOK] Ward to Ward variation – BCMA specific for a Dispense Drug

    13. 13 Pharmacy Orderable Item File (#50.7) Know the relationship between Dispense Drug & Pharmacy Orderable Item -Lookup into Dispense Drug File helps Know the relationship between Dispense Drug & Pharmacy Orderable Item -Lookup into Dispense Drug File helps

    14. 14 MM Order Menu Management ... [ORCM MGMT] OI Manage orderable items ... [ORCM ORDERABLES MENU] PM Enter/edit prompts [ORCM PROMPTS] GO Enter/edit generic orders [ORCM ORDERS] QO Enter/edit quick orders [ORCM QUICK ORDERS] QU Edit personal quick orders by user [ORCM QUICK ORDERS BY USER] ST Enter/edit order sets [ORCM ORDER SETS] AC Enter/edit actions [ORCM ACTIONS] MN Enter/edit order menus [ORCM MENU] **> Locked with ZZOR MENU AO Assign Primary Order Menu [OR PARAM ADD MENU] CP Convert protocols [ORCM PROTOCOLS] SR Search/replace components [ORCM SEARCH/REPLACE] LM List Primary Order Menus [ORCM LIST ORDER MENUS] DS Disable/Enable order dialogs [ORCM DISABLE] CS Review Quick Orders for Inactive ICD9 Codes [ORCM GMRC CSV CHECK] MR Medication Quick Order Report [OR MEDICATION QO CHECKER] CV Convert IV Inpatient QO to Infusion QO [OR CONVERT INP TO IV] Initial search – what exists already using “Enter/Edit Quick Orders” -before you create the QO use use a few critical characters -have to know how they start out however (PS, ORZ, etc.) Initial search – what exists already using “Enter/Edit Quick Orders” -before you create the QO use use a few critical characters -have to know how they start out however (PS, ORZ, etc.)

    15. 15 Search/replace components [ORCM SEARCH/REPLACE] Searches on “Display Text” Learning something new! Searches on “Display Text” as well as the “Name” FieldLearning something new! Searches on “Display Text” as well as the “Name” Field

    16. 16 Enter/edit quick orders [ORCM QUICK ORDERS] Select QUICK ORDER NAME: PS,ACETAMINO 26 PSIN AN ACETAMINOPHEN 650MG PO ON CALL PREMED 27 PSO ACETAMINOPHEN 1GM PO ONCE PRN PAIN/FEVER 28 PSO ACETAMINOPHEN 500MG PO Q6H PRN(AMB SURG) 29 PSO ACETAMINOPHEN 650MG PO Q6H PRN 30 PSO ACETAMINOPHEN SUPPOSITORY (PAL) 31 PSO AN ACETAMINOPHEN 650MG PO PRE-MED 32 PSO AN ACETAMINOPHEN 650MG PO PREMED 33 PSUD ACETAMINOPHEN 500MG PO ONCE PAIN/FEVER NHCU 33 results PS = Pharmacy Service Fewer characters using commas between keys words - broader search Requires that you have some knowledge of the sites naming conventions!33 results PS = Pharmacy Service Fewer characters using commas between keys words - broader search Requires that you have some knowledge of the sites naming conventions!

    17. 17 Enter/edit quick orders [ORCM QUICK ORDERS] Select QUICK ORDER NAME: PS,ACETAMINO,Q6H 1 PSNVA ACETAMINOPHEN 500MG PO Q6H PRN(AMB SURG) 2 PSIN ACETAMINOPHEN 1000MG PO Q6H PRN PAIN/FEVER 3 PSIN ACETAMINOPHEN 325MG PO Q6H PRN PAIN/FEVER 4 PSIN ACETAMINOPHEN 500MG PO Q6H PRN PAIN/FEVER 5 PSIN ACETAMINOPHEN 650MG PO Q6H PRN PAIN/FEVER 6 PSIN ACETAMINOPHEN 650MG PO Q6H PRN PAIN/FEVER (NHCU) 7 PSIN ACETAMINOPHEN 650MG PR Q6H PRN (ANTIPYRETIC) 8 PSIN ACETAMINOPHEN 650MG PR Q6H PRN PAIN/FEVER (NHCU) 9 PSIN ACETAMINOPHEN 650MG/20.3ML PO Q6H PRN (NHCU) 10 PSO ACETAMINOPHEN 500MG PO Q6H PRN(AMB SURG) 11 PSO ACETAMINOPHEN 650MG PO Q6H PRN PS ,Acetamino,Q6H Search reduced from 33 to 11 by being more specific and using comas -Naming convention previously used at site -Judgement -How many people potentially will use the Menu? Limited Menu for Specialist or for all of the Hospitalist? -Will it just be more confusing with drop-drown templates? (NOT) -Will it less efficient in the long run?PS ,Acetamino,Q6H Search reduced from 33 to 11 by being more specific and using comas -Naming convention previously used at site -Judgement -How many people potentially will use the Menu? Limited Menu for Specialist or for all of the Hospitalist? -Will it just be more confusing with drop-drown templates? (NOT) -Will it less efficient in the long run?

    18. 18 Limited File Manager – Read Only Quickly review Contents of existing QO Inquire to File Entries List File Attributes Print File Entries Search File Entries Statistics Select Limited File manager Option: Inquire to File Entries OUTPUT FROM WHAT FILE: ORDER DIALOG// Select ORDER DIALOG NAME: See details easily Limited File Manager – Read Only access – valuable tool Drug File Pharmacy Orderable Item Orderable ItemSee details easily Limited File Manager – Read Only access – valuable tool Drug File Pharmacy Orderable Item Orderable Item

    19. 19 Fileman view of a Quick Order – use to ignoring the scaffolding which contains ingredients -scan for essential ingredients Quick check the main features of the QO -adaptable with addition of drop-down menu in Provider Comments? -decision: -use an existing dialog & add some template fields to Prov.Comments? -need to include to the Provider doesn’t have to change anything? -no right/wrong – refects experience – risk associated with the medication (Aspirin oral vs Heparin IV) -who will be using – Specialist/experienced Resident or rotating housestaff. COPY Function does not exist for a Quick Order – as it does for a Menu. Fileman view of a Quick Order – use to ignoring the scaffolding which contains ingredients -scan for essential ingredients Quick check the main features of the QO -adaptable with addition of drop-down menu in Provider Comments? -decision: -use an existing dialog & add some template fields to Prov.Comments? -need to include to the Provider doesn’t have to change anything? -no right/wrong – refects experience – risk associated with the medication (Aspirin oral vs Heparin IV) -who will be using – Specialist/experienced Resident or rotating housestaff. COPY Function does not exist for a Quick Order – as it does for a Menu.

    20. 20 Unit Dose Quick Order Fields

    21. 21 Entering a New Quick Order QO Enter/edit quick orders Select QUICK ORDER NAME: You may enter a new ORDER DIALOG, if you wish Answer must be 3-63 characters in length. *Naming conventions at your site (if they make sense) or create your own *Internal usage of CACs *Transparency – ease of location

    22. 22 Word Count Place “Word Count” into your ribbon for convenience Word Document Type text – highlight – Click Word Count icon Place “Word Count” into your ribbon for convenience Word Document Type text – highlight – Click Word Count icon

    23. 23 Naming Conventions - Prefix Outpatient Medication PSO prefix Unit Dose Medication PSUD prefix IV Medications PSIV prefix Non-VA Medications PSNVA prefix Develop consistent naming conventions -find later -not easy software changes -return & edit old entries? Tough call. -change your mind – ideas evolve as things become more complex Searches made easierDevelop consistent naming conventions -find later -not easy software changes -return & edit old entries? Tough call. -change your mind – ideas evolve as things become more complex Searches made easier

    24. 24 Type of Quick Order DISPLAY GROUP NAME ACTIVITY ANTINEOPLASTICS ANTINEOPLASTICS IV ANTINEOPLASTICS OPT ANTINEOPLASTICS UD BLOOD PRODUCTS CARDIOLOGY CONDITION CONSULTS DIAGNOSIS DIALYSIS DIET ADDITIONAL ORDERS DIET ORDERS EARLY/LATE TRAYS GENERAL RADIOLOGY GI PROCEDURE IMAGING IV MEDICATIONS LABORATORY NHCU NON-VA MEDICATIONS NURSING OUTPATIENT MEALS OUTPATIENT MEDICATIONS POST OP PRE OP PRECAUTIONS PROCEDURES PROTOCOL SUPPLIES/DEVICES TUBEFEEDINGS UNIT DOSE MEDICATIONS VITALS/MEASUREMENTS Orders Tab Display Group – site set up may be more extensive locally Note: Clinic Orders is not available – UD & IV Qos -Note: Only see this prompt the first time through! -Need the Fileman Inquiry -Do homework & know processes: -IV vs Unit Dose Type (CPRS v27) expanded the IV Dialog -Pyxis – manufactured in Pharmacy – be kind to Phamacy -fewer edits – the better! -If the Finishing Pharmacist will have to convert to IV Format then Rule of Thumb - Place it in the IV Type to begin with. Orders Tab Display Group – site set up may be more extensive locally Note: Clinic Orders is not available – UD & IV Qos -Note: Only see this prompt the first time through! -Need the Fileman Inquiry -Do homework & know processes: -IV vs Unit Dose Type (CPRS v27) expanded the IV Dialog -Pyxis – manufactured in Pharmacy – be kind to Phamacy -fewer edits – the better! -If the Finishing Pharmacist will have to convert to IV Format then Rule of Thumb - Place it in the IV Type to begin with.

    25. 25 Dissecting a Quick Order Name PSUD HEPARIN 60 UNITS/KG IV PUSH CARD-ACS MD V09 <PREFIX – Display Identifier> <Orderable Item> <Dose> <Med Route> <Schedule> <Menu/Protocol> or <Unique Identifiers> Name: <3-63 character limit> <00 PSUD HEPARIN 60 UNITS/KG IV PUSH CARD-STEMI MD V09> <Return> -At a glance to see essential elements in dialog -easily retrievable -utility for CACs -Abbreviations Unique Identifiers (e.g. “AN” for ‘Antineoplastic’) LMWH = Low Molecular Weight Heparin -Uppercase -Prefix – identifies Display Group – IV Meds – Unit Dose – Opt –NVA -Evolve -attaching a date identifier -Whatever works for you & your colleagues Name: <3-63 character limit> <00 PSUD HEPARIN 60 UNITS/KG IV PUSH CARD-STEMI MD V09> <Return> -At a glance to see essential elements in dialog -easily retrievable -utility for CACs -Abbreviations Unique Identifiers (e.g. “AN” for ‘Antineoplastic’) LMWH = Low Molecular Weight Heparin -Uppercase -Prefix – identifies Display Group – IV Meds – Unit Dose – Opt –NVA -Evolve -attaching a date identifier -Whatever works for you & your colleagues

    26. 26 “Type of Quick Order” – Application Pkg IV MEDICATIONS IV Additives IV Solutions NON-VA MEDICATIONS Non-VA OUTPATIENT MEDICATIONS Pharmacy Orderable Item UNIT DOSE MEDICATIONS Pharmacy Orderable Item Choices displayed depends on which Applications have been turned on in the Drug File ^ADDI Additives File Select IV ADDITIVES PRINT NAME: HEPARIN DO NOT OVERLAP WITH LOW MOLECULAR WEIGHT HEPARIN (LMWH) PRINT NAME: HEPARIN// GENERIC DRUG: HEPARIN 1,000 UNITS/ML INJ 10ML// USED IN IV FLUID ORDER ENTRY: YES// ?Must be “Yes” to be visible in Quick Order ?Enter/edit QO restriction [ORCM QO ITEMS] (QO) (to block POI from Dialog display) SOLN PRimary Solution File (IV) Select IV SOLUTIONS PRINT NAME: HEPARIN 20000 UNITS *PREMIXED* 500 ML 500ML (20,000 UNITS) - DO NOT OVERLAP LOW MOL.WT HEPARIN PRINT NAME: HEPARIN 20000 UNITS *PREMIXED* Replace PRINT NAME {2}: GENERIC DRUG: HEPARIN/D5W 40 UNITS/ML SOLN *CP*// VOLUME: 500 ML// Select ELECTROLYTES: Select SYNONYM: DRUG INFORMATION: No existing text Edit? NO// AVERAGE DRUG COST: .0045226// INACTIVATION DATE: USED IN IV FLUID ORDER ENTRY: YES// PREMIX: YES// Choices displayed depends on which Applications have been turned on in the Drug File ^ADDI Additives File Select IV ADDITIVES PRINT NAME: HEPARIN DO NOT OVERLAP WITH LOW MOLECULAR WEIGHT HEPARIN (LMWH) PRINT NAME: HEPARIN// GENERIC DRUG: HEPARIN 1,000 UNITS/ML INJ 10ML// USED IN IV FLUID ORDER ENTRY: YES// ?Must be “Yes” to be visible in Quick Order ?Enter/edit QO restriction [ORCM QO ITEMS] (QO) (to block POI from Dialog display) SOLN PRimary Solution File (IV) Select IV SOLUTIONS PRINT NAME: HEPARIN 20000 UNITS *PREMIXED* 500 ML 500ML (20,000 UNITS) - DO NOT OVERLAP LOW MOL.WT HEPARIN PRINT NAME: HEPARIN 20000 UNITS *PREMIXED* Replace PRINT NAME {2}: GENERIC DRUG: HEPARIN/D5W 40 UNITS/ML SOLN *CP*// VOLUME: 500 ML// Select ELECTROLYTES: Select SYNONYM: DRUG INFORMATION: No existing text Edit? NO// AVERAGE DRUG COST: .0045226// INACTIVATION DATE: USED IN IV FLUID ORDER ENTRY: YES// PREMIX: YES//

    27. 27 Display Test – Descriptive to End User End User view - what all is inside of this Quick Order. -Brief essentials -Note: characters off limits (; , ^ - =) -Don’t labor too hard initially here. -Display can always be edited for individual Menus to fit the format of that Menu <Next slide> -Name minus the prefix & suffixes End User view - what all is inside of this Quick Order. -Brief essentials -Note: characters off limits (; , ^ - =) -Don’t labor too hard initially here. -Display can always be edited for individual Menus to fit the format of that Menu <Next slide> -Name minus the prefix & suffixes

    28. 28 Display Text Generally reflect the contents of the Quick Order -Second change to shape the display text into the context of the menu -“Display Text” reshaped to fit the context of the Menu on which it is being displayed -HELP-PROMPT: Answer must be 3-80 characters in length and cannot contain a semicolon (;), a comma (,), an up-arrow (^), a dash (-), or an equal sign (=). \ (back slash) for comma _(underline) for dash <Next slide> ~tilde Generally reflect the contents of the Quick Order -Second change to shape the display text into the context of the menu -“Display Text” reshaped to fit the context of the Menu on which it is being displayed -HELP-PROMPT: Answer must be 3-80 characters in length and cannot contain a semicolon (;), a comma (,), an up-arrow (^), a dash (-), or an equal sign (=). \ (back slash) for comma _(underline) for dash <Next slide> ~tilde

    29. 29 Workarounds for Prohibited Characters Get creative Depends on the context of the Text itsself -QO’s don’t tend to create as many problems for prohibited characters in the Display text here as they do when one is just adding general text to a Menu. Get creative Depends on the context of the Text itsself -QO’s don’t tend to create as many problems for prohibited characters in the Display text here as they do when one is just adding general text to a Menu.

    30. 30 User’s Display Toggles display between the User’s View (here) -and technical display (next slide)Toggles display between the User’s View (here) -and technical display (next slide)

    31. 31 Toggle (Technical Display) NAME – very first line that was created. Display textNAME – very first line that was created. Display text

    32. 32 Verify Order: Verify Order: -Later choices in creation may make this a moot point. -Display to Provider in same format as “Copy to New Order”. Limitations - Useful when: -no choices -straight forward order - want the Provider to see before accepting -not likely to need editing, but you still want the provider to see the contents -flexibility Advantage: -format easier to read -in combination with “Auto-Accept” gives display flexibility Don’t use: -Template fields requiring response -Continuous Schedule & Provider needs option to “Give Additional Dose Now”Verify Order: -Later choices in creation may make this a moot point. -Display to Provider in same format as “Copy to New Order”. Limitations - Useful when: -no choices -straight forward order - want the Provider to see before accepting -not likely to need editing, but you still want the provider to see the contents -flexibility Advantage: -format easier to read -in combination with “Auto-Accept” gives display flexibility Don’t use: -Template fields requiring response -Continuous Schedule & Provider needs option to “Give Additional Dose Now”

    33. 33 Description =[ WRAP ]====< DESCRIPTION >===[ <PF1>H=Help ]==== (Word Processing Field)  <For Internal Use Only> <prompt recall of reasons for order’s creation> <e.g. Date – Requestor – Reason for Request> <Edits/Date performed> <Your initials> <=======T=======T=======T=======TT====== Internals notes that remind you about this Quick Order.Internals notes that remind you about this Quick Order.

    34. 34 Medication Field Homework: -Busy field at times depending on Drug File -Identify the Dispense Drug that is being used -the Pharmacy Orderable Item associated FILE: #101.43 -- ORDERABLE ITEMS FILE #50.7 -- PHARMACY ORDERABLE ITEM FILE   MENU: Edit Orderable Items [PSS EDIT ORDERABLE ITEMS] Lookup into Dispense Drug File [PSS LOOK] Homework: -Busy field at times depending on Drug File -Identify the Dispense Drug that is being used -the Pharmacy Orderable Item associated FILE: #101.43 -- ORDERABLE ITEMS FILE #50.7 -- PHARMACY ORDERABLE ITEM FILE   MENU: Edit Orderable Items [PSS EDIT ORDERABLE ITEMS] Lookup into Dispense Drug File [PSS LOOK]

    35. 35 Complex Dose? Everyone know what a Complex Dose is? Use in limited situations -well defined and limited to only one round of therapy (pseudo-Medrol Dosepak), titration for some psychiatric meds. Caution – Inpatient – reserve for Patients on stabilized doses on things like Insulin Doses. -AM & PM doses are easier to manage if they are separate entries, otherwise you have to Review the Quick Order because the Provider Comments display in all versions of the Quick Order. You may find an Order Set in which you create two Quick Orders (one with a “Now” Schedule and another with the Standard Schedule) Issue is bouncing around several workgroups. Everyone know what a Complex Dose is? Use in limited situations -well defined and limited to only one round of therapy (pseudo-Medrol Dosepak), titration for some psychiatric meds. Caution – Inpatient – reserve for Patients on stabilized doses on things like Insulin Doses. -AM & PM doses are easier to manage if they are separate entries, otherwise you have to Review the Quick Order because the Provider Comments display in all versions of the Quick Order. You may find an Order Set in which you create two Quick Orders (one with a “Now” Schedule and another with the Standard Schedule) Issue is bouncing around several workgroups.

    36. 36 Duration Field – Complex Order UD & Outpatient -IV Dialogs -Intermittent IV’s (also Doses) -inside of the Complex Tab for Unit Dose & Outpatient Order Dialog-IV Dialogs -Intermittent IV’s (also Doses) -inside of the Complex Tab for Unit Dose & Outpatient Order Dialog

    37. 37 Complex Order - Conjunction And/then: A AND (AM Dose/PM Dose differ) T THEN (Sequential dosing) Enter AND if the next dose is to be administered concurrently with this one, or THEN if it is to follow after. LimitationsLimitations

    38. 38 Stay Alert Even viewing old Quick Order Look critically at your quick orders anytime your testing… Keep your eyes open when revisiting Orders. Note “7:” does not follow a sequence.Look critically at your quick orders anytime your testing… Keep your eyes open when revisiting Orders. Note “7:” does not follow a sequence.

    39. 39 Dosages Review Dosages Report [PSS DOSAGE REVIEW REPORT] (11909) PREDNISONE 10MG TAB Inactive Strength: 10 Units: MG Application Pa Possible Dosages: Dispense Units Per Dose: 1 Dose: 10MG Pa Dispense Units Per Dose: 2 Dose: 20MG Pa Dispense Units Per Dose: 3 Dose: 30MG Pa Dispense Units Per Dose: 4 Dose: 40MG Pa Dispense Units Per Dose: 5 Dose: 50MG Pa Dispense Units Per Dose: 6 Dose: 60MG Pa Dispense Units Per Dose: 7 Dose: 70MG Pa Local Possible Dosages: 1 TABLET (10 MG) Numeric Dose: 1 Dose Unit: TABLET(S) 2 TABLETS (20 MG) Numeric Dose: 2 Dose Unit: TABLET(S) 3 TABLETS (30 MG) Numeric Dose: 3 Dose Unit: TABLET(S) 4 TABLETS (40 MG) Numeric Dose: 4 Dose Unit: TABLET(S) 5 TABLETS (50 MG) Numeric Dose: 5 Dose Unit: TABLET(S) 6 TABLETS (60 MG) Numeric Dose: 6 Dose Unit: TABLET(S) 7 TABLETS (70 MG) Numeric Dose: 7 Dose Unit: TABLET(S) Review Dosages Report [PSS DOSAGE REVIEW REPORT] (11909) PREDNISONE 10MG TAB Inactive Strength: 10 Units: MG Application Pa Possible Dosages: Dispense Units Per Dose: 1 Dose: 10MG Pa Dispense Units Per Dose: 2 Dose: 20MG Pa Dispense Units Per Dose: 3 Dose: 30MG Pa Dispense Units Per Dose: 4 Dose: 40MG Pa Dispense Units Per Dose: 5 Dose: 50MG Pa Dispense Units Per Dose: 6 Dose: 60MG Pa Dispense Units Per Dose: 7 Dose: 70MG Pa Local Possible Dosages: 1 TABLET (10 MG) Numeric Dose: 1 Dose Unit: TABLET(S) 2 TABLETS (20 MG) Numeric Dose: 2 Dose Unit: TABLET(S) 3 TABLETS (30 MG) Numeric Dose: 3 Dose Unit: TABLET(S) 4 TABLETS (40 MG) Numeric Dose: 4 Dose Unit: TABLET(S) 5 TABLETS (50 MG) Numeric Dose: 5 Dose Unit: TABLET(S) 6 TABLETS (60 MG) Numeric Dose: 6 Dose Unit: TABLET(S) 7 TABLETS (70 MG) Numeric Dose: 7 Dose Unit: TABLET(S)

    40. 40 After Edit to Dosages Pharmacy ADPAC accessPharmacy ADPAC access

    41. 41 Dosage Field -Dosage/Rate Field – something – even free text -Schedule not retained - default to the Schedule from the Pharmacy Orderable Item once a Standard Schedule is entered by the Provider, but this may not be correct for what you are wanting to do…..so if nothing else place free text here until the fix comes out. Repair for Remedy HD366596/PSPO 1604 will be OR*3.0*326-Dosage/Rate Field – something – even free text -Schedule not retained - default to the Schedule from the Pharmacy Orderable Item once a Standard Schedule is entered by the Provider, but this may not be correct for what you are wanting to do…..so if nothing else place free text here until the fix comes out. Repair for Remedy HD366596/PSPO 1604 will be OR*3.0*326

    42. 42 Route New Menus coming with PRE Medication Route File Enter/Edit [PSS MEDICATION ROUTES EDIT] Medication Route Mapping Report [PSS MED ROUTE MAPPING REPORT] Medication Route Mapping History Report [PSS MED ROUTE MAPPING CHANGES] Request Change to Standard Medication Route [PSS MEDICATION ROUTE REQUEST] Default Med Route For OI Report [PSS DEF MED ROUTE OI RPT]New Menus coming with PRE Medication Route File Enter/Edit [PSS MEDICATION ROUTES EDIT] Medication Route Mapping Report [PSS MED ROUTE MAPPING REPORT] Medication Route Mapping History Report [PSS MED ROUTE MAPPING CHANGES] Request Change to Standard Medication Route [PSS MEDICATION ROUTE REQUEST] Default Med Route For OI Report [PSS DEF MED ROUTE OI RPT]

    43. 43 Schedule New Patches PSJ*5*113 & PSS*1*143New Patches PSJ*5*113 & PSS*1*143

    44. 44 Give Additional Dose Now -If there is a possibility of this box needing to be checked, you don’t want to set the “Verify” or the “Auto-Accept” fields to Yes – because you want the Provider to see this screen! (e.g. Antibiotic Quick Order) For a “Premed” for a procedure how, when you know that a “Now” does is not needed, Verify & Auto-Accept are good options to keep Providers from making unnecessary changes to an Order that is complete.-If there is a possibility of this box needing to be checked, you don’t want to set the “Verify” or the “Auto-Accept” fields to Yes – because you want the Provider to see this screen! (e.g. Antibiotic Quick Order) For a “Premed” for a procedure how, when you know that a “Now” does is not needed, Verify & Auto-Accept are good options to keep Providers from making unnecessary changes to an Order that is complete.

    45. 45 Priority We caution all of our Providers to not rely on things to happen automatically & electronically for true emergencies – touch base with the person who has to carry out that action. Heparin Protocol & some Anesthesia Orders Joint Commission requires a site to define “Stat” & “Now” – make sure you are keeping this is mind before using these terms loosely.We caution all of our Providers to not rely on things to happen automatically & electronically for true emergencies – touch base with the person who has to carry out that action. Heparin Protocol & some Anesthesia Orders Joint Commission requires a site to define “Stat” & “Now” – make sure you are keeping this is mind before using these terms loosely.

    46. 46 Provider Comments Information intended for: Provider Pharmacist Nurse Patient (Outpatient Quick Order) Usability Provider testers - cultivated *Template Fields give you the flexibility to be creative here! Text Fields that are excluded from the Order. (Provider oriented.) If space considerations are important: -Outpatient Rx: (CMOP restrictions) -Patient Instructions (1-240 characters) -Medication Instructions File (#51) will expand words (if you see bizarre text) *IV *** FILLED IN IV ROOM ***Usability Provider testers - cultivated *Template Fields give you the flexibility to be creative here! Text Fields that are excluded from the Order. (Provider oriented.) If space considerations are important: -Outpatient Rx: (CMOP restrictions) -Patient Instructions (1-240 characters) -Medication Instructions File (#51) will expand words (if you see bizarre text) *IV *** FILLED IN IV ROOM ***

    47. 47 Odd Comments Check Medications Instructions File (#51) SOLUTION was to enter “N.S.” which did not have an expansion from the Medications Instructions File Medication Instruction File Report [PSS MED INSTRUCTION REPORT] SOLUTION was to enter “N.S.” which did not have an expansion from the Medications Instructions File Medication Instruction File Report [PSS MED INSTRUCTION REPORT]

    48. 48 CPRS Template Fields Provider Comment’s Tool

    49. 49 Tools to Shape & Clarify Provider Comments Name format: CHA = Charleston (identifies locally created Template Fields Reference to VeHU Class:Name format: CHA = Charleston (identifies locally created Template Fields Reference to VeHU Class:

    50. 50 Combo Box

    51. 51 Combo Box - Preview Button

    52. 52 Flexibility Defaulting Value with additional drop down choices ICU Ventilator associated Orders. Default in a value, but also establish a range & add flexibility not to lock the Provider into those values. Need to know - toolsICU Ventilator associated Orders. Default in a value, but also establish a range & add flexibility not to lock the Provider into those values. Need to know - tools

    53. 53 Combination of Template Fields Note: Cannot make a brake (wrap) not interpreted. Intended as PROVIDER prompts only: CHA HEPARIN BOLUS Text *BOLUS Dose* One Time * Revisit after 6 months CHA ANTICOAG TXT Text (Use Actual Body Weight & Round dose to the nearest 100 Units) Note: So we checkbox “Exclude from Note” (i.e. exclude from Provider Comments because instructional only) CHA HEPARIN HL MD EXCEL Hyperlink Excel Calculator for MD CHA HEPARIN PRO CARDIO Hyperlink To Local Folder containing the Heparin Protocol for Cardiology CHA HEPARIN TXT CALC Text Clarifying text: After using the calculator above to obtain the bolus and continuous infusion rate, click okay to proceed to the next two screens creating two Orders: 1) Bolus – one time 2) Continuous Infusion with an Infusion Rate in “Units/Kg/Hr” Note: Cannot make a brake (wrap) not interpreted. Intended as PROVIDER prompts only: CHA HEPARIN BOLUS Text *BOLUS Dose* One Time * Revisit after 6 months CHA ANTICOAG TXT Text (Use Actual Body Weight & Round dose to the nearest 100 Units) Note: So we checkbox “Exclude from Note” (i.e. exclude from Provider Comments because instructional only) CHA HEPARIN HL MD EXCEL Hyperlink Excel Calculator for MD CHA HEPARIN PRO CARDIO Hyperlink To Local Folder containing the Heparin Protocol for Cardiology CHA HEPARIN TXT CALC Text Clarifying text: After using the calculator above to obtain the bolus and continuous infusion rate, click okay to proceed to the next two screens creating two Orders: 1) Bolus – one time 2) Continuous Infusion with an Infusion Rate in “Units/Kg/Hr”

    54. 54 Provider Comments Display Look at this with the eyes of a User: -experienced Residents/rotating Housestaff or a Specialty Service Rotating housestaff need more prompts we found Residents getting confused between the Bolus Dose & the Continuing Infusion -they don’t notice the little things like the Title Bar Note: The Title Bar in the case of an IVPB Additive is not helpful because it lists the Solution only – may require clarifying text.Look at this with the eyes of a User: -experienced Residents/rotating Housestaff or a Specialty Service Rotating housestaff need more prompts we found Residents getting confused between the Bolus Dose & the Continuing Infusion -they don’t notice the little things like the Title Bar Note: The Title Bar in the case of an IVPB Additive is not helpful because it lists the Solution only – may require clarifying text.

    55. 55 Provider Comments All of the technical language reduced to: Provider Comments (Heparin Protocol (Cardiology – ACS) -Suggested Bolus Dose: 60 Units/Kg *Maximum Dose: 5000 Units* ?Text for Pharmacist double check Wt: Weight: 161.67 lb (73.5 kg) Date ?Patient Data ObjectAll of the technical language reduced to: Provider Comments (Heparin Protocol (Cardiology – ACS) -Suggested Bolus Dose: 60 Units/Kg *Maximum Dose: 5000 Units* ?Text for Pharmacist double check Wt: Weight: 161.67 lb (73.5 kg) Date ?Patient Data Object

    56. 56 Provider Comments – Educational Teaching hospitals have more needs for education Hardest requirements is for insulins to be dosed in relation to a meal time Educate Residents to the variety of Schedules Med Error Committee/QA -feedback on what is working and what is not working -read minutes if not a member. Teaching hospitals have more needs for education Hardest requirements is for insulins to be dosed in relation to a meal time Educate Residents to the variety of Schedules Med Error Committee/QA -feedback on what is working and what is not working -read minutes if not a member.

    57. 57 Provider Comments Restrictions or Criteria for Use Note: Each check box is a required template field – all have to be checked before the Provider can proceed. Hyperlinks included: -Calculator -PBM Website with Prescribing GuidelinesNote: Each check box is a required template field – all have to be checked before the Provider can proceed. Hyperlinks included: -Calculator -PBM Website with Prescribing Guidelines

    58. 58 Combination Radio Buttons & Check Boxes Radio Buttons – only 1 response from group Check Boxes – all requiredRadio Buttons – only 1 response from group Check Boxes – all required

    59. 59 Provider Comments for the Finishing Pharmacist Pipes around Patient Data Object Brackets around CPRS Template Fields Other Print Info Field (Prints on IV Label) Infusion Clinic - Room Temp - Exp: 3 Hrs From Time Stamp ?60 character limit IV Label – Highlight, Drag & DropPipes around Patient Data Object Brackets around CPRS Template Fields Other Print Info Field (Prints on IV Label) Infusion Clinic - Room Temp - Exp: 3 Hrs From Time Stamp ?60 character limit IV Label – Highlight, Drag & Drop

    60. 60 Multiple techniques Combination of: -Text -Radio Buttons -Edit Box -Combo Box – suggested values – but allow free text -Date Field -Check Box (optional) -Word Processing (optional)Combination of: -Text -Radio Buttons -Edit Box -Combo Box – suggested values – but allow free text -Date Field -Check Box (optional) -Word Processing (optional)

    61. 61 Finally Reduced to…

    62. 62 Auto-Accept this Order? Should Provider have the option to: -Give Additional Dose Now Make sure you don’t have any Template Fields with a “defaulted” value that may be variable Useful when you have a complete Order that does not need changes. Remember that you can use the “Verify” field in combination with Auto-Accept for flexibility.

    63. 63 Review, Evaluate & Refine Flow of the Order from one Service to another is importantFlow of the Order from one Service to another is important

    64. 64 IV Type - Intermittent Conflicting parameters in Pharmacy set up between software, wards Test DAYS UNTIL STOP DATE/TIME: 100// DAYS UNTIL STOP FOR ONE-TIME: 1// SAME STOP DATE ON ALL ORDERS: YES// TIME OF DAY THAT ORDERS STOP: 1159// DEFAULT START DATE CALCULATION: USE NOW AS DEFAULT //Conflicting parameters in Pharmacy set up between software, wards Test DAYS UNTIL STOP DATE/TIME: 100// DAYS UNTIL STOP FOR ONE-TIME: 1// SAME STOP DATE ON ALL ORDERS: YES// TIME OF DAY THAT ORDERS STOP: 1159// DEFAULT START DATE CALCULATION: USE NOW AS DEFAULT //

    65. 65 IV Type - Continuous Limitation Fields are problematic – may want to verify! Infusion Rate: @Limitation Fields are problematic – may want to verify! Infusion Rate: @

    66. 66 IV Quick Orders IV Solution File (#52.7) SODIUM CHLORIDE 0.9% INJ Choose from: 18 ?Can’t free text in odd numbers like 3 ML 50 100 125 135 150 200 250 500 1000 Volume (in ml): 1000// Pharmacy ADPAC trickyPharmacy ADPAC tricky

    67. 67 IV Type (Continuous) Infusion Rate ml/hr is the default value expected Other rates with “@” User of the “@” sign but you need a lot of Provider trainingUser of the “@” sign but you need a lot of Provider training

    68. 68 IV Quick Orders – Provider Comments When used in controlled environment with few providers.IV Quick Orders – Provider Comments When used in controlled environment with few providers.

    69. 69 IV Additive – Message Field Prints on the IV Label – 60 character limit -very tight for Stability/Storage/Indication -Option with IV Additives “Message” Field has 30 characters Free Text – must apply across the Board to all IV Additives Special Filters – Light Protection Finishing Pharmacist cannot edit!Prints on the IV Label – 60 character limit -very tight for Stability/Storage/Indication -Option with IV Additives “Message” Field has 30 characters Free Text – must apply across the Board to all IV Additives Special Filters – Light Protection Finishing Pharmacist cannot edit!

    70. 70 CPRS v27 Routines Convert Unit Dose QOs to IV QOs Helpful – because you can just manipulate the Quick Order that already exists Don’t have to make any changes on the MenuHelpful – because you can just manipulate the Quick Order that already exists Don’t have to make any changes on the Menu

    71. 71 Pharmacy Orderable Item Restrict Display to Quick Order Only Search – not case sensitiveSearch – not case sensitive

    72. 72 IV Additives & Solutions IV Additives & Solutions have this extra twist that must be turned on to display for Quick Order useage.IV Additives & Solutions have this extra twist that must be turned on to display for Quick Order useage.

    73. 73 Outpatient Quick Order

    74. 74

    75. 75 Non-VA Quick Order Dose: -Enter a dose to populate the “Schedule” Field, then return & remove the “Dose”, the SCHEDULE will be retained. Edit Parameters ORWD NONVA REASON Non-VA Meds Statement/Reason ORWD NONVA REASON may be set for the following: 1 Division DIV [choose from INSTITUTION] 2 System SYS [TEST.CHARLESTON.MED.VA.GOV] Sequence Value -------- ----- 1 Recommended and Prescribed by VA Provider 2 Not Recommended or Prescribed by VA Provider 3 Self-Medication by Patient Dose: -Enter a dose to populate the “Schedule” Field, then return & remove the “Dose”, the SCHEDULE will be retained. Edit Parameters ORWD NONVA REASON Non-VA Meds Statement/Reason ORWD NONVA REASON may be set for the following: 1 Division DIV [choose from INSTITUTION] 2 System SYS [TEST.CHARLESTON.MED.VA.GOV] Sequence Value -------- ----- 1 Recommended and Prescribed by VA Provider 2 Not Recommended or Prescribed by VA Provider 3 Self-Medication by Patient

    76. 76 Non-VA Meds Statement/Reason CPRS Parameters ORWD NONVA REASON Non-VA Meds Statement/Reason 1 Division DIV [choose from INSTITUTION] 2 System SYS [TEST.CHARLESTON.MED.VA.GOV]CPRS Parameters ORWD NONVA REASON Non-VA Meds Statement/Reason 1 Division DIV [choose from INSTITUTION] 2 System SYS [TEST.CHARLESTON.MED.VA.GOV]

    77. 77 CPRS Order Dialog – Non-VA Med

    78. 78 Drug Text Field *Does not display for IV Orderable Items *74 characters or less will display entire text, but more than that only displays “Display Restrictions/Guidelines” *Drug Text Enter/Edit [PSS EDIT TEXT]*Does not display for IV Orderable Items *74 characters or less will display entire text, but more than that only displays “Display Restrictions/Guidelines” *Drug Text Enter/Edit [PSS EDIT TEXT]

    79. 79 Drug Test <74 Characters One Text item only less than 74 characters.One Text item only less than 74 characters.

    80. 80 Order Menu Management ... [ORCM MGMT] OI Manage orderable items ... PM Enter/edit prompts GO Enter/edit generic orders QO Enter/edit quick orders QU Edit personal quick orders by user ST Enter/edit order sets AC Enter/edit actions MN Enter/edit order menus AO Assign Primary Order Menu CP Convert protocols SR Search/replace components LM List Primary Order Menus DS Disable/Enable order dialogs CS Review Quick Orders for Inactive ICD9 Codes MR Medication Quick Order Report CV Convert IV Inpatient QO to Infusion QO

    81. 81 Disable/Enable order dialogs [ORCM DISABLE] Select ORDER DIALOG: ZPSIN HEPARIN 5000 UNITS IV PUSH (BOLUS) (ICU/UC) ANOTHER ONE: ?Could disable multiple QOs Enter a message to disable the dialog(s), or @ to enable again. MESSAGE: Disable Test ?Reason Are you ready? NO// YES. done. This inactivates the QOs wherever they are – be sure they are not still on Actively used menus. -”Disable” does not visually mark the QO “Z” in front of both the Name & Display Text will help you identify the “Disabled” QOsThis inactivates the QOs wherever they are – be sure they are not still on Actively used menus. -”Disable” does not visually mark the QO “Z” in front of both the Name & Display Text will help you identify the “Disabled” QOs

    82. 82 Search/replace components [ORCM SEARCH/REPLACE] Determine which QO’s are still actively used. *Copy/Paste – useful tool *Trace backward Fileman Report – Orders File Sort & Count -WHEN ENTERED: - ITEM ORDERED: Determine which QO’s are still actively used. *Copy/Paste – useful tool *Trace backward Fileman Report – Orders File Sort & Count -WHEN ENTERED: - ITEM ORDERED:

    83. 83

    84. 84

    85. 85

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