Preparing for Outpatient Pharmacy v7.0 & Inpatient v5.0

1. Preparing for Outpatient Pharmacy v7.0 & Inpatient v5.0 Steve Bowman January 8, 2006

2. Reference Manual • Pharmacy Ordering Enhancements (POE) Pharmacy Data Management (PDM V.1.0) Pre-Release Implementation Guide • This can be found on www.ihs.gov/ehr

3. Prior to coming to 5/7 training • Inactivate drugs that aren’t being used • Viking site inactivate ALL drugs • Use date greater than 1 year ago • Ensure non-formulary designation is correct • Enter Trade name synonyms with intended use = trade name • Correct NDC #s entered in 5-4-2 format • Standardize drug names • Use Generic Name_Strength_Dosage Form • I.E. IBUPROFEN 400MG TAB

4. Correct NDC #s in the Drug File • Use the FPN Report • Outpatient Pharmacy Manager Menu/ Supervisor Functions / FPN • identifies drugs with inappropriate NDCs • This will make NDF matching easier

5. Enter Trade Name Synonyms • Use Drug Enter/ Edit or Synonym Enter/Edit options (on PDM menu) • This will help providers when they order drugs through EHR • If this isn’t finished before you create orderable items, you’ll need to Edit Orderable Items and enter the synonyms there instead of in the Drug File

6. Standardize Drug Names • Try to stick with the format of Generic Name_Strength_Dosage Form IBUPROFEN 400MG TAB ENOXAPARIN 30MG/0.3ML INJ

7. National Drug File- TWICE • Automatic match Verify Merge • Print NOCL and MANC Reports • Rematch / Match Single Drugs Verify Merge • Print the NOCL and MANC Reports again • You won’t be able to match compounded drugs or drugs not found in the NDF

8. Make sure of the following before you proceed: • Pharmacy Data Management (PSS) patch 1 has been installed at your facility • Your site manager has assigned you the APSPSS security key • The site manager may have to create the key. Instructions on how to do this are at the end of the patch installation instructions.

9. Creating Orderable Items in Pharmacy Data Management • Use Drug Enter/Edit to inactivate drugs that aren’t matched to the NDF (see NOCL & MANC reports for a list of these drugs) • Create Pharmacy Orderable Items (PDM menu). Will be asked to Select P or V • use V to create the orderables based on the VA Generic Drug Name • Reactivate the drugs that you just inactivated • Manually Match Dispense Drugs so all active drugs are linked with an Orderable Item

10. Nouns Enter/Edit Option • Pharmacy Data Management Ordering Enhancements Pre-Release Instructions/Nouns Nouns Enter/Edit • Delete all nouns for these dosage forms: *DROPS,ORAL *ENEMA *ENEMA,RTL *LIQUID,AEROSOL *SOLN,RTL *SUPP,RTL *SUPP,VAG *SUPPOSITORY *SUSP,RTL

11. Select Instructions/Nouns Option: NOUNS Enter/Edit Select DOSAGE FORM NAME: ENEMA Dosage Form => ENEMA Select NOUN: CONTENTS NOUN:CONTENTS// @ Do you want to delete ‘CONTENTS’ ? No// Y

12. Auto Create Dosages • Pharmacy Data Management Ordering Enhancements Pre-Release Dosages Auto Create Dosages • This must be finished before you proceed. Use the Conversion Tracker option to see if the Auto Creation has finished.

13. Print the Review Dosages Report • Pharmacy Data Management Ordering Enhancements Pre-Release Dosages Review Dosages Report • This is a LONG report. You can print it in segments, a few letters at a time • -OR- Use the NSYN report from the FM searches secondary menu instead

14. Dosage report for drugs from A through C Outpatient Expansion PAGE: 1 ----------------------------------------------------------------------------------------------------- (84534) ABSORBASE Inactive Date: Strength: Units: Application Package: OU Possible Dosages: (None) Local Possible Dosages: SMALL AMOUNT Package: O (85177) ACEBUTOLOL 200MG CAP *N/F* Inactive Date: SPECIAL ORDER Strength: 200 Units: MG Application Package: OU Possible Dosages: Dispense Units Per Dose: 1 Dose: 200MG Package: IO 1 CAPSULE Dispense Units Per Dose: 2 Dose: 400MG Package: IO 2 CAPSULES Local Possible Dosages: (None)

15. Dosages Enter/Edit Option • Pharmacy Data Management Ordering Enhancements Pre-Release Dosages Dosages Enter/Edit • Using the Review Dosages Report, you can add, edit, or delete Possible Dosages and Local Possible Dosages

16. Things to keep in mind • Possible dosages were created for single entity tablets and capsules • Possible dosages for Outpatient use need to be created for combination tablets & capsules, oral liquids, and injections I=Inpatient O=Outpatient IO=Both

17. More things to keep in mind • Possible dosages were not created for combination drugs, drugs with % soln strength, eye drops, inhalers, topicals, drugs not matched with the NDF • Local possible dosages were created for the above drugs if there was an associated noun: TIMOLOL 10% SOLN,OTIC 1 DROP 2 DROPS

18. Select Dosages Option: ENTER/Edit Dosages Select Drug: CAPTOPRIL 1 CAPTOPRIL 25MG CV800 59772-7046-03 2 CAPTOPRIL 25MG UD CV800 51079-0864-20 CHOOSE 1-2: 1 CAPTOPRIL 25MG CV800 59772-7046-03 This entry is marked for the following PHARMACY packages: Outpatient Unit Dose Non-VA Med CAPTOPRIL 25MG Inactive Date: Strength from National Drug File match => 25 MG Strength currently in the Drug File => 25 MG Edit Strength? N// <ENTER> NO Strength => 25 Unit => MG

19. Select DISPENSE UNITS PER DOSE: ? Answer with POSSIBLE DOSAGES DISPENSE UNITS PER DOSE Choose from: 1 25 IO 2 50 IO You may enter a new POSSIBLE DOSAGES, if you wish Type a Number between 0 and 99999999, 4 Decimal Digits Select DISPENSE UNITS PER DOSE: .5 Are you adding '.5' as a new POSSIBLE DOSAGES (the 3RD for this DRUG)? No// Y (Yes) Dosage = 12.5MG POSSIBLE DOSAGES DOSE: 12.5// (No Editing) DISPENSE UNITS PER DOSE: .5// <ENTER> PACKAGE: IO BCMA UNITS PER DOSE: 1 Strength => 25 Unit => MG

20. Editing Dosages Tips • The Review Dosages Report can be run multiple times. Make sure that it is 132 columns or it won’t be useful. The Auto Create Dosages can also be rerun, with 2 different options – start over from scratch or build on Dosages already created.

21. Med Instruction Frequency • Pharmacy Data Management Ordering Enhancements Pre-Release Med Instruction/Frequency Medication Instruction Frequency Report • Frequency is used to help calculate days supply & quantity defaults. If frequency isn’t in the Administration Schedule file, the software looks in the Medication Instruction File

22. Medication Routes • Review all of the medication routes • Routes default to Oral for any orderable that does not have one entered for it • Will have to manually add routes for all non oral drugs • Make sure routes you plan to use are marked for ALL package use and have an outpatient expansion • Include a preposition as part of the route. You will need to delete prepositions from the Dosage Form file after Pharmacy v7 is installed at your site.

23. Standard Schedules • Edit any JCAHO “forbidden” schedules • Make sure that frequency is there & is correct – this will affect the days supply/quantity calculation • Check to make sure that the expansion is entered for outpatient use

24. Standard Schedules (cont.) • Make sure that you include Day of the Week schedules in the correct format & that they’re marked as D. • Enter the first 2 letters of the day of the week. This is the only way that RPMS will recognize the schedule. • Use a hyphen for multiple days of the week, e.g., MO-WE-FR, TU-TH-SA.

25. Medication Instructions • Ordering Enhancements Pre-release Med Instruction/Frequency Med Instruction Report • Use this report to identify med instructions that could be used as schedules • Enter frequency in minutes: Q2H = 120 Q3D = 4320

26. Edit Orderable Items • Pharmacy Data Management Orderable Item Management Edit Orderable Items • Use this option to put in the appropriate route of administration (blank=default of Oral. • Enter the appropriate Schedule Type (blank=default of Continuous). • You can enter a default Schedule from your Standard Schedules.

27. Patient Instructions Enter/Edit • Pharmacy Data Management Ordering Enhancements Pre-Release Patient Instructions Enter/Edit • Enter defaults that will automatically be appended to the Sig (indications for use, etc.) • Can enter Med. Instruction codes & the expansions will print

28. Select Pharmacy Orderable Item: IBUPROFEN TAB PATIENT INSTRUCTIONS: FPA - TAKE F/M FOR PAIN - TAKE WITH FOOD OR MILK Remember to type a period , a * or use a hyphen if you need to separate the patient instructions from the rest of the Sig.