Drug File – IV Additives and Solutions

1. Drug File – IV Additives and Solutions March 2010

2. IV Drugs • Entry in the Drug File as usual • NDC, match to NDF, Dosages, etc • Mark the drug as IV • This is where you get access to the Additives and Solutions files

3. This entry is marked for the following PHARMACY packages: Outpatient Unit Dose IV MARK THIS DRUG AND EDIT IT FOR: O - Outpatient U - Unit Dose I - IV W - Ward Stock C - Controlled Substances X - Non-VA Med Enter your choice(s) separated by commas : I I – IV ** You are NOW editing IV fields. ** AN IV ITEM? Yes// (Yes) Edit Additives or Solutions: Select one of the following: A ADDITIVES S SOLUTIONS Enter response: This is where we’re going to be working

4. IV Additives and Solutions Files • 2 files • IV Additives File • IV Solutions File • They are their own files, but I find it helpful to think of them as “subfiles” of the main drug file

5. Additives File Enter response: a ADDITIVES Select IV ADDITIVES PRINT NAME: AMP 5 AMPICILLIN - AMP16 - - AMP14 - - AMP24 - - AMP26 - - AMP0.5 - PRINT NAME: AMPICILLIN// GENERIC DRUG: AMPICILLIN SODIUM 1GM INJ// USED IN IV FLUID ORDER ENTRY: YES// DRUG UNIT: GM// NUMBER OF DAYS FOR IV ORDER: 30// USUAL IV SCHEDULE: Q6H// ADMINISTRATION TIMES: Select QUICK CODE: AMP0.5// QUICK CODE: AMP0.5// STRENGTH: 0.5 GM// USUAL INFUSION RATE: 30// OTHER PRINT INFO: USUAL IV SCHEDULE: Q6H// ADMINISTRATION TIMES: 0500-1100-1700-2300// USUAL IV SOLUTION: SODIUM CHLORIDE 0.9% 50 ML// MED ROUTE: IV PIGGYBACK// Select QUICK CODE: AVERAGE DRUG COST PER UNIT: 10// Select ELECTROLYTE: Select SYNONYM: AMP// DRUG INFORMATION: No existing text Edit? NO// INACTIVATION DATE: CONCENTRATION: MESSAGE:

6. Solutions File PRINT NAME: SODIUM CHLORIDE 0.9% Replace PRINT NAME {2}: GENERIC DRUG: SODIUM CHLORIDE 0.9% 1000ML INJ// VOLUME: 1000 ML// Select ELECTROLYTES: Select SYNONYM: NS// DRUG INFORMATION: No existing text Edit? NO// AVERAGE DRUG COST: INACTIVATION DATE: USED IN IV FLUID ORDER ENTRY: YES// Edit Additives or Solutions:

7. Clean Up • Run Fileman reports • Look For: • Duplicate Entries • Drugs you don’t actually have • Inconsistent Print Names (e.g. Normal Saline and Sodium Chloride for different entries)

8. Solutions File • What do you want in this file? • Only solutions that you have at your facility • Each volume/bag size that you have (use same print name) • Premixed solutions

9. Example Print Name Generic Drug DEXTROSE 10% DEXTROSE 10% 1000ML INJ DEXTROSE 25% DEXTROSE 25% 500ML INJ DEXTROSE 5% DEXTROSE 5% 250ML INJ DEXTROSE 5% DEXTROSE 5% 500ML INJ DEXTROSE 5% DEXTROSE 5% 1000ML INJ DEXTROSE 5% DEXTROSE 5% 50ML INJ DEXTROSE 5% DEXTROSE 5% 100ML INJ DEXTROSE 5% 0.45% NS DEXTROSE 5% 1/2NS 1000ML DEXTROSE 5% 1/2 NS W 20KCL DEXTROSE 5% IN 1/2NS W 20MEQ K DEXTROSE 5% and 0.9% NS DEXTROSE 5% and 0.9% NS 1000ML DEXTROSE 5% and 1/2NS DEXTROSE 5% and 1/2 NS 500ML I DEXTROSE 5% and 1/4 NS DEXTROSE 5% and 1/4 NS 1000ML Same print name but different volumes Premixed Solutions

10. Note on Premixed Solutions • Example – Ranitidine premixed bag • Most correct to make an orderable item like RANITIDINE 50MG IN NORMAL SALINE 50 ML, INJ SOLN • Put in IV solutions file • This is instead of having ranitidine as an Additive like any other type of piggyback you actually make on site in the pharmacy

11. IV Solutions File – Print Name PRINT NAME: SODIUM CHLORIDE 0.9% • This is what prints on the IV label • Don’t want to be too descriptive here, makes for a confusing label • Use “name” (with the quotes) to enter the same Print Name for more than one item PRINT NAME {2}: • Leave this blank

12. IV Solutions File – tie to drug file GENERIC DRUG: SODIUM CHLORIDE 0.9% 100ML INJ// • Put in drug from drug file entry • Will want separate entries for different volumes you carry

13. IV Solutions File VOLUME: 100 ML// • Volume of your bag Select ELECTROLYTES: • Used in TPNs Select SYNONYM: SALINE// • Synonym that will pull up this drug

14. IV Solutions File DRUG INFORMATION: No existing text Edit? NO// • Shows in Drug Inquiry option in IV menu, not in EHR AVERAGE DRUG COST: 5// • Cost per ml

15. IV Solutions File INACTIVATION DATE: • Use to inactivate obsolete entries USED IN IV FLUID ORDER ENTRY: YES// • Only effects EHR

16. Used in IV Fluid Order Entry?

17. Used in IV Fluid Order Entry? • This controls what shows on these 2 lists in the EHR Order dialog • Relatively few orders in EHR are done through this type of dialog • Basically only IV maintenance fluids and IV drips • More later, in EHR Quick Order presentation

18. Additives File • What do you want in this file? • Only those drugs that you have at your facility • May want different print names for pediatric use (mg instead of grams) • Will need separate entries with the same print name for different strengths ?

19. Example Select IV ADDITIVES PRINT NAME: AMPICILLIN 1 AMPICILLIN (PEDS PIGGYBACK) - MG UNITS - 2 AMPICILLIN (PEDS SYRINGE) - 30 MG/ML – 3 AMPICILLIN 500mg vial 4 AMPICILLIN 1g vial

20. Additives File PRINT NAME: AMPICILLIN// • Keep this simple • Do not include strength here GENERIC DRUG: AMPICILLIN SODIUM 500MG INJ// • Will want an entry for each of your strengths

21. Additives File USED IN IV FLUID ORDER ENTRY: • As before, only effects EHR • Do not need all your piggyback additives here • There are very few Additives that you will mark “Yes” here • EX: KCL, Insulin DRUG UNIT: MG// • Can use different units to help with peds IVs

22. Additives File NUMBER OF DAYS FOR IV ORDER: 7// USUAL IV SCHEDULE: Q6H// ADMINISTRATION TIMES: 01-07-13-19// • Each of these can be overridden by other files or parameters • Don’t worry much about setting it up here

23. Additives File Select QUICK CODE: • Quick Codes pre-fill some fields in the order entry process for pharmacists • Not to be confused with Quick Orders • Not a good mix with EHR • Causes new order to be created during med processing – confusing for providers and nursing • Probably won’t be fixed in the near future • So, please DO NOT USE

24. Additives File AVERAGE DRUG COST PER UNIT: .025// • Cost per unit you selected (mg, grams, mEq) Select ELECTROLYTE: • For TPNs Select SYNONYM: AMP// • Synonym to pull up drug

25. Additives File DRUG INFORMATION: No existing text Edit? NO// • Shows in Drug Inquiry in IV menu • Does not show in EHR INACTIVATION DATE: • For obsolete entries

26. IV Additives File CONCENTRATION: // • ? MESSAGE: • Will show on IV Label

27. Same Print Name, Multiple Entries • In Solutions File, it is the Volume field that helps describe the entry 6 SODIUM CHLORIDE 0.9% 500 ML 7 SODIUM CHLORIDE 0.9% 50 ML 8 SODIUM CHLORIDE 0.9% 100 ML 9 SODIUM CHLORIDE 0.9% 250 ML 10 SODIUM CHLORIDE 0.9% 1000 ML

28. Same Print Name, Multiple Entries • For Additives File, use Message field in Drug Enter/Edit to describe the entry GENERIC NAME: AMPICILLIN SODIUM 500MG INJ Replace VA CLASSIFICATION: AM111// DEA, SPECIAL HDLG: 6// NATIONAL FORMULARY INDICATOR: YES LOCAL NON-FORMULARY: VISN NON-FORMULARY: Select DRUG TEXT ENTRY: Select FORMULARY ALTERNATIVE: Select SYNONYM: 000015740320// SYNONYM: 000015740320// INTENDED USE: DRUG ACCOUNTABILITY// NDC CODE: 000015-7403-20// Select SYNONYM: MESSAGE: 500mg vial//

29. IV Additives File Select IV ADDITIVES PRINT NAME: AMPICILLIN 1 AMPICILLIN (PEDS PIGGYBACK) - MG UNITS - 2 AMPICILLIN (PEDS SYRINGE) - 30 MG/ML – 3 AMPICILLIN 500mg vial  this is from the drug file 4 AMPICILLIN 1g vial

30. Used in IV Fluid Order Entry?