Omnicell/Pyxis (BOP) Interface Update

1. Omnicell/Pyxis (BOP) Interface Update November 14, 2006

2. Thank you! • Claremore Indian Hospital • Lawton Indian Hospital • Choctaw Nation Health Care Center • Santa Fe Indian Hospital • Phoenix Indian Medical Center

3. Presenters • Carlene McIntyre, Pharm.D. Pharmacy Consultant, OIT • Jeff Walling, Pharm.D. Pharmacy Applications Coordinator, PIMC • John Coleman, Pharm.D. Chief Pharmacist, SFIH • Dan Diggins, Pharm.D. Inpatient Pharmacy Director, PIMC • Adrian Lujan Third Party Billing IT Specialist, OIT

4. BOP UpdateOverview • Introduction – Carlene McIntyre • Preparation – Jeff Walling • Outpatient Pharmacy – John Coleman • Inpatient Pharmacy – Dan Diggins • Third Party Billing – Adrian Lujan

5. Introduction • BOP v1.0 was released in July, 2005 • Initial BOP interface is one-way only • Sends ADT information from RPMS to the Automated Dispensing System (ADS) • Saves nursing time • Increases accuracy of patient information in the ADS

6. Introduction (cont.) • Patch 1 adds new functionality for Pyxis systems • Patch 2 will add the same for Omnicell systems • 2-way transfer of info between RPMS and the ADS • Specified drugs will show up as non-verified Rxs for pharmacist review • UD orders entered in RPMS are sent to the ADS • ADS info on drug removals and returns is sent to RPMS and is available for pharmacy & billing

7. Introduction (cont.) Patient Name, HRN Patient Location Allergies Inpatient UD Orders Charges (Removals) RPMSCredits (Returns) ADS

8. Introduction (cont.) • Outpatient sites must be using Pharmacy v7.0 before installing the patch • You must contact Omnicell or Pyxis to get their side of the interface set up correctly • In order to use profiling, inpatient sites must be using the RPMS Unit Dose package v5.0 to enter orders and the Automatic Replenishment/Ward Stock package must be set up

9. BOP UpdateOverview • Introduction – Carlene McIntyre • Preparation – Jeff Walling • Outpatient Pharmacy – John Coleman • Inpatient Pharmacy – Dan Diggins • Third Party Billing – Adrian Lujan

10. BOP Interface Set Up • Identify meds in Pyxis/Omnicell by RPMS IENs (internal entry numbers) • Designate Inpt Pyxis/Omnicell Meds as Ward Stock • AUTO Automatic Replenishment [PSGWMGR] **> Locked with PSGWMGR

11. BOP Interface Set Up • BOP Menu Options

19. BOP UpdateOverview • Introduction – Carlene McIntyre • Preparation – Jeff Walling • Outpatient Pharmacy – John Coleman • Inpatient Pharmacy – Dan Diggins • Third Party Billing – Adrian Lujan

20. Prior to interface • Pharmacists collected night charts from UCC • Pharmacists reviewed charts comparing Pyxis report to medical chart • Pharmacists entered prescriptions in RPMS • Time consuming

21. After Interface • Interface queues orders into RPMS • Pharmacists review and verify orders using verification option in RPMS • Add provider • Edit quantity and days supply • Dosing instructions

23. Interface Options in RPMS • List non-verified scripts - quick view of patients and meds • Non-verified counts - shows number of Rx’s in queue • Rx verification by clerk - verification and completion of order by pharmacist

24. Time saving advantages • Order is already partially entered in RPMS • Medication removed is entered, decreased risk of selecting wrong med during rx entry • Issue date and fill date, already entered

25. Lessons learned • Important to have Pyxis loaded correctly with correct RPMS medication ID number • No multiplier for 1 item removed to equal grams or number of tablets removed • Decide if pharmacy will continue to review medical chart or have the nurses keep a yellow copy of the PCC for pharmacy

26. Lessons Learned • BOP Drug File selection - medications taken home by patient - avoid one time, unit dose meds and injections incident to the providers visit

27. BOP UpdateOverview • Introduction – Carlene McIntyre • Preparation – Jeff Walling • Outpatient Pharmacy – John Coleman • Inpatient Pharmacy – Dan Diggins • Third Party Billing – Adrian Lujan

28. Inpatient PharmacyInterface Features • Real time Admission/Disch/Transfer info • Virtually eliminates need to manually enter patients • ADT entry into RPMS must be prompt • Allergies from Allergy Reaction Tracking pkg. • If mechanism “allergy” or “unknown” – will display • If mechanism is “pharmacologic” i.e. ADR – will not • Medication orders from RPMS Inpt Order Entry • Entered, edited, or discontinued in real time • “Profile” – displays only those meds ordered for patient • Eliminates cart fill – yea!!

29. Inpatient InterfaceEarly considerations • ADS meds must be entered as Ward Stock • This is essentially all oral solids! • Still need to run daily Pick List • Can print “to screen” • Keep u/d cart with drawer for each patient • Multi-dose containers, bulky items • Evaluate inpatient order entry work flow • One time and stat orders • Meds available for over-ride status

30. ADS Display of Meds (Patient Profile) • ADS screen shows list of meds for each patient • Black text indicates med is available in cabinet • “Grayed out” = med is in the Pyxis formulary, but not in the cabinet on that unit • Med not appearing = med not in Pyxis formulary* • Lead/Lag Time (defined in ADS) • Allows nurse to remove dose early or late • e.g. lead time = 4 hours, RN can get 9am dose at 5am • *If first dose of new order is not due till 9am tomorrow, med will not display on screen until 5am tomorrow!

31. ADS Display of Meds (continued) • Dispense drug/strength is displayed • May not be the same as dosage required! LORAZEPAM 2MG SYRINGE ATIVAN ORDER # 285-7154 DOSE: 1-2MG RT: IV FREQ: Q4H PRN LAST: MON, NOV 13 2006 21:03 NOTES: FOR ANXIETY POTASSIUM CHLORIDE 10MEQ U/D TAB K-DUR ORDER # 285-7154 DOSE: 20MEQ RT: ORAL FREQ: TID W/ MEALS LAST: MON, NOV 13 2006 08:37 NOTES: 2 X 10MEQ TABS TACROLIMUS 1MG CAP PROGRAF ORDER # 285-7155

32. Special CasesRange Orders • Morphine 2 to 10 mg IV prn • Can enter multiple dispense drugs; e.g 4mg and 10mg • Nurse can choose either MORPHINE 4MG SYRINGE MORPHINE ORDER # 285-7154 DOSE: 2-10MG RT: IV FREQ: Q4H PRN LAST: MON, NOV 13 2006 21:03 NOTES: FOR PAIN MORPHINE 10MG SYRINGE MORPHINE ORDER # 285-7154 DOSE: 2-10MG RT: ORAL FREQ: Q4H PRN LAST: MON, NOV 13 2006 08:37 NOTES: FOR PAIN PROMETHAZINE 25MG AMPULE PHENERGAN ORDER # 285-7155

33. Special CasesOddball Dosages, e.g. Prednisone 8mg • Requires two different dispense drugs • Use “Special Instructions” field to alert nursing staff PREDNISONE 1MG TAB DELTASONE ORDER # 285-7138 DOSE: 8MG RT: ORAL FREQ: QDAY LAST: MON, NOV 13 2006 08:37 NOTES: 1 X 5MG + 3 X 1MG TABS PREDNISONE 5MG TAB DELTASONE ORDER # 285-7139 DOSE: 8MG RT: ORAL FREQ: QDAY LAST: MON, NOV 13 2006 08:37 NOTES: 1 X 5MG + 3 X 1MG TABS PROMETHAZINE 25MG AMPULE PHENERGAN ORDER # 285-7155

34. Problem Issues • IV Push Vials (e.g. Lasix 20mg/2mL) • Default VA dosages: 10mg/1ml; 20mg/2ml • Choosing default dose of 20mg/2ml causes Pyxis to prompt nurse to remove “2 vials” (40mg!) • Solution: change default doses to eliminate “ / 2ml “ • Formulary issue • When new drug added to RPMS drug dictionary, write down IEN and enter into Pyxis formulary at same time • Otherwise, “Unknown” drugs will appear in Pyxis formulary when order entered into RPMS inpt package

35. BOP UpdateOverview • Introduction – Carlene McIntyre • Getting Ready – Jeff Walling • Outpatient Pharmacy – John Coleman • Inpatient Pharmacy – Dan Diggins • Third Party Billing – Adrian Lujan

36. Third Party Billing Screens

37. Data Flow

38. Claim Editor • Changes released in Patch 8 • Billing clerk must have access to claim editor to view charges. • Billing clerk reviews items and decides which ones to populate in the Claim Editor • Billing clerk approves a bill to the appropriate third party payer

48. Billing Responsibility • Knowing what payer processes. • Not all supplies covered. • Ensure items come across • Ensure date of service is entered. • Ensure charge is populated.

50. Issues • Data not completely populated • Items not ‘uploaded’ to claim editor • Manual entry of items by billing clerk