Medication Conversion Process at Veteran Healthcare System of the Ozarks

1. Medication Conversion Process at Veteran Healthcare System of the Ozarks Notice New Directions, Strength, and Quantity STEP 1: CREATE PATIENT LIST PROFILE As drug patents expire and national shortages continue to rise, more and more facilities are relying on pharmacies to take quick, decisive action in terms of therapeutic substitution and conversion. Normally, this is performed through a tedious process in which patients are manually selected and medication orders are converted by editing specific fields one at a time. At Veterans Health System of the Ozarks (VHSO), we developed a MACRO and KEYBOARD MAPPING system which streamlines and speeds up the conversion process. Step 1: Patients with specific medications, strengths and frequencies are sorted accordingly and stored in a specific “Patient List” file. Step 2: The MACRO will automatically select the next patient in the “Patient List” file. This removes the need for manual patient selection and drastically decreases wasted time. Step 3: Medication orders can be quickly and safely converted by using KEYBOARD MAPPING. KEYBOARD MAPPING reduces the number of keystrokes (and therefore time) by assigning a specific sequence of keystrokes to another key located on the keyboard. OBJECTIVES Step 2: “READ_LOOP” MACRO in VISTA KEYBOARD MAP OPTIONS EXAMPLE: KEYBOARD MAP SUMMARY REDUCED CONVERSION TIME • Creating MACRO for patient specific, automated processing • Reducing keystrokes using KEYBOARDMAPPING • Example 1: KCl 8mEq Conversion, 2 KEYS were mapped to 134 keystrokes! • Example 2: Warfarin generic conversion, 1500 patients were SAFELY converted in 20 hours! (~75pts/hour!) • ABILITY TO DOCUMENT CONVERSION IN CPRS • Viewing release date in “DETAILS” of order • Editing Remarks field in medication order • ABILITY TO EDUCATE PATIENT • Standard comment mapped into every conversion, e.g. “NOTICE: NEW DIRECTIONS AND STRENGTH” Acquire all medications with status of Active/Suspense/Hold Patient list should include: • Patient SSN (import as text to prevent leading zeros in SSN from being truncated) • Patient name • Directions • Quantity • Days supply • Last fill date • Prescribing provider Import SSNs as TEXT(preferred) or using Rx numbers (using ‘#’ sign plus Rx number) Sort patient list as required (e.g., based on med strength, refills remaining, etc.) Create a text document of SSNs using Microsoft notepad (Also Edit the MACRO to location and name text document, save to a shared drive ) (S:\NAME OF FOLDER HERE\NAME OF FILE.txt) Eric Spahn, PharmD; John Hawley, PharmD, BCPS; Brad Hodge, PharmD EXAMPLE: PATIENT LIST FILE Describe the medication conversion process at VHSO Generate and manipulate a patient list for medication conversion Use a Macro in CRT (the program used to access VISTA) to automatically load patients for conversion Create and Apply a Keyboard Map in CRT for Conversion INTRODUCTION Edit orderable item: discontinuing and converting simultaneously Copy function: ability to leave directions the same Other considerations: • Number of characters in patient instructions field • Medication drug-drug interactions • Field numbers (change based on type of map and steps) • Edit remarks section to place conversion in CPRS • Changing default Written to Policy or ServiceCorrection • Determined by Macro list (refills remaining) F10 KEY (KEYSTROKE#1): RESULTS F10 KEY (KEYSTROKE#1): EXECUTION EDIT ORDERABLE ITEM EXAMPLE: KEYBOARD MAP PAGE UP KEY (KEYSTROKE#2): RESULTS CREATING A KEYBOARD MAP EXAMPLE: KEYBOARD MAP STEP 2: “READ_LOOP” MACRO in VISTA DIRECTING MACRO TO PATIENT LIST FILE EG: COPY FUNCTION VHA VISN 16 Veteran Healthcare System of the Ozarks (VHSO) Fayetteville, Arkansas STEP 3: KEYBOARD MAP SETUP After selecting PotassiumChloride 8MEQ SA Tab, this screen appears. After entering the keystrokes, select the desired function key to execute the keyboard map and click “Map” Select the F10 key. Note the changes. Example Notepad SSN list.