Crime Scene:The route of “IM” is not available

• Police Report:– Provider wants to

order a one-time dose of Ceftriaxone to be given “IM” but that route is not available

Crime Scene:The route of “IM” is not available

• Solution: RPMSPDMDosagesDosage Form File Enter/Edit

**************************************************Select DOSAGE FORM NAME: INJ,SOLN 1 INJ,SOLN 2 INJ,SOLN,SACHOOSE 1-2: 1 INJ,SOLNNAME: INJ,SOLNSelect MED ROUTE FOR DOSAGE FORM: IV PIGGYBACK//

INTRAMUSCULAR 1 INTRAMUSCULAR IMAre you adding 'INTRAMUSCULAR' as a new MED ROUTE FOR DOSAGE FORM (the 4TH for this DOSAGE

FORM)? No// YES

Crime Scene:The route of “IM” is NOW available

Crime Scene: Pharmacist wishes to finish a pending IV piggyback order,

but the option to finish it as an IV isn’t there?!?!

DC Discontinue FL FlagED Edit FN FinishSelect Item(s): Next Screen// FN FinishCOMPLETE THIS ORDER AS IV OR UNIT DOSE? IV//

This prompt is missing!

Crime Scene: Finishing IV piggyback orders

• Solution: The Medication Routes File

Select MEDICATION ROUTES NAME: IVPB IV PIGGYBACK IVPB

NAME: IV PIGGYBACK//ABBREVIATION: IVPB//PACKAGE USE: ALL PACKAGES//OUTPATIENT EXPANSION: IVPB//OTHER LANGUAGE EXPANSION:IV FLAG: YES//

Many different scenarios…..IV Flag in the

Medication Routes File

Dispense Drug’s Application Use

Which Order View screen will be

displayed to the user

Special Processing

IV IV IV None

IV Unit Dose Unit Dose Prompt User to Finish Order as IV or

Unit Dose

IV IV and Unit Dose IV Prompt User to Finish Order as IV or

Unit Dose

Non-IV IV IV Prompt User to Finish Order as IV or

Unit Dose

Non-IV Unit Dose Unit Dose None

Non-IV IV and Unit Dose Unit Dose Prompt User to Finish Order as IV or

Unit Dose

Crime Scene: Solution/Additive not Available when making an “IV Medication” Quick Order

• Pharmacist is building an IV Quick Order for SODIUM CHLORIDE 0.9% with 40MEQ KCL When building the quick order the Solution isn’t listed

Select QUICK ORDER NAME: PSIVZ SODIUM CHLORIDE 0.9% W/40MEQ KCLNAME: PSIVZ SODIUM CHLORIDE 0.9% W/40MEQ KCL ReplaceDISPLAY TEXT: KCL 40mEq in 0.9% NS ReplaceVERIFY ORDER: YES//DESCRIPTION: No existing text Edit? NO//Solution: SODIUM CHLORIDE 0.9% W/40MEQ KCL ??Enter a base solution for this order.

AN IV ITEM? Yes// Y (Yes)Edit Additives or Solutions: Select one of the following: A ADDITIVES S SOLUTIONSEnter response: SOLUTIONSSelect IV SOLUTIONS PRINT NAME: SODIUM CHLORIDECHOOSE 1-15: 15 SODIUM CHLORIDE 0.9% 40MEQ KCL 1000 MLPRINT NAME: SODIUM CHLORIDE 0.9% 40MEQ KCL ReplacePRINT NAME {2}:GENERIC DRUG: SOD. CHL. 0.9% W/ 40MEQ KCL 1000ML (INJ)VOLUME: 1000 ML//Select ELECTROLYTES: CHLORIDE// ELECTROLYTES: CHLORIDE// CONCENTRATION: .04 MEQ/ML//Select ELECTROLYTES:Select SYNONYM:DRUG INFORMATION: No existing text Edit? NO//AVERAGE DRUG COST: .01679//INACTIVATION DATE:USED IN IV FLUID ORDER ENTRY: NO//Edit Additives or Solutions:

CHANGE TO YES

Crime Scene: Solution/Additive not Available when making an “IV Medication” Quick Order

• When should the Prompt “Used in IV Fluid Order Entry” be Marked “Yes”– All Additives and Solutions that are

Continuous/Intermittent IV Infusions• Typically Large Volume Admixtures

– Not Scheduled IVPBs

Crime Scene: Unable to Transfer from “Inpatient to Outpatient”

Crime Scene: Unable to Transfer from “Inpatient to Outpatient”

• Solution– One Orderable Item is required for both the Bulk Outpatient

Dispense Drug and the Unit Dose Inpatient Dispense Drug*************************************************************

Orderable Item -> CITALOPRAM Dosage Form -> TAB

Dispense Drugs:---------------CITALOPRAM 40MG TABCITALOPRAM 20MG TABCITALOPRAM 20MG U/D TABCITALOPRAM 10MG TAB

Crime Scene: Transfer to Outpatient Dialog (Setting Defaults)

• Police Report: Why are the fields “Pick Up” and “Refills” not filled in?

Crime Scene: Transfer to Outpatient Dialog (Setting Defaults)

• Solution: There is none!– No default exists in the inpatient order file to

convert data when transferring from inpatient to outpatient

– Old VA Function?– Computer fills in what it can from the inpatient

order– Provider must fill in the information upon ordering

the medication

Crime Scene: Units Per Dose (U/D) in the Dispense Drug Field Inaccurate

• Scenario: – An inpatient is on Carvedilol 6.25mg PO BID– Computer wants to use ½ tablet of Carvedilol

12.5mg Unit Dose as the dispense drug– Pharmacy has Carvedilol 6.25mg Unit Dose tablets

available in the Omni-Cell/Pyxis– Why is this happening?

DEMO,PATIENT INPATIENT Ward: 2S MED/ CWA HRN: 999997 Room-Bed: Ht(cm): 152.40 01/12/2010 DOB: 05/19/50 (59) Wt(kg): 114.55 02/05/2010

(1)Orderable Item: CARVEDILOL TAB Instructions:(2)Dosage Ordered: 6.25MG (3)Start: 02/10/10 21:00(4) Med Route: ORAL (5) Stop: 05/21/10 16:00(6) Schedule Type: CONTINUOUS(8) Schedule: BID(9) Admin Times: 0900-2100(10) Provider: STEARLE,CARLA D DURATION:(11) Special Instructions:

(12) Dispense Drug U/D Inactive Date CARVEDILOL 12.5MG TAB U/D 0.5

Crime Scene: Units Per Dose (U/D) in the Dispense Drug Field Inaccurate

Crime Scene: Units Per Dose (U/D) in the Dispense Drug Field Inaccurate

• Solution: Check the Possible Dosages in Drug Enter/Edit– Unit Dose Entries should typically only have one

possible dosage• Carvedilol 6.25mg U/D

– Possible Dosage: 6.25mg=1 tablet

• Carvedilol 12.5mg U/D– Possible Dosage: 12.5mg=1 tablet