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

v5.0v5.0

Steve BowmanSteve Bowman

January 8, 2006January 8, 2006

Reference ManualReference Manual

Pharmacy Ordering Enhancements (POE) Pharmacy Ordering Enhancements (POE) Pharmacy Data Management (PDM V.1.0) Pharmacy Data Management (PDM V.1.0) Pre-Release Implementation GuidePre-Release Implementation Guide

This can be found on www.ihs.gov/ehrThis can be found on www.ihs.gov/ehr

Prior to coming to 5/7 Prior to coming to 5/7 trainingtraining

Inactivate drugs that aren’t being used Inactivate drugs that aren’t being used Viking site inactivate ALL drugsViking site inactivate ALL drugs Use date greater than 1 year agoUse date greater than 1 year ago

Ensure non-formulary designation is correctEnsure non-formulary designation is correct Enter Trade name synonyms with intended Enter Trade name synonyms with intended

use = trade nameuse = trade name Correct NDC #s entered in 5-4-2 formatCorrect NDC #s entered in 5-4-2 format Standardize drug namesStandardize drug names

Use Generic Name_Strength_Dosage FormUse Generic Name_Strength_Dosage Form I.E. IBUPROFEN 400MG TABI.E. IBUPROFEN 400MG TAB

Correct NDC #s in the Drug Correct NDC #s in the Drug FileFile

Use the FPN ReportUse the FPN Report Outpatient Pharmacy Manager Menu/ Supervisor Functions / Outpatient Pharmacy Manager Menu/ Supervisor Functions /

FPNFPN identifies drugs with inappropriate NDCsidentifies drugs with inappropriate NDCs This will make NDF matching easierThis will make NDF matching easier

Enter Trade Name Enter Trade Name SynonymsSynonyms

Use Drug Enter/ Edit or Synonym Use Drug Enter/ Edit or Synonym Enter/Edit options (on PDM menu)Enter/Edit options (on PDM menu)

This will help providers when they This will help providers when they order drugs through EHRorder drugs through EHR

If this isn’t finished before you create If this isn’t finished before you create orderable items, you’ll need to Edit orderable items, you’ll need to Edit Orderable Items and enter the Orderable Items and enter the synonyms there instead of in the synonyms there instead of in the Drug FileDrug File

Standardize Drug NamesStandardize Drug Names

Try to stick with the format of Try to stick with the format of Generic Name_Strength_Dosage Generic Name_Strength_Dosage FormForm

IBUPROFEN 400MG TABIBUPROFEN 400MG TAB

ENOXAPARIN 30MG/0.3ML INJENOXAPARIN 30MG/0.3ML INJ

National Drug File- National Drug File- TWICETWICE

Automatic match Verify Merge Automatic match Verify Merge Print NOCL and MANC ReportsPrint NOCL and MANC Reports Rematch / Match Single Drugs Verify Rematch / Match Single Drugs Verify

Merge Merge Print the NOCL and MANC Reports againPrint the NOCL and MANC Reports again You won’t be able to match compounded You won’t be able to match compounded

drugs or drugs not found in the NDFdrugs or drugs not found in the NDF

Make sure of the following Make sure of the following before you proceed:before you proceed:

Pharmacy Data Management (PSS) Pharmacy Data Management (PSS) patch 1 has been installed at your patch 1 has been installed at your facilityfacility

Your site manager has assigned you Your site manager has assigned you the APSPSS security keythe APSPSS security key

The site manager may have to create The site manager may have to create the key. Instructions on how to do the key. Instructions on how to do this are at the end of the patch this are at the end of the patch installation instructions.installation instructions.

Creating Orderable Items in Creating Orderable Items in Pharmacy Data ManagementPharmacy Data Management

Use Drug Enter/Edit to inactivate drugs that Use Drug Enter/Edit to inactivate drugs that aren’t matched to the NDF (see NOCL & aren’t matched to the NDF (see NOCL & MANC reports for a list of these drugs)MANC reports for a list of these drugs)

Create Pharmacy Orderable Items (PDM Create Pharmacy Orderable Items (PDM menu). Will be asked to Select P or V menu). Will be asked to Select P or V use use VV to create the orderables based on the VA to create the orderables based on the VA

Generic Drug NameGeneric Drug Name Reactivate the drugs that you just inactivatedReactivate the drugs that you just inactivated Manually Match Dispense Drugs so all active Manually Match Dispense Drugs so all active

drugs are linked with an Orderable Itemdrugs are linked with an Orderable Item

Nouns Enter/Edit OptionNouns Enter/Edit Option

Pharmacy Data Management Pharmacy Data Management Ordering Ordering Enhancements Pre-Release Enhancements Pre-Release Instructions/Nouns Instructions/Nouns Nouns Enter/Edit Nouns Enter/Edit

Delete all nouns for these dosage forms:Delete all nouns for these dosage forms:*DROPS,ORAL *DROPS,ORAL *ENEMA *ENEMA *ENEMA,RTL*ENEMA,RTL*LIQUID,AEROSOL *SOLN,RTL*LIQUID,AEROSOL *SOLN,RTL*SUPP,RTL *SUPP,RTL *SUPP,VAG*SUPP,VAG*SUPPOSITORY *SUPPOSITORY *SUSP,RTL*SUSP,RTL

Select Instructions/Nouns Option: Select Instructions/Nouns Option: NOUNS NOUNS Enter/EditEnter/Edit

Select DOSAGE FORM NAME: Select DOSAGE FORM NAME: ENEMAENEMA

Dosage Form => ENEMADosage Form => ENEMA

Select NOUN: Select NOUN: CONTENTSCONTENTS

NOUN:CONTENTS// NOUN:CONTENTS// @@ Do you want to delete ‘CONTENTS’ ? No// Do you want to delete ‘CONTENTS’ ? No// YY

Auto Create DosagesAuto Create Dosages

Pharmacy Data Management Pharmacy Data Management Ordering Enhancements Pre-Release Ordering Enhancements Pre-Release

Dosages Dosages Auto Create DosagesAuto Create Dosages

This must be finished before you This must be finished before you proceed. Use the Conversion Tracker proceed. Use the Conversion Tracker option to see if the Auto Creation has option to see if the Auto Creation has finished.finished.

Print the Review Dosages Print the Review Dosages ReportReport

Pharmacy Data Management Pharmacy Data Management Ordering Ordering Enhancements Pre-Release Enhancements Pre-Release Dosages Dosages Review Dosages ReportReview Dosages Report

This is a LONG report. You can print it in This is a LONG report. You can print it in segments, a few letters at a timesegments, a few letters at a time

-OR- Use the NSYN report from the FM -OR- Use the NSYN report from the FM searches secondary menu insteadsearches secondary menu instead

Dosage report for drugs from A through C Dosage report for drugs from A through C Outpatient Expansion PAGE: 1 Outpatient Expansion PAGE: 1

----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

(84534) ABSORBASE Inactive Date:(84534) ABSORBASE Inactive Date: Strength: Units: Application Package: OUStrength: Units: Application Package: OU Possible Dosages: (None)Possible Dosages: (None) Local Possible Dosages:Local Possible Dosages: SMALL AMOUNT Package: OSMALL AMOUNT Package: O

(85177) ACEBUTOLOL 200MG CAP *N/F* Inactive (85177) ACEBUTOLOL 200MG CAP *N/F* Inactive Date:Date:

SPECIAL ORDERSPECIAL ORDER Strength: 200 Units: MG Application Package: Strength: 200 Units: MG Application Package:

OUOU Possible Dosages:Possible Dosages: Dispense Units Per Dose: 1 Dose: 200MG Dispense Units Per Dose: 1 Dose: 200MG

Package: IO 1 CAPSULEPackage: IO 1 CAPSULE Dispense Units Per Dose: 2 Dose: 400MG Dispense Units Per Dose: 2 Dose: 400MG

Package: IO 2 CAPSULESPackage: IO 2 CAPSULES Local Possible Dosages: (None) Local Possible Dosages: (None)

Dosages Enter/Edit OptionDosages Enter/Edit Option

Pharmacy Data Management Pharmacy Data Management Ordering Enhancements Pre-Release Ordering Enhancements Pre-Release

Dosages Dosages Dosages Enter/EditDosages Enter/Edit

Using the Review Dosages Report, Using the Review Dosages Report, you can add, edit, or delete Possible you can add, edit, or delete Possible Dosages and Local Possible DosagesDosages and Local Possible Dosages

Things to keep in mindThings to keep in mind Possible dosages were created for Possible dosages were created for

single entity tablets and capsulessingle entity tablets and capsules Possible dosages for Outpatient use Possible dosages for Outpatient use

need to be created for combination need to be created for combination tablets & capsules, oral liquids, and tablets & capsules, oral liquids, and injectionsinjections

I=InpatientI=InpatientO=OutpatientO=Outpatient

IO=BothIO=Both

More things to keep in mindMore things to keep in mind

Possible dosages were not created for Possible dosages were not created for combination drugs, drugs with % soln combination drugs, drugs with % soln strength, eye drops, inhalers, topicals, strength, eye drops, inhalers, topicals, drugs not matched with the NDFdrugs not matched with the NDF

Local possible dosages were created for Local possible dosages were created for the above drugs if there was an associated the above drugs if there was an associated noun: noun:

TIMOLOL 10% SOLN,OTICTIMOLOL 10% SOLN,OTIC 1 DROP 1 DROP 2 DROPS2 DROPS

Select Dosages Option: ENTER/Edit Dosages

Select Drug: CAPTOPRIL 1 CAPTOPRIL 25MG CV800 59772-7046-03 2 CAPTOPRIL 25MG UD CV800 51079-0864-20CHOOSE 1-2: 1 CAPTOPRIL 25MG CV800 59772-7046-03 This entry is marked for the following PHARMACY packages:OutpatientUnit DoseNon-VA Med

CAPTOPRIL 25MG Inactive Date:

Strength from National Drug File match => 25 MGStrength currently in the Drug File => 25 MG

Edit Strength? N// <ENTER> NO

Strength => 25 Unit => MG

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: IOBCMA UNITS PER DOSE: 1

Strength => 25 Unit => MG

Editing Dosages TipsEditing Dosages Tips

The Review Dosages Report can be The Review Dosages Report can be run multiple times. Make sure that it run multiple times. Make sure that it is 132 columns or it won’t be useful.is 132 columns or it won’t be useful.

The Auto Create Dosages can also be The Auto Create Dosages can also be rerun, with 2 different options – start rerun, with 2 different options – start over from scratch or build on over from scratch or build on Dosages already created.Dosages already created.

Med Instruction FrequencyMed Instruction Frequency

Pharmacy Data Management Pharmacy Data Management Ordering Ordering Enhancements Pre-ReleaseEnhancements Pre-Release Med Med Instruction/FrequencyInstruction/Frequency Medication Medication Instruction Frequency ReportInstruction Frequency Report

Frequency is used to help calculate days Frequency is used to help calculate days supply & quantity defaults. If frequency isn’t supply & quantity defaults. If frequency isn’t in the Administration Schedule file, the in the Administration Schedule file, the software looks in the Medication Instruction software looks in the Medication Instruction FileFile

Medication RoutesMedication Routes Review all of the medication routesReview all of the medication routes Routes default to Oral for any orderable that does Routes default to Oral for any orderable that does

not have one entered for itnot have one entered for it Will have to manually add routes for all non oral Will have to manually add routes for all non oral

drugsdrugs Make sure routes you plan to use are marked for Make sure routes you plan to use are marked for

ALL package use and have an outpatient ALL package use and have an outpatient expansionexpansion

Include a preposition as part of the route. You will Include a preposition as part of the route. You will need to delete prepositions from the Dosage Form need to delete prepositions from the Dosage Form file after Pharmacy v7 is installed at your site.file after Pharmacy v7 is installed at your site.

Standard SchedulesStandard Schedules

Edit any JCAHO “forbidden” Edit any JCAHO “forbidden” schedulesschedules

Make sure that frequency is there & Make sure that frequency is there & is correct – this will affect the days is correct – this will affect the days supply/quantity calculationsupply/quantity calculation

Check to make sure that the Check to make sure that the expansion is entered for outpatient expansion is entered for outpatient useuse

Standard Schedules (cont.)Standard Schedules (cont.)

Make sure that you include Day of Make sure that you include Day of the Week schedules in the correct the Week schedules in the correct format & that they’re marked as D.format & that they’re marked as D.

Enter the first 2 letters of the day of Enter the first 2 letters of the day of the week. This is the only way that the week. This is the only way that RPMS will recognize the schedule.RPMS will recognize the schedule.

Use a hyphen for multiple days of the Use a hyphen for multiple days of the week, e.g., MO-WE-FR, TU-TH-SA.week, e.g., MO-WE-FR, TU-TH-SA.

Medication InstructionsMedication Instructions

Ordering Enhancements Pre-release Ordering Enhancements Pre-release Med Instruction/FrequencyMed Instruction/Frequency Med Med

Instruction ReportInstruction Report Use this report to identify med Use this report to identify med

instructions that could be used as instructions that could be used as schedulesschedules

Enter frequency in minutes:Enter frequency in minutes: Q2H = 120Q2H = 120

Q3D = 4320Q3D = 4320

Edit Orderable ItemsEdit Orderable Items

Pharmacy Data Management Orderable Pharmacy Data Management Orderable Item Management Edit Orderable ItemsItem Management Edit Orderable Items

Use this option to put in the appropriate Use this option to put in the appropriate route of administration (blank=default of route of administration (blank=default of Oral.Oral.

Enter the appropriate Schedule Type Enter the appropriate Schedule Type (blank=default of Continuous).(blank=default of Continuous).

You can enter a default Schedule from You can enter a default Schedule from your Standard Schedules.your Standard Schedules.

Patient Instructions Patient Instructions Enter/EditEnter/Edit

Pharmacy Data Management Pharmacy Data Management Ordering Enhancements Pre-Release Ordering Enhancements Pre-Release

Patient Instructions Enter/Edit Patient Instructions Enter/Edit Enter defaults that will automatically Enter defaults that will automatically

be appended to the Sig (indications be appended to the Sig (indications for use, etc.)for use, etc.)

Can enter Med. Instruction codes & Can enter Med. Instruction codes & the expansions will printthe expansions will print

Select Pharmacy Orderable Item: Select Pharmacy Orderable Item: IBUPROFENIBUPROFEN TABTAB

PATIENT INSTRUCTIONS: PATIENT INSTRUCTIONS: FPA - TAKE F/MFPA - TAKE F/M

FOR PAIN - TAKE WITH FOOD OR MILKFOR PAIN - TAKE WITH FOOD OR MILK

Remember to type a period , a * or use a hyphen if Remember to type a period , a * or use a hyphen if you need to separate the patient instructions you need to separate the patient instructions from the rest of the Sig.from the rest of the Sig.