Download OR*3*215 CPRS GUI V26 - VA Pharmacy Online Classroom

Enhanced Medication
Order Checks
The Future is Now
The Phases of PRE
The Pharmacy Re-Engineering (PRE) project is being
developed incrementally, beginning with enhancements
to VistA order checks in Inpatient Pharmacy,
Outpatient Pharmacy and CPRS
 Non-dosing phase - Current order checks for duplicate
drug (OP only), duplicate therapy, and drug
interactions will be enhanced
 Dosing phase - New dosing checks will alert providers
and pharmacists of either insufficient or excessive
dosages

2
The Faces of PRE
Business Owner - Pharmacy Benefits Management
 Developers, Software Architects
 Project Managers
 Analysts - (Functional, Quality, Business)
 Pharmacy Workgroup Members
 Test Sites/Testers
 Cognitive Engineer

Alpha and Beta Test Site Representation
from Large, Small, and Integrated Sites
Site
Tuscaloosa (Alpha)
Charleston
Heartland-East
Palo Alto
Northern California
Boise
Primary Tester(s)
Martin Lowe, Al Havens
Dionne Roney
Jim Hewins
Ester Song
Bonnie Dugoni
Robert Moore, Cindy Seburn
4
NDF Relationship with FDB




Vista NDF data is mapped to a commercial drug database,
First Data Bank (FDB)
Data pertaining to duplicate therapies, drug interactions,
and dosages is contained by FDB’s Drug Information
Framework
Order checks are performed using FDB data, unless a
custom record exists
FDB’s Enhanced Therapeutic Classification (ETC) system
allows for drugs to be assigned multiple classes.
5
FDB Enhanced Drug Interactions

FDB Severity levels
Severity Level 1 - Contraindicated Drug Combination
 Severity Level 2 - Severe Interaction
 Severity Level 3 - Moderate Interaction
 Severity Level 9 - Undetermined (Alternative Med)


Translation of VistA severity levels
Critical (equivalent to FDB severity level 1)
 Significant (equivalent to FDB severity level 2)
 FDB severity levels 3 & 9 are NOT displayed in VistA

6
NDF/FDB Relationship with PECS



New GUI Application – Pharmacy Enterprise
Customization System (PECS) allows for
customization of FDB data at a national level
Custom VA data entered in PECS will override
FDB data
Potential types of custom VA data:
Severity level of drug interaction
 Clinical effects description/monograph
 Entry of custom interaction
 Class duplication allowances

7
Requests for PECS Customization




Local VistA Drug Interaction file #56 will cease to be
used for drug interaction checks
Local customization requests will be accomplished via
new a VistA option, “Request Changes to Enhanced Order
Check Database option”
Customization requests with be reviewed in committee
and the decision will be relayed to the requestor
In the future, requests will entered via the PECS
application
8
CPRS Version 28
PRE Functionality Highlights
Duplicate Therapy * Drug Interaction * Dosing
9
Duplicate Therapy Checks
The name of the duplicate therapeutic categor(ies) will
display based on the FDB assigned class
10
Duplications Continued
Note Therapeutic Categories
11
Drug-Drug Interactions


Order check displays are updated to include the clinical effects of the
drug interaction
A professional drug interaction monograph is also available via an
optional monograph button included in the order check box
12
CPRS Monograph Display
Note the drop-down box
for selecting multiple
applicable interaction
monographs
13
New Dosage Order Checks


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
Dose warning appears upon acceptance of medication order
Single and/or total daily doses are checked against dosages set by FDB
If a dosage is within normal dosing ranges, then no dose warnings will display
If a check cannot be performed then only general dosing information is displayed
14
Dosage Check Display
During Order Signing Process
15
Outpatient Pharmacy
PRE Functionality Highlights
16
Display Sequence for
Outpatient Order Checks

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System Errors
Duplicate Drug
Clozapine
Allergy/ADR (local & remote) or Non-Assessment
CPRS checks generated backdoor (3 new checks)
Local & Remote Duplicate Therapy
Order Level Error Messages – Duplicate Therapy
Dosing Check Warnings
Order Level Error/Warning Messages - Dosing
17
CPRS Dangerous Med Order Checks
Now Available in Pharmacy Packages



Aminoglycoside Ordered (OP, IV, UD)
Metformin –Lab Results (OP, UD)
Dangerous Meds for Patient >64 (OP, IV, UD)
 Currently only applies to 3 drugs
 Amitriptylline, Chlorpropamide,
Dipyridamole
18
Dangerous Med Order Checks

Example of Aminoglycoside warning message
***Aminoglycoside
Aminoglycoside
Found>) [Est.
equation using

Ordered***
- est. CrCl: <Unavailable> (<Results Not
CrCl based on modified Cockcroft-Gault
Adjusted Body Weight (if ht > 60 in)]
Example of age related warning message
***Dangerous Meds
Patient is 72.
impairment and
Consider other
for Patient >64***
Amitriptyline can cause cognitive
loss of balance in older patients.
antidepressant medications on formulary.
19
Therapeutic Duplication Basics

Each FDB therapeutic class is assigned a number
of “duplication allowances” which determine
how many duplicate class orders can be entered
before a duplicate therapy warning will display



Therapeutic classes that have a duplication allowance
of 1 won’t trigger a warning until the entry of a third
Rx from that same class
The duplication allowance for a class can be
customized
The customized value takes precedence
20
Outpatient Therapeutic Duplication
------------------------------------------------------------------------------*** THERAPEUTIC DUPLICATION *** EZETIMIBE 10MG/SIMVASTATIN 10MG TAB with
Local Rx for ATORVASTATIN CALCIUM 10MG TAB
RX: 2054954
Drug: ATORVASTATIN CALCIUM 10MG TAB
SIG: TAKE ONE TABLET BY MOUTH EVERY EVENING
QTY: 30
Refills remaining: 11
Provider: COLON,AMY
Issued: 03/02/10
Status: Active
Last filled on: 03/02/10
Processing Status: Not released locally (Window) Days Supply: 30
------------------------------------------------------------------------------Press Return to Continue:
Duplicate Therapy Class(es): HMGCo-A Reductase Inhibitors
==================================================================
21
Outpatient Therapeutic Duplication
------------------------------------------------------------------------------*** THERAPEUTIC DUPLICATION *** EZETIMIBE 10MG TAB with Pending Order for
EZETIMIBE 10MG/SIMVASTATIN 80MG TAB
Pending Drug: EZETIMIBE 10MG/SIMVASTATIN 80MG TAB
SIG: TAKE 3 TABLETS BY MOUTH EVERY EVENING
Quantity: 90
# of Refills: 0
Provider: COLON,AMY
Issue Date: MAR 3,2010@23:49:17
Provider Comments:
------------------------------------------------------------------------------Press Return to Continue:
Duplicate Therapy Class(es): Selective Cholesterol Absorption Inhibitor
=====================================================================
22
Drug Interactions Warning
Message Display

Displays severity – Critical then Significant



Within severity, the sequence of the order display is
sorted by local, remote, pending, and NonVA orders
Contains a short description of the potential
clinical effects of the interaction
A detailed professional drug interaction
monograph is available for display
23
Outpatient Drug Interactions
----------------------------------------------------------------***Critical*** Drug Interaction with PIMOZIDE 2MG TAB and Local Rx for AMIODARONE
HCL (PACERONE) 200MG TAB
RX: 2054826
Drug: AMIODARONE HCL (PACERONE) 200MG TAB
SIG: TAKE ONE-HALF TABLET BY MOUTH EVERY 12 HOURS
QTY: 30
Refills remaining: 11
Provider: COLON,AMY
Issued: 03/04/10
Status: Active
Last filled on: 03/04/10
Processing Status: Not released locally (Window) Days Supply: 30
Concurrent use may result in prolongation of the QTc interval, which may result in potentially lifethreatening arrhythmias.(1)
----------------------------------------------------------------Display Interaction Monograph? No//
24
Professional Monograph
Drug Interaction with PIMOZIDE 2MG TAB and Local Rx: #2054826 AMIODARONE HCL(PACERONE) 200MG TAB
This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or
discontinuing any drug or commencing any course of treatment.
MONOGRAPH TITLE: Pimozide/Class I and III Antiarrhythmics
SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be
dispensed or administered to the same patient.
MECHANISM OF ACTION: Concurrent use may possibly result in additive effects on the QTc interval.(1)
CLINICAL EFFECTS: Concurrent use may result in prolongation of the QTc interval, which may result in potentially life-threatening
arrhythmias.(1)
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: Concurrent therapy with pimozide and Class I and III antiarrhythmics should be avoided. The
manufacturer of pimozide states that concurrent therapy with agents that prolong the QTc interval is contraindicated.(1)
DISCUSSION: There is no clinical documentation to support this interaction. Pimozide has been shown to prolong the QTc interval.
Therefore, the manufacturer of pimozide states that concurrent therapy with agents that prolong the QTc interval is contraindicated
because of the risk of additive effects on the QTc interval.(1) No other clinical documentation is available.
REFERENCE:
1.Orap (pimozide) US prescribing information. Gate Pharmaceuticals July, 2009.
Copyright 2010 First DataBank, Inc.
25
Outpatient Drug Interactions
Example of a Custom Severity
------------------------------------------------------------------------------***Critical*** Drug Interaction with GEMFIBROZIL 600MG TAB and Local Rx for
ATORVASTATIN CALCIUM 10MG TAB
RX: 2054954
Drug: ATORVASTATIN CALCIUM 10MG TAB
SIG: TAKE ONE TABLET BY MOUTH EVERY EVENING
QTY: 30
Refills remaining:
Provider: COLON,AMY
Issued:
Status: Active
Last filled on:
Processing Status: Not released locally (Window)
Days Supply:
11
03/02/10
03/02/10
30
Concurrent administration of HMG-CoA reductase inhibitors and fibric acid
derivatives has been associated with severe myopathy, rhabdomyolysis and
acute renal failure.
------------------------------------------------------------------------------Display Interaction Monograph? No//
26
Custom Severity Scenario Continued
Monograph View
Professional Monograph
Drug Interaction with ATORVASTATIN CALCIUM 20MG TAB and Pending Order
GEMFIBROZIL 600MG TAB
This information is generalized and not intended as specific medical advice. Consult your healthcare
professional
before taking or discontinuing any drug or commencing any course of treatment.
MONOGRAPH TITLE: Selected HMG-CoA Reductase Inhibitors/Selected Fibrates
SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse
interaction.
MECHANISM OF ACTION: Unknown.
CLINICAL EFFECTS: Concurrent administration of HMG-CoA reductase inhibitors and fibric acid
derivatives
has been associated with severe myopathy, rhabdomyolysis and acute renal failure.
PREDISPOSING FACTORS: Renal impairment may significantly increase the potential for adverse
consequences. Press Return to Continue or "^" to Exit:
(Remainder of monograph not included in capture)
27
Dosing Order Checks

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Warning of low or high dose
Checks for single dose and total daily dose
General dosing range will display if a check
cannot be done
FDB dosages for an ingredient may vary based
on dosage form, route, patient weight, patient
BSA, patient age
With backdoor entries, the check is done after
passing the conjunction field
28
High Dose Warnings for Single and
Total Daily Doses in Backdoor Entry
VERB: TAKE// TAKE
DISPENSE UNITS PER DOSE(TABLET(S)): 16// 16
Dosage Ordered: 40MG
NOUN: TABLETS// TABLETS
ROUTE: ORAL (BY MOUTH)// ORAL (BY MOUTH)
Schedule: BID-DIABETES// (TWICE A DAY BEFORE MEALS)
LIMITED DURATION (IN DAYS, HOURS OR MINUTES):
CONJUNCTION:
Press Return to continue,'^' to exit:
GLYBURIDE 2.5MG TAB: Single dose amount of 40 MILLIGRAMS exceeds the maximum single
dose amount of 10 MILLIGRAMS.
GLYBURIDE 2.5MG TAB: Total dose amount of 80 MILLIGRAMS/DAY exceeds the dosing
range of 1.25 MILLIGRAMS/DAY to 20 MILLIGRAMS/DAY.
29
Single and Total Daily Dose
Warnings for Excessive Doses
METFORMIN HCL 500MG TAB: Single dose amount of 3000
MILLIGRAMS exceeds the maximum single dose amount of 1000
MILLIGRAMS.
METFORMIN HCL 500MG TAB: Total dose amount of 6000
MILLIGRAMS/DAY exceeds the dosing range of 850
MILLIGRAMS/DAY to 2550 MILLIGRAMS/DAY.
30
High Dose Warnings for MultiIngredient Drugs
EZETIMIBE 10MG/SIMVASTATIN 10MG TAB: Single dose form amount of
10 TABLET(S) exceeds the maximum single dose form amount of 1
TABLET(S).
EZETIMIBE 10MG/SIMVASTATIN 10MG TAB: Total dose form amount of
10 TABLET(S)/DAY exceeds the dosing range of 1 TABLET(S)/DAY to 1
TABLET(S)/DAY.
Do you want to Continue? Y//
31
Dosing Checks – Pending Order
View of CPRS Check
Pending OP Orders (ROUTINE) Mar 01, 2010@09:45:16
Page: 1 of 3
DOSING,HARV
PID: 181-18-1818
Ht(cm): 192.99 (12/07/2009)
DOB: JUN 15,1955 (54)
Wt(kg): 136.36 (12/07/2009)
Order Checks:
WARFARIN (COUMADIN) NA 7.5MG (YELLW) TAB: Single dose amount of 15
MILLIGRAMS exceeds the maximum single dose amount of 10 MILLIGRAMS.
Overriding Provider: BRIGHTON,FRIENDLY
Overriding Reason: Not paying attention
WARFARIN (COUMADIN) NA 7.5MG (YELLW) TAB: Total dose amount of 30
MILLIGRAMS/DAY exceeds the dosing range of 0.409 MILLIGRAMS/DAY to 10
MILLIGRAMS/DAY.
Overriding Provider: : BRIGHTON,FRIENDLY
Overriding Reason: Not paying attention
*(1) Orderable Item: WARFARIN TAB
(2)
CMOP Drug: WARFARIN (COUMADIN) NA 7.5MG (YELLW) TAB
+
32
VistA Dosing Checks for Pending
Orders Occur at the Accept Prompt
Select Item(s): Next Screen// A Accept
Now Processing Enhanced Order Checks! Please wait...
WARFARIN (COUMADIN) NA 7.5MG (YELLW) TAB: Single dose amount of 15
MILLIGRAMS exceeds the maximum single dose amount of 10 MILLIGRAMS.
WARFARIN (COUMADIN) NA 7.5MG (YELLW) TAB: Total dose amount of 30
MILLIGRAMS/DAY exceeds the dosing range of 0.409 MILLIGRAMS/DAY to 10
MILLIGRAMS/DAY.
Do you want to Continue? Y// ES
Do you want to Process medication
WARFARIN (COUMADIN) NA 7.5MG (YELLW) TAB: P// ROCESS MEDICATION
Enter your Current Signature Code: SIGNATURE VERIFIED
Now creating Pharmacy Intervention
33
Dosing Checks for Drugs with
Dosages Dependent on Body Surface
Area or Weight Values
ENOXAPARIN 40MG/0.4ML INJ SYRINGE 0.4ML: Single dose amount of
400 MILLIGRAMS exceeds the maximum single dose amount of 129.27273
MILLIGRAMS.
ENOXAPARIN 40MG/0.4ML INJ SYRINGE 0.4ML: Total dose amount of
800 MILLIGRAMS/DAY exceeds the dosing range of 40 MILLIGRAMS/DAY
to 2.1 MILLIGRAMS/KG/DAY.
34
Error Warning /General Dosing
Range Display
This patient does not have a weight value on file, and the specific drug requires a
weight for dosing calculations. Single and daily checks could not be done, so a
general dosing range is displayed.
Maximum Single Dose Check could not be performed for Drug:
ENOXAPARIN 40MG/0.4ML INJ SYRINGE 0.4ML
Reason: Weight required.
Daily Dose Range Check could not be performed for Drug:
ENOXAPARIN 40MG/0.4ML INJ SYRINGE 0.4ML
Reason: Weight required.
General dosing range for ENOXAPARIN 40MG/0.4ML INJ SYRINGE 0.4ML
(SUBCUTANEOUS): 40 MG/DAY to 2.1 MG/KG/DAY
35
Dosing Checks for Complex
Orders




Each section of the complex order (separated by
conjunctions) is represented by a “sequence”
Dosage calculations for dose warnings are
performed differently depending on the type of
conjunction that is selected (and, then, except)
Each sequence is totaled separately with a
“Then” conjunction
Cumulative dose from each sequence is used for
the total daily dose calculation when the “and”
conjunction is used
36
Complex Order Using “Then”
Conjunction
Sig example: 15mg bid for 1 day, then 20mg bid
DOSE SEQ 1:
WARFARIN (COUMADIN) NA 5MG (PEACH) TAB: Single dose amount of 15
MILLIGRAMS exceeds the maximum single dose amount of 7.5 MILLIGRAMS.
WARFARIN (COUMADIN) NA 5MG (PEACH) TAB: Total dose amount of 30
MILLIGRAMS/DAY exceeds the dosing range of 0.409 MILLIGRAMS/DAY to 7.5
MILLIGRAMS/DAY.
DOSE SEQ 2:
WARFARIN (COUMADIN) NA 5MG (PEACH) TAB: Single dose amount of
20MILLIGRAMS exceeds the maximum single dose amount of 7.5 MILLIGRAMS.
WARFARIN (COUMADIN) NA 5MG (PEACH) TAB: Total dose amount of 40
MILLIGRAMS/DAY exceeds the dosing range of 0.409 MILLIGRAMS/DAY to 7.5
MILLIGRAMS/DAY.
37
Dosage Check Exclusions






Supply items
Item is not matched to NDF
Orderable item is inactive
No GCNSEQ number available
The "exclude from dosage checks" field in the Dosage
Form file is set to YES and the 'override DF dose
check exclusion' field in the VA Product file is set to
NO
The "exclude from dosage checks" field in the Dosage
Form file is set to NO and the 'override DF dose check
exclusion' field in the VA Product file is set to YES
38
Sample List of Potential Drug and
Order Level Messages

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
Drug not matched to NDF
No GCNSEQNO exists for VA
Product
No active Dispense Drug
found
No active, marked for IV
Fluid Order Entry IV
Additive/Solution found
One or more required patient
parameters unavailable:
<PARAMETER(S) LISTED>
Invalid or Undefined Dose
Route
Invalid or Undefined Dose
Type
Invalid or Undefined Dose
Invalid or Undefined Dose
Unit

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


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


Free Text Dosage could not be
evaluated
FDB dosing information is not
available for this drug.
At least one Schedule is a Day
of Week Schedule
One or more Free Text Dosages
could not be evaluated
Bad GCNSEQNO assigned to VA
Product
Invalid or Undefined Dose Rate
Invalid or Undefined Duration
Invalid or Undefined Duration
Rate
Invalid or Undefined Frequency
39
Inpatient Pharmacy
PRE Functionality Highlights
40
Overview: Inpatient Pharmacy
Application Enhancements




Enhanced duplicate therapy order check to
utilize FDB’s Enhanced Therapeutic
Classification System which allows for multiple
classes per drug
New Maximum Single Dosage order check
New Daily Dosage Range order check
Provide general dosing information for a drug
when dosage checks cannot be performed
41
Overview: Inpatient Pharmacy
Application Enhancements
(continued)



Ability to perform order checks on IV Premix
solutions (IV Solutions identified by the local
site as “Premixes”) in addition to Unit Dose and
IV Additives in current system
Remove Duplicate Drug Order Check from
Inpatient Medications application
Allow the user to take action after an
Allergy/ADR order check is displayed for
Inpatient Medications application
42
Overview: Inpatient Pharmacy
Application Enhancements
(continued)


Create new field in IV Additives file (#52.6) to
provide default for CPRS additive frequency
field for continuous IV orders with additives
Provide auto-population of additive frequency
field upon software installation also Modify Drug
Enter/Edit option and Additives File stand alone
option to manage the new additive frequency
field for an IV Additive
43
Overview: Inpatient Pharmacy
Application Enhancements
(continued)

Provide a quick and timely notification of
recently discontinued/expired outpatient and
inpatient medication orders


An inpatient ward parameter shall be created in the
INPATIENT WARD PARAMETERS file (#59.6) to allow
local facilities to set a timeframe for which a discontinued and
expired inpatient (IV & UD) medication order will be
identified as ‘recently discontinued/expired’ for a ward.
The inpatient ward parameter allows for a minimum value of
one (1) hour and a maximum value of one hundred twenty
(120) hours. Set by system and ward (ward overrides system)
44
New Functionality:
Recently Discontinued/Expired
(local parameter, system and “by ward”)
MJMTESTFRANK,SIX F
PID: 999-99-9999
DOB: 06/06/21 (88)
Dx: SENILE DEMENTIA
Ward: ECU INT
Room-Bed: 191-2
Ht(cm): 177.80 (02/08/10)
Wt(kg): 65.45 (02/08/10)
Last transferred: ********
5
LITHIUM CARBONATE CAP,ORAL
C 02/18 03/20 A
Give: 300MG PO BID-WF
6
OMEPRAZOLE CAP,EC
C 02/18 03/20 A
Give: 20MG PO QD-(EVERY DAY)
- - - - - - - - RECENTLY DISCONTINUED/EXPIRED (LAST 24 HOURS) - - - - - - - 7
LAMOTRIGINE TAB,ORAL
C 02/18 02/18 D
Give: 25MG PO BID
Enter ?? for more actions
PI Patient Information
SO Select Order

PU Patient Record Update
NO New Order Entry

Select Action: Quit//
45
Inpatient Pharmacy Order Check
Sequence

Creation of new Error Messages will require a
new sequence of message display to the user

system level error message examples: vendor database
cannot be reached, connection to vendor database has been
disabled

drug level error message examples: NDF entry missing
GCNSEQ Number, local drug not matched to NDF, OI
with no active dispense drug

order level error message examples: missing patient age,
cannot calculate order dose, invalid dose route (not mapped
to FDB)
46
Inpatient Pharmacy Order Check
Sequence
(continued)











System Errors
Allergy/ADR (local & remote)
CPRS checks generated backdoor (3 new checks)
Drug Level Errors
Inpatient Critical Drug Interaction
Local & Remote Outpatient Critical Drug Interactions
Inpatient Significant Drug Interactions
Local & Remote Outpatient Significant Drug Interactions
Order Level Error Messages – Drug Interactions
Duplicate Therapy –Inpatient, Local & Remote Outpatient
Order Level Error Messages – Duplicate Therapy
47
Inpatient Pharmacy Order Check
Sequence
(continued)

Dosing Messages follow the Non-Dosing
Messages
 Dosing Check Warnings are displayed after
Duplicate Therapy Order Level error
messages.
This drug not recommended for a patient of this age.
 Dosing is not established for a patient of this age.

 Dosing
Check Order Level Error messages
are displayed after Dosing Check Warnings.
48
Inpatient Pharmacy Order Check
Triggers (Non-Dosing)




Entering a new IV or Unit Dose medication
order through pharmacy options
Finishing a pending IV or Unit Dose medication
order
Renewing an IV or Unit Dose order
Creating a new Unit Dose order when editing
the orderable item (to a new orderable item)
through pharmacy options
49
Inpatient Pharmacy Order Check
Triggers (Non-Dosing)
(continued)




Editing the IV additive field (changing existing
additive or adding new additive) for an IV order
Editing the IV solution field (changing existing
solution or adding a new solution) for an IV
order (IV solutions marked as Premix)
Entering a new Unit Dose medication order
using backdoor pharmacy order sets
Copying an IV or Unit Dose medication order,
thereby creating a new order.
50
Inpatient Pharmacy Order Check
Triggers (Dosing)

Same conditions apply for Dosing triggers with
the addition of editing specific fields:

Unit Dose order: Dosage Ordered
Units per Dose (for Dispense
Drug)
Med Route
Schedule

IV order
Infusion rate
Schedule
Med Route
Volume
Number of “bottles” of IV Additive
51
Pending Unit Dose Order #1
FIVE MJMTESTFRANK,SIX F
PID: 999-99-9999
DOB: 06/06/21 (88)
Sex: MALE
Dx: SENILE DEMENTIA
Ward: ECU INT
A
Room-Bed: 191-2
Ht(cm): 177.80 (02/08/10)
Wt(kg): 65.45 (02/08/10)
Admitted: 02/08/10
Last transferred: ********
- - - - - - - - - - - - - - - - - A C T I V
1
BENZTROPINE TAB
Give: 1MG PO BID
2
DIGOXIN CAP,ORAL
Give: 0.1MG PO QD-(EVERY DAY)
3
DOFETILIDE CAP,ORAL
Give: 125MCG PO BID
4
LITHIUM CARBONATE CAP,ORAL
Give: 300MG PO BID-WF
- - - - - - - - - - - - - - - - P E N D I
5
AMILORIDE/HCTZ TAB
Give: 1 TABLET PO QD-(EVERY DAY)
+
Enter ?? for more actions
PI Patient Information
SO
PU Patient Record Update
NO
Select Action: Next Screen//
E - - - - - - - - - - - - - - - - C 02/18 03/20 A
C
02/18
03/20 A
NF
C
02/18
03/20 A
NF
C
02/18
03/20 A
N G - - - - - - - - - - - - - - - ? ***** ***** P NF
Select Order
New Order Entry
52
Pending Unit Dose Order #1
MJMTESTFRANK,SIX F
PID: 666-66-6696
DOB: 06/06/21 (88)
*(1)Orderable Item:
Instructions:
*(2)Dosage Ordered:
Duration:
*(4)
Med Route:
Ward: ECU INT
Room-Bed: 191-2
A
Ht(cm): 177.80 (02/08/10)
Wt(kg): 65.45 (02/08/10)
AMILORIDE/HCTZ TAB *N/F*
1 TABLET
1 TABLET
ORAL (BY MOUTH)
<DIN>
(3)Start: 02/18/10
REQUESTED START: 02/19/10
(5) Stop: 03/20/10
12:45
09:00
18:00
(6) Schedule Type: CONTINUOUS
*(8)
Schedule: QD-(EVERY DAY)
(9)
Admin Times: 09
*(10)
Provider: MARTINKO,MICHAEL [es]
(11) Special Instructions:
(12) Dispense Drug
AMILORIDE HCL 5/HCTZ 50MG TAB *N/F*
+
Enter ?? for more actions
BY Bypass
FL Flag
DC Discontinue
FN Finish
Select Item(s): Next Screen// NEXT SCREEN
U/D
1
<<<<<<<<<<<<<
Inactive Date
53
Pending Unit Dose Order #1
CRITICAL drug-drug interaction: AMILORIDE HCL 5/HCTZ 50MG TAB & LITHIUM
CARBONATE 300MG CAP - Thiazide diuretics administered to patients receiving
lithium causes a significant rise in serum lithium concentrations that may
result in lithium toxi
Overriding Provider: MARTINKO,MICHAEL
Overriding Reason: patient receiving from outside physician
Previous adverse reaction to: HYDROCHLOROTHIAZIDE (LOCAL)
Overriding Provider: MARTINKO,MICHAEL
Overriding Reason: patient receiving from outside physician
Enhanced Order Checks cannot be performed for Local Outpatient Drug:
OMEPRAZOLE CAP,EC(Drug not matched to NDF)
Overriding Provider: MARTINKO,MICHAEL
SIGNIFICANT drug-drug interaction: AMILORIDE HCL 5/HCTZ 50MG TAB & DOFETILIDE
125MCG CAP - Concurrent use of dofetilide with hydrochlorothiazide may result
in elevated levels and clinical effects of dofetilide, as well as prolongation
of the QT
Overriding Provider: MARTINKO,MICHAEL
SIGNIFICANT drug-drug interaction: AMILORIDE HCL 5/HCTZ 50MG TAB & POTASSIUM
CHLORIDE 10MEQ SA TAB - May observe hyperkalemia which may be severe or even
54
fatal.
Pending Unit Dose Order #1
MJMTESTFRANK,SIX F
PID: 666-66-6696
DOB: 06/06/21 (88)
*(1)Orderable Item:
Instructions:
*(2)Dosage Ordered:
Duration:
*(4)
Med Route:
Ward: ECU INT
Room-Bed: 191-2
A
Ht(cm): 177.80 (02/08/10)
Wt(kg): 65.45 (02/08/10)
AMILORIDE/HCTZ TAB *N/F*
1 TABLET
1 TABLET
<DIN>
(3)Start: 02/18/10
REQUESTED START: 02/19/10
(5) Stop: 03/20/10
ORAL (BY MOUTH)
12:45
09:00
18:00
(6) Schedule Type: CONTINUOUS
*(8)
Schedule: QD-(EVERY DAY)
(9)
Admin Times: 09
*(10)
Provider: MARTINKO,MICHAEL [es]
(11) Special Instructions:
(12) Dispense Drug
AMILORIDE HCL 5/HCTZ 50MG TAB *N/F*
+
Enter ?? for more actions
BY Bypass
FL Flag
DC Discontinue
FN Finish
Select Item(s): Next Screen// FN
<<<<<<<<<<<<<
U/D
1
Inactive Date
55
Pending Unit Dose Order #1
Order Checks:
CRITICAL drug-drug interaction: AMILORIDE HCL 5/HCTZ 50MG TAB & LITHIUM
CARBONATE 300MG CAP - Thiazide diuretics administered to patients receiving
lithium causes a significant rise in serum lithium concentrations that may
result in lithium toxi
Overriding Provider: MARTINKO,MICHAEL
+
Enter ?? for more actions
Enter RETURN to continue or '^' to exit:
56
Pending Unit Dose Order #1
A Drug-Allergy Reaction exists for this medication and/or class!
Drug: AMILORIDE HCL 5/HCTZ 50MG TAB
Ingredients: HYDROCHLOROTHIAZIDE (LOCAL)
Drug Class: CV701 THIAZIDES/RELATED DIURETICS (LOCAL)
Do you want to Intervene? NO//
NO
<<<<<<<<<<<<<<<
57
Pending Unit Dose Order #1
A Drug-Allergy Reaction exists for this medication and/or class!
Drug: AMILORIDE HCL 5/HCTZ 50MG TAB
Ingredients: HYDROCHLOROTHIAZIDE (LOCAL)
Drug Class: CV701 THIAZIDES/RELATED DIURETICS (LOCAL)
Do you want to Intervene? NO//
NO
Now Processing Enhanced Order Checks!
Please wait...
Enhanced Order Checks cannot be performed for Local Outpatient Drug:
OMEPRAZOLE CAP,EC
Reason: Drug not matched to NDF
Press Return to continue...
58
Pending Unit Dose Order #1
============================================================================
This patient is receiving the following order(s) that have a Drug
Interaction with AMILORIDE HCL 5/HCTZ 50MG TAB:
LITHIUM CARBONATE CAP,ORAL
Give: 300MG PO BID-WF
C
02/18
03/20
A
***Critical*** Thiazide diuretics administered to patients receiving
lithium causes a significant rise in serum lithium concentrations that may
result in lithium toxicity.
..............................................................................
DOFETILIDE CAP,ORAL
Give: 125MCG PO BID
C
02/18
03/20
A
***Significant*** Concurrent use of dofetilide with hydrochlorothiazide
may result in elevated levels and clinical effects of dofetilide, as well
as prolongation of the QT interval.(1)
..............................................................................
Press Return to continue...
[RETURN]
59
Pending Unit Dose Order #1
Rx
Drug
ST REM Issued Last Fill
----------------------------------------------------------------------------$2054922
POTASSIUM CHLORIDE 10MEQ SA TAB
A 3 02/18/10 02/18/10
Qty: 90
SIG: TAKE ONE TABLET BY MOUTH EVERY DAY
***Significant*** May observe hyperkalemia which may be severe or even
fatal.
==============================================================================
Display Professional Interaction Monograph(s)? NO//
60
Pending Unit Dose Order #1
Rx
Drug
ST REM Issued Last Fill
----------------------------------------------------------------------------$2054922
POTASSIUM CHLORIDE 10MEQ SA TAB
A 3 02/18/10 02/18/10
Qty: 90
SIG: TAKE ONE TABLET BY MOUTH EVERY DAY
***Significant*** May observe hyperkalemia which may be severe or even
fatal.
==============================================================================
Display Professional Interaction Monograph(s)? NO// YES
1.
2.
3.
<<<<<<<<
DOFETILIDE and AMILORIDE/HYDROCHLOROTHIAZIDE (SIGNIFICANT - I)
LITHIUM and AMILORIDE/HYDROCHLOROTHIAZIDE (CRITICAL - I)
POTASSIUM CHLORIDE and AMILORIDE/HYDROCHLOROTHIAZIDE (SIGNIFICANT - O)
Select Monograph(s) for printing by number:
(1-3):
61
Pending Unit Dose Order #1
Rx
Drug
ST REM Issued Last Fill
----------------------------------------------------------------------------$2054922
POTASSIUM CHLORIDE 10MEQ SA TAB
A 3 02/18/10 02/18/10
Qty: 90
SIG: TAKE ONE TABLET BY MOUTH EVERY DAY
***Significant*** May observe hyperkalemia which may be severe or even
fatal.
==============================================================================
Display Professional Interaction Monograph(s)? NO//
1.
2.
3.
DOFETILIDE and AMILORIDE/HYDROCHLOROTHIAZIDE (SIGNIFICANT - I)
LITHIUM and AMILORIDE/HYDROCHLOROTHIAZIDE (CRITICAL - I)
POTASSIUM CHLORIDE and AMILORIDE/HYDROCHLOROTHIAZIDE (SIGNIFICANT - O)
Select Monograph(s) for printing by number:
(1-3):
1-3
<<<<<<<<<<
62
Pending Unit Dose Order #1
Rx
Drug
ST REM Issued Last Fill
----------------------------------------------------------------------------$2054922
POTASSIUM CHLORIDE 10MEQ SA TAB
A 3 02/18/10 02/18/10
Qty: 90
SIG: TAKE ONE TABLET BY MOUTH EVERY DAY
***Significant*** May observe hyperkalemia which may be severe or even
fatal.
==============================================================================
Display Professional Interaction Monograph(s)? NO//
1.
2.
3.
DOFETILIDE and AMILORIDE/HYDROCHLOROTHIAZIDE (SIGNIFICANT - I)
LITHIUM and AMILORIDE/HYDROCHLOROTHIAZIDE (CRITICAL - I)
POTASSIUM CHLORIDE and AMILORIDE/HYDROCHLOROTHIAZIDE (SIGNIFICANT - O)
Select Monograph(s) for printing by number: (1-3):
DEVICE: HOME//
[RETURN]
<<<<<<<<<<<<<<
1-3
63
Pending Unit Dose Order #1
Professional Monograph
Drug Interaction with DOFETILIDE and AMILORIDE/HYDROCHLOROTHIAZIDE
This information is generalized and not intended as specific medical
advice. Consult your healthcare professional before taking or
discontinuing any drug or commencing any course of treatment.
MONOGRAPH TITLE:
Dofetilide/Hydrochlorothiazide
SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug
combination is contraindicated and generally should not be dispensed or
administered to the same patient.
MECHANISM OF ACTION: Hydrochlorothiazide may decrease the excretion of
dofetilide and may decrease potassium levels.(1)
CLINICAL EFFECTS: Concurrent use of dofetilide with hydrochlorothiazide
may result in elevated levels and clinical effects of dofetilide, as
well as prolongation of the QT interval.(1)
Press Return to continue...
[RETURN]
<<<<<<<<<<<<<<<<<<<<
64
Pending Unit Dose Order #1
REFERENCES:
1.Shapiro S, Slone D, Lewis GP, Jick H. Fatal drug reactions among
medical inpatients. JAMA 1971 Apr 19;216(3):467-72.
2.Simborg DW. Medication prescribing on a university medical service-the
incidence of drug combinations with potential adverse interactions.
Johns Hopkins Med J 1976 Jul;139(1):23-6.
Copyright 2010 First DataBank, Inc.
Do you want to Continue with AMILORIDE HCL 5/HCTZ 50MG TAB? NO//
YES
<<<<<<<
65
Pending Unit Dose Order #1
REFERENCES:
1.Shapiro S, Slone D, Lewis GP, Jick H. Fatal drug reactions among
medical inpatients. JAMA 1971 Apr 19;216(3):467-72.
2.Simborg DW. Medication prescribing on a university medical service-the
incidence of drug combinations with potential adverse interactions.
Johns Hopkins Med J 1976 Jul;139(1):23-6.
Copyright 2010 First DataBank, Inc.
Do you want to Continue with AMILORIDE HCL 5/HCTZ 50MG TAB? NO//
YES
Now creating Pharmacy Intervention
For AMILORIDE HCL 5/HCTZ 50MG TAB
PROVIDER:
66
Pending Unit Dose Order #1
REFERENCES:
1.Shapiro S, Slone D, Lewis GP, Jick H. Fatal drug reactions among
medical inpatients. JAMA 1971 Apr 19;216(3):467-72.
2.Simborg DW. Medication prescribing on a university medical service-the
incidence of drug combinations with potential adverse interactions.
Johns Hopkins Med J 1976 Jul;139(1):23-6.
Copyright 2010 First DataBank, Inc.
Do you want to Continue with AMILORIDE HCL 5/HCTZ 50MG TAB? NO//
YES
Now creating Pharmacy Intervention
For AMILORIDE HCL 5/HCTZ 50MG TAB
PROVIDER: MARTINKO,MICHAEL J
RECOMMENDATION: 8 NO CHANGE
MJM
192
OI&T STAFF
See 'Pharmacy Intervention Menu' if you want to delete this
intervention or for more options.
Would you like to edit this intervention? N// O
67
Pending Unit Dose Order #1
MJMTESTFRANK,SIX F
PID: 666-66-6696
DOB: 06/06/21 (88)
*(1)Orderable Item:
Instructions:
*(2)Dosage Ordered:
Duration:
*(4)
Med Route:
Ward: ECU INT
Room-Bed: 191-2
A
Ht(cm): 177.80 (02/08/10)
Wt(kg): 65.45 (02/08/10)
AMILORIDE/HCTZ TAB *N/F*
1 TABLET
1 TABLET
<DIN>
(3)Start: 02/18/10
REQUESTED START: 02/19/10
(5) Stop: 03/20/10
ORAL (BY MOUTH)
12:45
09:00
18:00
(6) Schedule Type: CONTINUOUS
*(8)
Schedule: QD-(EVERY DAY)
(9)
Admin Times: 09
*(10)
Provider: MARTINKO,MICHAEL [es]
(11) Special Instructions:
(12) Dispense Drug
AMILORIDE HCL 5/HCTZ 50MG TAB *N/F*
+
Enter ?? for more actions
ED Edit
Select Item(s): Next Screen//
AC
U/D
1
Inactive Date
ACCEPT
68
Pending Unit Dose Order #2
MJMTESTHELLO,EIGHT H
PID: 999-99-9999
DOB: 08/08/33 (76)
Sex: MALE
Dx: CHEMO COLON CA
Ward: INTERME
Room-Bed: 337-1
AD
Ht(cm): 170.18 (03/05/07)
Wt(kg): 69.14 (03/05/07)
Admitted: 03/05/07
Last transferred: ********
- - - - - - - - - - - - - - N O N - V E R I F I E D - - - - - - - - - - - - 1
HEPARIN (DIABETIC) 10000 UNITS
? ***** ***** N
in DEXTROSE 5% (BRAUN) 100 ML 100 ml/hr
- - - - - - - - - - - - - - - - P E N D I N G - - - - - - - - - - - - - - - 2
SALSALATE TAB
? ***** ***** P
Give: 1500MG PO QID
3
MULTIVITAMIN (10ML) 5 ML
? ***** ***** P
in DEXTROSE 5% 1000 ML 100 ml/hr
Enter ?? for more actions
PI Patient Information
PU Patient Record Update
Select Action: Quit//
SO
NO
Select Order
New Order Entry
69
Pending Unit Dose Order #2
MJMTESTHELLO,EIGHT H
PID: 999-99-9999
DOB: 08/08/33 (76)
*(1)Orderable Item:
Instructions:
*(2)Dosage Ordered:
Duration:
*(4)
Med Route:
Ward: INTERME
Room-Bed: 337-1
AD
Ht(cm): 170.18 (03/05/07)
Wt(kg): 69.14 (03/05/07)
SALSALATE TAB
1500MG
1500MG
ORAL (BY MOUTH)
(3)Start: 02/18/10
REQUESTED START: 02/18/10
(5) Stop: 03/20/10
15:36
17:00
18:00
(6) Schedule Type: CONTINUOUS
*(8)
Schedule: QID
(9)
Admin Times: 09-13-17-21
*(10)
Provider: MARTINKO,MICHAEL [es]
(11) Special Instructions:
(12) Dispense Drug
SALSALATE 750MG TAB
+
Enter ?? for more actions
BY Bypass
FL Flag
DC Discontinue
FN Finish
Select Item(s): Next Screen//
U/D
2
Inactive Date
70
Pending Unit Dose Order #2
Order Checks:
Order for SALSALATE 750MG TAB may represent duplication of therapy. Order(s)
exist for {ASPIRIN 325MG TAB[PENDING]} in the same theraputic categor(ies):
Non-Narcotic Analgesics Salicylate/NSAID, Non-Steroidal Anti-Inflammatory
Agents
Overriding Provider: MARTINKO,MICHAEL
Overriding Reason: DOSE IS AVAILABLE IN CPRS
Enhanced Order Checks cannot be performed for Local Outpatient Drug: ALUM
ACETATE/ZINC OXIDE/AQUAPHOR (CMPD) PASTE(Drug not matched to NDF)
Overriding Provider: MARTINKO,MICHAEL
SIGNIFICANT drug-drug interaction: SALSALATE 750MG TAB & HEPARIN (DIABETIC)
10000 UNITS - Increased risk of bleeding which may extend for several days
beyond discontinuation of salicylates.
Overriding Provider: MARTINKO,MICHAEL
ORDER NOT VERIFIED
BY Bypass
FL Flag
DC Discontinue
FN Finish
Select Item(s): Quit// FN
Finish
<<<<<<<<<<<<<<<<<<<<
71
Pending Unit Dose Order #2
Order Checks:
Order for SALSALATE 750MG TAB may represent duplication of therapy. Order(s)
exist for {ASPIRIN 325MG TAB[PENDING]} in the same theraputic categor(ies):
Non-Narcotic Analgesics Salicylate/NSAID, Non-Steroidal Anti-Inflammatory
Agents
Overriding Provider: MARTINKO,MICHAEL
+
Enter ?? for more actions
Enter RETURN to continue or '^' to exit:
72
Pending Unit Dose Order #2
Order Checks:
Order for SALSALATE 750MG TAB may represent duplication of therapy. Order(s)
exist for {ASPIRIN 325MG TAB[PENDING]} in the same theraputic categor(ies):
Non-Narcotic Analgesics Salicylate/NSAID, Non-Steroidal Anti-Inflammatory
Agents
Overriding Provider: MARTINKO,MICHAEL
+
Enter ?? for more actions
Enter RETURN to continue or '^' to exit:
Now Processing Enhanced Order Checks!
[ENTER]
<<<<<<<<<<<<<
Please wait...
Enhanced Order Checks cannot be performed for Local Drug: MULTIVITAMIN (10ML)
5 ML
Reason: No GCNSEQNO exists for VA Product
Enhanced Order Checks cannot be performed for Local Outpatient Drug: ALUM
ACETATE/ZINC OXIDE/AQUAPHOR (CMPD) PASTE
Reason: Drug not matched to NDF
Press Return to continue...
73
Pending Unit Dose Order #2
=============================================================================
This patient is receiving the following order(s) that have a Drug
Interaction with SALSALATE 750MG TAB:
HEPARIN (DIABETIC) 10000 UNITS
in DEXTROSE 5% (BRAUN) 100 ML 100 ml/hr
?
*****
*****
N
***Significant*** Increased risk of bleeding which may extend for several
days beyond discontinuation of salicylates.
=============================================================================
Display Professional Interaction Monograph(s)? NO//
74
Pending Unit Dose Order #2
=============================================================================
This patient is receiving the following order(s) that have a Drug
Interaction with SALSALATE 750MG TAB:
HEPARIN (DIABETIC) 10000 UNITS
in DEXTROSE 5% (BRAUN) 100 ML 100 ml/hr
?
*****
*****
N
***Significant*** Increased risk of bleeding which may extend for several
days beyond discontinuation of salicylates.
=============================================================================
Display Professional Interaction Monograph(s)? NO// NO
<<<<<<<<<
Do you want to Intervene with SALSALATE 750MG TAB? NO//
NO
<<<<<<<<<<<
75
Pending Unit Dose Order #2
=====================================================================
This patient is already receiving the following INPATIENT and/or OUTPATIENT
order(s) for a drug in the same therapeutic class as SALSALATE 750MG TAB:
Pending Drug: ASPIRIN 325MG TAB
Eff. Date: 02/18/10
Qty: 30
Refills: 1
SIG: TAKE ONE TABLET BY MOUTH EVERY DAY
Prov: MARTINKO,MICHAEL
Duplicate Therapy Class(es): Non-Narcotic Analgesics Salicylate/NSAID,
Non-Steroidal Anti-Inflammatory Agents
Press Return to continue...
76
Pending Unit Dose Order #2
=====================================================================
This patient is already receiving the following INPATIENT and/or OUTPATIENT
order(s) for a drug in the same therapeutic class as SALSALATE 750MG TAB:
Pending Drug: ASPIRIN 325MG TAB
Eff. Date: 02/18/10
Qty: 30
Refills: 1
SIG: TAKE ONE TABLET BY MOUTH EVERY DAY
Prov: MARTINKO,MICHAEL
Duplicate Therapy Class(es): Non-Narcotic Analgesics Salicylate/NSAID,
Non-Steroidal Anti-Inflammatory Agents
Press Return to continue...
[RETURN]
<<<<<<<<<<<<<
SALSALATE 750MG TAB: Total dose amount of 6000 MILLIGRAMS/DAY exceeds
the dosing range of 500 MILLIGRAMS/DAY to 4000 MILLIGRAMS/DAY.
Do you want to Continue? NO//
77
Pending Unit Dose Order #2
=====================================================================
This patient is already receiving the following INPATIENT and/or OUTPATIENT
order(s) for a drug in the same therapeutic class as SALSALATE 750MG TAB:
Pending Drug: ASPIRIN 325MG TAB
Eff. Date: 02/18/10
Qty: 30
Refills: 1
SIG: TAKE ONE TABLET BY MOUTH EVERY DAY
Prov: MARTINKO,MICHAEL
Duplicate Therapy Class(es): Non-Narcotic Analgesics Salicylate/NSAID,
Non-Steroidal Anti-Inflammatory Agents
Press Return to continue...
SALSALATE 750MG TAB: Total dose amount of 6000 MILLIGRAMS/DAY exceeds
the dosing range of 500 MILLIGRAMS/DAY to 4000 MILLIGRAMS/DAY.
Do you want to Continue? NO// YES
<<<<<<<<<<<<<<
Now creating Pharmacy Intervention
For SALSALATE 750MG TAB
PROVIDER:
78
Unit Dose Order Example #3
NON-VERIFIED UNIT DOSE
MJMTESTALPHA,ONE A
PID: 111-11-1111
DOB: 01/01/01 (9)
Feb 05, 2010@13:59:07
Ward: C SURGE
Room-Bed: 327-1
(1)Orderable Item: GABAPENTIN CAP,ORAL
Instructions:
(2)Dosage Ordered: 800MG
Duration:
(4)
Med Route: ORAL (BY MOUTH)
Page:
1 of
2
Ht(cm): ______ (________)
Wt(kg): ______ (________)
<DIN>
(3)Start: 02/05/10
13:59
(5) Stop: 03/07/10
18:00
(6) Schedule Type: CONTINUOUS
(8)
Schedule:
Q3H
(9)
Admin Times: 03-06-09-12-15-18-21-24
(10)
Provider: ARMFIELD,DESIREE
(11) Special
Instructions:
(12) Dispense Drug
GABAPENTIN 400MG CAP
ED Edit
Select Item(s): Next Screen//
U/D
2
AC
Inactive Date
ACCEPT
79
Unit Dose Order Example #3
NON-VERIFIED UNIT DOSE
MJMTESTALPHA,ONE A
PID: 111-11-1111
DOB: 01/01/01 (9)
Feb 05, 2010@13:59:07
Ward: C SURGE
Room-Bed: 327-1
(1)Orderable Item: GABAPENTIN CAP,ORAL
Instructions:
(2)Dosage Ordered: 800MG
Duration:
(4)
Med Route: ORAL (BY MOUTH)
Page:
1 of
2
Ht(cm): ______ (________)
Wt(kg): ______ (________)
<DIN>
(3)Start: 02/05/10
13:59
(5) Stop: 03/07/10
18:00
(6) Schedule Type: CONTINUOUS
(8)
Schedule:
Q3H
(9)
Admin Times: 03-06-09-12-15-18-21-24
(10)
Provider: ARMFIELD,DESIREE
(11) Special
Instructions:
(12) Dispense Drug
GABAPENTIN 400MG CAP
ED Edit
Select Item(s): Next Screen//
U/D
2
AC
Inactive Date
ACCEPT
80
Unit Dose Order Example #3
Maximum Single Dose Check could not be performed for Drug: GABAPENTIN 400MG CAP
Reason: Weight required.
Daily Dose Range Check could not be performed for Drug: GABAPENTIN 400MG CAP
Reason: Weight required.
General dosing range for GABAPENTIN 400MG CAP (ORAL): 10 MG/KG/DAY to 35
MG/KG/DAY
Press Return to continue...
81
Unit Dose Order Example #3
NON-VERIFIED UNIT DOSE
MJMTESTDELTA,FOUR D
PID: 444-44-4444
DOB: 04/04/34 (75)
Feb 05, 2010@16:42:56
Ward: C SURGE
Room-Bed: 326-2
(1)Orderable Item: GABAPENTIN CAP,ORAL
Instructions:
(2)Dosage Ordered: 400MG
Duration:
(4)
Med Route: ORAL (BY MOUTH)
Page:
1 of
2
Ht(cm): ______ (________)
Wt(kg): ______ (________)
<DIN>
(3)Start: 02/05/10
16:43
(5) Stop: 03/07/10
18:00
(6) Schedule Type:
CONTINUOUS
(8)
Schedule: BID-WF
(9)
Admin Times: 0730-1730
(10)
Provider: STOESZ,DOREEN B
(11) Special Instructions:
(12) Dispense Drug
GABAPENTIN 400MG CAP
ED Edit
Select Item(s): Next Screen//
U/D
1
AC
Inactive Date
ACCEPT
82
Unit Dose Order Example #3
NON-VERIFIED UNIT DOSE
MJMTESTDELTA,FOUR D
PID: 444-44-4444
DOB: 04/04/34 (75)
Feb 05, 2010@16:42:56
Ward: C SURGE
Room-Bed: 326-2
(1)Orderable Item: GABAPENTIN CAP,ORAL
Instructions:
(2)Dosage Ordered: 400MG
Duration:
(4)
Med Route: ORAL (BY MOUTH)
Page:
1 of
2
Ht(cm): ______ (________)
Wt(kg): ______ (________)
<DIN>
(3)Start: 02/05/10
16:43
(5) Stop: 03/07/10
18:00
(6) Schedule Type:
CONTINUOUS
(8)
Schedule: BID-WF
(9)
Admin Times: 0730-1730
(10)
Provider: STOESZ,DOREEN B
(11) Special Instructions:
(12) Dispense Drug
GABAPENTIN 400MG CAP
ED Edit
Select Item(s): Next Screen//
U/D
1
AC
Inactive Date
ACCEPT
83
Unit Dose Order Example #3
GABAPENTIN 400MG CAP: Total dose amount of 800 MILLIGRAMS/DAY is below
the dosing range of 900 MILLIGRAMS/DAY to 2400 MILLIGRAMS/DAY.
Do you want to Continue? NO//
84
Unit Dose Order Example #3
The FDB dosing range for the first patient (age 9
years) is in MG/KG which is weight-related
Range Dose High:
Range Dose Low:
35.0 MG/KG/DAY
10.0 MG/KG/DAY
The FDB dosage range for the second patient (age 75
years) is MG only. NOT weight dependent.
Range Dose High:
Range Dose Low:
2400.0 MG/DAY
900.0 MG/DAY
85
IV Order Example #4
NON-VERIFIED IV
MJMTESTCHARLES,THREE C
PID: 333-33-3393
DOB: 03/03/53 (56)
Feb 28, 2010@12:00:45
Ward: C SURGE
Room-Bed: 129-1
*(1) Additives:
HEPARIN (DIABETIC) 1000 UNITS
*(2) Solutions:
DEXTROSE 5% 250 ML
Duration:
*(3) Infusion Rate: 100 ml/hr
*(5)
Med Route: IV
*(7)
Schedule:
(8)
Admin Times:
*(9)
Provider: MARTINKO,MICHAEL [w]
(10)
Other Print:
Remarks :
IV Room: CHEYENNE RM#272
+
Enter ?? for more actions
DC
Discontinue
RN
(Renew)
HD
(Hold)
OC
(On Call)
ED
Edit
AL
Activity Logs
Select Item(s): Next Screen//
Page:
1 of
2
Ht(cm): 177.80 (02/07/10)
Wt(kg): ______ (________)
Type: ADMIXTURE
(4)
Start: 02/28/10
11:59
Stop: 03/03/10
Last Fill: ********
Quantity: 0
Cum. Doses:
24:00
(6)
(11)
VF
FL
Verify
Flag
86
IV Order Example #4
HEPARIN (DIABETIC) 1000 UNITS: Total dose amount of 400 UNIT(S)/HOUR is
below the dosing range of 833 UNIT(S)/HOUR to 1667 UNIT(S)/HOUR.
Do you want to Continue? NO//
87
IV Order Example #4
HEPARIN (DIABETIC) 1000 UNITS: Total dose amount of 400 UNIT(S)/HOUR is
below the dosing range of 833 UNIT(S)/HOUR to 1667 UNIT(S)/HOUR.
Do you want to Continue? NO//
YES
<<<<<<<<<<<<
88
IV Order Example #4
HEPARIN (DIABETIC) 1000 UNITS: Total dose amount of 400 UNIT(S)/HOUR is
below the dosing range of 833 UNIT(S)/HOUR to 1667 UNIT(S)/HOUR.
Do you want to Continue? NO//
YES
Select ADDITIVE: HEPARIN (DIABETIC)//D50
VISN FORM (NDC)
DEXTROSE (50%)
<<<<<<<<<<<<<
(The units of strength for this additive are in ML)
Strength: 10
10 ML
<<<<<<<<<<<<<<<<<<<<
BOTTLE:
Select ADDITIVE:
89
IV Order Example #4
NON-VERIFIED IV
MJMTESTCHARLES,THREE C
PID: 333-33-3393
DOB: 03/03/53 (56)
Feb 28, 2010@12:01:15
Ward: C SURGE
Room-Bed: 129-1
*(1) Additives:
HEPARIN (DIABETIC) 1000 UNITS
DEXTROSE (50%) 10 ML
<<<<<<<<<<<<<
*(2) Solutions:
DEXTROSE 5% 250 ML
Duration:
*(3) Infusion Rate: 100 ml/hr
*(5)
Med Route: IV
*(7)
Schedule:
(8)
Admin Times:
*(9)
Provider: MARTINKO,MICHAEL [w]
(10)
Other Print:
Remarks :
IV Room: CHEYENNE RM#272
+
Enter ?? for more actions
AC
Accept
ED
Edit
Select Item(s): Next Screen//
Page:
1 of
2
Ht(cm): 177.80 (02/07/10)
Wt(kg): ______ (________)
Type: ADMIXTURE
(4)
11:59
Stop: 03/03/10
Last Fill: ********
Quantity: 0
Cum. Doses:
24:00
(6)
Start: 02/28/10
(11)
90
IV Order Example #4
Daily Dose Range Check could not be performed for Drug: HEPARIN (DIABETIC)
1000 UNITS
Reason: Weight required.
General dosing range for HEPARIN (DIABETIC) 1000 UNITS (INTRAVENOUS): 50
UNIT/KG/DAY to 60000 UNIT/DAY
Press Return to continue...
91
IV Order Example #4
ORDER #1
PSJFDB(1,"DOSE_TYPE")="MAINTENANCE"
PSJFDB(1,"DOSE_UNIT")="UNIT(S)"
PSJFDB(1,"DRUG_IEN")=152
PSJFDB(1,"DRUG_NM")="HEPARIN (DIABETIC) 1000 UNITS"
PSJFDB(1,"DURATION")=1
PSJFDB(1,"DURATION_RT")="HOUR"
PSJFDB(1,"FREQ")=1
PSJFDB(1,"ROUTE")="CONTINUOUS INFUSION"
PSJFDB(1,"RX_NUM")="I;2V;PROSPECTIVE;1"
PSJFDB(1,"SPECIFIC")=1
ORDER #2
PSJFDB(1,"DOSE_TYPE")="MAINTENANCE"
PSJFDB(1,"DOSE_UNIT")="UNIT(S)"
PSJFDB(1,"DRUG_IEN")=152
PSJFDB(1,"DRUG_NM")="HEPARIN (DIABETIC) 20000 UNITS"
PSJFDB(1,"DURATION")=1
PSJFDB(1,"DURATION_RT")="DAY"
PSJFDB(1,"FREQ")="Q1H"
PSJFDB(1,"ROUTE")="INTRAVENOUS"
PSJFDB(1,"RX_NUM")="I;3V;PROSPECTIVE;1"
PSJFDB(1,"SPECIFIC")=1
92
IV Order Example #4
ORDER #1
PSJFDB(1,"DOSE_TYPE")="MAINTENANCE"
PSJFDB(1,"DOSE_UNIT")="UNIT(S)"
PSJFDB(1,"DRUG_IEN")=152
PSJFDB(1,"DRUG_NM")="HEPARIN (DIABETIC) 1000 UNITS"
PSJFDB(1,"DURATION")=1
PSJFDB(1,"DURATION_RT")="HOUR"
PSJFDB(1,"FREQ")=1
PSJFDB(1,"ROUTE")="CONTINUOUS INFUSION“ <<<<<<<<<<<<<<<<
PSJFDB(1,"RX_NUM")="I;2V;PROSPECTIVE;1"
PSJFDB(1,"SPECIFIC")=1
ORDER #2
PSJFDB(1,"DOSE_TYPE")="MAINTENANCE"
PSJFDB(1,"DOSE_UNIT")="UNIT(S)"
PSJFDB(1,"DRUG_IEN")=152
PSJFDB(1,"DRUG_NM")="HEPARIN (DIABETIC) 20000 UNITS"
PSJFDB(1,"DURATION")=1
PSJFDB(1,"DURATION_RT")="DAY"
PSJFDB(1,"FREQ")="Q1H"
PSJFDB(1,"ROUTE")="INTRAVENOUS“
<<<<<<<<<<<<<<<<<<<
PSJFDB(1,"RX_NUM")="I;3V;PROSPECTIVE;1"
PSJFDB(1,"SPECIFIC")=1
93
New Functionality:
IV Additive Frequency
CPRS GUI Entry Screen
94
New Functionality:
IV Additive Frequency
(continued)

The additive frequency value selected for an IV
Additive within a continuous CPRS IV order shall be
stored in the bottle field for the IV additive within the
Pharmacy IV order.

If additive frequency value in CPRS is ‘1 bag/day’ this value shall be
represented as ‘in bottle 1’ (stored as ‘1’) in the Pharmacy IV order.

If additive frequency value selected in CPRS is ‘All bags’ this value shall
be represented as ‘all bottles’ (stored as null) in the Pharmacy IV order.
If additive frequency value selected for in CPRS is ‘See comments’ this
value shall be represented as ‘all bottles’ (stored as null) in the Pharmacy
IV order.
Note: The pharmacist will have to manually edit the bottle field for the IV additive based
on the provider instructions in the Provider comments from the CPRS order.
95

New Functionality:
IV Additive Frequency
(continued)
Inpatient Order Entry
Feb 17, 2010@17:14:57
Page:
1 of
1
DSIPREMOTE,FIVE
Ward: B52AP
PID: 999-99-9999
Room-Bed: AX240A-3
Ht(cm): ______ (________)
DOB: 03/01/70 (39)
Wt(kg): ______ (________)
Sex: MALE
Admitted: 06/16/09
Dx: HEADACHE
Last transferred: ********
------------------------------------------------------------------------------- - - - - - - - - - - - - - - - P E N D I N G - - - - - - - - - - - - - - - 2
MULTIVITAMIN 5 ML (1)
? ***** ***** P
in D5W 1000 ML 100 ml/hr
3
MULTIVITAMIN 6 ML
? ***** ***** P
in D5W 1000 ML 100 ml/hr
4
MULTIVITAMIN 7 ML
? ***** ***** P
in D5W 1000 ML 100 ml/hr
----------Enter ?? for more actions-------------------------------------------PI Patient Information
SO Select Order
PU Patient Record Update
NO New Order Entry
Select Action: Quit//
96
New Functionality:
IV Additive Frequency
(entered as “1 bag/day”)
DSIPREMOTE,FIVE
Ward: B52AP
PID: 999-99-9999
Room-Bed: AX240A-3
Ht(cm): ______ (________)
DOB: 03/01/70 (39)
Wt(kg): ______ (________)
-----------------------------------------------------------------------------*(1) Additives:
Type: ADMIXTURE
MULTIVITAMIN 5 ML 1
<<<<<<<<<
*(2) Solutions:
D5W 1000 ML
Duration:
(4)
Start: 02/17/10 17:13
*(3) Infusion Rate: 100 ml/hr
*(5)
Med Route: IV
(6)
Stop: 02/18/10 24:00
*(7)
Schedule:
Last Fill: ********
(8)
Admin Times:
Quantity: 0
*(9)
Provider: MARTINKO,MICHAEL J [es]
Cum. Doses:
(10)
Other Print:
+---------Enter ?? for more actions------------------------------------------DC
Discontinue
FL
Flag
ED
Edit
FN
Finish
97
New Functionality:
IV Additive Frequency
(entered as “all bags”)
DSIPREMOTE,FIVE
Ward: B52AP
PID: 999-99-9999
Room-Bed: AX240A-3
Ht(cm): ______ (________)
DOB: 03/01/70 (39)
Wt(kg): ______ (________)
-----------------------------------------------------------------------------*(1) Additives:
Type: ADMIXTURE
MULTIVITAMIN 6 ML
<<<<<<<<<<<<<<
*(2) Solutions:
D5W 1000 ML
Duration:
(4)
Start: 02/17/10 17:13
*(3) Infusion Rate: 100 ml/hr
*(5)
Med Route: IV
(6)
Stop: 02/18/10 24:00
*(7)
Schedule:
Last Fill: ********
(8)
Admin Times:
Quantity: 0
*(9)
Provider: MARTINKO,MICHAEL J [es]
Cum. Doses:
(10)
Other Print:
+---------Enter ?? for more actions------------------------------------------DC
Discontinue
FL
Flag
ED
Edit
FN
Finish
98
New Functionality:
IV Additive Frequency
(entered as “see comments”)
DSIPREMOTE,FIVE
Ward: B52AP
PID: 999-99-9999
Room-Bed: AX240A-3
Ht(cm): ______ (________)
DOB: 03/01/70 (39)
Wt(kg): ______ (________)
-----------------------------------------------------------------------------*(1) Additives:
Type: ADMIXTURE
MULTIVITAMIN 7 ML
*(2) Solutions:
D5W 1000 ML
Duration:
(4)
Start: 02/17/10 17:13
*(3) Infusion Rate: 100 ml/hr
*(5)
Med Route: IV
(6)
Stop: 02/18/10 24:00
*(7)
Schedule:
Last Fill: ********
(8)
Admin Times:
Quantity: 0
*(9)
Provider: MARTINKO,MICHAEL J [es]
Cum. Doses:
(10)
Other Print:
Provider Comments: ADD IN BAGS 1 AND 4
<<<<<<<<<<<<<<<<<<<
(11) Remarks :
+---------Enter ?? for more actions-----------------------------------------99
Enhanced Pharmacy Order Check
Implementation Schedule
Release
#
Project Deliverable
1
PRE V0.5 Foundational Enhancements
2
Pharmacy Enterprise Customization System (PECS)
3
Order Checks Phase 1 (Non-Dosing)
4
Order Checks Phase 2 (Dosing)
5
Pharmacy Enterprise Customization System Enhancements
6
Enhanced Order Checks
Note: These releases all precede “ PRE v1.0 ” functionality
100
Enhanced Pharmacy Order Check
Implementation Schedule
Release
#
Project Deliverable
1
PRE V0.5 Foundational Enhancements
2
Pharmacy Enterprise Customization System (PECS)
3
Order Checks Phase 1 (Non-Dosing)
4
Order Checks Phase 2 (Dosing)
5
Pharmacy Enterprise Customization System Enhancements
6
Enhanced Order Checks
Note: These releases all precede “ PRE v1.0 ” functionality
101
Enhanced Pharmacy Order Check
Implementation Schedule
(continued)
102
Enhanced Pharmacy Order Check
Implementation Schedule
(continued)
103
Pharmacy Re-Engineering
What’s Next After Dosing?
Release
#
Project Deliverable
1
PRE V0.5 Foundational Enhancements
2
Pharmacy Enterprise Customization System (PECS)
3
Order Checks Phase 1 (Non-Dosing)
4
Order Checks Phase 2 (Dosing)
5
Pharmacy Enterprise Customization System Enhancements
6
Enhanced Order Checks
Note: These releases all precede “ PRE v1.0 ” functionality
104
Increment 5
PECS Enhancements

PECS Usability Improvement





Improved Request Processes
Improved Query Functionality and Results Display
Improved User Assignments
Drug- Drug Interaction Wizard
PECS Additional Custom Tables


Custom Classifications, IDs, Messages, Attributes,
Indications
Compound Drugs
105
Increment 6
Enhanced Order Checks







Enhanced order check reporting capabilities
Display of Hepatic and Renal Impairment Indicator
Dosage Checks –Profile Modifications
Independent Drug-Drug Interaction Check Option
Enhanced user notifications for discontinued products
Display signs and symptoms (local, remote or both)
associated with an Allergy/ADR
Incorporate consumer drug interaction monograph in
the new Check Drug Interaction and
finishing/dispensing processes
106
QUESTIONS
&
COMMENTS
Amy K. Colón R.Ph.
[email protected]
Michael J. Martinko, R.Ph.
[email protected]
107