PHARMACY REENGINEERING (PRE) Version 0.5 Pre-Release Implementation Guide PSS*1*129 & PSS*1*147 February 2010 Department of Veterans Affairs Office of Enterprise Development Revision History Date Revised Patch Description Pages Number 02/2010 All PSS*1*147 Added Revision History page. Updated patch references to include PSS*1*147. Described files, fields, options and routines added/modified as part of this patch. Added Chapter 5, Additive Frequency for IV Additives, to describe the steps needed to ensure correct data is in the new IV Additive REDACTED 01/2009 All PSS*1*129 Original version REDACTED February 2010 Pharmacy Reengineering (PRE) V. 0.5 Pre-Release i Implementation Guide PSS*1*129 & PSS*1*147 Revision History (This page included for two-sided copying.) ii Pharmacy Reengineering (PRE) V. 0.5 Pre-Release February 2010 Implementation Guide PSS*1*129 & PSS*1*147 Table of Contents Introduction ................................................................................................................................. 1 Purpose ....................................................................................................................................1 Project Description ....................................................................................................................1 Scope ........................................................................................................................................3 Menu Changes ..........................................................................................................................4 Pharmacy Data Management menu (Restructured) ................................................................................ 4 Enhanced Order Checks Setup Menu (New) ......................................................................................... 5 IV Additive/Solution Reports (New) ..................................................................................................... 5 Functionality................................................................................................................................5 Steps .......................................................................................................................................20 Local Medication Route Mapping ........................................................................................................ 20 Local Possible Dosage Setup ............................................................................................................... 21 Frequency Review ................................................................................................................................ 23 Identify IV Solution PreMixes ............................................................................................................. 23 Enter/Edit Additive Frequency for IV Additives ................................................................................ 23 Chapter 1 – Local Medication Route Mapping ........................................................................25 Medication Route Mapping Report ..........................................................................................26 Find Unmapped Local Medication Routes ...............................................................................28 Request Change to Standard Medication Route......................................................................30 Map Local Medication Route to Standard ................................................................................32 Medication Route File Enter/Edit .............................................................................................33 Medication Route Mapping History Report ..............................................................................36 Chapter 2 – Local Possible Dosage Setup ..............................................................................39 Local Possible Dosages Report .............................................................................................. 41 February 2010 Pharmacy Reengineering (PRE) V. 0.5 Pre-Release iii Implementation Guide PSS*1*129 & PSS*1*147 Table of Contents Find Unmapped Local Possible Dosages ................................................................................45 Request Change to Dose Unit ................................................................................................. 49 Map Local Possible Dosages ..................................................................................................50 Enter/Edit Dosages .................................................................................................................56 Drug Enter/Edit .......................................................................................................................58 Strength Mismatch Report .......................................................................................................66 Review Dosages Report ..........................................................................................................68 Chapter 3 – Frequency Review ................................................................................................69 Administration Schedule File Report .......................................................................................70 Medication Instruction File Report ...........................................................................................73 Chapter 4 – Identify IV Solution PreMixes ...............................................................................77 IV Solution Report ...................................................................................................................78 Mark PreMix Solutions ............................................................................................................81 Drug Enter/Edit ....................................................................................................................... 82 Primary Solution File (IV) ........................................................................................................83 Chapter 5 – Enter/Edit Additive Frequency for IV Additives .................................................. 85 IV Additive Report ...................................................................................................................86 Drug Enter/Edit .......................................................................................................................91 Appendix A: Standard Medication Routes File .......................................................................95 Appendix B: New DOSE UNITS File with FDB mapping ......................................................... 97 Appendix C: List of Dosage Forms to Exclude from Dosage Checks ................................. 101 Appendix D: VA Products with OVERRIDE DF DOSE CHK EXCLUSION field set to ‘Yes’ 103 Appendix E: Examples of Local Medication Route Mappings to Standard ........................ 127 Appendix F: Local Possible Dosages Report ...................................................................... 131 iv Pharmacy Reengineering (PRE) V. 0.5 Pre-Release February 2010 Implementation Guide PSS*1*129 & PSS*1*147 Introduction Purpose This Implementation Guide provides information needed to implement the Pharmacy Reengineering (PRE) Version 0.5 Pre-Release patch PSS*1*129 and Pre-Release Enhancements patch PSS*1*147. The intended audience for this document is the Pharmacy staff responsible for maintaining Pharmacy files. In order to be able to implement a portion of the enhanced order checking functionality, specifically the new dosing checks, the work required by this Pre-Release patch PSS*1*129 and Pre-Release Enhancements patch PSS*1*147 must be completed. Project Description The PRE V. 0.5 project will deliver enhanced order checking functionality utilizing HealtheVet (HeV) compatible architecture to the field and address some Patient Safety Issues (PSI) regarding order checks. PRE V. 0.5 will implement the enhanced order checking accomplished in 2006 with the development of the Proof -Of-Concept (POC). Services provided by First DataBank (FDB), our current drug database vendor, will be utilized. A Pre-Release will be delivered to allow for file mapping, setup, and review in preparation of the new dosing checks to be implemented in PRE V. 0.5. A Graphical User Interface (GUI) application will be developed to allow for customization of FDB standard reference tables used in the enhanced order checking. The GUI application will be utilized by the National Drug File (NDF) Manager or designee to update the FDB custom tables. In the future, access will be given to local users to request custom changes. A process via File Transfer Protocol (FTP) to update local/regional instances of FDB standard and custom tables from a national database will also be provided. Enhanced Order Checking Features for PRE V. 0.5: • Enhanced drug-drug interaction order check to provide the clinician with more information by displaying a short description of the clinical effects of the drug interaction and providing an optional view of a detailed professional drug interaction monograph • The Enter/Edit Local Drug Interaction [PSS INTERACTION LOCAL ADD] option will be deleted • Create a new option called Request Changes to Enhanced Order Check Database to allow custom requests by pharmacy users • The Edit Drug Interaction Severity [PSS INTERACTION SEVERITY] stand alone option will be deleted