112 Pharmacy Applications Enhancements Overview

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112 Pharmacy Applications Enhancements Overview

• Eric Williamson (Project Manager)
• Sue Fauth (IM Functional Analyst)
• Brian Tapper (OP Functional Analyst)

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Agenda

• PLQE Project Update
• Functional Overview
• 2008 Quarter 3 Enhancements
• 2008 Quarter 4 Enhancements
• 2009 Quarter 1 Enhancements
• Future Work
• Approved 2009 PSI Enhancements
• Additional PSIs Submitted for Approval
• Questions or Comments

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Project Update
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Project Updated Description

• Scope
• Approved enhancement requests for Pharmacy Legacy
  applications
  
• Starting 2009, focused solely on PSIs
• Benefit to Installation
• Address patient safety issues, legislative/regulat
  ory changes, and user/site requested changes
  
• Enhance productivity, reduce costs, and/or
  improve the ability to provide care

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Project Update Schedule

• General Release Cycle
• Requirement Specifications (3 months)
• Design and Development (3 months)
• Testing (3 months)
• Planned Releases
• FY08 Q3 (August 2008)
• FY08 Q4 (September 2008)
• FY09 Q1 (December 2008)
• FY09 Q2 (March 2009)
• FY09 Q3 (June 2009)
• FY09 Q4 (September 2009)

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Project Update OED Testing Process

• Testing Process Stages
• Stage I Internal (Team) Testing
• Stage II Testing Services
• Stage III Production Site Testing
• Stage IV Final Review and Approval

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Functional Overview
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2008 Q3 Enhancements

• Sun Setting PPP NSR 20070805
• Enhanced Inpatient Medications Messaging
• Enhancement of the Medication Administration
  Record (MAR)
  

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Sun Setting PPP NSR 20070805

• All options for the Pharmacy Prescription
  Practices (PPP) application will be marked Out of
  Order.
  
• Communication to all stakeholders that this
  application will be retired.
  
• Impacts to External Interfaces.

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Placing PPP Menu Options Out of Order

• PPP (EDIT) PARAMETER Edit Parameter File
• PPP BACKGROUND PURGE LOGFILE Background Purge
  Logfile
  
• PPP BACKGROUND PURGE XREF Purge Other Facility
  Xref
  
• PPP BATCH Prescription Practices Daily Batch
  Option
  
• PPP BUILD FFX Build/Rebuild Other Facility Xref
• PPP DISPLAY FOREIGN VISITS Display Visits to
  other Facilities
  
• PPP EDIT DOMAIN Edit Unresolved Domain Entries
• PPP EDIT FFX Edit other Facility Cross-Reference
• PPP INIT PURGE LOGFILE JOB Initialize Logfile
  Purge
  
• PPP INIT PURGE XREF JOB Initialize Xref Purge
• PPP INIT STAT Initialize Statistic File
• PPP MAIN Prescription Practices Utilities
• PPP MERGED SITE EDIT Add/Edit Merged Sites
• PPP PRINT CLINIC PROFILES Print Clinic Medication
  Profiles
  
• PPP PRINT FFX Print Other Facility
  Cross-Reference...
  
• PPP PRINT LOG Print Log File
• PPP PRINT STATISTICS Print Statistic File
• PPP PURGE LOGFILE Purge Log File
• PPP PURGE LOGFILE MENU Purge Logfile Menu

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Impacts to External Interfaces

• The following external interfaces will be
  impacted by retiring the PPP application.
  
• AUTOMATED MED INFO EXCHANGE (DVBA)
• INCOME VERIFICATION MATCH (IVM)
• REGISTRATION

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Calls to the PPP Application

• Patient Prescription Processing
• Barcode Batch Prescription Entry
• Complete Orders from OERR
• Edit Prescriptions
• Process Internet Refills
• Action Profile
• Print from Suspense File
• TPB Rx (Prescription) Entry
• Process Telephone Refills

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Enhanced Inpatient Meds Messaging

• An email message is generated to the members of
  PSJ STAT NOW PENDING ORDER and PSJ STAT NOW
  ACTIVE ORDERSTAT when medications are ordered
  using Inpatient Medications for Outpatients
  (IMO).
• Email message generated to the above mail groups
  will be modified to include the hospital clinic.
  (For an IMO Clinic Location).
  
• HL7 message shall be modified to include a value
  for CLINIC if the location is a clinic.
  

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STAT Medication Orders

• CPRS
• Inpatient Medications Application

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STAT Order Through CPRS

• CPRS STAT ORDER
• A clinic can be set up to accept Inpatient
  Medications by setting the field in ADMINISTER
  INPATIENT MEDS file (44) to Yes.
  
• Within the CPRS application, the provider orders
  Inpatient Medications using the Unit Dose
  ordering dialog choosing the priority of STAT
  from the drop down Priority Menu box.

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STAT Medication Order - CPRS
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STAT Orders Through Inpatient Meds

• The provider can enter a Schedule Type ONE-TIME
  in the Inpatient Medications application PSJ OE
  and select STAT as the schedule.
  
• A STAT and NOW Order Notification has been added
  in IM to send a text message to pharmacy and
  nursing staff when orders are received with a
  priority of STAT or a schedule of NOW.

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STAT Orders Through Inpatient Meds

• PSJ STAT NOW PENDING ORDER
• Notifies the user when a pending STAT or NOW
  order has been received from CPRS.
  
• PSJ STAT NOW ACTIVE ORDER
• Notifies the user when a pending STAT or NOW
  order has been verified and made active.

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MAR Enhancement

• Printing of MAR Labels
• Order/Renewal date shall be printed on the left
  side of the label and shall be attached to the
  MAR.
  
• The date will be included on the left side as
  well as the right side of the label.
  
• The PSJU LABEL option shall add the order/renewal
  date to the label.
  
• Options generating the MAR report are PSJU 7D
  MAR, PSJU 14D MAR, and PSJU 24H MAR.
  
• The revised MAR label shall display the
  order/renewal date on the left side and right
  side of the label when the MAR report is
  generated.

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2008 Q4 Enhancements

• Returned Drug Credits (GAO Report)
• Duplicate Drugs Message Enhancements
• Display of both FILL DATE and RELEASE DATE
• Print from Suspense
• Notice of Privacy Practice Reminder on Laser
  Labels
  
• Automate Refill Processing from CPRS

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Returned Drug Credits

• Despite the improved results obtained from
  using pharmaceutical return contractors, without
  agency oversight of returned drugs and related
  credits based on established performance measures
  as called for in our standards for internal
  control, VHA cannot be reasonably assure that
  stewardship of agency resources is effective.

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Returned Drug Credits (con't)

• Internal Control of Credits received for Returned
  Drugs (GAO Report).
  
• Document drugs returned.
• Document a notification of credit received.
• Provide a list of drugs for a given period of
  time and include status of the drug.
  
• New cancel function.

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Returned Drug Credits (con't)

• Authorized Users ONLY
• Actions available from the new option- RETURNED
  DRUG CREDITS
  
• User identifies the pharmacy location.
• Enter drug for return.
• Once the drug is identified, the user can proceed
  to enter the additional fields of information.
  
• The user will not be allowed to manually enter
  the drug name. The drug must be listed in the
  LOCAL DRUG LIST file (50) and will be populated
  from the file.

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Returned Drug Credits (con't)

• Updating the Status of a Drug
• Retrieve drug from the list of entered drugs.
• Status change (Example returned, cancelled).
• Status of Returned/Picked up
• Update whom it was returned to.
• Indicate updating inventory.
• Status of Credit was Received
• Enter credit amount.

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Returned Drug Credits (con't)

• Data Entry Fields
• Date of data entry
• A batch number
• An item number
• Drug name
• National Drug Code (NDC)
• Unique Product Code (UPC). Note that either NDC
  or UPC would be required and not necessarily
  both.
  
• Quantity (total number x units) e.g. 30
  capsules or 1000 ml
  
• Manufacturer name
• Expiration date
• Status Field

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Returned Drug Credit (con't)

• STATUS FIELD
• The following are mutually exclusive options
• Awaiting Return
• Returned
• Credit Notification Received
• Credit Received
• Credit not Received
• Cancelled

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Returned Drug Credits (con't)

• Sample Returned Drug Credit Report (Summary)

AWAITING Pick-up Return Credit Report (SUMMARY)
Page 1
CONTRACTOR/MFR GUARANTEED RETURNS INC.
STATUS AWAITING PICK-UP PHARM LOCATION
DATE RANGE 12/01/2007 THRU 04/30/2008
DATE RUN 04/30/2008_at_083493
DRUG(NDC) QTY UN
DATE UPD BATCH 0804-002 ATENOLOL 100MG T
AB (00423-3334-00) 30 BX 04/09/08 YES
TETRACYCLINE 250MG CA (04641-0610-25) 100 CP
12/21/07 NO
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Returned Drug Credits (con't)

• Sample Returned Drug Credit Report (Summary)

Page 1 CONTRACTOR/MFR GUARANTEED RETURNS INC.
STATUS PICKED UP PHARM LOCATION
DATE RANGE 12/01/2007 THRU 04/30/
2008 DATE RUN 04/30/2008_at_083493
DRUG(NDC) QTY UN
DATE UPD CREDIT BATCH 0804-001 ATEN
OLOL 100MG TAB (00423-3334-00) 30 BX
04/09/08 YES 105.20 CAPTOPRIL 50MG TABS (001
28-7507-01) 10 TA 03/10/08 NO 92.44
PYRIDOSTIGMINE 5MG/ML (02930-3033-23) 5 BT
01/25/08 YES 21.00 TETRACYCLINE 250MG CA (0
4641-0610-25) 100 CP 12/21/07 NO 1,203.02


BATCH TOTAL 1,421.66

TOTALS 3 Batches, 12 Drugs TOTAL ESTIMATED CREDI
T 1,421.66
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Returned Drug Credits (con't)

• Sample Returned Drug Credit Report - Detail

Page 1 PHARM LOCATION B
ATCH 0804-001 CONTRACTOR/MFR GUARANTEED RETUR
NS INC. STATUS AWAITING PICK-UP
DATE RANGE 12/01/2007 THRU 04/30/2008
DATE RUN 04/30/2008_at_083493 Drug ATENOLOL
100MG TAB Credit Status PENDING
Mfr. BAYER
Credit Amount
NDC 00423-3334-39
Exp. Date 01/20/2008 Quantity 30
Created BY
LAST1,USER1 Unit BOTTLE
Created ON 04/08/08 1230
UPC 1020930923022093 Drug CAPTOPRIL 50MG T
ABS Credit Status PENDING
Mfr. PFIZER
Credit Amount NDC 00128-7507-01
Exp. Date 03/10/2008
Quantity 10
Created BY LAST3,USER3 Unit TABLET
Created ON 04/30/08
1111 UPC 1020930000090309

Return Credit Report (DETAIL)
Page 2 CONTRACTOR/MFR GUARA
NTEED RETURNS INC. BATCH 0802-001
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Returned Drug Credits (con't)

• AUDITING
• Changing the status of the drug will appear on
  the report.
  
• The report will show drugs that have been
  cancelled.
  
• The report will show drug credits received.

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Returned Drug Credits (con't)

• Additional Assumptions
• Part of the PSA application.
• New option.
• New file created.
• Data Fields populated automatically from other
  existing files.
  
• Controlled Substances out of scope.

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Duplicate Drug Message Enhancements

• PSI -027-236 and RT223633
• Currently, if a drug is filled by CMOP, then the
  release date is displayed on the duplicate order
  check.
  
• If the drug was a local fill, then the release
  date does not show on the duplicate order check.
  
  

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Duplicate Drug Message Enhancements (con't)

• The following duplicate drug messages are
  currently generated under the heading CMOP
  Status
  
• CMOP Status Terminated on 2/11/08
• CMOP Status Released by CMOP on 3/11/08
• CMOP Status Not Dispensed

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Duplicate Drug Message Enhancements (con't)

• Current Duplicate Drug Message
• Duplicate Drug TRAVOPROST 0.004 OPH SOLN in
  Prescription 2385163C
  
• Status Active
  Issued
  02/27/08
  
• CMOP Status Released by CMOP on 03/11/08_at_2221
• SIG PLACE 1 DROP IN BOTH
  EYES AT BEDTIME GLAUCOMA
  
• QTY 5
  of refills 9
  
• Provider Refills
  remaining 9
  
• 
  Last filled on
  03/17/08
  
• 
  Days Supply 30

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Duplicate Drug Messaging Enhancements

• Rename the heading on the screen from CMOP
  Status to Processing Status.
  
• The Processing Status message will appear on
  all releases CMOP or Local.
  
• Change the messages to one of the following
• Processing Status Transmitted to CMOP on
  2/11/08
  
• Processing Status Released by CMOP on 3/11/08
• Processing Status Released locally on 3/11/08
• Processing Status Not Release to CMOP

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Duplicate Drug Messaging Enhancements (cont)

• Enhanced Duplicate Drug Message
• Duplicate Drug TRAVOPROST 0.004 OPH SOLN in
  Prescription 2385163C
  
• Status Active
  Issued
  02/27/08
  
• Processing Status Released by CMOP on
  03/11/08_at_2221
  
• SIG PLACE 1 DROP IN BOTH
  EYES AT BEDTIME GLAUCOMA
  
• QTY 5
  of refills 9
  
• Provider Refills
  remaining 9
  
• 
  Last filled on
  03/17/08
  
• 
  Days Supply 30
  

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Duplicate Drug Message Enhancements (con't)

• Enhanced Duplicate Drug Message
• Duplicate Drug TRAVOPROST 0.004 OPH SOLN in
  Prescription 2385163C
  
• Status Active
  Issued
  02/27/08
  
• Processing Status Released locally on
  03/11/08_at_2221
  
• SIG PLACE 1 DROP IN BOTH
  EYES AT BEDTIME GLAUCOMA
  
• QTY 5
  of refills 9
  
• Provider Refills
  remaining 9
  
• 
  Last filled on
  03/17/08
  
• 
  Days Supply 30
  

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Display LAST FILL DATE and RELEASE DATE

• PSI-027-236 and RT223633
• The Last Fill Date on the Medication Profile may
  be inaccurate and misleading.
  
• Pharmacists requested the need to see either the
  Last Fill Date or the Release Date depending on
  the situation.
  

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Display LAST FILL DATE and RELEASE DATE (con't)

• New Functionality
• Medication Profile Screen will allow users to
  have the option of viewing either the LAST FILL
  date or the RELEASE date.
  
• Adding a hidden option.
• Default will be the LAST FILL date.
• New RDD option.
• If no RELEASE date, field will be blank.

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Display LAST FILL DATE and RELEASE DATE (con't)

• Current Medication Profile LAST FILL date

Medication Profile Page 1 of
2 PID 000-00-0000
Ht(cm) 177.80
DOB Wt(kg) 113.64 SEX
Non-VA Meds on File Last entry on

ISSUE LAST REF DAY
RX DRUG
QTY ST DATE FILL REM SUP


-------------------------------------ACTIVE-------
------------------------------
1 2781064 AMOXICILLIN 250MG CAP
180 E 02-21 02-21 11 30
2 2913955A DIGOXIN 0.25MG TAB
30 A 10-05 10-05 11 30
3 3022035 DOCUSATE NA 250MG CAP
30 S 12-28 03-13 10 30
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Display LAST FILL DATE and RELEASE DATE (con't)

• Future Medication Profile RELEASE Date

Medication Profile Page 1 of
2 PID 000-00-0000
Ht(cm) 177.80
DOB Wt(kg) 113.64 SEX
Non-VA Meds on File Last entry on

ISSUE REL REF DAY
RX DRUG
QTY ST DATE DATE REM SUP


-------------------------------------ACTIVE-------
------------------------------
1 2781064 AMOXICILLIN 250MG CAP
180 E 02-21 02-28 11 30
2 2913955A DIGOXIN 0.25MG TAB
30 A 10-05 11-05 11 30
3 3022035 DOCUSATE NA 250MG CAP
30 S 12-28 03-28 10 30
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PRINT FROM SUSPENSE

• PSO7286 is on hold due to DG5.3688
• Print From Suspense File option PS PNDLBL
• ROUTE is mail and the address is foreign
• Prescription shall not be send to automate
  filling equipment or to the label printer.
  
• The fill will remain on suspense

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PRINT FROM SUSPENSE (con't)

• This functionality will be implemented after the
  REGISTRATION package V.5.3 patch DG5.3688 is
  nationally released which introduces the COUNTRY
  field to the PATIENT file (55).

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Notice of Privacy Practice Reminder

• This enhancement will place the following
  narrative after the Patient Name line at the top
  of the PMI Document in both English or Spanish
  
• The VA Notice of Privacy Practices, IB 10-163,
  which outlines your privacy rights, is available
  on-line at http//www1.va.gov/Health_Benefits/ or
  you may obtain a copy by writing the VHA Privacy
  Office (19F2), 810 Vermont Avenue NW, Washington,
  DC 20420.

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Notice of Privacy Practice Reminder (con't)
The following example illustrates the enhancement
in bold
NAME, Rx VA PRINT NAME
The VA Notice of Privacy Practices, IB 10-163, w
hich outlines your privacy rights, is available
on-line at http//www1.va.gov/Health_Benefits/ or
you may obtain a copy by writing the VHA Privacy
Office (19F2), 810 Vermont Avenue NW, Washington,
DC 20420. SIMVASTATIN - ORAL (SIM-vuh-stat-in)

COMMON BRAND NAME(S
) Zocor

USES Simvastatin is used, along with a
cholesterol-lowering diet, to help lower
cholesterol and fats (triglycerides) in the
blood. Reducing cholesterol and triglycerides
helps prevent strokes and heart attacks.
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Automate CPRS Refill Processing

• Currently when a refill is sent from CPRS to
  Outpatient Pharmacy, an entry is made in the
  PENDING OUTPATIENT ORDERS FILE (52.41) only.
  
• This enhancement will automate that process.

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Automate CPRS Refill Processing (con't)

• Request no longer stored in the PENDING
  OUTPATIENT ORDERS file (52.41)
  
• The request shall be processed at the time it is
  received.
  
• New field to indicate the refill was sent from
  CPRS.

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Automate CPRS Refill Processing (con't)

• Reason a refill cannot be processed.
• MailMan message shall be sent containing text
  explaining why the refill cannot be processed.
  
• Consistency checking will be the same as
  currently exists in Internet Refill processing.

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Automate CPRS Refill Processing (con't)

• Values pre-set for Auto Refills

Prompt/Criteria Pre-set Value FILL DATE
TODAY MAIL/WINDOW MAIL Will these refi
lls be Queued or Suspended? SUSPENDED
PROCESS AUTO REFILLS FOR INPAT? Based on the in
formation in the OUTPATIENT SITE file (59).
If no response in file 59, the default
shall be NO. PROCESS AUTO REFILLS FOR CNH?
Based on the information in the
OUTPATIENT SITE file (59). If no
response in file 59, the default shall
be NO.
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2009 Quarter 1 Enhancements

• Complex Orders Duration Field (PSI-06-176- Remedy
  Ticket 168928)
  
• CMOP Refill Documentation (PSI-07-090 Remedy
  Ticket 189923)
  
• Multiple Prescriptions -Exact Name (PSI-06-176
  Remedy Ticket 168928)
  

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Complex Order Duration Field

• PSI-06-176 and Remedy Ticket 168928 Complex
  outpatient prescription order
  
• Pharmacist is not required to enter a duration
  when a THEN conjunction is utilized.
  
• Problem encountered when the outpatient order was
  transferred to inpatient.
  

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CMOP Refill Documentation

• PSI-07-090 Remedy Ticket 189923
• Due to Social Security Number (SSN) information
  on the CMOP Refill.
  
• VA Privacy Office request to remove the SSN as an
  identifier.

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Multiple Prescriptions with Exact Name

• PSI-06-176- Remedy Ticket 168928 Multiple
  Prescriptions with Exact Name
  
• Outpatient Pharmacy doesnt allow two active
  prescriptions with exact same dispensed name.
  
• Titration causes workarounds.

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Multiple Prescriptions with Exact Name (con't)

• Allow a multiple prescription when a titration
  dose is required.
  
• Separate prescription numbers.
• Instructions.
• Future fill date.
• Generate Message to Activity Log.

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Future Work
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Future PSIs - Prioritized

• Carry-Over From FY08
• PSI-06-0155 Copy and Change Functions
• Patients receiving prescriptions without
  ordering.
  
• The new prescription is created then
  Disassociated from the original prescription.
  
• PSI-07-134 Allergy/Adverse Reactions
• Allergy Order Checks.
• Retain Intervention Assessments.
• PSI-07-068 Expiring IVs on the VDL
• Nursing wants to be notified that an IV order is
  soon to expire.
  
• The nurse opens the BCMA Virtual Due List (VDL)
  she/he does not know that the IV order is set to
  expire in 10 minutes.
  

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Future PSIs- Prioritized

• PSI-06-027 BCMA Dispense Drug Display Error
• Nursing can mistake the Dispense Drug for the
  Dosage ordered.
  
• PSI-03-043 Done orders not on Meds Tab
• The Done Orders from the providers does not
  transfer from CPRS to Pharmacy.
  
• The Done Orders is not displayed in the Pharmacy
  Package.
  

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Future PSIs for Consideration

• PSI-06-040 Order checks for DC's/Expired Orders
• Medication order checks do not occur against
  orders that have recently expired or been
  discontinued in Inpatient Meds.
  
• PSI-07-018 Review of Pending Pharmacy Orders
• Providers are entering injectable medication
  orders for patients in outpatient clinics
  (non-IMO) and since the sites have not
  implemented IMO pharmacy staff have been ignoring
  the pending orders.

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Future PSIs for Consideration (con't)

• PSI-07-055 Overlapping of Administrative Times
• Site reports there is the potential for a patient
  to be given an over dose of a medication when
  administration times within standard schedules
  overlap.
• This can happen within Inpatient Medications
  with an AND complex order.
  
• PSI-07-073 Editing of Dispense Drug and Dispense
  Units fields
  
• Changes to dispensed drug field (12) do not have
  an audit trail which makes it difficult to detect
  the source of any errors.
  

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Future PSIs for Consideration (con't)

• PSI-07-181 Prescriptions strength was changed
  and create a new Rx.
  
• A prescriptions strength was changed in CPRS
  creating a new Rx.  The original Rx had been
  transmitted to CMOP on the previous day.  When
  finishing, the pharmacist missed the previous day
  transmission to CMOP of the original. 
• Both Rx's were mailed to the patient in the same
  package from the CMOP.
  
• PSI-07-206 Drugs in the CN101 class and one drug
  in the CN103 did not generate an order check.
  
• An issue was raised where a lot of "false"
  returns or order checks were occurring with drugs
  in the CN10 class range.
  

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Future PSIs for Consideration (con't)

• PSI-07-241 Order Checks not being recorded
• Order check for a Drug-Allergy is not recorded in
  the Outpatient and Inpatient Pharmacy packages
  when order check is bypassed.
  
• PSI-08-026 Incorrect Med Routes Listed
• Incorrect med routes may be listed since CPRS
  pulls all possible med routes from dosage form in
  PDM.
  

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Future PSIs for Consideration (con't)

• PSI-07-108 Administrative Time Edits
• Upon editing the administration time for an
  inpatient order (to an earlier time) after a
  medication has been given, the order appears on
  the BCMA Missed Medication Report if the
  parameters exclude the original administration
  time
• PSI-07-166 Editing Complex Orders
• Edited start date on a complex order sequence
  does not update child orders.

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Questions or Comments?