Drug File Management Class

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Drug File ManagementClass 114H

• Don Lees, R.Ph.
• Daphen Shum, R.Ph.
• Jeanne Tuttle, R.Ph.

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Learning Objectives

• At the conclusion of this class students should
  be able to
• List available resources for populating drug file
  fields
• Create a new drug entry
• Demonstrate orderable item fields associated with
  new drug entry
• Describe the interactive roles of the NDF manager
  and the manager of the local drug file
• Apply system tools to drug file entry that will
  enhance decision support
• Describe the PBM OnLine Product Database

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Drug File Impact

• Medication order entry in CPRS
• BCMA
• Drug Accountability
• Costs
• Clinical Reminders
• Quick order set-up and maintenance
• Alerts
• Interactions
• Duplicate Therapy
• Allergies/Adverse Reactions

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Gathering Information

• National Drug File
• Product packaging (e.g. manufacturer bottle,
  package insert)
• On line product information (e-fax, Micromedex,
  manufacturer website)
• FDA http//www.accessdata.fda.gov/scripts/cder/dru
  gsatfda/index.cfm
• Prime vendor / invoice (cost)
• Inquire to National Files
• PBM Online Product Database
• http//vaww.apps.cmop.va.gov/PBMOnlineProductDatab
  ase/Search.aspx

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Inquire to National Files

• Option located in National Drug File Menu, under
  the menu Inquiry Options.
• Information provided
• Proper spelling and format for drug name
• VA Print Name
• NDC
• Package size
• Package type
• Order unit
• Dispense unit

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PBM Intranet Site

• Information on
• Drug and treatment criteria
• Drug contracts, prices
• VA do not substitute list
• ISMP medication safety Alerts
• Drug monitoring and dosing recommendations
• Closed distribution/special handling drug
• National formulary
• http//vaww.pbm.va.gov/pbm/menu.asp

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Drug Enter

• Drug Enter/Edit Option located in Pharmacy Data
  Management (PDM)
• Consolidates entries for all pharmacy packages -
  Drug File 50
• Restrict access to option
• Need PSNMGR key to do match with NDF
• PDM Software Manuals
• http//www.va.gov/vdl/application.asp?appid93

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PDM Software Manual

• Information and examples of all the functionality
  contained within the PBM package.
• Other Language Translation Set-up
• Appendices for lists of Spanish equivalents for
  some of the more common terms used for
  administration schedules, dosage forms, local
  possible dosages, medication instructions, and
  medication routes.
• Warning Labels

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Basic Information needed

• Generic name
• Brand name
• Dosage form, strength
• VA drug class
• What care setting will the drug be used
  (inpatient, outpatient, IV, non VA)
• Print name (40 character)
• Cost

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Lets Get Started

• Signing In
• Everyone will sign in using the same codes
• ACCESS CODE 1pharmacist
• VERIFY CODE pharmacist1

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National Drug File Update Process

• 45 day process
• 14 days for data entry
• 7 days for data review
• 21 days for site tests
• Outlook message with changes sent to pharmacy
  ADPAC group
• 5 days post release CMOP installs

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National Drug File Update ProcessPatch Messages

• Product Message (National)
• New products
• Formulary changes
• CMOP change
• Interaction Changes (National)
• New/Edited interactions
• Products unmarked for Drug-Drug interactions
• Local Message (Local)
• Products locally unmarked for from NDF
• Outlook Message (National)
• Covers edits not reported in the product message
• Inactivations, Generic Name, Dispense Units,
  Dosage Form etc.

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PBM Online Product Database

• A tool to submit requests to the PBM for
  additions/changes to the National Drug File.
• A system to store/view NDF and CMOP data
  including drug pictures.
• Web based The system is open to everyone within
  the VA, however it was originally intended to be
  used by ADPACs.
• Search screens These allow the user to find
  basic information about products.
• New requests The ability to request new products
  or edits.
• Accountability Users will know the status of
  requests. In addition reports can be initiated to
  compile statistics on requests.

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PBM Online Product Database Search Criteria

• http//vaww.apps.cmop.va.gov/PBMOnlineProductDatab
  ase/Search.aspx

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PBM Online Product DatabaseSearch Results
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PBM Online Product Database Search Result
Detailed
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National Drug File Updates Local
Responsibilities

• Monitor Outlook message before installation of
  patch
• Rematch and remark products as required
• Coordinate with CMOP when product names and CMOP
  IDs change.
• Edit formulary status
• Report errors
• Request new products

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Enhancing Your Entry

• OI-DRUG TEXT ENTRY
• Drug information
• Dosing guidelines
• Restrictions
• Criteria for use
• MESSAGE Field
• Limited to 68 characters
• Warnings for high alert medications, sound
  alike/look alike, tablet splitting
• QUANTITY DISPENSE MESSAGE field
• PATIENT INSTRUCTION field

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Drug Text

• May be used to enter information on drugs,
  restrictions, guidelines, ordering protocols
• Some entries are populated by the National Drug
  File
• May be tied to dispense drug or pharmacy
  orderable item
• Viewable through CPRS and Pharmacy
• Provides decision support in real time

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Drug Text Options

• There are 2 options in the PDM option Drug
  Text
• Select Pharmacy Data Management Option Drug Text
• 1 Drug Text Enter/Edit
• 2 Drug Text File Report
• CHOOSE 1-2 1 Drug Text Enter/Edit
• This option enables you to edit entries in the
  DRUG TEXT file.
• CHOOSE 1-2 2 Drug Text File Report
• This report shows each selected drug text entry
  and lists all drugs
• and orderable items linked to it.

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Provider sees the message when ordering the
medication
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Screen capture showing disp quantity message
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Drug Interaction Management

• PDM sub menu Drug Interaction Management
• Composed of 2 options
• Enter/Edit Local Drug Interaction
• Report of Locally Entered Interactions
• Not a substitute for duplicate therapy alerts.
• Interactions entered should be evidenced based.

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Drug Interaction Management

• Interactions are sent out by the NDF
• Sites may change a significant interaction to
  critical but they cannot change a critical to
  significant
• Sites may enter additional interactions locally
• All locally entered interactions are evaluated by
  the NDF Support Group (NDFSG).

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Drug Interaction Management

• Critical interaction requires the pharmacist to
  document an intervention before proceeding
• Significant interactions ask a pharmacist if they
  want to document an intervention but allows the
  pharmacist to proceed with prescription
  processing if no intervention is documented
• Local sites and pharmacy users cannot turn off
  the drug interaction portion of the pharmacy
  package
• In CPRS it is possible to turn off the alerts at
  both the facility and user level.

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Your Impact

• Patient safety
• Patients overall health and wellness
• Patient satisfaction
• Staff satisfaction
• Operational efficiencies
• Performance measures
• Quality monitors