Defaulting PHA Inpatient Label Comments Based on Dose

Herb Bromenshenkel RPh

North Country Health Services

Pyxis screen

North Country Health Services

Pharmacy Information

MEDITECH Magic since 1990 Pyxis machines in all areas No inpatient cart fill Meds loaded and unloaded as needed

Custom load reports Manual MAR, Not generated by

MEDITECH

Pyxis Information

First line of label comments flows to Pyxis machine and displays for nurse

Dose is not always the same unit stored in Pyxis2 tabs½ tabs Injections: Solumedrol 80 mg (1.28 ml)

Pharmacy Enters Label Comments

To aid nursing, pharmacy would enter dose comments in line 1 of label comments.Pharmacy tried for standard format:Examples:

Dose: 1.28 ML = 80 MG Solumedrol 80mg (125 mg/2 ml)

Dose: 1.5 TABS X 40 MG = 60 MG Furosemide 40 mg tab

Problems with Pharmacy Entry

Format not consistentGoal was for nurse to see volume or number

of tabs before size of product I.e.: Dose: 1.5 TABS x 40 MG = 60 mg vs.: Dose: 40 mg x 1.5 Tabs = 60 mg

Possibility for error due to calculation or typo

Solution

Rule determines if dose is different than dispensing size. If different:

Rule calculates dose string Rule prompts user with string User specifies if rule sets first line in label comments

Customized post live No messages for: Senokot 2 tabs

Dose 1 x 2 TABS = 2 TABS

What Displays

Varies if tabs/caps versus liquids/injections Tabs/Caps:

*Dose: 0.5 TABS X 20 MG = 10 MG*Dose: 2 TABS X 20 MG = 40 MG

Liquids/Injections:*Dose: 1.28 ML = 80 MGWe put an “*” to indicate which ones computer

set (quality assurance)

Actual Display

Key Points

Rule only sets comment if user selects “Y” If comments exist, they are moved down 1 line

What it is going to be does not display unless user enter/Edit label comments Once user enters “Y” at Edit label Comments, set

comments display If doing multiple dose edits on same rx, best to

exist and come in and make one change Have done, without problems

When Select Edit Label Comments

Other Examples:

Setup

Computer Set

One Rule Numerous Custom Keywords Most keywords pull simple data Two keywords more extensive

Determines units/doseRuns report to set Label Comments

Keyword used in rule runs NPR report which puts the comments into the data structure

Simple Keywords

z label.comment.1 @label.comment[1]

z dose.and.unit @PHA.RX.dose.and.unit

Z drug.order.size @PHA.DRUG.order.size[@med]

Z drug.order.unit @PHA.DRUG.order.unit[@med]

More Complex Keywords #1 z disp.form.p.dose.un

IF{@dose^V1,@PHA.DRUG.order.unit[@med]^V1A,@PHA.DRUG.order.size[@med]^V2,@PHA.DRUG.dispense.size[@med]^V3,@PHA.DRUG.strength.amt1[@med]^ST1,@PHA.DRUG.strength.amt2[@med]^ST2,@PHA.DRUG.dispense.unit[@med]^VU,@PHA.DRUG.dispense.form[@med]^VF,@PHA.DRUG.admin.form[@med]^AF,IF{(V2=V3)&(AF'=V1A) 1,IF{V2'=V1 1,V1:10D/V2^VR,VR:3D^VR,%Z.strip.trailing.zeros(VR)^MSDOSE,"*Dose: "_MSDOSE_" "_VF_"S X "_V3_" "_V1A_" = "_V1_" "_V1A^/Z.INFO};IF{(AF'=V1A) 1,ST1:10D/ST2^CON,%Z.strip.trailing.zeros(CON)^CON,V1:10D/CON^VR,VR:3D^VR,%Z.strip.trailing.zeros(VR)_" "_VU^MSDOSE,"*Dose: "_MSDOSE_" = "_V1_" "_V1A^/Z.INFO};1;1}}

More Complex Keyword #2

z set.lab.com.1.4 %PHA.RX.zcus.hab.rule.label.comment.1.4.M.ck(urn); Rule runs report which files data to data structure

Report

Report Macro – Copy/PasteIF{/RULE.EVAL="REFILL"!(/RULE.EVAL="TXN") ^?;^/}^q,@Chg.prefix(PHA.RX,?,[q]),IF{/RULE.EVAL="REFILL"!(/RULE.EVAL="TXN") ^:;^/}^c,@Chg.prefix(PHA.RX,:,[c]),/patient^patient,/urn^urn,/PHA.REF.urn^PHA.REF.urn,/med^med,@t.med.rule^med.rule,/txn.date^txn.date,/txn.q^txn.q,

/Z.INFO^LAB1,IF{/TR[urn]CM[1]$5="*Dose" LAB1^/TR[urn]CM[1];/TR[urn]CM[4]^/TR[urn]CM[5],/TR[urn]CM[3]^/TR[urn]CM[4],/TR[urn]CM[2]^/TR[urn]CM[3],

/TR[urn]CM[1]^/TR[urn]CM[2],LAB1^/TR[urn]CM[1]},1;

Actual Rule

Rule Code to Copy/Paste[f z label.comment.1]^LAB1,[f z dose.and.unit]^DOSEU,[f z drug.order.size]_" "_[f z drug.order.unit]^ORDD,IF{DOSEU=ORDD 1;[f rx dose]^CDOSE,[f rx start date]^STK,[f rx pt type]^PTY,[f rx ord type]^OTY,IF{STK_.=.!(PTY="OUT")!(CDOSE=0)!(OTY'="M") 1;IF{[f rx dose]=0&(OTY'="M") 1;[f z disp.form.p.dos.un]^INFO,IF{INFO=1!(INFO=LAB1)!(INFO_.=.) [f rx ok];("Set Internal Label Comments to:"_INFO)^ASK,IF{1'=[f rx yes/no](ASK) 1;[f z set.lab.com.1.4]}}};1}};

Where activated - CDP

Questions

Herb Bromenshenkel RPHhbromenshenkel@nchs.com218-333-5527