1. Dosages and Application Package Use Pharmacy Data Management (PDM) Urban Health Programs August 2010

2. Section Objectives Describe and manage Dosages –Possible Doses –Local Possible Doses Describe and manage Application Package Use Demonstrate impact on EHR ordering

3. Creating Dosages Integrated with Drug Enter/Edit Also has own menu Dosages can be “Possible” or “Local Possible” –Possible doses are created when drug is matched to NDF –Local possible doses are created by the site

4. Possible Doses Automatically creates a dose of “1” and “2” for each unit in the strength field –May not always be appropriate or complete –Can edit, add, and delete entries Only created for single ingredient solid dosage forms No “range” doses allowed (e.g. 1-2 tablets) Converts a numeric dose into patient readable language: Selectable dose: 250mg Label reads: 1 Tablet

5. Local Possible Doses Must be created for multiple ingredient items, suspensions, topicals, ophthalmics, etc. –If no possible doses for Outpt use, will autocreate doses of “1” and “2” for each noun associated with that dosage form –Can be inappropriate and/or incomplete “WYSIWYG”—what you see is what you get Possible doses and Local Possible doses cannot both be seen in EHR for the same package –Possible doses take precedence, and if they exist local possible doses will be ignored

6. Possible Doses and Dispense Drugs

7. Edit Dosage from Drug Enter/Edit Just a reminder...you are editing AMOXICILLIN 250MG CAPS. Strength from National Drug File match => 250 MG Strength currently in the Drug File => 250 MG Strength => 250 Unit => MG POSSIBLE DOSAGES: DISPENSE UNITS PER DOSE: 1 DOSE: 250MG PACKAGE: IO DISPENSE UNITS PER DOSE: 2 DOSE: 500MG PACKAGE: IO LOCAL POSSIBLE DOSAGES: Do you want to edit the dosages? N// YES Changing the strength will update all possible dosages for this Drug. STRENGTH: 250//

8. Edit Dosage from Drug Enter/Edit Select DISPENSE UNITS PER DOSE: ? Answer with POSSIBLE DOSAGES DISPENSE UNITS PER DOSE Choose from: 1 250 IO 2 500 IO You may enter a new POSSIBLE DOSAGES, if you wish Type a Number between 0 and 99999999, 4 Decimal Digits Select DISPENSE UNITS PER DOSE: 1 250 IO DISPENSE UNITS PER DOSE: 1// PACKAGE: IO// Select DISPENSE UNITS PER DOSE: 2 500 IO DISPENSE UNITS PER DOSE: 2//

9. Edit Dosage from Drug Enter/Edit PACKAGE: IO// Select DISPENSE UNITS PER DOSE: 4 Are you adding '4' as a new POSSIBLE DOSAGES (the 3RD for this DRUG)? No// Y (Yes) Dosage = 1000MG POSSIBLE DOSAGES DOSE: 1000// (No Editing) DISPENSE UNITS PER DOSE: 4// PACKAGE: IO Select DISPENSE UNITS PER DOSE: 3 Are you adding '3' as a new POSSIBLE DOSAGES (the 4TH for this DRUG)? No// Y (Yes) Dosage = 750MG POSSIBLE DOSAGES DOSE: 750// (No Editing)

10. Edit Dosage from Drug Enter/Edit DISPENSE UNITS PER DOSE: 3// PACKAGE: IO Select DISPENSE UNITS PER DOSE: Enter/Edit Local Possible Dosages? N// YES Strength: 250 Unit: MG Select LOCAL POSSIBLE DOSAGE: 1 CAPSULE Are you adding '1 CAPSULE' as a new LOCAL POSSIBLE DOSAGE (the 1ST for this DRUG)? No// Y (Yes) LOCAL POSSIBLE DOSAGE: 1 CAPSULE// PACKAGE: IO Both Strength: 250 Unit: MG Select LOCAL POSSIBLE DOSAGE:

11. Application Package Use Through Drug Enter/Edit only Packages you see depends on keys you hold Should only be marked for where you will use it, PLUS non-VA med if applicable Each Application Package Use letter has different fields associated with it

12. Application Package Use, cont. Options: MARK THIS DRUG AND EDIT IT FOR: O - Outpatient U - Unit Dose I - IV W - Ward Stock D - Drug Accountability C - Controlled Substances X - Non-VA Med A - ALL

13. Application Package Use, cont. If only Outpatient, will probably only use “O” and “X” –If not marked for “O” provider will not be able to enter orders for this item –X for Non-VA Meds will allow for use of upcoming Outside meds package, and eventually ePrescribing May use “C” for controlled substances

14. ******************************************************************************* This entry is marked for the following PHARMACY packages: Outpatient Non-VA Med MARK THIS DRUG AND EDIT IT FOR: O - Outpatient U - Unit Dose I - IV W - Ward Stock D - Drug Accountability C - Controlled Substances X - Non-VA Med A - ALL Enter your choice(s) separated by commas : O,X O - Outpatient X - Non-VA Med ** You are NOW editing OUTPATIENT fields. ** AN Outpatient Pharmacy ITEM? Yes// Y (Yes) CORRESPONDING INPATIENT DRUG: MAXIMUM DOSE PER DAY: LOCAL NON-FORMULARY:

15. NORMAL AMOUNT TO ORDER: SOURCE OF SUPPLY: CURRENT INVENTORY: ACTION PROFILE MESSAGE (OP): MESSAGE: QUANTITY DISPENSE MESSAGE: OP EXTERNAL DISPENSE: Do you wish to mark/unmark as a LAB MONITOR or CLOZAPINE DRUG? Enter Yes or No: YES Mark/Unmark for Lab Monitor or Clozapine: Select one of the following: L LAB MONITOR C CLOZAPINE Enter response: LAB MONITOR ** You are NOW editing LAB MONITOR fields. ** Select LAB TEST MONITOR: WBC// SPECIMEN TYPE: BLOOD// MONITOR MAX DAYS: 90// ? ** You are NOW Marking/Unmarking for NON-VA MEDS. ** A Non-VA Med ITEM? Yes// (Yes)