1. The IN Group www.theingroup.com Steve Botwinski 573-651-4420 office 573-651-0066 cell steve.botwinski@theingroup.com Worked Magic Hospital for 22 years Worked with The IN Group for 1 year.

2. BLACK BOX WARNING How do we get the information past pharmacy order entry to other users?

3. I guess this is one of those new drugs that has a Black Box Warning Associated with it!

4. Getting Information to Pharmacy 1. Set up CDS with button for BBW 2. Set up in CDS short text box to type in short warning for pharmacists. 3. Write Global rule that if BBW warning exists then warn pharmacists and display message. 4. Can have rule to remind Pharmacist to print monograph to patient location.

10. http://www.formularyproductions.com

11. Click on Pharmacy Resources

12. Click on Drugs With Black Box Warnings

13. Click on Preference of Lookup Class, Alpha etc,

14. Choose Drug Searching For In Example Promethazine

15. Click onDrug

16. Now we must get the information out to other care providers In Magic and Client Server 1. Using PCS, POM, BMV rules (Magic must be at least 5.6) Will continue in Client Server 5.6 and afterwards look at other client server versions and Magic.

17. ***Word of Warning**** In Client Server 5.6 PCS rules and Magic MAR ADMIN must and only can be written in the line editor in the rules dictionary, you cannot write a NPR rule. Currently several problems exist in PCS rule writing and are currently in development to fix. ( I will explain issues as we get to them)

18. PCS RULE

19. FILL IN PAGE 1

20. GO TO EDITOR SCREEN

21. TYPE: LINE

22. IN MOST CASES YOU WANT THE BBW TO POP UP ANY TIME THE MEDICATION IS ADMINISTERED FOR THE NURSE TO SEE. BUT IN SOME CASES SUCH AS PROMETHAZINE IF THE PATIENT IS OVER 2 YEARS OLD THERE IS NO REASON TO WASTE THE NURSES TIME.

23. SHOW BBW ALL TIMES GO TO DATA FIELD RX MEDICATION

24. CHOOSE rx med

25. COMPARISON IS “EXISTS” so if medication exits activate rule

26. FIRST PCS RULE ISSUE *LINK Choices are “AND” “OR” “ELSE” CURRENTLY YOU CAN ONLY USE THE ELSE LINK FOR PCS RULES, IF YOU TRY AND USE THE AND or OR WILL NOT WORK. SO YOU CAN ONLY HAVE ONE COMPARITIVE STATEMENT

27. BUTTONS HAVE CHOICE OF “CLOSE” “ERASE” OR “OVERRIDE”. If you choose close the warning pops up and the nurse clicks on close and the box goes away with no record that nurse saw or acknowledged the warning. If you choose override they have to choose a override comment then hit override button and that will get recorded in the order history.

28. CREATING OVERRIDE BUTTON (MIS DICTIONARY)

29. CREATE OVERRIDE CATEGORY

30. CREATE OVERRIDE COMMENT AND LINK TO CATEGORY

31. PCS RULE ISSUE 2 When the override box appears the nurse will hit the up or down arrow to pull up the correct response. IF THERE IS ONLY ONE OVERRIDE COMMENT IT DOES NOT WORK AND THE USER IS STUCK IN AN ENDLESS LOOP AND CANNOT ESCAPE FROM THE RULE BOX. IN DEVELOPMENT AT MEDITECH SO ALWAYS HAVE MORE THAN ONE COMMENT ASSOCIATED WITH A CATEGORY

32. CREATE SECOND COMMENT

33. ADD BUTTON AND ATTACH CORRECT CATEGORY

35. NEXT WE ADD THE MESSAGE THE NURSE WILL SEE. THIS IS WHY IT HAS TO BE DONE IN THE LINE EDITOR BECAUSE YOU MUST PUT MESSAGE IN THE LINE EDITOR MESSAGE BOX Best way to accomplish is to copy and paste from BBW source. Edit to the way you would like it to be seen. YOU ARE NOT LIMITED TO THE THREE LINES YOU SEE. THE BOX WILL EXPAND SO YOU COULD PASTE A LARGE AMOUNT OF INFORMATION. **IF IT’S GETS TO LARGE WILL THEY REALLY READ IT???**

37. Since you can only have one comparative your LINK line will for now be ELSE

39. AND YOUR RULE MUST END WITH THE “END” LINE WITH OUTCOME OF “OK”

40. SO THE RULE LOOKS LIKE:

41. AND WHEN THE NURSE ADMINISTERS THE MED:

42. Nurse must now choose a override comment, then hit the override button to continue

43. THERE IS A WARNING NOT TO TAKE THE DRUG IF YOUR BLOOD PRESSURE IS TOO LOW.

44. SINCE THIS DRUG’S BBW IS FOR CHILDREN ONLY UNDER AGE 2, WHY WOULD WE WANT TO SEE IT FOR AN OLDER PATIENT. IF YOU HAVE A SINGLE COMPARATIVE WE CAN CHANGE THE RULE TO MAKE THE RULE ONLY SHOW IF THE PATIENT IS UNDER 2 YEARS OLD. NURSES DON’T NEED TO SEE THINGS THAT ARE NOT RELAVENT TO THEIR PATIENTS.

46. FUTHER IDEAS FOR DRUGS THAT THE BBW WARNS TO CHECK, SUCH AS A LAB VALUE OR RESPIRATORY RATE. YOU CAN CREATE A ASSESMENT SO THE NURSE HAS TO ENTER THE CURRENT RESP RATE. CREATE A LAB VIEW SO THE NURSE CAN SEE THE CURRENT LAB LEVEL THAT MIGHT BE AFFECTED AND NOTE LAB WAS CHECKED. YOU CAN ALSO CREATE SPECIALIZED QUERIES IF YOU DESIRE. THESE ARE ALL ATTACHED TO THE DRUG ON THE PCS TAB OF THE DRUG DICTIOANRY

48. RULE FOR MAGIC (5.6)

49. MAGIC MAR ADM RULE

50. USE ALL THE POSSIBLE CLINICAL TOOLS YOU CAN SO YOU DON’T GET EXPOSED TO PROBLEMS