1. Drug File – IV Additives and Solutions June 2011

2. IV Drugs Entry in the Drug File as usual –NDC, match to NDF, Dosages, etc –Use Tall-Man naming as appropriate Mark the drug as IV This is where you get access to the Additives and Solutions files

3. This entry is marked for the following PHARMACY packages: Outpatient Unit Dose IV MARK THIS DRUG AND EDIT IT FOR: O - Outpatient U - Unit Dose I - IV W - Ward Stock C - Controlled Substances X - Non-VA Med Enter your choice(s) separated by commas : I I – IV ** You are NOW editing IV fields. ** AN IV ITEM? Yes// (Yes) Edit Additives or Solutions: Select one of the following: A ADDITIVES S SOLUTIONS Enter response: This is where we’re going to be working

4. IV Additives and Solutions Files 2 files –IV Additives File –IV Solutions File They are their own files, but I find it helpful to think of them as “subfiles” of the main drug file

5. Additives File Enter response: a ADDITIVES Select IV ADDITIVES PRINT NAME: AMP 5 AMPICILLIN - AMP16 - - AMP14 - - AMP24 - - AMP26 - - AMP0.5 - PRINT NAME: AMPICILLIN// GENERIC DRUG: AMPICILLIN SODIUM 1GM INJ// USED IN IV FLUID ORDER ENTRY: YES// DRUG UNIT: GM// NUMBER OF DAYS FOR IV ORDER: 30// USUAL IV SCHEDULE: Q6H// ADMINISTRATION TIMES: Select QUICK CODE: AMP0.5// QUICK CODE: AMP0.5// STRENGTH: 0.5 GM// USUAL INFUSION RATE: 30// OTHER PRINT INFO: USUAL IV SCHEDULE: Q6H// ADMINISTRATION TIMES: 0500-1100-1700- 2300// USUAL IV SOLUTION: SODIUM CHLORIDE 0.9% 50 ML// MED ROUTE: IV PIGGYBACK// Select QUICK CODE: AVERAGE DRUG COST PER UNIT: 10// Select ELECTROLYTE: Select SYNONYM: AMP// DRUG INFORMATION: No existing text Edit? NO// INACTIVATION DATE: CONCENTRATION: MESSAGE:

6. Solutions File PRINT NAME: SODIUM CHLORIDE 0.9% Replace PRINT NAME {2}: GENERIC DRUG: SODIUM CHLORIDE 0.9% 1000ML INJ// VOLUME: 1000 ML// Select ELECTROLYTES: Select SYNONYM: NS// DRUG INFORMATION: No existing text Edit? NO// AVERAGE DRUG COST: INACTIVATION DATE: USED IN IV FLUID ORDER ENTRY: YES// Edit Additives or Solutions:

7. Clean Up Run Fileman reports Look For: –Duplicate Entries –Drugs you don’t actually have –Inconsistent Print Names (e.g. Normal Saline and Sodium Chloride for different entries)

8. Solutions File What do you want in this file? –Only solutions that you have at your facility –Each volume/bag size that you have (use same print name) –Premixed solutions

9. Example Print Name Generic Drug DEXTROSE 10% DEXTROSE 10% 1000ML INJ DEXTROSE 25% DEXTROSE 25% 500ML INJ DEXTROSE 5% DEXTROSE 5% 250ML INJ DEXTROSE 5% DEXTROSE 5% 500ML INJ DEXTROSE 5% DEXTROSE 5% 1000ML INJ DEXTROSE 5% DEXTROSE 5% 50ML INJ DEXTROSE 5% DEXTROSE 5% 100ML INJ DEXTROSE 5% 0.45% NS DEXTROSE 5% 1/2NS 1000ML DEXTROSE 5% 1/2 NS W 20KCL DEXTROSE 5% IN 1/2NS W 20MEQ K DEXTROSE 5% and 0.9% NS DEXTROSE 5% and 0.9% NS 1000ML DEXTROSE 5% and 1/2NS DEXTROSE 5% and 1/2 NS 500ML I DEXTROSE 5% and 1/4 NS DEXTROSE 5% and 1/4 NS 1000ML Same print name but different volumes Premixed Solutions

10. Note on Premixed Solutions Example – Ranitidine premixed bag –Most correct to make an orderable item like RANITIDINE 50MG IN NORMAL SALINE 50 ML, INJ SOLN Put in IV solutions file –This is instead of having ranitidine as an Additive like any other type of piggyback you actually make on site in the pharmacy

11. IV Solutions File – Print Name PRINT NAME: SODIUM CHLORIDE 0.9% –This is what prints on the IV label –Don’t want to be too descriptive here, makes for a confusing label –Use “name” (with the quotes) to enter the same Print Name for more than one item PRINT NAME {2}: –Leave this blank

12. IV Solutions File – tie to drug file GENERIC DRUG: SODIUM CHLORIDE 0.9% 100ML INJ// –Put in drug from drug file entry –Will want separate entries for different volumes you carry

13. IV Solutions File VOLUME: 100 ML// –Volume of your bag Select ELECTROLYTES: –Used in TPNs Select SYNONYM: SALINE// –Synonym that will pull up this drug

14. IV Solutions File DRUG INFORMATION: No existing text Edit? NO// –Shows in Drug Inquiry option in IV menu, not in EHR AVERAGE DRUG COST: 5// – Cost per ml

15. IV Solutions File INACTIVATION DATE: –Use to inactivate obsolete entries USED IN IV FLUID ORDER ENTRY: YES// –Only effects EHR

16. Used in IV Fluid Order Entry?

17. This controls what shows on these 2 lists in the EHR Order dialog Relatively few orders in EHR are done through this type of dialog –Basically only IV maintenance fluids and IV drips –More later, in EHR Quick Order presentation

18. Additives File What do you want in this file? –Only those drugs that you have at your facility –May want different print names for pediatric use (mg instead of grams) –Will need separate entries with the same print name for different strengths ?

19. Example Select IV ADDITIVES PRINT NAME: AMPICILLIN 1 AMPICILLIN (PEDS PIGGYBACK) - MG UNITS - 2 AMPICILLIN (PEDS SYRINGE) - 30 MG/ML – 3 AMPICILLIN 500mg vial 4 AMPICILLIN 1g vial

20. Additives File PRINT NAME: AMPICILLIN// –Keep this simple –Do not include strength here GENERIC DRUG: AMPICILLIN SODIUM 500MG INJ// –Will want an entry for each of your strengths

21. Additives File USED IN IV FLUID ORDER ENTRY: –As before, only effects EHR –Do not need all your piggyback additives here –There are very few Additives that you will mark “Yes” here – EX: KCL, Insulin DRUG UNIT: MG// –Can use different units to help with peds IVs

22. Additives File NUMBER OF DAYS FOR IV ORDER: 7// USUAL IV SCHEDULE: Q6H// ADMINISTRATION TIMES: 01-07-13-19// –Each of these can be overridden by other files or parameters –Don’t worry much about setting it up here

23. Additives File Select QUICK CODE: –Quick Codes pre-fill some fields in the order entry process for pharmacists –Not to be confused with Quick Orders –Not a good mix with EHR –Causes new order to be created during med processing – confusing for providers and nursing –Probably won’t be fixed in the near future –So, please DO NOT USE

24. Additives File AVERAGE DRUG COST PER UNIT:.025// –Cost per unit you selected (mg, grams, mEq) Select ELECTROLYTE: –For TPNs Select SYNONYM: AMP// –Synonym to pull up drug

25. Additives File DRUG INFORMATION: No existing text Edit? NO// –Shows in Drug Inquiry in IV menu –Does not show in EHR INACTIVATION DATE: –For obsolete entries

26. IV Additives File CONCENTRATION: // –? MESSAGE: –Will show on IV Label

27. Same Print Name, Multiple Entries In Solutions File, it is the Volume field that helps describe the entry 6 SODIUM CHLORIDE 0.9% 500 ML 7 SODIUM CHLORIDE 0.9% 50 ML 8 SODIUM CHLORIDE 0.9% 100 ML 9 SODIUM CHLORIDE 0.9% 250 ML 10 SODIUM CHLORIDE 0.9% 1000 ML

28. Same Print Name, Multiple Entries For Additives File, use Message field in Drug Enter/Edit to describe the entry GENERIC NAME: AMPICILLIN SODIUM 500MG INJ Replace VA CLASSIFICATION: AM111// DEA, SPECIAL HDLG: 6// NATIONAL FORMULARY INDICATOR: YES LOCAL NON-FORMULARY: VISN NON-FORMULARY: Select DRUG TEXT ENTRY: Select FORMULARY ALTERNATIVE: Select SYNONYM: 000015740320// SYNONYM: 000015740320// INTENDED USE: DRUG ACCOUNTABILITY// NDC CODE: 000015-7403-20// Select SYNONYM: MESSAGE: 500mg vial//

29. IV Additives File Select IV ADDITIVES PRINT NAME: AMPICILLIN 1 AMPICILLIN (PEDS PIGGYBACK) - MG UNITS - 2 AMPICILLIN (PEDS SYRINGE) - 30 MG/ML – 3 AMPICILLIN 500mg vial  this is from the drug file 4 AMPICILLIN 1g vial

30. Used in IV Fluid Order Entry?