Pharmacy Package Parameters for BCMA Coordinators: An Overview BCMA National Call – January 5,...

Pharmacy Package Parameters for BCMA Coordinators: An Overview

BCMA National Call – January 5, 2015Steve Corma, RPhPharmacist ConsultantBar Code Resource OfficeOffice of Informatics and Analytics

VETERANS HEALTH ADMINISTRATION 2

Objectives

Following this presentation, attendees will be able to:

• Describe the various Pharmacy package parameters , settings, & work processes that impact BCMA.

• Identify the accepted default settings in use today (where applicable) & the impact of alternative settings.

• Assist in identifying & troubleshooting issues that may arise as a result of Pharmacy package settings & work processes.


Parameters & Settings for Discussion

• Parameters Edit Menu (UD)• Auto-Discontinue Set-Up• Inpatient Ward Parameters Edit• Clinic Definition• Systems Parameters Edit

• Site Parameters (IV)• Individual Labels (IV)

• Medication Route File Enter/Edit• Synonym Enter/Edit• Enter/Edit Dosages• Edit Orderable Items


Parameter Menu Edit (UD)

Auto-Discontinue Set-Up• Description: This allows the site to determine if patients' Inpatient

Medications (IV and Unit Dose) orders are d/c'd when the patient is transferred between wards, between services, or to authorized absence. This determination can be made on a ward-by-ward and/or service-by-service basis.

• Replaced by CPRS Auto D/C business rules, however this parameter is still active & may in use at some sites.

• Recommendation: Only utilize CPRS Auto D/C rules & delete all settings for this parameter.

• *CAUTION* - use of this parameter in conjunction with CPRS Auto D/C business rules will cause unintended consequences if not in “sync”


Parameter Menu Edit (UD) Continued

Inpatient Ward Parameters Edit• Description: Allows user to edit the Inpatient Ward Parameters. These

parameters determine how the Inpatient Medications package (& BCMA to some extent) will react for users acting on patients who reside on the corresponding wards.

• Primarily controls default start & stop dates on orders placed through CPRS or “backdoor pharmacy”

• There are many settings listed under this parameter which will not be discussed as they are specific to pharmacy only (example: choosing default printers) or no longer apply (example: settings for printing labels for paper MARs)


Inpatient Ward Parameters Edit

Parameter• DAYS UNTIL STOP DATE/TIME:

• DAYS UNTIL STOP FOR ONE-TIME:

• SAME STOP DATE ON ALL ORDERS:

Description• This is the number of days a standard

order should last. Typically set to 30 days for acute care ward & 90 days for CLC.

• the number of days a one-time order should last. The number can be from 1-100, however, it cannot exceed the number of days that standard orders last (DAYS UNTIL STOP DATE/TIME). Typically set to 1 day.

• This is a flag, that if found to be YES, uses the STOP DATE/TIME from the patient's first order as a default value for the STOP DATE/TIME of all of the patient's following orders. Typically set to “NO”


Inpatient Ward Parameters Edit

Parameter• TIME OF DAY THAT ORDERS STOP:

• DEFAULT START DATE CALCULATION:

• SELF MED' IN ORDER ENTRY:

Description• This is a time of day that, if found, will be

used in calculating the default value for the STOP DATE/TIME of patients' orders. Typically individualized for each site.

• This field allows the ward to tell the package how the default start date for orders should be calculated. The default may use the next admin time, the closest admin time, or the current time (now) as the default start date for Unit Dose and IV orders. Typically set to “use now as default”.

• If `YES' (or a 1) is entered here, the regular order entry process will prompt the user for SELF MED and HOSPITAL SUPPLIED SELF MED for each order entered.



Clinic Definition: This option allows the site to define how Inpatient Orders for Outpatients will behave and be handled on a clinic-by-clinic basis.

Parameter Description• NUMBER OF DAYS UNTIL STOP:

• AUTO-DC IMO ORDERS:

• This is the number of days to default the length of an order. Cannot exceed 365 days. Typically, “one-time” visits (e.g. ED) would be set to 1 day.

• This field gives the site the ability to define, by clinic, whether or not inpatient orders for outpatients should be auto-d/c'd on patient movements. This field will only affect those orders where Inpatient Medications V. 5.0 controls the discontinue action. If the patient movement discontinue action is handled by any other package, this field will have no effect. Typically set to “yes”



Parameter• SEND TO BCMA?:

• MISSING DOSE PRINTER:

• PRE-EXCHANGE REPORT DEVICE:

Description• This field will determine if inpatient orders

for outpatients in this clinic will be made available to the Bar Code Medication Administration package. Typically, set to “yes” once clinic is set up.

• This is the print device that this Clinic will use to print Missing Dose requests. This device overrides the default "Clinic Missing Dose Request Printer:" device (stored as an XPAR Division parameter), set by the BCMA Site Parameters GUI Client, for Clinics. Site to determine.

• The device most frequently used to print the Pre-Exchange Report for this CLINIC. This device will be shown as the default for the 'Select DEVICE for PRE-EXCHANGE UNITS REPORT:' prompt when printing the Pre-Exchange Report.



Parameter• IMO DC/EXPIRED DAY LIMIT:

• Systems Parameters Edit

Description• This field contains the number of days that

DC/Expired orders will be included in the enhanced order checks for drug interaction and therapeutic duplications for clinic orders. If this field is left blank, a default value of 30 days will be used. Typically, a minimum of 30 days is recommended but a site may choose a longer length of time (e.g. 120 days) to account for expired outpatient prescriptions that the patient may still be taking.

• This allows the user (supervisor or coordinator) to edit parameters that affect the Inpatient Medications package as a whole.


Site Parameters (IV)

Parameter• LVP'S GOOD FOR HOW MANY DAYS:

• HYPERAL GOOD FOR HOW MANY DAYS

Description• This number is used when the stop date of

a new order is computed. In other words, if Large Volume IV's are good for 14 days and a new order is input with a start date of today, the stop date will be 'T+14'.

• Type a Number between 1 and 31. This number is used when the stop date of a new order is computed. In other words, if a hyperal order is good for 14 days and a new order is entered today, the default stop date will be 14 days from today. Typically, most sites use 1 day to allow for daily evaluation of labs.


Site Parameters (IV) ContinuedParameter• PB'S GOOD FOR HOW MANY DAYS:

• SYRN'S GOOD FOR HOW MANY DAYS:

• CHEMO'S GOOD FOR HOW MANY DAYS:

• STOP TIME FOR ORDER:

Description• This number is used when the stop date of a

new order is computed. In other words, if a piggyback order is good for 14 days and a new order is entered today, the default stop date will be 14 days from now. Typically, 30 days is used.

• Type a Number between 1 and 31. This field is used to determine the stop date for the Syringes order. Typically, 30 days is recommended.

• This field is used to determined the stop date for the Chemo order. Highly variable by site.

• Enter the TIME of the day that orders should end. For example if IV's are good for 14 days and an order's start date/time is MAY 01 1985@1200 and 2200 is entered at this prompt, then the default stop date/time will be MAY 14 1985@22:00.


Site Parameters (IV) Continued

Parameter• EXPIRE ALL ORDERS ON SAME DAY:

• Individual Labels (IV) (note: this is an option, not parameter)

Description• Enter a '1' to stop all IV orders

automatically on the same day. The day the orders are stopped will be the 'STOP DATE' of the FIRST ACTIVE IV order found in the file. The stop/date that is found will be shown as a default for the stop/date of the IV ORDER. Typically set to “no”.

• Print New Labels or Reprint IV Labels: for Pharmacy compounded IV’s, once printed, that bag is “available” to nursing to administer, whether that bag is physically on the unit or not. Nurse can only scan “available” bags - bags do not have to be scanned in sequence.


Medication Route File Enter/Edit

• This option provides the ability to edit data for entries in the MEDICATION ROUTES (#51.2) File.

• Example: IV PiggybackSelect MEDICATION ROUTES NAME: IV PIGGYBACK IVPBNAME: IV PIGGYBACK// ABBREVIATION: IVPB// PACKAGE USE: ALL PACKAGES// IV FLAG: YES//

This field shall designate IV medication routes. This will help determine how Inpatient Medication orders entered through CPRS will be finished in the Pharmacy package.

PROMPT FOR INJ. SITE IN BCMA: YESThe purpose of this field is to provide a way to indicate that a medication route needs to have a prompt for injection site in BCMA.

DISPLAY ON IVP/IVPB TAB IN BCMA?: YES


Synonym Enter/Edit

• The option provides easy access to update the synonym information for an entry in the local DRUG file.

• For the purposes of BCMA, the synonym is the “scanned bar code” for a particular dispense drug & strength

• Example: Acetaminophen 325mg tabSelect DRUG GENERIC NAME: ACETAMINOPHEN 325MG TAB CN103 Select SYNONYM: TYLENOL// INTENDED USE: TRADE NAME// NDC CODE: Select SYNONYM: ? Answer with SYNONYM Choose from: 1 000839508016 2 TYLENOL You may enter a new SYNONYM, if you wish. ANSWER MUST BE 1-40 CHARACTERS IN LENGTH


Enter/Edit Dosages

• This option allows you to edit Possible Dose fields and Local Possible Dose fields for a selected entry from the DRUG (#50) File.

• When setting up doses, the system associates it with the correct number of dispense drug units when the POSSIBLE DOSAGES field is populated.

• Local possible dosages are set up in the same manner when more customization is needed.

• There is also a field called “BCMA UNITS PER DOSE” which controls the number of times a dispense drug unit needs to be scanned in BCMA independent of how many dispense drug units are actually needed. If set improperly, it will prompt the nurse to scan too many or too few times to deliver the needed dose.

• It is recommended that this field be left blank in almost all cases to allow the system to use the correct number of dispense units associated with the dose.


Edit Orderable Items

Parameters• DAY (nD) or DOSE (nL) LIMIT:

Description• If found when this drug is ordered, this is

used to calculate a DEFAULT value for the STOP DATE prompt of the order. If the number entered here is followed by a "D", that NUMBER OF DAYS will be added to the START DATE to calculate the STOP DATE. If the number entered is followed by an "L", the number is used as the NUMBER OF DOSES to calculate the STOP DATE. This is best used for NARCOTICS and ANTIBIOTICS.


Edit Orderable Items Continued

Parameter• DEFAULT MED ROUTE:

• USE DOSAGE FORM MED ROUTE LIST:

• SYNONYM:

Description• If a MED ROUTE is entered here, that med

route is used as a DEFAULT value during order entry when this drug is selected.

• If you answer YES to the prompt, the DEFAULT MED ROUTE (if populated) and the list of med routes associated with the DOSAGE FORM of the orderable item (if populated) will be displayed as selectable med routes during medication ordering dialog. If you answer NO, the DEFAULT MED ROUTE (if populated) and POSSIBLE MED ROUTES list will be displayed instead.

• Used to populate trade names to make drug selection easier for providers. This is NOT used to add bar codes for scanning


Summary

• There are many parameters/settings/options in pharmacy packages that are the foundation for inpatient ward & clinic order behavior.

• Most of these have been in place for years & are probably working well at your site (IF IT AIN’T BROKE, DON’T FIX IT!).

• Most new challenges come from setting up new wards or making changes to existing ones. Look at the parameters already set up for a similar existing ward & copy when possible to get the same results.

• Rule out human error - is it a person issue or system issue?• Don’t try to troubleshoot issues in a silo – involve your pharmacy ADPAC &/or CAC.• There’s help out there – BCRO SharePoint discussion board, “ask a question of

BCRO”, BCMA Coordinators mail group, Vista Documentation Library, etc.


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Pharmacy Package Parameters for BCMA Coordinators: An Overview BCMA National Call – January 5,...

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