Pharmacy Issues

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Revision as of 03:52, 26 April 2005 by 68.171.114.173 (talk) (→‎Steps to Adding One Drug / Making Available in CPRS)
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This page will contain notes to work out pharmacy programming issues.

Initiated by K. Toppenberg 4/2005

Keys Needed for Pharm. Setup

David Whitten searched pharmacy routines and found keys that were needed for some of the pharmacy setup routines. Here are the keys that were found: PSA ORDERS, PSAMGR, PSJ RPWARN, PSB MANAGER, PSB CPRS MED BUTTON, PSB INSTRUCTOR, PROVIDER, PSD TECH, PSDMGR, PSD BUMGR, PSD ERROR, PSD PARAM, PSD TRAN

Files and Relationships

  • VA PRODUCT file (file #50.68, ^PSNDF(50.68,*)) holds ALL possible drugs. Some people refer to this as the National Drug File.
  • DRUG file (file #50, ^PSDRUG(*)) holds all the drugs in the local formulary. This links to above.
  • PHARMACY ORDERABLE ITEM file (file #50.7, ^PS(50.7,*)) holds things that can be ordered from the pharmacy. This links to above.
  • ORDERABLE ITEM file (file #101.43, ^ORD(101.43,*)) hols things that can be ordered, including labs and drugs. This links to above.
  • ORDER QUICK VIEW file (file #101.44, ^ORD(101.44,*)) holds "quick order" entries. This links to above.


What I Have Learned so Far

1. For meds to show up in the dialog box in CPRS, it must have a entry like this: 

file: 101.44 (ORDER QUICK VIEW);  
 record: ORWDSET O RX;  
   subfile: SET MEMBER (101.442)
     record: SET MEMBER: _IEN_ pointer to 101.43 (ORDERABLE ITEM)   ... a drug would go here
     record: SET MEMBER: _IEN_ pointer to 101.43 (ORDERABLE ITEM)   ... a drug would go here
     record: SET MEMBER: _IEN_ pointer to 101.43 (ORDERABLE ITEM)   ... a drug would go here
     record: SET MEMBER: _IEN_ pointer to 101.43 (ORDERABLE ITEM)   ... a drug would go here

2. In file 101.43 (ORDERABLE ITEM) an entry for the drug must exist like this: 

file 101.43
 record: .01 NAME = LISINOPRIL
           2 ID = "Unique identifier, created from primary key passed in the 
                  Orderable Items update message from each package; it will be 
                  in the form of 'package code;99XXX' where XXX indicates the 
                  package table originating this item (i.e. RAP,LRT,etc.)
                  [e.g. in my system, then entry for DILTIAZEM TAB is 1;99PSP]
                  "Package code" should be the IEN on the PHARMACY ORDERABLE ITEM (#50.7)

3. If file 50.7 (PHARMACY ORDERABLE ITEM), 

 Note: new drugs may not be added unless PSEDITNM>0.  
       Also, in the MED ROUTE field, the input transform does not allow an input of "ORAL".  
         If the MED ROUTE is left blank, I believe the default to be shown in CPRS is ORAL.
 There is no direct link from file 50.7 up to file 50.  The link is FROM file #50 TO #50.7
 This file can hold the synonyms of a drug etc.

4. In file 50 (DRUG, ^PSDRUG): 

 Field 2.1 should contain a link to entry in file 50.7 (PHARMACY ORDERABLE ITEM)
 There must be an entry coresponding to the ID from 101.43 above. i.e. The "ASP" cross-reference 
 for the field "PHARMACY ORDERABLE ITEM (#2.1) i.e. ^PSDRUG("ASP",+ID,*) should exist.


Steps to Adding One Drug / Making Available in CPRS

GTM>set PSEDITNM=1 GTM>D D^DI

VA FileMan 22.0 Select OPTION: enter OR EDIT FILE ENTRIES

INPUT TO WHAT FILE: DRUG// 50.7 PHARMACY ORDERABLE ITEM 

                                         (3 entries)

EDIT WHICH FIELD: ALL//

Select PHARMACY ORDERABLE ITEM NAME: VIAGRA 

 Are you adding 'VIAGRA' as a new PHARMACY ORDERABLE ITEM (the 4TH)? No// Y
 (Yes)
  PHARMACY ORDERABLE ITEM DOSAGE FORM: tab
    1   TAB
    2   TAB,BUCC,SA
    3   TAB,BUCCAL
    4   TAB,CHEWABLE
    5   TAB,CHEWG GUM

Press <RETURN> to see more, '^' to exit this list, OR CHOOSE 1-5: 1 TAB 

  PHARMACY ORDERABLE ITEM INACTIVE DATE:

DOSAGE FORM: TAB// (No Editing) IV FLAG: INACTIVE DATE: DAY (nD) or DOSE (nL) LIMIT: ?? 

    Type a whole number between 0 and 99, 0 decimal digits, followed by either
    a "D" (for NUMBER OF DAYS) or an "L" (for DOSE LIMIT).

DAY (nD) or DOSE (nL) LIMIT: 2L MED ROUTE: SCHEDULE TYPE: r FILL ON REQUEST SCHEDULE: SUPPLY: Select SYNONYM: VIAGRA 

 Are you adding 'VIAGRA' as a new SYNONYM (the 1ST for this PHARMACY ORDERABLE ITEM)? No// Y  (Yes)

Select SYNONYM: Select OI-DRUG TEXT ENTRY: PATIENT INSTRUCTIONS: [Do not take with nitroglycerin] 

[Do not take with nitroglycerin]

OTHER LANGUAGE INSTRUCTIONS: NON-VA MED:

Select PHARMACY ORDERABLE ITEM NAME:

Select OPTION:

Note: You have to go back and edit the INACTIVE DATE, and delete the value.



Now create link from #50, field 2.1 --> 50.7

Select OPTION: eNTER OR EDIT FILE ENTRIES

INPUT TO WHAT FILE: DRUG// 50 DRUG (5173 entries) EDIT WHICH FIELD: ALL// pharmACY ORDERABLE ITEM THEN EDIT FIELD:

Select DRUG GENERIC NAME: viagra 1 VIAGRA SILDENAFIL (Viagra) 50MG TAB GU900 Use for 25mg dose only 2 VIAGRA SILDENAFIL (Viagra) 100MG TAB GU900 ONLY 4 DOSES PER MONTH ALLOWED CHOOSE 1-2: 1 SILDENAFIL (Viagra) 50MG TAB GU900 Use for 25mg dose only PHARMACY ORDERABLE ITEM: viagra TAB 04-25-2005 <--- Date is an INACTIVE data. Delete value in 50.7

Select DRUG GENERIC NAME: viag 1 VIAGRA SILDENAFIL (Viagra) 50MG TAB GU900 Use for 25mg dose only 2 VIAGRA SILDENAFIL (Viagra) 100MG TAB GU900 ONLY 4 DOSES PER MONTH ALLOWED CHOOSE 1-2: 2 SILDENAFIL (Viagra) 100MG TAB GU900 ONLY 4 DOSES PER MONTH ALLOWED PHARMACY ORDERABLE ITEM: viagra TAB 04-25-2005 <--- Date is an INACTIVE data. Delete value in 50.7

Select DRUG GENERIC NAME:

Select OPTION:

Now find IEN for newly added entry in PHARMACY ORDERABLE ITEM.

Select OPTION: inqUIRE TO FILE ENTRIES

OUTPUT FROM WHAT FILE: PHARMACY ORDERABLE ITEM// Select PHARMACY ORDERABLE ITEM NAME: viagra TAB ANOTHER ONE: STANDARD CAPTIONED OUTPUT? Yes// (Yes) Include COMPUTED fields: (N/Y/R/B): NO// b BOTH Computed Fields and Record Number (IEN)

NUMBER: 4 <--- *** THE IEN *** NAME: VIAGRA DOSAGE FORM: TAB 

 DAY (nD) or DOSE (nL) LIMIT: 2L       SCHEDULE TYPE: FILL ON REQUEST

SYNONYM: VIAGRA 

 PATIENT INSTRUCTIONS: [Do not take with nitroglycerin]

Select PHARMACY ORDERABLE ITEM NAME:

Now

Relevent Menu Options

Here is a pharmacy option/menu setup I gathered: 

  cv     Protocol Conversion Utilities ... [ORCM CONVERSION UTILITIES]
  Mgr    Pharmacy Data Management ... [PSS MGR]
  NDF    National Drug File Menu ... [PSNMGR]
  Out    Outpatient Pharmacy Manager ... [PSO MANAGER]
         Drug Accountability Menu ... [PSA DRUG ACCOUNTABILITY MENU]
         Drug Receipt History Review [PSA DRUG HISTORY]
         Drug Transaction History [PSA DRUG DISPLAY]
         Enter/Edit a Drug [PSA DRUG ENTER/EDIT]
         Inquire/Compare DRUG file/ITEM MASTER file [PSA DRUG INQUIRE]

Debug of Ordering a Drug from CPRS

Email coorespondence

Wei Wang wrote:

I have tried to enter a new pharmacy orderable items and drugs through the PDM Drug enter/edit program. After the drug is put in, I can order it from the character-based CPRS but it does not display in the Medication Order dialog box for the GUI CPRS.

The only inpatient medication orderable items that display in the GUI CPRS are items contained in the record "ORWDSET UD RX" in the file ORDER

QUICK VIEW. But new updates to the drugs and orderable items do not effect this record. Any idea how I should enter new drugs and/or pharmacy orderable items so they will appear on the GUI CPRS too?

Thanks,

Wei Wang Oleen Healthcare Information Management


The reason was that we didn't start TaskMan while entering the drugs so job of "updating Quick View" is scheduled but not run. After we started TaskMan and waited for a little while, all drugs now show nicely in the GUI interface.

Wei

Thanks to Todd in Iowa who helped us with resolve the problem! Nancy Anthracite

=-=-=-=-=-=-

Hi Finally I am able to see the drugs and order them from CPRS. Nancy's old mail really helped. A record has to be added into the ORDER QUICK VIEW file. This file probably holds the parameters required by CPRS. The new record is something like: Name : ORWDSET O RX QUICK ORDER : PS MEDS SET MEMBER : "ORDERABLE ITEM" Regards Nick



I have been tinkering with being able to order medications in CPRS.

Based on recent posts, it seems that an entry is required in the ORDER QUICK VIEW file, in the record: ORWDSET O RX. Here is my file now:

Select ORDER QUICK VIEW NAME: orwdset O RX ANOTHER ONE: STANDARD CAPTIONED OUTPUT? Yes// (Yes) Include COMPUTED fields: (N/Y/R/B): NO// b BOTH Computed Fields and Record Number (IEN)

NUMBER: 2 NAME: ORWDSET O RX 

 LAST UPDATE: 59653,46064

QUICK ORDER: PS MEDS DISPLAY TEXT: <Some text> SET MEMBER: CALCIUM DISPLAY TEXT: (CALCIUM)

Now, rather when getting an error when trying to order a medicine, I am given chose of ordering one "medicine" -- namely calcium.

So it seems that I need to load my formulary into this file.

When I look at the data structure for the file, though, I see that the drug (in this case "calcium") is stored as a free text name, not a pointer to the DRUG file (file # 50).

So how do I make this link, or am I off target?

Thanks Kevin



Hi The SET MEMBER comes from the PHARMACY ORDERABLE ITEM file for medications. Drugs can be added into this file through the DRUG ENTER/EDIT option. Bye Nick


Nick,

Thanks for you help so far.

I have explored the DRUG ENTER/EDIT option (option: PSA DRUG ENTER/EDIT) and found that I could laboriously load up my forumulary with the drugs one at a time -- clearly impossible for a full forumulary (too many)

Then I found the option to Merge National Drug file Datas into Local File (option: PSNMGR). I did this, and there were no errors. Somewhere along the way I created a "pharmacy" out of which to work in the OUTPATIENT SITE file. Now, when I got to the DRUG ENTER/EDIT option, there are 5173 drugs loaded.

But when I go into Fileman, and look inthe PHARMACY ORDERABLE ITEM file, it is completely empty.

Any ideas about how to get this populated?

Thanks Kevin


The pointer is from the Drug file #50 I believe. I got something to work by putting someting into the orderables file. I know there a pointer from the drug file to the orderables file. Jim Gray

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