Configuring a Drug for CPRS Medication Outpatient

Configuring a Drug for CPRS Medication, Outpatient

Overview

A common problem when configuring medications in VistA is that a drug exists in the DRUG file (#50), exists in the PHARMACY ORDERABLE ITEM file (#50.7), and is available for Medication, Inpatient ordering, yet does not appear in Medication, Outpatient ordering in CPRS. How to do this in detail is surprisingly missing from the VDL Pharma manuals.

The instinct is often to use FileMan to edit entries in files #50 and #50.7. While FileMan can display and edit fields, it does not execute the Pharmacy Data Management logic required to properly configure a drug for Outpatient Pharmacy.

The correct approach is to use the Pharmacy Data Management (PDM) Drug Enter/Edit option.

Symptoms

A drug:

• Exists in DRUG file (#50)
• Exists in PHARMACY ORDERABLE ITEM file (#50.7)
• Can be ordered through Medication, Inpatient
• Does not appear in Medication, Outpatient

Example:

BUPRENORPHINE 8MG/NALOXONE 2MG TAB
BUPRENORPHINE 2MG/NALOXONE 0.5MG TAB

Root Cause

The drug may have been configured for Unit Dose (Inpatient) but not properly configured for Outpatient Pharmacy.

Editing the DRUG file directly through FileMan does not expose the package-specific prompts that establish Outpatient Pharmacy relationships and cross-references.

Required Security Keys

The user performing the configuration must have appropriate pharmacy privileges.

Typical keys include:

PSNMGR
PSORPH
PSJU MGR

Depending on local implementation, additional keys may be required.

In a test environment, the security key indexes may need to be rebuilt or manually set.

Example:

S ^XUSEC("PSORPH",DUZ)=""
S ^XUSEC("PSJU MGR",DUZ)=""

Example used during testing:

S ^XUSEC("PSORPH",341)=""
S ^XUSEC("PSJU MGR",341)=""

Do Not Use FileMan Alone

Editing File 50 or File 50.7 directly through FileMan is not sufficient.

The required prompts do not appear in FileMan because they are generated by Pharmacy Data Management application logic.

Instead use:

Pharmacy Data Management Menu
  → Drug Enter/Edit

Procedure

Select the desired drug:

BUPRENORPHINE 8MG/NALOXONE 2MG TAB

or

BUPRENORPHINE 2MG/NALOXONE 0.5MG TAB

Near the end of the Drug Enter/Edit session, the system displays:

This entry is marked for the following PHARMACY packages:
 Unit Dose

MARK THIS DRUG AND EDIT IT FOR:
O  - Outpatient
U  - Unit Dose
X  - Non-VA Med

Enter:

O,U

This marks the drug for both Outpatient Pharmacy and Unit Dose.

Configure Outpatient Fields

When prompted:

** You are NOW editing OUTPATIENT fields. **

Answer:

AN Outpatient Pharmacy ITEM? Yes

Specify the corresponding inpatient drug.

Example:

CORRESPONDING INPATIENT DRUG:
BUPRENORPHINE 8MG/NALOXONE 2MG TAB

or

CORRESPONDING INPATIENT DRUG:
BUPRENORPHINE 2MG/NALOXONE 0.5MG TAB

Continue through the remaining prompts.

Configure Unit Dose Fields

When prompted:

** You are NOW editing UNIT DOSE fields. **

Answer:

AN Unit Dose ITEM? Yes

Verify the corresponding outpatient drug:

CORRESPONDING OUTPATIENT DRUG:
BUPRENORPHINE 8MG/NALOXONE 2MG TAB

or

CORRESPONDING OUTPATIENT DRUG:
BUPRENORPHINE 2MG/NALOXONE 0.5MG TAB

Continue through the remaining prompts.

Orderable Item Matching

Drug Enter/Edit then performs Orderable Item matching.

Typical output:

** You are NOW in the ORDERABLE ITEM matching for the dispense drug. **

BUPRENORPHINE 8MG/NALOXONE 2MG TAB is already matched to

BUPRENORPHINE 8MG/NALOXONE 2MG TAB TAB,SUBLINGUAL

If the match is correct:

Do you want to match to a different Orderable Item? NO

Add Drug to CPRS Outpatient Ordering

Even after the drug is configured for Outpatient Pharmacy, it may still not appear in CPRS Medication, Outpatient.

The drug must also be present in the outpatient medication quick-order view:

ORWDSET O RX

Verify that the medication appears in the outpatient ordering configuration used by CPRS.

Verification

After configuration:

1. Restart CPRS if necessary.

1. Open:

Orders
  → Medication, Outpatient

1. Search for:

BUPRENORPHINE

The configured products should now appear as outpatient-orderable medications.

Troubleshooting

Drug exists but does not appear in Medication, Outpatient

Verify:

• Drug was edited through PDM Drug Enter/Edit, not FileMan alone.
• Drug is marked for Outpatient Pharmacy.
• Drug is marked for Unit Dose if dual-use is desired.
• Corresponding inpatient and outpatient drug relationships are populated.
• Drug is present in ORWDSET O RX.
• User has appropriate pharmacy security keys.

Drug appears Inpatient but not Outpatient

This is often caused by the drug being configured only for Unit Dose.

Re-enter Drug Enter/Edit and verify the Outpatient configuration section was completed.

Notes

• The existence of entries in DRUG (#50) and PHARMACY ORDERABLE ITEM (#50.7) does not guarantee outpatient orderability.
• Medication, Inpatient and Medication, Outpatient use different configuration paths.
• Pharmacy Data Management Drug Enter/Edit performs setup logic that is not available through direct FileMan editing.
• CPRS outpatient ordering may additionally require configuration in ORWDSET O RX.

See Also

• Enter A Drug
• Pharmacy Data Management
• CPRS
• Outpatient Pharmacy
• Orderable Items