January 2012

MailMan and Pharmacy

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Objectives

At the end of this session, participants should be able to:• Discuss need for a system to communicate errors and

system messages to users.• Identify specific messages that apply to pharmacy

maintenance and assist in patient safety practices.• Take appropriate action based on the various system

messages .• Explain reasoning behind and procedures to set up user

parameters for MailMan.• Navigate within MailMan.• Recommend MailMan groups to set up with site manager.

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System Messages

• System messaging systems can alert the informaticist to issues on the system.

• These can include messages that require action, as well as messages that are informational in nature.

• These may be patient specific, or general database maintenance issues.

• If using RPMS, most of these messages will be delivered through MailMan.

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MailMan Explained (in basic fashion)

• MailMan is a message system within RPMS “Roll and Scroll”—it is NOT an email program like Outlook!• It can be used to communicate with other RPMS

users, though they can only see these inside the RPMS “Roll & Scroll.”

• Other items such as Outlook email, notifications, broadcasts, and chats are more useful for this now.

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MailMan Explained (in basic fashion)

• Still useful for getting information from/about packages, updates, and drug file problems.

• Users need to know how to get to MailMan, and some configuration options that can make it easier to use.

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Accessing MailMan

• At most menu prompts that are NOT asking for patient information, type “MAIL.”

• Or, enter two question marks at any menu prompt and look for the “common” menu options (they will vary by user):

FAC Change User's Selected Facility [AZUX DUZ(2) CHANGE]PATH Menu Path [XUZUSERPATH]TBOX User's Toolbox ... [XUSERTOOLS]VA View Alerts [XQALERT] Continue [XUCONTINUE] Halt [XUHALT] MailMan Menu ... [XMUSER] Restart Session [XURELOG] Time [XUTIME] Where am I? [XUSERWHERE]

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Customizing MailMan

The Main MailMan menu: NML New Messages and Responses RML Read/Manage Messages SML Send a Message Query/Search for Messages AML Become a Surrogate (SHARED,MAIL or Other)

Personal Preferences ... Other MailMan Functions ... Help (User/Group Info., etc.) ...

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Personal Preferences

User Options Edit Banner Edit Surrogate Edit Message Filter Edit Delivery Basket EditGML Enroll in (or Disenroll from) a Mail Group

Personal Mail Group Edit Forwarding Address Edit

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User OptionsSelect Personal Preferences Option: user Options EditEditing data in the MAILBOX file:BANNER: The banner is displayed to others whenever they address mail to you.MESSAGE ORDER: Newest First// ? In which order do you want your messages to appear? Choose from: N Newest First O Oldest FirstNEW MESSAGES READ ORDER: Newest First// ?MESSAGE READER: Detailed Full Screen// ?? There are several ways to read and manage your messages: Classic - the one that has been around for years. Detailed Full Screen - full screen, with a detailed message list. Summary Full Screen - full screen, with a summary message list. 'Classic' is the default, if you don't choose any. In the next prompt, 'message reader prompt', you will be able to specify whether the

reader you choose should be used all the time or whether you want to be asked each time.

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User OptionsMESSAGE READER PROMPT: ? Should MailMan ask you which message reader to use every time you go to read messages? Choose from: Y Yes, ask me N No, don't ask me, just use the defaultNEW MESSAGES DEFAULT OPTION: LIST ALL NEW MESSAGES// ? Select default new messages option Choose from: LB LIST BASKETS WITH NEW MAIL LN LIST ALL NEW MESSAGES P PRINT ALL NEW MESSAGES R READ NEW MAIL BY BASKETSHOW MESSAGE PREVIEW: ? Do you want to see a preview of the message subject and sender? Choose from: Y YES, SHOW MESSAGE PREVIEW N NO, DO NOT SHOW ITMESSAGE ACTION DEFAULT: DELETE// ? Enter an 'I' for 'Ignore' or a 'D' for 'Delete'. Choose from: I IGNORE D DELETE

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User OptionsASK BASKET?: ? If no, MailMan will not ask basket name when user sends message to himself. Choose from: y YES n NOSHOW TITLES: ? Enter 'Yes' if you want to see senders' and recipients' titles. Choose from: 1 YES 0 NOPRIORITY RESPONSES FLAG: ? Choose from: 0 Responses are PRIORITY 1 Responses are ORDINARYPRIORITY RESPONSES PROMPT: ? Enter 'Ask' or 'Do not ask'. Choose from: 0 ASK EACH TIME MESSAGE IS READ 1 DO NOT ASK EACH TIME MESSAGE IS READP-MESSAGE FROM:MAILMAN INSTITUTION:NETWORK SIGNATURE LINE 1 OF 3:NETWORK SIGNATURE LINE 2 OF 3:NETWORK SIGNATURE LINE 3 OF 3:INTRODUCTION: No existing text Edit? NO//

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User OptionsEditing the priority order for reading baskets with new messages.Note: You don't need priority ordering unless you want to change the default 'read new messages' basket from IN to other basket(s).Select BASKET: ? Answer with BASKET Choose from:

Editing data in the NEW PERSON file:PREFERRED EDITOR: SCREEN EDITOR - VA FILEMAN// ? Answer with ALTERNATE EDITOR NAME Choose from: LINE EDITOR - VA FILEMAN SCREEN EDITOR - VA FILEMAN XTENSIBLE EDITOR

STREET ADDRESS 1:STREET ADDRESS 2:STREET ADDRESS 3:CITY:STATE:ZIP CODE:OFFICE PHONE:FAX NUMBER:VOICE PAGER:DIGITAL PAGER:ADD'L PHONE 1:ADD'L PHONE 2:

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Filter MessagesSelect Personal Preferences Option: message Filter EditFILTER MESSAGES?: ? If you have mail filters set up, do you want to use them? Choose from: N NO Y YESSelect FILTER: ?? You may enter a new FILTER, if you wish This is the name of your filter. The filter is used by MailMan to determine into which basket to place a

message. Messages can be filtered based on up to three criteria which must all be true: - Subject contains - Message is from - Message is to For example, if you specify 'subject contains' and 'message is from', the filter takes effect only if the subject

contains the string you specify AND the message is from the person you specify. If you wish the filter to take effect upon 'subject contains' OR 'message is from' you must create two filters,

one with 'subject contains', and the other with 'message is from'. Filtering takes place during message delivery and can also be selected as a basket action. The filter is

ignored during delivery under the following conditions: - The message already exists in one of your baskets. - The message is from you, and you specified a basket (other than the IN basket) at the transmit prompt. - The sender has specified a delivery basket and you have allowed it.

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Filter MessagesSelect Personal Preferences Option: MESSage Filter EditFILTER MESSAGES?: YES//Select FILTER: ALLERGY Are you adding 'ALLERGY' as a new FILTER (the 1ST for this MAILBOX)? No// Y (Yes)ORDER: ? Type a Number between 1 and 999, 0 Decimal DigitsBASKET: ALLERGIES Are you adding 'ALLERGIES' as a new BASKET (the 3RD for this MAILBOX)? No// Y (Yes) STATUS: ? Choose from: 0 OFF 1 ONSTATUS: 1 ONSUBJECT CONTAINS: ? Answer must be 3-25 characters in length.SUBJECT CONTAINS: REACTIONFROM:ADDRESSED TO:VAPORIZE DAYS: ? Type a Number between 7 and 365, 0 Decimal DigitsVAPORIZE DAYS:DELIVER NEW?: ?? If you don't answer, or delete the answer, the default is YES. YES means that the message will be delivered as usual, and made new as usual. NO means that the message will be delivered as usual, but it won't be made new, so you won't know it's arrived unless you check. This will only apply to new messages which you have not seen before. It won't apply to responses or forwarded messages with responses. It won't

apply when you filter messages which are already in your mailbox. Choose from: Y YES N NOSelect FORWARD TO:

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Processing MailMan Messages

• If you set your message option to LIST, you can perform actions on several messages at once.

• Delete, Resequence, Print, Later, New, etc.:• LATER will make the message new at a later time.• RESEQUENCE re-numbers the messages if you have

deleted a few.• You can DELETE those messages you can see in the

list, or some of them:• Use 1-52; or 2-5, 6-12; etc.

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Processing MailMan MessagesEnter message number or command: ???Enter a message number (1-52) to read a message in this basket.Enter an internal message number to read any message still on the system,which you ever sent or received. Enter: ?string Search for messages in this basket whose subject contains the specified string ??string Search for messages you once sent or received whose subject begins with the specified string .(-)n or n-m,a,c-d (de)select message n or a list of messages .(-)* (de)select all messages CD Change Detail P Print messages D Delete messages Q Query (search for) messages F Forward messages R Resequence messages H Headerless Print messages S Save messages to another basket L Later messages T Terminate messages N New message list V Vaporize date set messages NT New Toggle messagesPress ENTER or + to go to the next page. Enter +n to page forward n pages.Enter = to refresh this page; ^ to exit this list.

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Mail Groups

• A Site Manager can enter users into different mail groups to receive bulletins:• A bulletin is a message within RPMS Roll and Scroll—it is

NOT an email message!• Bulletins are sometimes informational, but other times

they indicate some action needs to be taken.• Users CAN delete these without taking the action, so it is

important that they are looked at and taken care of promptly.

• Site Manager must assign people to the groups.• Site Manager must assign groups to the bulletins.

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Some available Bulletins:

• National Drug File• AWP updates (tasked or single)• Missing Costs (Unit Dose or IV, mostly)• Adverse Reaction Tracking• Allergy to Verify• Allergy Entered in Error• P&T, change to Signs/symptoms, etc.• Request New Reactant

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National Drug File Patches

• Often get several messages, not all of which require action

• Impacts drug file, adverse reaction tracking, POS/Billing, etc.

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Sample MessagesSubj: Products with changed classes [#13062] 02/25/10@14:18 44 linesFrom: NDF MANAGER In 'IN' basket. Page 1-------------------------------------------------------------------------------Product: BARRIER,ASSURA COLOPLAST #14233Old Class: XA600New Class:XA602

Product: CATHETER,SELF-CATH COUDE 14FR COLOPLAST #50202Old Class: XA599New Class:XA510

Product: CATHETER,SELF-CATH COUDE 14FR COLOPLAST #50203Old Class: XA599New Class:XA510

Product: CATHETER,SELF-CATH COUDE 16FR COLOPLAST #50204Old Class: XA599New Class:XA510

Product: DRESSING,BIOPATCH 4MM JJ#4150Old Class: XA100New Class:XA105

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Sample MessagesSubj: DRUGS UNMATCHED FROM NATIONAL DRUG FILE [#13060] 02/25/10@14:18 69 linesFrom: NDF MANAGER In 'IN' basket. Page 1-------------------------------------------------------------------------------

The following active entries in your DRUG file (#50) have beenunmatched from the National Drug File (NDF). The VA Productname and CMOP ID corresponding to the unmatched local drug filename are listed on the indented line beneath each entry. AnInactivation Date may be listed for entries when this reasonapplies. Until you rematch these entries to NDF, they will nottransmit to CMOP and drug-drug interaction checks will not checkfor these products. It is critical that you rematch theseproducts immediately. You may also need to match a neworderable item. Any possible dosages and local possibledosages for these unmatched products have been deleted.Therefore, the dosages for each unmatched product shouldbe reviewed after the rematch or recreated if the productcan not be rematched to a VA Product through the NDFmatching process.

DRUG IEN INACTIVATION DATE------------------------------------------------------------------------------- NONE

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Sample MessagesSubj: UPDATED INTERACTIONS [#13059] 02/25/10@14:18 263 linesFrom: NDF MANAGER In 'IN' basket. Page 1-------------------------------------------------------------------------------The following interactions in National Drug File (NDF) have been added,edited or inactivated. These changes are the result of review andrecommendations from the NDF support group.

ADDED INTERACTIONS

ALFENTANIL/ISOCARBOXAZID Critical ALFENTANIL/LINEZOLID Critical ALFENTANIL/PHENELZINE Critical ALFENTANIL/RASAGILINE Critical ALFENTANIL/SELEGILINE Critical ALFENTANIL/TRANYLCYPROMINE Critical AMPRENAVIR/DELAVIRDINE MESYLATE Critical AMPRENAVIR/RIFABUTIN Significant AMPRENAVIR/ROSUVASTATIN Significant AMPRENAVIR/TADALAFIL Significant ATAZANAVIR/ATORVASTATIN CALCIUM Significant ATAZANAVIR/DEXLANSOPRAZOLE Critical ATAZANAVIR/ESOMEPRAZOLE Critical

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Sample MessagesSubj: DATA UPDATE FOR NDF [#13058] 02/25/10@14:18 540 linesFrom: NDF MANAGER In 'IN' basket. Page 1-------------------------------------------------------------------------------

The following VA Products have been added to the NationalDrug File. You may wish to review, then match or unmatchlocal drug file entries based on this updated information.

ATTENDS BRIEF PULL-ON XX-LARGE (CMOP - XT311) (DISPENSE UNIT - EA) 999004-6395-39 BANDAGE,DERMACEA 2IN X 4YD NONSTERILE KEN#441124 (CMOP - XT340) (DISPENSE UNIT - EA) 008884-4411-24 BANDAGE,DERMACEA 2IN X 4YD STERILE KEN#441108 (CMOP - XT336) (DISPENSE UNIT - EA) 008884-4411-08 BANDAGE,DERMACEA 3IN X 4YD NONSTERILE KEN#441123 (CMOP - XT341) (DISPENSE UNIT - EA) 008884-4411-23 BANDAGE,DERMACEA 3IN X 4YD STERILE KEN#441107 (CMOP - XT337) (DISPENSE UNIT - EA)

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Sample MessagesSubj: INTERACTIONS and ALLERGIES UPDATED [#13047] 02/25/10@13:02 29 linesFrom: NDF MANAGER In 'IN' basket. Page 1-------------------------------------------------------------------------------

The following interactions have been edited because theyinvolved ingredients that are not primary ingredients.

none found

The following interactions have been deleted becausePrimary Ingredient/Other Ingredient combination alreadyexists in the DRUG INGREDIENTS file involved ingredientsthat are not primary ingredients.

GATIFLOXACIN/PIOGLITAZONE HCLGEMFIBROZIL/PIOGLITAZONE HCL

================================================================Allergy information for the following patients has been changed.Patient: Pxxx,Bxxx LxxxNon-primary ingredient PIOGLITAZONE HCLwas replaced with primary ingredient PIOGLITAZONE HCL

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AWP Updates (from tasked job)• These are triggered every time the TaskMan job for

AWP updating is run, OR when the AWP Manual Update option is run.

• Usually 5 or more messages• Often require action: editing the drug file entry to

comply with the needed information• Might involve NDC numbers, dispense units per

order unit, or other information preventing the local file from being updated with new AWP information.

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Sample MessagesSubj: Outpatient Pharmacy AWP Automatic Update [#12995] 02/23/10@15:04 200 linesFrom: OUTPATIENT PHARMACY DEVELOPER In 'IN' basket. Page 1-------------------------------------------------------------------------------A Pricing update was performed on your system on FEB 23,2010.The total number of records updated = 650

Listed below are the active drugs that were not updated and the error codes.Please review and correct all errors before attempting to run the manualAWP update option.Note: any 'missing 660 node' errors means that information like (ie. Reorder Level, Order Unit, Price Per Order Unit, Dispense Units Per Order unit, Price Per Dispense Unit, etc) is missing!

DOPamine 400MG/250ML INJ - MISSING 660 NODE IN DRUG FILEBETHANECHOL 10MG TAB U/D - MISSING DISPENSE UNIT IN DRUG FILEACETAMINOPHEN 120MG SUPP - DISP UNITS DON'T MATCH - Medi = 237 / Local = 12ACYCLOVIR 200MG CAPS - NDC'S DON'T MATCHACETAMINOPHEN 120MG SUPP - NO ACTUAL ACQUISTION PRICE FOR THIS NDC IN AWP MED-

TRANSACTION FILE

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AWP Updates (single item)Subj: NOTIFICATION OF DRUG PRICE (AWP/AAC) UPDATE [#13319] 03/17/10@14:0610 linesFrom: PHARMACY NOTIFICATION In 'IN' basket. Page 1 *New*-----------------------------------------------------------------------THE NDC NUMBER HAS BEEN UPDATED FOR THE DRUG BELOW BY USER,ESTUDENT.THE RESULTS OF THE AWP AND AAC UPDATE PRICES ARE(86137) LAP NACL 0.9% 50ML ADDV BAG-0040710166 - NDC'S DON'T MATCH

OR:

Subj: NOTIFICATION OF DRUG PRICE (AWP/AAC) UPDATE [#13316] 03/17/10@13:5510 linesFrom: PHARMACY NOTIFICATION In 'IN' basket. Page 1 *New*-------------------------------------------------------------------------------THE NDC NUMBER HAS BEEN UPDATED FOR THE DRUG BELOW BY USER,LSTUDENT.THE RESULTS OF THE AWP AND AAC UPDATE PRICES ARE(86135) CLEOCIN PHOS/D5W 300MG 50ML 24-00009338102 - NO ACTUAL ACQUISTION PRICE FOR

THIS NDC# IN THE AWP MED-TRANSACTION FILE(86135) CLEOCIN PHOS/D5W 300MG 50ML 24-00009338102 - NO PROBLEM WITH THIS PRICE

UPDATE FOR AWP AND AAC

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Missing Cost (Unit Dose)Subj: COST NOT FOUND ON DRUG ITEMS [#13171] 03/16/10@12:46 39 linesFrom: MEDICATIONS,UNIT DOSE In 'IN' basket. Page 1-------------------------------------------------------------------------------The following items from your DRUG file were found to have NO DATA in their PRICE PER DISPENSE UNIT field: ATROPINE SULF 1% OPTH SOL. (15ML) LACTULOSE 10GM/15ML SYRUP HOMATROPINE 5% OPHTH SOLN-5ML ALBUTEROL MDI (17GM) HYDROXYZINE= 25MG TAB CARBAMIDE PEROXIDE 6.5% OTIC (15ML) MORPHINE SULFATE 30MG *SR* TAB METHYLPREDNISOLONE 125MG INJ (2ML) KETOROLAC TROMETHAMINE 30MG/ML INJ IBUPROFEN 100MG/5ML SUSP. (473ML) NICOTINE TRANSDERMAL 7MG/DAY LORazepam 2MG/1ML TUBEX INJ (10'S) GREEN LADY/LIDOCAINE 50:50 CLOTRIMAZOLE 1% CREAM (30GM) AEROCHAMBER PLUS WITH FLOWSIGNAL OXYCODONE/APAP 5/325MG TAB (6'S) PREPACK ASPIRIN 81MG CHEW TAB U/D

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Missing Cost (Additives and Solutions)

Subj: MISSING COST INFORMATION [#13178] 3/16/10@16:46 1 lineFrom: IV PHARMACY PACKAGE In 'IN' basket. Page 1---------------------------------------------------------------REGULAR INSULIN IN THE ADDITIVES FILE.

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Adverse Reaction Tracking

• Verification notices no longer sent as Bulletins:• Instead, sent as EHR notifications• Also show as “Alerts” in RPMS

• Will only show IF:• User holds the GMRA-Allergy Verify key AND• User is a member of the mail group that is tied to

the GMRA Verify Drug Allergy bulletin• Other Adverse Reaction messages still sent as

bulletins.

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Adverse Reaction Needing Verification

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Adverse Reaction Needing Verification

Subj: REACTION ENTERED IN ERROR [#12990] 02/23/10@14:44 17 linesFrom: USER,ZSTUDENT In 'IN' basket. Page 1-------------------------------------------------------------------------------The following reaction has been ENTERED IN ERROR. Please ensure that thepatient's Chart/ID Band are updated to reflect this change. Patient: Txxx,Axxx M SSN: 10-87-37 Reaction: PENE Location: OUT PATIENT Originator: USER,ASTUDENT Entered in Error by: USER,ZSTUDENT Entered in Error on: Feb 23, 2010@14:44:04

Comments: ENTERED IN ERROR Date: Feb 23, 2010@14:44:04 User: USER,ZSTUDENT Title: CAUSATIVE AGENT MIS-SPELLED, CORRECTED ENTRY ALREADY PRESENT.

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Adverse Reaction Needing Verification

Subj: Request to add new reactant [#4895] 05/04/11@08:25 20 linesFrom: ALLERGY PACKAGE In 'IN' basket. Page 1---------------------------------------------------------------------------A request to add SEABASS as a new reactant was enteredby HESS,BARBARA for patient DEMO,PATIENT AMBER (7862)

User's contact information:Title : CONTRACT PROGRAMMEROffice Phone:Digital Pager:

The user added the following comment:

This patient has throat swelling from seabass.

Please verify with the user the intended reactant and then take theappropriate action. Be sure to try alternate spellings, etc beforerequesting new reactants. If this reactant does require review foraddition, please submit through the IHS RPMS Feedback page athttp://www.ihs.gov/RPMS using the RPMS Application ‘Pharmacy-New Reactant/Symptom Request (PRSR)’

Please note, an allergy to SEABASS was NOT entered for this patient!