Managing Pharmacy Drug Managing Pharmacy Drug DataData

Optimizing Pharmacy Data Management

Mary Ann Niesen, Pharm.D.

Adding a new drug

Follow standardized format:Generic name, strength, form

Albuterol 90mcg/spray MDI

Clopidogrel 75mg Tab

Be sure to fill out key fields:DEA code, order unit, dispense unit, dispense

units/order unit, NDC, etc.

National Drug File

Match through the drug entry screenIf unable to match, manually assign a VA Drug

class code.

This is required for correct functioning of doses, allergy checks, CRS taxonomies, etc.

May need matches verified and merged if the user does not have correct keys.

Dosages/Local dosages

Review or add dosages/local dosagesDosages = tied to National Drug File

Entry of mg strength is translated to number of tablets on label

Can add or delete these as needed

Local Dosages = entered locallyLiteral text will be displayed on label

Can have both but will not work well with EHR

Misc. Fields by Type of use

Mark drug as appropriate:Inpt, outpt, controlled, unit dose, non-VA, etc.Quantity disp. message will display in EHR

when dose is chosen (and in Pharmacy package back-end processing) so provider knows what size tube/bottle/package to prescribe.

Drug can be tied to a lab test (not a panel!) for checking during data entry (Simvastatin and AST).

Orderable itemsThese are the “basic” building blocks for all

orders, not just pharmacy.

For Pharmacy, these should be drug and form WITHOUT strength.Exception—insulin needs type included

(“regular insulin”, not “insulin”)

Choose form carefully!

Can set some defaults—route, schedule, text, etc.

Update an existing drugUpdate fields as needed, instead of entering

new drug

Inactivate drugs no longer in useNEVER delete a drug!

Re-activate if needed

Make sure NDC and bottle size match

Re-match to National Drug File if needed (but will need to re-do dosages changes)

Nouns and verbs

Nouns and verbs relate the dosage form and the dose to the instructions printed on the label:In Take 1 tablet every 6 hours “take” is the verb

and “tablet” is the noun

In Shake well and give 5 ml 3 times a day “shake well and give” is the verb and “ml” is the noun

Routes

Routes are tied to dosage forms and/or orderable itemsSome routes are unnecessary and can be

marked as National package only

Routes can be added—“topical body” for permethrin cream

PO is the default route

Standard Schedules

Continuous, One-time, or Day of week

Include a time interval (in minutes)

Allow for calculation of quantity based on dose and days supply for most drugs

In back-end prescription processing, can still use old “medication instructions” but only standard schedules show in EHR.

DosagesDosage vs Local Possible Dosage

Dosages can be tied to inpt, outpt, or both

Some dosage forms have Dosages that can only be tied to inpt—must still make Local possible dosages for outpt use

How to handle doses of “1-2 tablets”?

If Dosages exist, cannot “see” local possible dose in EHR

Dosage Forms

A National File

Form chosen when matching to orderable item

Can be confusingXR vs ER vs SR, etc.

May need to edit verbsReconsitutable oral powder was “mix and take”

changed to “shake well and give”

Drug/Orderable item text

Can be tied to individual drug or to orderable item

Can be prepared in word processing application then cut and pasted into RPMS

Will cause a link to show in the order dialog box in EHR (and additional question in Pharmacy package)

Used for pediatric dose charts, restrictions, or special instructions

Importance of good PDM setupEssential for trouble free use of POS,

Adverse Reaction Tracking, EHRAllergy checks may not trigger if VA drug class

not entered

Drug will not be billed if NDC doesn’t match package size

Many CRS (GPRA) taxonomies based on VA drug class or NDC…