Sentri7 Best Practices: Increasing Efficiency & AdoptionQuorum Health Pharmacy Education Series
ProCE, Inc.www.ProCE.com 1
2017 Pharmacy Education Series
October 26, 2017Sentri7 Best Practices: Increasing Efficiency & Adoption
Speakers:
Joe DeMattei, Pharm.D. Laura PurdyDirector of Pharmacy Supervisor, Application SpecialistsCrossroads Community Hospital Clinical Software Solutions
Wolters Kluwer
Providing Continuing Education For Healthcare Professionals
Submission of an online post‐test and evaluation is the only way to obtain CE credit for this webinar
Go to www.ProCE.com/QuorumRx
Webinar attendees will also receive an email with a direct link to the web page
Print your CE statement of completion online
– Credit for live or enduring (not both)
Deadline: November 24, 2017
CPE Monitor (applicable to pharmacists)
– CE credit automatically uploaded to NABP/CPE Monitor upon completion of post‐test and evaluation (user must complete the “claim credit” step)
Online Evaluation, Self-Assessmentand CE Credit
Attendance Code
Code will be provided at the end of today’s activity 2
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How to Ask a Question
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B. Keith Yarde, R.Ph., M.S
Pharmacy Operations Director
QUORUM Health
Update on Current Pharmacy Initiatives and Strategies
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October 26, 2017Sentri7 Best Practices: Increasing Efficiency & Adoption
Speakers:
Joe DeMattei, Pharm.D. Laura PurdyDirector of Pharmacy Supervisor, Application SpecialistsCrossroads Community Hospital Clinical Software Solutions
Wolters Kluwer
Providing Continuing Education For Healthcare Professionals
It is the policy of ProCE, Inc. to ensure balance, independence, objectivity and scientific rigor in all of its continuing education activities. Faculty must disclose to participants the existence of any significant financial interest or any other relationship with the manufacturer of any commercial product(s) discussed in an educational presentation. Dr. DeMattei does not have any relevant commercial and/or financial relationships to disclose. Ms. Purdy does not have any relevant commercial and/or financial relationships to disclose.
Please note: The opinions expressed in this activity should not be construed as those of the CME/CE provider. The information and views are those of the faculty through clinical practice and knowledge of the professional literature. Portions of this activity may include unlabeled indications. Use of drugs and devices outside of labeling should be considered experimental and participants are advised to consult prescribing information and professional literature.
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Sentri7 Best Practices: Increasing Efficiency & AdoptionQuorum Health Pharmacy Education Series
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CE Activity Information & Accreditation
ProCE, Inc. (Pharmacist)
– 2.0 contact hours
Funding:This activity is self‐funded through Quorum Health.
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Sentri7 Best Practices: Increasing Efficiency & Adoption
October 26, 2017
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Sentri7 Best Practices: Increasing Efficiency & AdoptionQuorum Health Pharmacy Education Series
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Learning Objectives
Describe new tools in rule writing to enhance Sentri7® alerts List new features to streamline Dashboard view Discuss how rule prioritization, real-time
notification, and advanced reviews can drive improved performance metrics Describe dashboard-centric vs. patient-centric
workflows in Sentri7 Describe Sentri7 antibiogram reporting Explain how Sentri7 can be used at Quorum for
workflow, regimen optimization, antimicrobial stewardship, and regulatory compliance
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ADVANCED TOOLS IN RULE WRITING
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Zero Occurrences Operator
Look for the absence of a drug order or lab result
In the past, other negation operators used such as Is Not, Is Not In were used to try to mimic the new operator; however, they would sometimes produce unexpected results
When used at the top of a rule block (for drug orders, chemistry lab results), you can set the operator to 0 or no to find zero occurrences of the specific
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IV/PO THERAPEUTIC INTERCHANGE
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WARFARIN WITHOUT INR
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1. Dashboard Approach2. Patient Approach
Sentri7® Recommended Surveillance Workflows:
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Types of Documentation
Advanced Review
May be used when the rule alert has been reviewed, but no clinical action is taken at that time
May be used when therapy is appropriate and no clinical change is necessary
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Sentri7® Examples of Advanced Review
IV/PO Linezolid - Patient meets rule criteria for therapy interchange but due to nausea cannot be converted to oral administration; document findings and reset time to follow-up
Albumin Assessment - Confirmed that patient received an infusion of albumin that was deemed appropriate based on criteria for use recommendations. No additional albumin is ordered and no follow-up is necessary.
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Advanced Review Workflow
Click Review link to the right of the alert
Document pertinent notes in ‘Notes’ section
Select Reset Time when additional review is clinically necessary (if not, select ‘Never’)
Click Review to close
This will gray the patient out for the
selected times as a visual cue that the patient has been
reviewed. This patient will re-illuminate when review time expires.
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Advanced Review Workflow
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Advanced Review Workflow
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Types of Documentation
Closed (One-Time) Intervention (‘Submit’ with no further follow-up)
May be used to document if clinical action was taken on an alert and no additional monitoring or follow-up is necessary
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Sentri7® Examples Closed (One-Time) Interventions
IV/PO Linezolid - IV linezolid therapy was adjusted to oral therapy; document intervention and ‘Submit’ outcome with no further follow-up
Insulin Formulary Use - Patient had order for non-formulary insulin product and was switched over to a formulary insulin; document intervention and ‘Submit’ with no further follow-up
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Closed (One-Time) Intervention Workflow
Click INT link to the right of the alert
Document pertinent notes in the ‘Event’ section
Complete following question in Outcomes section:
‘Was the primary INT accepted?’
‘YES’ = clinical action made
‘NO’ = clinical action not taken or physician did not
accept
Select Primary Physician and click ‘Submit’
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Closed (One-Time) Intervention Workflow
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Types of Documentation
Open (Monitoring) Intervention (‘Submit, Continue F/U’)
May be used to document clinical action or potential action that needs further monitoring or follow-up
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Sentri7® Examples Open (Monitoring) Interventions
Warfarin Patients – Patient has active warfarin therapy and requires dosing and monitoring daily; document an intervention and ‘Submit, Continue F/U’ then update due date when next clinical review is necessary
Vancomycin Monitoring – Patient has active gentamicin therapy and requires dosing, laboratory, and culture monitoring. Document an intervention and ‘Submit, Continue F/U’
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Open (Monitoring) Intervention Workflow
Click INT link to the right of the
alert
Document pertinent
notes in the ‘Event’ section
Enter pertinent notes in
‘Follow Up’ section
Update due date when next clinical
review is necessary
Click ‘Submit, Continue
F/U’
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Open (Monitoring) Intervention Workflow
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Open & Closed Intervention Flow
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Surveillance Workflow: Dashboard Approach
Initiative-centric
Streamline Dashboard surveillance with new design features
No limit to # of rules per tab
Hide rules with 0 patients
Tab count
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Dashboard Approach: More than 10 rules per tab
No longer limited to 10 rules per tab
Allows you to consolidate similar rules under a single tab, thus reducing dashboard clutter and size
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Dashboard Approach: Hide rules with zero patient qualifications
With this feature engaged, rules with 0 patient hits can be hidden from view
Feature respects the service area filter
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Dashboard Approach: Tab Count
Feature enables you to easily see how many unreviewed patients exist on each tab, adding efficiency to Dashboard surveillance
Count appears in parenthesis next to each tab name, and count reflects Service Area Filter
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Dashboard Approach
Sentri7® Recommended Surveillance Workflow Demonstration:
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Surveillance Workflow: Patient Approach
Patient-Centric
Streamline Patient tab surveillance with prioritization features
Service Area Filter
Rule Priority
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Patient Approach: Service Area Filter
Engage Service Area Filter for your assigned units to display patients matching rules in your rounding area(s)
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Patient Approach: Rule Priority
Sort patient list by priority to display highest priority patients at top by clicking twice on Rule Matches column header
Sentri7 will display number and identify rules for each priority (high, medium, or low) in Rule Match column
Hover over rule match column to view rules
Rules that were already reviewed will be grayed out
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Modify rule priority on Rules tab and engage real time email/text notifications for high priority alerts
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Patient Approach
Sentri7® Recommended Surveillance Workflow Demonstration:
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INTRODUCING THE RULE PERFORMANCE REPORT
Aligning Sentri7 Setup and Workflow to Improve Clinical Outcomes
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Rule Performance Report (New October 2017!)
Report is intended to help measure whether Sentri7 patient alerts are being addressed effectively and in a timely manner, answering questions such as: What percentage of patients on our Antimicrobial Stewardship
rules are being reviewed or intervened on?
How long does it take someone to respond to patient alerts in the ICU?
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Rule Performance Metrics
Rule performance is then calculated as the number of patients who were reviewed and/or intervened on divided by the total number of unique patients who qualified for the rule
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Rule Performance Metrics
Every unique patient to quality on a rule for greater than 10 minutes is evaluated and placed in 1 of 3 buckets:
Unreviewed
Reviewed Only
Intervened On
Multiple reviews/interventions on the same patient are only counted once toward overall performance, even if the patient qualifies for the rule multiple times
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Data Display - Trending Components
Display what proportion of patients are reviewed and intervened on over time
Analyze data by Rule, Dashboard Tab, or Point of Care
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Data Display - Rule Performance Breakdown
By rule, shows raw rule performance metrics (patient alerts, # of patients reviewed, etc.) over time
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Data Display – Response Time by Priority
Displays how long, on average, it takes someone to respond to a patient alert
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How can I get this report?
Will be emailed every 5th of the month to all Sentri7 Pharmacy Administrators with email addresses in Sentri7 user profile
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Generating your Sentri7®
Antibiogram through Data Matching
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Sentri7® Antibiogram
Developed under the CLSI guidelines
Customizable to indicate non-formulary medications, restricted antimicrobials, and relative cost of antibiotics
Rolling 12-month, real-time
Filter by specimen and location
View year-over-year trending with the 5-year susceptibility graph
Match local terms to standards for consistency
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What is data matching?
Process of standardizing your local microbiology data (left) to consistent and industry terminology (right)
Local Facility Data can be matched to a standard value from the Matched Data dropdown or set to “DO NOT MATCH” – Sentri7® excludes these values from the antibiogram
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Why is data matching important?
Your microbiology data is unique
Matching to a standard format is critical and required to accurately use antibiogram
Must be completed before use of antibiogram and will periodically require updated matching
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What data matching is required?
Organism Names
Susceptibility Results
Susceptibility Tests
Culture Test Name
Point of Care (Location)
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Organisms
Match your local system organism names to a standard list of pathogens
Any organisms found in “Not Matched” or “Do Not Match” will be excluded from antibiogram
Tip: Match gram negative rods to “Do Not Match,” as these were likely preliminary results without susceptibility testing
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Susceptibility Tests
Match agents used by local microbiology to test the sensitivity of an organism to standard CDC-recognized antibiotics
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Susceptibility Result
Must be matched to one of the standard interpretations (S, S-DD, I, R, NS, N) so the susceptibility percentage can be calculated properly
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Additional guidance on Data Matching for your Sentri7® Antibiogram:
Sentri7® Pharmacy Enhanced Antibiogram Flash Tutorial (15:00) https://asp.pharmacyonesource.com/help/Sentri7/
tutorials/Demo/Antibiogram_2016_Q1/Antibiogram_2016_Q1.htm
Sentri7® Pharmacy Antibiogram FAQ https://asp.pharmacyonesource.com/help/Sentri7/
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Antimicrobial Stewardship
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Antibiogram
Advantages over Facility-generated antibiogram:
Gives the most current version of susceptibility trends at the facility Lab-driven antibiograms often only updated annually
Can manipulate dates to see trends in susceptibility
Sentri7 antibiogram defaults to only show bacteria with > 30 isolates (WHO recommendation)
Sentri7 shows separate susceptibility info for MRSA & MSSA
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Antibiogram: Facility-generated
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Antibiogram- Sentri7
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Antibiogram- Sentri7
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Antimicrobial Stewardship
48 hour assessment of all antibiotics
Assessment of appropriateness for all pts. on anti-pseudomonal antibiotics & antibiotics for MRSA
Bug/Drug mismatch
Narrowing of antibiotic spectrum
Inappropriate antibiotic duplication
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Regulatory Compliance
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Regulatory Compliance CDC, Joint Commission: Antimicrobial
Stewardship
Rule showing all antibiotics active for 48-72 hours (CDC recommendation)
Rule to aid assessing appropriateness of tx. For all patients on anti-pseudomonal tx. and all pts. On anti-MRSA tx.
Antibiogram providing pharmacist w/ most current susceptibilities
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Regulatory Compliance Joint Commission National Patient Safety
Goals
“Take extra care with patients on anticoagulants” Anticoagulant rules showing lab trends on all
anticoag pts.
Duplicate anticoagulant rule
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Regulatory Compliance Joint Commission- Clarify priority of use
Pts. on multiple PRN Anti-emetics
Multiple PRN Antipyretics
Multiple PRN pain meds
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Priority of Use Rule:
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Sentri7 Workflow Rules
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Workflow
Cart fill
Advantages to using Sentri7 for cart fill: No need to edit orders to change floor stock
status
Advanced Review option lets you determine when that pt./drug will show up again (e.g. never, in 5 days, 3 days, etc.)
Can customize to make dose-specific E.g. Levetiracetam IV doses > 500 mg
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Cart Fill: Dose-specific
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Workflow
Cart fill
Advantages to using Sentri7 for cart fill: No need to edit orders to change floor stock
status
Advanced Review option lets you determine when that pt./drug will show up again (e.g. never, in 5 days, 3 days, etc.)
Can customize to make dose-specific E.g. Levetiracetam IV doses > 500 mg
Can also make Pyxis-specific or unit-specific
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Cart Fill: Unit-specific
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Workflow
Patient Own Medications
Displays all patients who have a “Patient Own Medication” profiled
Using the review function allows all users to see when a Pt. Own Med has been verified
Allows Pharmacy to profile a patient’s home med before it has been brought to the hospital to clear up work queue
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Patient Own Medications
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Workflow Allergy Check
What it is: Prompt to check the allergies of all new admits
to ensure no free text medication allergies on the profile
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Allergy Check
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Workflow Allergy Check
What it is: Prompt to check the allergy screen of all new
admits to ensure no free text medication allergies on the profile
Why it’s important: HMS will not screen medications for allergies
that are entered as free text medication allergies
From the pt. profile screen, it’s impossible to determine if HMS recognizes the allergy or not
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Allergy Check
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Allergy Check, cont.
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Workflow Interdisciplinary Rounds Lab Display
Creates a simple, consolidated place to view most common labs & trends for patients in one location
Can be tailored to be unit-specific for hospitals with unit-specific pharmacists
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Workflow Interdisciplinary Rounds Lab Display
Creates a simple, consolidated place to view most common labs & trends for patients in one location
Can be tailored to be unit-specific for hospitals with unit-specific pharmacists
Can also add a Microbiology link to easily access patient’s culture history
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Workflow
Pharmacy to dose orders
Order clarifications
Therapeutic interchange documentation
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Sentri7 Workflow Notifications
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Sentri7 Notifications
You can be notified two ways:
1. Text message
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Text Notifications
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Sentri7 Notifications
You can be notified two ways:
1. Text message
2. E-mail
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E-mail Notifications
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Sentri7 Notifications
You can be notified two ways:
1. Text message
2. E-mail
Benefits:
No PHI displayed in notifications; can use cell phone or personal e-mail for notifications
Notifications sent as soon as MD/RN enters the order (i.e. as soon as it shows up to verify)
Allows you to create safety checks that you don’t have to actively view a report to use
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Sentri7 Notifications
Possible uses for notifications
Lab/micro results:
Vancomycin & Aminoglycoside levels resulted
INR resulted
Finalized culture & sensitivity reports
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Sentri7 Notifications
Possible uses for notifications
Drug-specific notifications:
Call back drug notification
Respiratory Therapy notification of new nebulizer pts.
Pharmacy to dose notifications
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Sentri7 Notifications
Possible uses for notifications
“Background” safety checks: GI bleed pts. w/ GI irritating drugs or anticoagulants
ordered
Contact precaution pts. prescribed common canister MDI
C. difficile-positive pts. prescribed antidiarrheal
Double check that pts. aren’t prescribed drugs they’re allergic to
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Sentri7 Notifications
Possible uses for notifications Double check that pts. aren’t prescribed drugs they’re
allergic to
HMS does not prioritize allergies when displaying warnings on a given order Especially in post-op pts. this can result in seeing anywhere
from 2-6 pages of duplicate therapy warnings prior to even seeing the allergy warning
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Allergy Screening Notification
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Allergy Screening Notification
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Allergy Screening Notification
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Regimen Optimization
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Regimen Optimization Reports
Drug-Food Interactions
Levothyroxine given before any food/med
PO Quinolones before/after food d/t calcium
Rivaroxabann doses > 15 mg given w/ meal
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Regimen Optimization Reports
Drug-Drug Interactions
PO Quinolones w/ Calcium/Mg/Fe/Al
Drug-specific Frequency/Timing
Diuretics
Stimulants
DM Meds/short-acting insulins before meals
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Regimen Optimization Reports
Identify meds that should be added to a patient’s regimen
ICU pts. Needing stress ulcer prophylaxis
DM pts. not on Aspirin, ACE-Inhibitor/ARB, or Statin
Sliding Scale Insulin Pts. w/o D50W profile
Eliquis & Prednisone Taper pts.
Can use for drug interactions/duplicate therapy screenings to decrease alerts in HMS & reduce alert fatigue
E.g. multiple potassium-increasing therapies
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