Difference between revisions of "Pharmacy Issues"

Revision as of 10:59, 29 October 2005

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,*)) holds 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. File 50.7 (PHARMACY ORDERABLE ITEM):

 **A record in this file should be created first.  
 .01 field should be the generic name of the drug.
 When the record is created, an entry in 101.43 (ORDERABLE ITEM) will automatically be made.
 Also, a record in in ORDER QUICK VIEW will also be created (but it is incomplete--see below.)
 Note: new drugs may not be added unless PSEDITNM>0.  So to setup a drug in fileman,
       set PSEDITNM=1 from the command-line, then DO D^DI to get into Fileman with vars intact.
 In the MED ROUTE field, the input transform does not allow an input of "ORAL".  (If left
 blank ORAL will be shown in CPRS)
 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.
 When this record is created, for some reason it is automatically given the current
   date in the INACTIVE DATE field--meaning it is created in an inactive state.  One must
   go back and edit the record a second time to remove the entry from this field.
 

2. In file# 50 (DRUG, ^PSDRUG):

 This file will hold a separate record for every different medication/tablet size.
 For example, there will be one for AMOXICILLIN 250, and another for AMOXICILLIN 500.
 Both of the above records would be linked to one record in the PHARMACY ORDERABLE ITEM,
 i.e. an AMOXICILLIN record.
 To create a link will be in field 2.1 (the PHARMACY ORDERABLE ITEM field), which will
   hold a pointer to file 50.7 (PHARMACY ORDERABLE ITEM file)
 
 (old, confused notes--best ignored)
 There must be an entry coresponding to the ID from 101.43, i.e. The "ASP" 
 cross-reference for the field "PHARMACY ORDERABLE ITEM (#2.1) i.e. ^PSDRUG("ASP",+ID,*)
 should exist.  

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

  This entry should have been made automatically when the PHARMACY ORDERABLE ITEM was
  created.
 
 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)

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

 Again, this entry should have been created automatically when the PHARMACY ORDERABLE ITEM
 was created.  But for some reason, the DISPLAY TEXT field is not filled in.  Without this,
 the drug will not appear in CPRS.  So this must be manually supplied.

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
             DISPLAY TEXT: "A name to appear in CPRS appears here.
     record: SET MEMBER: _IEN_ pointer to 101.43 (ORDERABLE ITEM)   ... a drug would go here
             DISPLAY TEXT: "A name to appear in CPRS appears here.
     record: SET MEMBER: _IEN_ pointer to 101.43 (ORDERABLE ITEM)   ... a drug would go here
             DISPLAY TEXT: "A name to appear in CPRS appears here.
     record: SET MEMBER: _IEN_ pointer to 101.43 (ORDERABLE ITEM)   ... a drug would go here
             DISPLAY TEXT: "A name to appear in CPRS appears here.

Other Important Pharmacy Files and Relationships

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:

... to be continued later.....

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

This has been moved here: Pharmacy Setup Emails

xxx xxxx 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,

xxx xxxx

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.

xxx

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

This was the thread that helped us to get the medications list filled 
in CPRS. Please let us know if it helps. 

Regards
Usha
-Original Message -
From: "Toni Petersen" <toni.petersen@ahsinc.com>
To: <hardhats-members@lists.sourceforge.net>
Sent: Thursday, February 10, 2005 9:39 PM
Subject: RE: [Hardhats-members] pharmacy drugs not visible in CPRS
 

> Refer to the Vista documentation, Pharmacy Data Management (PDM) User
> Manual, Section 1.9, where Orderable Items are discussed. If the
> orderable item (in file 50.7) is created, and matched to the local drug
> file (50), the item will be visible in CPRS to order.
>
> The specific drug file which has to be populated is the local drug file
> (file 50) created through PDM Drug Enter/Edit, not PSA Drug Enter/Edit.
> This file (50) is also a different drug file than the National Drug
> File, as described in the PSN module documentation.  Unfortunately, I do
> not think there is an automated way to populate File 50 with locally
> used drugs.
>
> The reason the "matching" to orderable item, and the "marking" for
> inpatient, outpatient, etc. functions exist in PDM Drug Enter/Edit is
> that it is easier for the physician, (and reduces potential for error
> during item selection), to have a short list of drugs available in CPRS
> to select, rather than a list of 5000 or so. There are differences in
> the drug lists for inpatient and outpatient use, although some items
> will be common to both.
>  
> PSA Drug Enter/Edit involves pharmacy inventory management, and the
> locations created therein refer to locations of the drugs, (for ward
> stock or satellite pharmacy inventory management) not locations of the
> patients.
>
> Also, I believe there is a way to configure CPRS, so that the physician
> does not have to select whether or not he is ordering inpatient, or
> outpatient drugs. If CPRS is configured accordingly, when the patient is
> selected, the patient's location (an inpatient bed, clinic location,
> etc) determines the ordering module (inpatient or outpatient) displayed
> to the physician for order entry.
>
> I hope this helps clarify the matter further.
>
>
> Toni Beare Petersen, R.Ph.
> American Healthcare Solutions, Inc.
> Toni.Petersen@ahsinc.com
> 970.846.8591 (cell)
> www.ahsinc.com

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

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 xxxx

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 xxxx

xxxx,

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. xxx xxxx