I had a chance this morning to look at how the Albany VA handles this question. If you select Simvastatin, 40mg., the text dispensing instructions automatically say "Simvastatin, 80mg., one half tablet daily." Select Simvastatin, 20mg., and you get "Simvastatin, 40mg., one half tablet daily." There is a note which says, "If patient is unable to use tablet cutter, indicate under comments." You are also supposed to write for a tablet cutter as well.
Mike Kevin Toppenberg wrote: > One of the doctors in our group used VistA while in residency at the > VA, and he has expressed his dislike of CPRS drug prescribing. He > described having to "stand on one's head" to prescribe drugs the way > one wants to. I didn't understand what he was talking to until now. > > I am finding that one can only dispense tablets in quantities that are > in the database, and this is a big hassle. > > For example, for cost savings, I have at times had patients take Zocor > 80 mg tablet, 1/4 daily. To allow this for flexibility and for other > possible doses, the Zocor entry in file# 50 would have to this: > > 903-POSSIBLE DOSAGES : > Multiple Entry #1 > .01-DISPENSE UNITS PER DOSE : 0.25 > 1-DOSE : 20 > Multiple Entry #2 > .01-DISPENSE UNITS PER DOSE : .5 > 1-DOSE : 40 > Multiple Entry #3 > .01-DISPENSE UNITS PER DOSE : 1 > 1-DOSE : 80 > > With a Zocor 80, it wouldn't be approprite to give 2 pills, but with > some drugs it would be appropriate, or perhaps even more (i.e. > ibuprofen 200 mg * 4 tablets) > > So my plan has been to put the FDA drug data into VistA and let the > doctor use his medical training to write out the correct prescription, > to be submitted to an outpatient pharmacist for dispensing. It looks > like to do this I need to add the following possible dosing allowances > for EACH drug: > 0.25, 0.5, 1, 2, 3, 4 > Of course this is just for pills. What about creams, IV solutions? > The FDA database does not contain any information about typical > dosing, maximum daily dose, toxicity etc > > In summary, the VistA system seems designed to allow a pharmacist to > put in the appropriate dosing for a particular drug, and it is > difficult for a physcian to be more creative with dosing that was not > anticipated. But this approach makes the system nearly impossible to > completely fill with ALL possible medications due to the huge amount > of time this would take to put in each drug individually. I would > stongly suspect that this is why no one already has a complete > formulary. > > In CPRS there is a "complex dosing" tab. I wish there was a > multiplier column. This would allow a doctor to write: > Zocor 80 mg * [0.25] PO QHS. > > I just realized another limitation is the allowed frequencies. There > are the usualy Q1h, Q2h, even QOD, etc. But there is no allowance for > 1x/month, 1x/week, 2x/wk, 4x/wk etc. > It looks like there are some free text fields that allow me to get > around some of this. But it does feel strongly like "standing on > one's head" to get the job done. And it looses the quantitated data > in fields that allow future data manipulation. > > Hmmm... I'll have to think about this.. > > Kevin > > Using Tomcat but need to do more? Need to support web services, security? > Get stuff done quickly with pre-integrated technology to make your job easier > Download IBM WebSphere Application Server v.1.0.1 based on Apache Geronimo > http://sel.as-us.falkag.net/sel?cmd=lnk&kid=120709&bid=263057&dat=121642 > _______________________________________________ > Hardhats-members mailing list > Hardhats-members@lists.sourceforge.net > https://lists.sourceforge.net/lists/listinfo/hardhats-members > ------------------------------------------------------------------------- Take Surveys. Earn Cash. Influence the Future of IT Join SourceForge.net's Techsay panel and you'll get the chance to share your opinions on IT & business topics through brief surveys -- and earn cash http://www.techsay.com/default.php?page=join.php&p=sourceforge&CID=DEVDEV _______________________________________________ Hardhats-members mailing list Hardhats-members@lists.sourceforge.net https://lists.sourceforge.net/lists/listinfo/hardhats-members
