We have EDM/POM med ordering and BMV live. Here are notes I used for
our pharmacists training sessions and 'where we put what', including
Label Comments. Meditech doesn't really give you any guidance in
deciding where to put information. You just need to look at the various
fields from upstream and downstream with the POM and e-MAR products and
try to decide what each field is best suited for in handling order
information.
Dose - we will be trying to eliminate zero-dosing as much as possible.
Items like insulin, MDP oral liquids, compounds where the dose is in mgs
(e.g. spironolactone suspension) will be entered with the numeric value
instead of zero-dosing the order. The MDP order types are now
suppressed from refill lists by the order type, so we no longer have to
use zero-dose to keep scheduled doses from dispensing.
Dose Instructions - still need to use this field for some multi-dose
items because the dose is non-numeric. Examples:
Apply liberally
Sparingly
Thin layer
Remember, only dose goes here...nothing about
site of application
PRN Reason - Currently not required field, but probably heading that
way. This field accepts free text or dictionary entries. We have to
manually build each PRN Reason and attach them to the appropriate drug.
If we don't have anything attached to the drug, ALL PRN Reasons show in
the lookup. This can be too many to look through. Once we attach
something, then it is restricted and easier to identify the appropriate
reasons. Examples:
SBP greater than 180
PRN sleep
Nausea/Vomiting
Constipation
As Laxative of Choice.
Agitation
Muscle Cramps
Itching during dialysis
After each loose stool
Mild (score 2-4) pain
If you have a PRN Reason that is too long to type into this field, then
it belongs in Admin Criteria.
Label Comments - This is now used for pharmacy ancillary
comments/generic drug information or instructions to nursing. Examples:
Note Dose
This drug entered with multiple routes
Shake Well
Refrigerate
Therapy beyond five days not recommended.
Therapeutic Interchange messages
NF drug entries (generic, dose, brand name)
Give 30-60 minutes prior to meal time, unless ordered
otherwise
Extended Release Table - Do Not Crush
HYDROCHLOROTHIAZIDE 25MG/TRIAMTERENE 37.5MG
Prep Instructions - For Pharmacy, Nursing, Respiratory Therapy special
preparation instructions. If there are prep instructions, they will
print out on a separate IV label and can be useful for the IV room.
Examples:
Pharmacy: To prepare D12.5W, withdraw 31.25 ml
of fluid from a 500 ml bag of D10W.
Put 31.25 ml of D50W into the bag. The
total volume will be 500 ml.
Nursing: Add 2.5 ml Sterile water to 250 mg vial
to make 100 mg/ml concentration and
withdraw ordered dose.
Special Instructions - First line used by pharmacy for special tubing
instructions. Otherwise, nursing can use this to communicate between
shifts for special instructions to one another. Examples would be,
patient won't take with cranberry juice. Remember, having something in
the first line will cause a second label to print out that will be
attached to the product to help ensure it gets tubed to a special
location
Admin Criteria - This is where all physician ordering information
belongs. It can be one of three formats (text, table, CDS - customer
defined screen). Text is the most common when you are free text typing
in information. The description field is required, but doesn't show
anywhere (I just type 'ft' for free text). The 'Display' field will
show on the POV if you enter something there, otherwise just type in the
text box. Table structure can be used, but it is probably more for
order set type order such as Heparin Protocol, Sliding Scale Insulins.
CDS's have to be built by PHA/IS. Examples are PCA settings, TPN NPO
Rate. Examples of Admin Criteria
Left eye
Both eyes
x1 dose
After four (4)pm day before surgery.
Apply to both Nares while CPAP ordered.
Discontinue EPO post-operatively when the Hgb reaches
13 g/dl. If there are signs and symptoms of
bleeding, EPO
should be continued until bleeding is ruled out.
Jeff Lee
Assistant Director of Pharmacy, Support Services
DCH Regional Medical Center
809 University Blvd E.
Tuscaloosa, AL 35401
(205) 750-5323
[EMAIL PROTECTED]
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________________________________
From: [email protected] [mailto:[EMAIL PROTECTED] On Behalf
Of Lanoue, Ed T
Sent: Wednesday, March 21, 2007 8:32 AM
To: [email protected]
Subject: [MEDITECH-L] Negative Medication Orders: Where to build them in
PHA
Hi All,
Thanks to the L- I now know what a "negative medication order" is.
Do not crush tablets, etc. I had traditionally built them in label
comments but am wondering how other users have set theirs up?
Specifically what are POM users doing?
Thanks a lot!
Ed
Edward Lanoue, RPh
Pharmacy Information Systems
Southwestern Vt Medical Center
100 Hospital Drive East
Bennington, VT 05201
phone: 802-447-5370
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