Okay - I hope that this will help - although we have Medispan - not FDB. Also,
we are not using the new allergy update yet as we are just getting it in
TEST.
I think that in these cases, the user is doing a look-up by brand or Trade
name. It appears that only drugs which are combinations of drugs
have the "strength" listed and this is most likely because there are difference
"combinations" available and the "strength" is probably part of the
Brand/Trade name. I suspect that this would happen for Septra DS/Septra SS,
Percocet, Vicodin Es, Lortab 7.5 etc. The actual database flaw here, appears to
be that
Darvocet N-100 was not listed as a separate drug in the RXM drug database. - Or
the drug was pulled in from the FSV data base and the Darvost N-50
was built with the n-50 in the trade, but the Darvocet-N only had the strength
in the strength field and not in the trade name field. In this case Darvocet
N-100 and Darvocet N-50 are both trade names although they could both be listed
as Darvocet-N, which is a separate entity from Darvocet. .
If you were looking up by generic you would find propoxyphene-n W/apap , or
however the generic was worded in the RXM dictionary.
Propoxyphene
Ingredient
Propoxyphene Hcl
Generic
Propoxyphene Hcl W/ Apap Generic
Propoxyphene-N W/APAP Generic
(If your dictionary was loaded using your entire FSV formulary, you would have
far more entries to choose from)
Since we loaded our RXM drug dictionary using entries from pharmacy and editing
them and then adding more drugs as we needed them,
our "look-up" for allergies is probably somewhat different than some others.
In our PHA drug dictionary - many of the drugs had strengths built into the
generic because that used to be the only place we could put a percent sign and
have the drugs work for dispensing the correct size of tube for outpatient
prescriptions..
(We would have to put the size of the tube in grams in the PHARMACY DRUG
strength fields). Once that drug is pulled over to RXM, you can edit the BRAND
name
and the Generic text and change the strength field to equal 1%. But the
mnemonic of the generic will still refer back to the original text from
pharmacy,
so if you are looking up allergies by generic you may see a generic listing
from RXM which is linked to a generic menmonic, and another generic listing
linked to the same mnemonic, but which is coming over from pharmacy.
This is how I originally brought the drugs from PHA into the RXM dictionary.
However, if you place the 20,60, 80 gm for the size of the tube into the
strength field, then you will have lookups that have the SIZE of the tube
incorporated so that they would look like:
hydrocortisone ointment Hydrocortisone 30 gm
hydrocortisone ointment Hydrocortisone 60 gm
hydrocortisone ointment Hydrocortisone 80 gm AND
you would not be able to differentiate between strengths.
and if you were to then incorporate the strength into the trade or generic
field you would then get something like this:
hydrocortisone ointment 1% Hydrocortisone 30 gm
hydrocortisone ointment 1% Hydrocortisone 60 gm
hydrocortisone ointment 1% Hydrocortisone 80 gm
hydrocortisone ointment 2% Hydrocortisone 30 gm
hydrocortisone ointment 2% Hydrocortisone 60 gm
hydrocortisone ointment 2% Hydrocortisone 80 gm
So by having the % in the strength field instead of the size of the tube, the
look up is shorter:
hydrocortisone ointment Hydrocortisone 1%
generic
hydrocortisone ointment Hydrocortisone 2%
generic
But you can't tell what size tube you are dispensing and can only enter 30 gm,
60 gm , 80 gms into the dispense quantity strings. This leaves the MD no way
to order 2 tubes of 80 gms or 3 tubes of 60 gms.But in RXM you can replace the
size (30 gms) with the strength (1%)
but that will only leave you the option of building your strings as 30 gm or 60
gm dispense quantities. There is no way for an MD to order 2 tubes of
30 gms unless you build separate drug entries for each size of tube (i.e. 30
gms, 60 gms, 80 gms) and dispense forms as tubes.
(This is a flaw in the RXM prescription ordering/dictionary system - not a
dictionary building problem).
So for the purpose of entering/ordering drugs for prescriptions and allergies,
the final solution was the best.
This pulls the generic plus the strength, or, if you are looking up by
brand/trade name, whatever is in the BRAND/TRADE name. It is unfortunate that
entering allergies into Meditech seems to require a degree in pharmacological
chemistry to know what is important and what is not.
We ask that our ER nurses do the best they can and pharmacy is to update all
allergies and check the entries each time a patient is admitted.
I was hoping the MIS allergy dictionary would alleviate some of these problems.
Good luck, Cindy
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"Muhlbauer, Carol" <[EMAIL PROTECTED]>
Sent by: [email protected]
To
"Charlie Downs" <[EMAIL PROTECTED]>, "Thompson, Jeff" <[EMAIL PROTECTED]>,
04/06/2007 04:42 PM
<[email protected]>
cc
Subject
RE:
[MEDITECH-L] Fw: Allergens
I am working with our nursing staff now, the feedback I am getting is they do
not want the strength. If the patient doesn't know the strength they were
taking, nursing is hesitant to pick one of the entries.
I have created an "Unidentified" allergen for them to place these
"questionable" entries in. Then the Pharmacist codes them appropriately.
Carol
Carolyn Muhlbauer
Assist. Director Applications, Development and Support
Doylestown Hospital
595 W. State St.
Doylestown, PA 18901
215-345-2408
-----Original Message-----
From: [email protected] [mailto:[EMAIL PROTECTED] Behalf Of
Charlie Downs
Sent: Thursday, April 05, 2007 7:44 AM
To: Thompson, Jeff; [email protected]
Subject: Re: [MEDITECH-L] Fw: Allergens
Jeff- I checked with Melinda and somehow it was left off of the tape.
However, if we are talking strengths, why don't they list the different
strengths for things like Lanoxin, Zestril, Lipitor, etc. I don't see where
Darvocet-N is any different from these. I've never had a patient give a
strength when giving me an allergy, so if they don't give a strength, then
it is up to us to arbitrarily pick a strength, which may be incorrect. If
they were being consistent, then they would display strengths for
everything.
Charlie
Charles Downs Pharm.D.
Washington County Hospital
Inpatient Pharmacy
251 E. Antietam Street
Hagerstown, MD, 21740
301-790-8904
----- Original Message -----
From: "Thompson, Jeff" <[EMAIL PROTECTED]>
To: "Charlie Downs" <[EMAIL PROTECTED]>; <[email protected]>
Sent: Monday, April 02, 2007 9:37 AM
Subject: RE: [MEDITECH-L] Fw: Allergens
Hi, Charlie. Respectfully, I'm going to disagree. I think the lookup
is the Brand name of the drug. This makes it easier for non-pharmacy
users to be more exact. I've noticed that if the strength is included in
the Brand name it seems to be there. I do realize that not having DCN
100 doesn't fit this so it should be added to be consistent.
Jeff Thompson, R.Ph.
Pharmacy Informatics
Newman Regional Health
Emporia, KS 66801
Direct: 620-340-6150
-----Original Message-----
From: [email protected] [mailto:[EMAIL PROTECTED] On Behalf
Of Charlie Downs
Sent: Wednesday, March 28, 2007 10:34 AM
To: [email protected]
Subject: [MEDITECH-L] Fw: Allergens
Below is a message that I sent to Melinda Carson at FDB regarding the
way the allergens pick list from FDB looks. I wanted to know if people
agree with what I am asking them to do?
Thanks,
Charlie
> Melinda - Last night I was staffing and noticed that when I entered an
> allergy for Darvocet, I got the following choices:
> Darvocet-N 50 Multiple
> Darvon Multiple
> Darvon Compound 32 Multiple
> Darvon Compound-65 Multiple
> Darvon-N Multiple
>
> Darvocet-N 100 wasn't even listed, so shouldn't it be? The other
> option is to just not put a strength and just have Darvocet-N. The
> same for Darvon Compound - why not get rid of the strength. I've never
> seen a strength listed for a med when it is listed as an allergy.
>
> Also, Vicodin and Lortabs are listed kind of the same way
> 1 Vicodin Multiple
> 2 Vicodin ES Multiple
>
> 1 Lortab Multiple
> 2 Lortab 10/500 Multiple
> 3 Lortab 7.5 Multiple
> 4 Lortab Elixir Multiple
>
> Something like Zocor isn't listed separately for each strength, so
> neither should any drug - it makes no sense. Granted if we are looking
> at excipient allergies, it may be an issue, but like I said, I've
> never seen a strength written on an allergy in my entire life.
> Thanks,
> Charlie
>
> Charles Downs Pharm.D.
> Washington County Hospital
> Inpatient Pharmacy
> 251 E. Antietam Street
> Hagerstown, MD, 21740
> 301-790-8904
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