Hi - Had to take out most of the defaults in our LARGE VOLUME IV order 
sets for this same reason. If you build a 1 liter IV order set with some 
additives
and have a default rate in the order set of 125 ml/hr (which fills in with 
a default time of 8 hrs), when a user enters the order set,  and changes 
the rate according to an order that says "run at 100 ml/hr), The total 
VOLUME of the IV gets changed to  800 mls. If the rate is 150 ml/hr, the 
TOTAL VOLUME gets changed to 1200 ml.
I gave up trying to talk to Meditech about this.  I think part of the 
problem may be that the programmers do not have a clear understanding of 
what happens in an IV room or how these items are dispensed. 
EXAMPLE:
Piggybacks - one type of IV are usually order by the SIG and not by the 
rate, so the programming works okay on those.
With LARGE volumes, You have to deal with standard bag sizes of 500 ml or 
1000 ml and the put  your additves in. This will increase the volume.
You build an order set to accommodate standard Items like D5%.45NS  1liter 
 with 40 MeQ of Kcl and 1 gm of Calcium gluconate. This gives you a slight 
volume increase to 1020 ml or something, but you still have this standard 
basic size bag and when you build the ORDER SET, for convenience you might 
default in a standard rate of 125 ml/hr which produces and 8 hrs time 
period.
It used to be (before Meditech fixed the " bug"), you could pull up that 
order set, and if the order was for  d5.45NS with 40 KCL and 1 gm CA and 
10 cc of MVI at 100 ml/hr, you added the MVI to the order set and changed 
the rate to 100 ml/hr.  Then the DURATION of the bag would change to
10 hrs. THE volume of the bag would reflect the extra 10 ml of MVI - not a 
big deal in terms of the rate.
We would NOT change the VOLUME to 800 ml to match the 8 hr rate because 
the bags come as 1000 ml. 
I know there are several places that have expressed issues with this and I 
was under the impression that it would be fixed in 5.6.   THE "fix" that 
was done in 5.4 or 5.5  was what actually caused this problem.






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"Goldmacher, Brian" <[EMAIL PROTECTED]> 
Sent by: [email protected]
05/08/2007 01:46 AM

To
<[email protected]>
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Subject
[MEDITECH-L] RE: Pharmacy 5.6 IV order types






Susan,
I am continuing to try to impress the same point to Meditech in regards to 
IV order types.  I have had the task open for almost a year, and Meditech 
is steadfast that their logic is appropriate.   I can't think of any 
reason to have the volume change. Here is how the rate and duration fields 
work.  The documentation in the order type dictionary is no longer 
correct.  If the pharmacist enters a rate, THAT field is considered "more 
important" than the duration or the volume because the pharmacist manually 
entered data into the rate field.  So after the volume is calculated, if 
the user changes the duration, the rate won't change because that is 
"important".  This also works the other way.  If the pharmacists manually 
enters 8 hrs as the duration, the duration field is more "important" and 
an edit to the rate will change the volume.  This becomes especially 
confusing during a copy and edit because the pharmacist entering the new 
order does not know which field was manually ente!
 red on the original order. 
I proposed to Meditech, at the very minimum, there should be an asterisk 
or something that indicates which field was manually entered.  Then the 
pharmacists could be trained to change only that field. 

Brian Goldmacher
Pharmacy Information Systems Coordinator
Doylestown Hospital
215-345-2200 X4323

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