Okay - thanks - I have already had them "fix" the lookup. There was apparently
a DTS for this. I have to go back and look. Then I will post it. Maybe the
DTS was actually just setting it back to look the way it did in 5.5. Thank you
for the hint on making our own mnemonics. Now, what about the suspense file?
No suspense file. If you put in RT\and enter the trade name and hit look up,
there is no NDC in the look up to match against the NDC of the drug you have in
your hand. There is also the problem that - at least with Medispan, there will
occasionally be the generic in the trade name field.
Then , if you go to look up the drug by the NDC number and don't know where
that 11th place-holder 0 goes you might as well just throw darts.
The old suspense file was better and much more useful for pharmacy and could
have been made useful for RXM without taking the functionality away from
pharmacy.
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"Makara, Susan" <[EMAIL PROTECTED]>
07/05/2007 12:37 PM
To
<[EMAIL
PROTECTED]>, "Charlie Downs" <[EMAIL PROTECTED]>
cc
"Howes,
Lori" <[EMAIL PROTECTED]>, <[EMAIL PROTECTED]>,
<[email protected]>
Subject
RE:
[MEDITECH-L] MIX Request PHA - ISMP NOTICE LARGE DOSE AT TOP MIX
Cindy: we went live with 5.6 several weeks ago and had many problems
with drug lookups in test once we had done our first formulary load.
We eventually had MT reset them to look identical to 5.4. The C (for
combination of generic equiv., trade, generic) was absolutely useless
until this was done. We also had problems with the exact lookup for
mnemonic working incorrectly in 5.6 as well.
As for the formulary: to copy from the "retail" section and create your
own mnemonics:
Enter the mnemonic for the med you want. When you get to the copy from
drug field you need to enter: RT\Repla and then do lookup (where Repla
is the first few letters of the TRADE name of the med you are looking
for ........ and notice the proper case). Then you can copy the entry
you want to your own mnemonic and then do any further edits you want to
do.
Susan
Susan Makara, B.Sc.(Pharm)
Coordinator Pharmacy Information Systems
Interior Health 2355 Acland Rd., Kelowna, B.C. V1X 7X9
* 250-491-6756 * [EMAIL PROTECTED]
Fax: 250-491-6710
"Information for Live: Excellence in Service, Excellence in Information,
Excellence in Health"
-----Original Message-----
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of
[EMAIL PROTECTED]
Sent: Thursday, July 05, 2007 11:57 AM
To: Charlie Downs
Cc: 'Howes, Lori'; [EMAIL PROTECTED];
[email protected]
Subject: Re: [MEDITECH-L] MIX Request PHA - ISMP NOTICE LARGE DOSE AT
TOP MIX
I think that might be a good idea. I am testing 5.6 and had to have a
DTS added because with the user set to "C" things were sorting very
badly.
Now they are sorting similarly to the way Charlie has described. One
thing I thought that I had figured out is that they sort alphabetically
by mnemonic, because ours were sorting numerically in correct order by
mnemonic as well. However, if you look at Charlie's example, in the
Sinequan sort, DOXE10C is listed before DOXE100C and in the DOXEPIN sort
DOXE100C is listed before the DOXE10C mnemonic - so even that idea isn't
consistent.
We also used to put our own short mnemonics into the generic equivalent
field - i.e. FUR20, DIG25, to help make look ups easier, but those are
slowly being removed because they make the length of the lookup list
longer and the duplication are more confusing to look at.. Our users
seem to be more comfortable just putting in the first 3 or 4 letters of
the trade or generic and hitting [lookup]. Apparently, with one of the
upgrade, the formulary service will no longer allow the user to create
their own mnemonics for the drugs they pull in from the suspense file. I
am afraid this could create problems also, as most of these FSV
mnemonics are worthless. So sorting by strength would be something
worthwhile to look into.
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"Charlie Downs" <[EMAIL PROTECTED]>
Sent by: [EMAIL PROTECTED]
To
"'Howes, Lori'" <[EMAIL PROTECTED]>, <[email protected]>
07/05/2007 04:53 AM
cc
Subject
Re: [MEDITECH-L] MIX Request PHA - ISMP NOTICE LARGE DOSE AT TOP MIX
Lori - With the brand name, using the default of C in the access
dictionary, here is what I get:
1 SINEQUAN 10 MG CAP Doxepin HCl 10 MG CAP
DOXE10C
2 SINEQUAN 100 MG CAP Doxepin HCl 100 MG CAP
DOXE100C
3 SINEQUAN 25 MG CAP Doxepin HCl 25 MG CAP
DOXE25C
4 SINEQUAN 50 MG CAP Doxepin HCl 50 MG CAP
DOXE50C
5 SINEQUAN 75 MG CAP Doxepin HCl 75 MG CAP
DOXE75C
6 SINEQUAN ORAL CONC 1 ML Doxepin HCl 10 MG/ML ML
DOXEL120
Entering the generic name - I get this:
1 DOXEPIN HCL Doxepin HCl 100 MG CAP
DOXE100C
2 DOXEPIN HCL Doxepin HCl 10 MG CAP
DOXE10C
3 DOXEPIN HCL Doxepin HCl 25 MG CAP
DOXE25C
4 DOXEPIN HCL Doxepin HCl 50 MG CAP
DOXE50C
5 DOXEPIN HCL Doxepin HCl 75 MG CAP
DOXE75C
6 DOXEPIN HCL Doxepin HCl 10 MG/ML ML
DOXEL120
So, it doesn't even seem to be consistent as to which is first between a
brand name look-up and a generic name look-up. But I do agree that this
is a safety issue and makes sense. Furthermore, if Meditech and the
formulary service vendors could get their dose range checking working
correctly, it would be less of an issue. I've built a lot of my own dose
ranges because the ones with FDB give too many worthless alerts. I
believe that the bigger issue here is that a dose range check would have
caught this.
Charlie
Charles Downs PharmD
Washington County Hospital
251 E. Antietam Street
Hagerstown, MD, 21740
301-790-8904
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of Howes, Lori
Sent: Tuesday, July 03, 2007 4:20 PM
To: [email protected]
Subject: [MEDITECH-L] MIX Request PHA - ISMP NOTICE LARGE DOSE AT TOP
MIX
Hello,
Our Pharmacy department has created a MIX request, and is hoping to get
other Meditech PHA users to join us to convince Meditech that this is
something we need them to look at. Here is our request;
Brief Description/Synopsis of Request
When selecting a Drug, we would like the lowest strength to be the first
selection.
How are you currently handling this now?
We have no workaround.
What problem will be resolved?
Our system has the potential to contribute to a similar error like the
one below that happened at another hospital; In an outpatient pharmacy
located in a hospital, a prescription for SINEQUAN (doxepin) 100 mg was
entered into the computer and dispensed instead of the correct strength
of 10 mg. Neither the technician who pulled the 100 mg strength from the
shelf nor the verifying pharmacist caught the error. The patient took
500 mg of doxepin daily for one month before the error was corrected.
The error was discovered when the prescription was transferred to
another pharmacy and the receiving pharmacist expressed concern about
the high dosage. Since the error, the patient has been experiencing
residual drowsiness and fatigue. The physician is now slowly decreasing
the dosage. The pharmacy software system may have played a role in the
error. Upon entering Sinequan on the product line, the list of
matching results placed Sinequan 100 mg on the first line followed by
Sinequan 10 mg. It is believed that the sequential listing of both
strengths, with a ten-fold difference, contributed to the selection of
the wrong strength, as did the listing of the higher strength first.
Proposed Solution
Describe in detail how you think the system could be changed,
considering Dictionaries Parameters, Input and Output Screens, and
Reports.
When selecting a Drug, we would like the lowest strength to be the
first selection.
System Impact
Describe why this enhancement is important.
How does it improve the MEDITECH system?
What impact will it have on users?
It will lessen the impact of user error.
Although neither is acceptable, user error is inevitable and the thought
process is that underdosing is less dangerous than overdosing.
Lori Howes
Business Systems Analyst - Clinical Support Niagara Health System -
Cecil G Shaver Data Centre
541 Glenridge Avenue
St. Catharines, ON
L2T 4C2
905-378-4647 X44857
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