Actually, I like the new way. As far as the NDC number not showing up if the drug is in the dictionary, the suspense file is the same way. As far as the 11th character, I assumed that everyone in pharmacy knows that the 11 digit NDC number goes in a 5-4-2 format. That is more an issue with the drug companies abbreviating the NDC than it is with MediTech or the FSV. I don't mind entering the price because the main thing that I am looking at is the whole system for adding a medication is easier to teach my back-up people. I have been trying to teach them to do the suspense file thing for almost a year now, and they just can't remember all of the steps because of how intimidating it seems, but the new way, you don't have to go into multiple menus, you are in the drug menu and you are just converting the way the drug shows up as opposed to pulling it from a file and then editing it. It is a conversion and edit from the same screen which and my people can conceptually see that as opposed to the whole suspense file thing. If it does that plus the RXM enhancements with medication reconciliation historical meds that I can take advantage of on my reports, then I don't view it as a bug at all.
Robert B. Scranton RPh Pharmacy Information Specialist Adena Regional Medical Center Chillicothe, OH 43154 (740)779-7898 [EMAIL PROTECTED] Confidentiality Notice: The information contained in this electronic transmission is confidential and may be legally privileged. It is intended only for the addressee(s) named above. If you are not an intended recipient, be aware that any disclosure, copying, distribution or use of the information contained in this transmission is prohibited and may be unlawful. If you have received this transmission in error, please notify us by telephone or by email by replying to this email. After replying, please erase it from your computer system. -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Sent: Thursday, July 05, 2007 7:57 PM To: Scranton, Robert Cc: [email protected]; [EMAIL PROTECTED] Subject: Re: [MEDITECH-L] MIX Request PHA - ISMP NOTICE LARGE DOSE AT TOP MIX They told me this too. But here is the problem. There is now no more suspense file. In the drug dictionary, you put in RTN\ and an NDC number to look up a drug. But if you want to pull the drug in your hand into your pharmacy dictionary, you get a list by NDC, generic ID and Meditech mnemonic - NO AWP, price or anything. And if you have the drug in your hand with the 10 digit NDC and you don't know where that 11th place-holder 0 goes to put it into Meditech to look up, you might as well just hit random keys. Also, with the suspense file the way it used to be - if the drug was already in your PHA dictionary, the drug was marked to the right with a YES, in 5.6, if you put in the NDC of a drug that is already in your dictionary after RTN\ and you don't know it's already in your dictionary, it doesn't come up and you may never know why. If you enter RT\ and then enter a name and hit lookup - you get the generic name, the meditech mnemonic (which is useless) and the trade name but no NDC so you have no way of matching the drug in your hand with the one on the screen except to keep pulling drugs up one by one. Also there are no AWPs listed to check or anything. This was supposedly done so that you could pull a drug for retail use only into the dictionary if the drug was needed just for RXM. The better solution would have been to leave the suspense file. Allow RXM access to the same suspense file but disallow certain field from filling into RXM. That way someone working in the RXM dictionary could see if a drug was in the PHA dictionary right there, because there would be a YES. I am hoping this is a big bug. But I am afraid not. It is the biggest mess I have seen. Once again, Meditech put a patch on something in pharmacy to make do for another module without asking or consulting with the pharmacists or the people who know what they are doing. This e-mail message, including its attachments, is for the sole use of the intended recipient(s) and may contain confidential or privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message. "Scranton, Robert" <[EMAIL PROTECTED]> Sent by: [EMAIL PROTECTED] To <[email protected]> 07/05/2007 02:07 PM cc Subject Re: [MEDITECH-L] MIX Request PHA - ISMP NOTICE LARGE DOSE AT TOP MIX I found out from my Pharmacy person at Meditech that on 5.6, you can enter RTN\12345678901 Where 12345678901 is the NDC number. This allows you to pull up the actual NDC of the drug you want to make formulary. I could not find this in any of the 5.6 documentation, but it works. I found out that sometimes it does pay off when I ask trivial questions because I find it easier to add drugs by NDC number instead of name. Robert B. Scranton RPh Pharmacy Information Specialist Adena Regional Medical Center Chillicothe, OH 43154 (740)779-7898 [EMAIL PROTECTED] Confidentiality Notice: The information contained in this electronic transmission is confidential and may be legally privileged. It is intended only for the addressee(s) named above. If you are not an intended recipient, be aware that any disclosure, copying, distribution or use of the information contained in this transmission is prohibited and may be unlawful. If you have received this transmission in error, please notify us by telephone or by email by replying to this email. After replying, please erase it from your computer system. -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Makara, Susan Sent: Thursday, July 05, 2007 3:37 PM To: [EMAIL PROTECTED]; Charlie Downs Cc: Howes, Lori; [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. This e-mail message, including its attachments, is for the sole use of the intended recipient(s) and may contain confidential or privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message. "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 Confidentiality Notice: This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message. ***** CONFIDENTIALITY NOTICE ***** This message contains confidential information and is intended only for the individual named. If you are not the named addressee you should not disseminate, distribute or copy this e-mail. 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