Managing Pharmacy Drug Managing Pharmacy Drug DataData
Optimizing Pharmacy Data Management
Mary Ann Niesen, Pharm.D.
Adding a new drug
Follow standardized format:Generic name, strength, form
Albuterol 90mcg/spray MDI
Clopidogrel 75mg Tab
Be sure to fill out key fields:DEA code, order unit, dispense unit, dispense
units/order unit, NDC, etc.
National Drug File
Match through the drug entry screenIf unable to match, manually assign a VA Drug
class code.
This is required for correct functioning of doses, allergy checks, CRS taxonomies, etc.
May need matches verified and merged if the user does not have correct keys.
Dosages/Local dosages
Review or add dosages/local dosagesDosages = tied to National Drug File
Entry of mg strength is translated to number of tablets on label
Can add or delete these as needed
Local Dosages = entered locallyLiteral text will be displayed on label
Can have both but will not work well with EHR
Misc. Fields by Type of use
Mark drug as appropriate:Inpt, outpt, controlled, unit dose, non-VA, etc.Quantity disp. message will display in EHR
when dose is chosen (and in Pharmacy package back-end processing) so provider knows what size tube/bottle/package to prescribe.
Drug can be tied to a lab test (not a panel!) for checking during data entry (Simvastatin and AST).
Orderable itemsThese are the “basic” building blocks for all
orders, not just pharmacy.
For Pharmacy, these should be drug and form WITHOUT strength.Exception—insulin needs type included
(“regular insulin”, not “insulin”)
Choose form carefully!
Can set some defaults—route, schedule, text, etc.
Update an existing drugUpdate fields as needed, instead of entering
new drug
Inactivate drugs no longer in useNEVER delete a drug!
Re-activate if needed
Make sure NDC and bottle size match
Re-match to National Drug File if needed (but will need to re-do dosages changes)
Nouns and verbs
Nouns and verbs relate the dosage form and the dose to the instructions printed on the label:In Take 1 tablet every 6 hours “take” is the verb
and “tablet” is the noun
In Shake well and give 5 ml 3 times a day “shake well and give” is the verb and “ml” is the noun
Routes
Routes are tied to dosage forms and/or orderable itemsSome routes are unnecessary and can be
marked as National package only
Routes can be added—“topical body” for permethrin cream
PO is the default route
Standard Schedules
Continuous, One-time, or Day of week
Include a time interval (in minutes)
Allow for calculation of quantity based on dose and days supply for most drugs
In back-end prescription processing, can still use old “medication instructions” but only standard schedules show in EHR.
DosagesDosage vs Local Possible Dosage
Dosages can be tied to inpt, outpt, or both
Some dosage forms have Dosages that can only be tied to inpt—must still make Local possible dosages for outpt use
How to handle doses of “1-2 tablets”?
If Dosages exist, cannot “see” local possible dose in EHR
Dosage Forms
A National File
Form chosen when matching to orderable item
Can be confusingXR vs ER vs SR, etc.
May need to edit verbsReconsitutable oral powder was “mix and take”
changed to “shake well and give”
Drug/Orderable item text
Can be tied to individual drug or to orderable item
Can be prepared in word processing application then cut and pasted into RPMS
Will cause a link to show in the order dialog box in EHR (and additional question in Pharmacy package)
Used for pediatric dose charts, restrictions, or special instructions
Importance of good PDM setupEssential for trouble free use of POS,
Adverse Reaction Tracking, EHRAllergy checks may not trigger if VA drug class
not entered
Drug will not be billed if NDC doesn’t match package size
Many CRS (GPRA) taxonomies based on VA drug class or NDC…