PHARMACYREENGINEERING(PRE)Version0.5

Pre-Release

ImplementationGuide

PSS*1*129PSS*1*147

February 2010

DepartmentofVeteransAffairs

OfficeofEnterpriseDevelopment

August 2008Pharmacy Reengineering (PRE)1

PDMPre-ReleaseImplementationGuide

Revision History

Date / Revised Pages / Patch Number / Description
02/2010 / All / PSS*1*147 / Added Revision History page.
Updated patch references to include PSS*1*147.
Described files, fields, options and routines added/modified as part of this patch. Added Chapter 5, Additive Frequency for IV Additives, to describe the steps needed to ensure correct data is in the new IV Additive (J. Freese, DM; K. Lowry, Tech. Writer)
01/2009 / All / PSS*1*129 / Original version
(M. Mims, PM, V Howell, Tech. Writer)

(This page included for two-sided copying.)

August 2008Pharmacy Reengineering (PRE)1

PDMPre-ReleaseImplementationGuide

TableofContents

Introduction

Purpose

Project Description

Scope

Menu Changes

Pharmacy Data Management menu (Restructured)

Enhanced Order Checks Setup Menu (New)

IV Additive/Solution Reports (New)

Functionality

Steps

Local Medication Route Mapping

Local Possible Dosage Setup

Frequency Review

Identify IV Solution PreMixes

Enter/Edit Additive Frequency for IV Additives

Chapter 1 – Local Medication Route Mapping

Medication Route Mapping Report

Find Unmapped Local Medication Routes

Request Change to Standard Medication Route

Map Local Medication Route to Standard

Medication Route File Enter/Edit

Medication Route Mapping History Report

Chapter 2 – Local Possible Dosage Setup

Local Possible Dosages Report

Find Unmapped Local Possible Dosages

Request Change to Dose Unit

Map Local Possible Dosages

Enter/Edit Dosages

Drug Enter/Edit

Strength Mismatch Report

Review Dosages Report

Chapter 3 – Frequency Review

Administration Schedule File Report

Medication Instruction File Report

Chapter 4 – Identify IV Solution PreMixes

IV Solution Report

Mark PreMix Solutions

Drug Enter/Edit

Primary Solution File (IV)

Chapter 5 – Enter/Edit Additive Frequency for IV Additives

IV Additive Report

Drug Enter/Edit

Appendix A: Standard Medication Routes File

Appendix B: New DOSE UNITS File with FDB mapping

Appendix C: List of Dosage Forms to Exclude from Dosage Checks

Appendix D: VA Products with OVERRIDE DF DOSE CHK EXCLUSION field set to ‘Yes’

Appendix E: Examples of Local Medication Route Mappings to Standard

Appendix F: Local Possible Dosages Report

August 2008Pharmacy Reengineering (PRE)1

PDMPre-ReleaseImplementationGuide

Introduction

Purpose

ThisImplementationGuideprovidesinformationneededtoimplementthePharmacyReengineering(PRE)Version0.5Pre-ReleasepatchPSS*1*129 and Pre-Release Enhancements patch PSS*1*147.TheintendedaudienceforthisdocumentisthePharmacystaffresponsibleformaintainingPharmacyfiles.

Inordertobeabletoimplementaportionoftheenhancedordercheckingfunctionality,specificallythenewdosingchecks,theworkrequiredbythisPre-ReleasepatchPSS*1*129 and Pre-Release Enhancements patch PSS*1*147mustbecompleted.

ProjectDescription

ThePREV.0.5projectwilldeliverenhancedordercheckingfunctionalityutilizingHealtheVet(HeV)compatiblearchitecturetothefieldandaddresssomePatientSafetyIssues(PSI)regardingorderchecks.PREV.0.5willimplementtheenhancedordercheckingaccomplishedin2006withthedevelopmentoftheProof-Of-Concept(POC).ServicesprovidedbyFirstDataBank(FDB),ourcurrentdrugdatabasevendor,willbeutilized.APre-Releasewillbedeliveredtoallowforfilemapping,setup,andreviewinpreparationofthenewdosingcheckstobeimplementedinPREV.0.5.AGraphicalUserInterface(GUI)applicationwillbedevelopedtoallowforcustomizationofFDBstandardreferencetablesusedintheenhancedorderchecking.TheGUIapplicationwillbeutilizedbytheNationalDrugFile(NDF)ManagerordesigneetoupdatetheFDBcustomtables.In the future, access willbegiventolocaluserstorequestcustomchanges.AprocessviaFileTransferProtocol(FTP)toupdatelocal/regionalinstancesofFDBstandardandcustomtablesfromanationaldatabasewillalsobeprovided.

EnhancedOrderCheckingFeaturesforPREV.0.5:

  • Enhanceddrug-druginteractionorderchecktoprovidetheclinicianwithmoreinformationbydisplayingashortdescriptionoftheclinicaleffectsofthedruginteractionandprovidinganoptionalviewofadetailedprofessionaldruginteractionmonograph
  • TheEnter/EditLocalDrugInteraction[PSSINTERACTIONLOCALADD]optionwillbedeleted
  • CreateanewoptioncalledRequestChangestoEnhancedOrderCheckDatabasetoallow custom requests by pharmacy users
  • TheEditDrugInteractionSeverity[PSSINTERACTIONSEVERITY]standaloneoptionwillbedeleted
  • EnhancedduplicatetherapyorderchecktoutilizeFDB’sEnhancedTherapeuticClassificationSystemwhichallowsformultipleclassesperdrug
  • NewMaximumSingleDosageordercheck
  • NewDailyDosageRangeordercheck
  • Providegeneraldosinginformationforadrugwhendosagecheckscannotbeperformed
  • IncorporatenewdosagecheckswithinOutpatientPharmacyverificationoptions
  • Redesign drug interaction and duplicate therapy order check display warnings and action prompts for Inpatient Medications (IV and Unit Dose) application to minimize user confusion (PSI-07-080)
  • Addnewinterventiontypestoaccommodateinterventionsaddedfordosagechecks
  • OrdercheckdisplaysequencechangesforefficiencyandconsistencybetweenOutpatientPharmacyandInpatientMedicationsapplications(PSI-07-080)
  • OrdercheckinformationdisplaychangesforconsistencybetweenRemoteDataInteroperability(RDI)andlocalmedicationorderinformationandforimprovedreadabilityandprocessing
  • Provideerrormessagesatthesystem,drugororderlevelwhenordercheckscannotbeperformed
  • SendaprioritynotificationmessagetoamailgroupwhenFDBlinkisdown
  • Abilitytoperformdrug-druginteraction,duplicatetherapyanddosingorderchecksonPreMixsolutions(PSI-06-01)
  • Provideaquickandtimelynotificationdisplayofrecentlydiscontinued/expiredoutpatientandinpatientmedicationorders
  • Providequickidentificationoftheactiononthemedicationprofilebywhichanoutpatientor inpatientorderwasdiscontinuedorheld
  • ProvidedisplaychangestoDuplicateDrugOrderCheckforoutpatientpharmacytobeconsistentwiththeenhancedDrugInteractionandDuplicateTherapyOrderChecks
  • Remove Duplicate Drug Order Check from Inpatient Medications application; all duplicate drug orders will be presented as duplicate therapy warnings
  • ProvideInterventionMenuhiddenactiononadditionalListManorderscreensforbothOutpatientPharmacyandInpatientMedicationsapplications
  • AdditionofthreenewComputerized Patient Record System (CPRS) (OE./RR)V.3.0OrderChecks(AminoglycosideOrdered,GlucophageLabResults,andDangerousMedsforPatient>64)toPharmacybackdoororderchecks
  • ProvideanoptiontoallowausertochecktoseeifthelinktotheFDBdatabaseisupordown
  • ProvideconsistencybetweenAllergy/ADRordercheckdisplaysinOutpatientPharmacyandInpatientMedications
  • AllowtheusertotakeactionafteranAllergy/ADRordercheckisdisplayedforInpatientMedicationsapplication
  • Provideusernotificationsofupdates/additionswithinStandardMedicationRoutesfile
  • Create/ModifyApplicationProgrammersInterfaces(APIs)(i.e.CPRS,etc)inMenvironment tosupportordercheckenhancements
  • Provide an option to allow a user to disable/enable the connection to the vendor database
  • Provide an option to ensure that the connection to the vendor database is operational and that the enhanced order checks can be executed successfully
  • Provide option to keep track of when and for how long the vendor database connection is unavailable

HeVConstructionincludes:

  • Component(s)toutilizeservicesprovidedbyacommercialdrugdatabasetosupportLegacyVistAordercheckchanges

Theenhancementstodrug-druginteractions,duplicatetherapy,duplicatedrugorderchecksandintroductionofnewdosingordercheckswillalsobeincorporatedwithintheCPRSapplication.

Scope

ThepurposeofthisPREV.0.5Pre-ReleasepatchistohavesitesperformsomepreparationworkfortheupcomingreleaseofthePharmacyReengineering(PRE)Version0.5ordercheckenhancements.EnhancingcurrentDrug-DruginteractionandDuplicateClassorderchecks,aswellasintroducingnewdosingordercheckswillbeaccomplishedbyutilizingaFirstDataBank(FDB)DrugInformationFramework(DIF)databaseandAPIs.InterfacingtoFDB’sdatabaseandutilizingtheirAPIsrequiressomemappingtobeperformedbetweenVistAfilesandFDBtables.LocalMedicationRouteswillhavetobemappedtoaStandardMedicationRoutewhichismappedtoanFDBtableentry.InordertobeabletoperformdosingchecksonaLocalPossibleDosage,whichisfreetext,siteswillbeaskedtobreakdowneachLocalPossibleDosageintoaNumericDoseandDoseUnit.TheFREQUENCY(INMINUTES)field(#2)of ADMINISTRATIONSCHEDULEfile(#51.1)andtheFREQUENCY(INMINUTES)field(#31)oftheMEDICATIONINSTRUCTIONfile(#51)willrequirereviewtoensuretheyhavebeenpopulated, if appropriate. Thefrequencyisnecessarywhenexecutingadailydoserangecheckonaprescribeddrugwithinanorder.SiteswillbeaskedtoidentifyIVSolutionsthatareconsideredasPreMixessothattheycanbeincludedinorderchecks.

Patch PSS*1*147 – Pre-Release Enhancements creates a new ADDITIVE FREQUENCY field (#18) in the IV ADDITIVES file (#52.6). During the post-init the patch will auto populate the field with data. A new IV Additive Report [PSS ADDITIVE REPORT] is provided for users to review the data for accuracy and edit if necessary. This new field will be used to provide a default value for the ADDITIVE FREQUENCY field in CPRS for the IV Fluid dialog when continuous IV orders with additives are entered.

PharmacyDataManagementV.1.0package,PSS*1*129 and PSS*1*147 patches,createnewfieldsandfilesandprovidereportsandoptionstoassistinthepopulationandmaintenanceofdatanecessaryforthefutureinstallationoftheEnhancedOrderChecksPREV.0.5projectpatchesforPharmacyDataManagementV.1.0,InpatientMedicationsV.5.0,OutpatientPharmacyV.7.0andCPRS.

MenuChanges

AnewEnhancedOrderChecksSetupMenuhasbeencreatedunderthemainPharmacyDataManagementmenu.TheexistingPharmacyDataManagementmenuhasbeenrestructuredtoaddsomeofthesamenewreportsandoptionsontheEnhancedOrderChecksSetupMenu.TheEnhancedOrderChecksSetupMenuwillbedeletedoncePREV.0.5isreleased.DetailsonthenewandmodifiedoptionscanalsobefoundinthePharmacy Reengineering (PRE) V.0.5 Pre-Release ReleaseNotes,PharmacyDataManagement(PDM)V.1.0 UserManualandPharmacyDataManagement(PDM) V.1.0 TechnicalManual.

PharmacyDataManagementmenu(Restructured)

[PSSMGR]

SelectPharmacyDataManagementOption:??

CMOPMark/Unmark(Singledrug)[PSSXXMARK]

**>LockedwithPSXCMOPMGR

Dosages...[PSSDOSAGESMANAGEMENT]

DrugEnter/Edit[PSSDRUGENTER/EDIT]

DrugInteractionManagement...[PSSDRGINTERMANAGEMENT]

ElectrolyteFile(IV)[PSSJIELECTROLYTEFILE]

LookupintoDispenseDrugFile[PSSLOOK]

MedicationInstructionManagement...[PSSMEDINSTRUCTIONMANAGEMENT]

MedicationRoutesManagement...[PSSMEDICATIONROUTESMGMT]

OrderableItemManagement...[PSSORDERABLEITEMMANAGEMENT]

FormularyInformationReport[PSSNFI]

DrugTextManagement...[PSSDRUGTEXTMANAGEMENT]

PharmacySystemParametersEdit[PSSSYSEDIT]

StandardScheduleManagement...[PSSSCHEDULEMANAGEMENT]

SynonymEnter/Edit[PSSSYNONYMEDIT]

ControlledSubstances/PKIReports...[PSSCS/PKIREPORTS]

SendEntireDrugFiletoExternalInterface[PSSMASTERFILEALL]

EnhancedOrderChecksSetupMenu...[PSSENHANCEDORDERCHECKS]

IV Additive/Solution Reports ... [PSS ADDITIVE/SOLUTION REPORTS]

WarningBuilder[PSSWARNINGBUILDER]

WarningMapping[PSSWARNINGMAPPING]

EnhancedOrderChecksSetupMenu(New)

[PSSENHANCEDORDERCHECKS]

SelectPharmacyDataManagementOption:ENHANCedOrderChecksSetupMenu

FindUnmappedLocalMedicationRoutes[PSSMEDROUTESINITIALMAPPING]

MapLocalMedicationRoutetoStandard[PSSMAPONEMEDROUTE]

MedicationRouteMappingReport[PSSMEDROUTEMAPPINGREPORT]

MedicationRouteFileEnter/Edit[PSSMEDICATIONROUTESEDIT]

MedicationRouteMappingHistoryReport[PSSMEDROUTEMAPPINGCHANGES]

RequestChangetoStandardMedicationRoute[PSSMEDICATIONROUTEREQUEST]

FindUnmappedLocalPossibleDosages[PSSLOCALDOSAGESEDITALL]

MapLocalPossibleDosages[PSSLOCALDOSAGESEDIT]

LocalPossibleDosagesReport[PSSLOCALPOSSIBLEDOSAGES]

StrengthMismatchReport[PSSSTRENGTHMISMATCH]

Enter/EditDosages[PSSEDITDOSAGES]

RequestChangetoDoseUnit[PSSDOSEUNITREQUEST]

MarkPreMixSolutions[PSSMARKPREMIXSOLUTIONS]

IVSolutionReport[PSSIVSOLUTIONREPORT]

AdministrationScheduleFileReport[PSSSCHEDULEREPORT]

MedicationInstructionFileReport[PSSMEDINSTRUCTIONREPORT]

IV Additive/Solution Reports (New)

[PSS ADDITIVE/SOLUTION REPORTS]

SelectPharmacyDataManagementOption:IV Additive/Solution Reports

IV Additive Report (New)

IV Solution Report

NOTE:TheseoptionsdonotaffectthecurrentfunctionalityoftheInpatientMedications,OutpatientPharmacy,orCPRSapplications.

Functionality

FunctionalityofthePREV.0.5Pre-Release (PSS*1*129)and Pre-Release enhancements (PSS*1*147) patchescanbedividedintofive areas:

  1. LocalMedicationRouteMapping
  2. LocalPossibleDosageSetup
  3. FrequencyReview
  4. IdentifyIVSolutionPreMixes
  5. Enter/Edit Additive Frequency for IV Additives

Ofthesefive,theareathatwillcommandthemosttimeistheLocalPossibleDosageSetup.Inordertoaccuratelyperformdosagechecks,itisveryimportantthateachLocalPossibleDosagebebrokendowntoanappropriateDoseUnitandcorrespondingNumericDose.

Eachofthefive affectedareasisdiscussedindetailbelow.

  1. LocalMedicationRouteMapping

Inordertoperformadosagecheck,themedicationroutebywhichamedicationisgivenmustbetakenintoaccount.SincetheFirstDataBank(FDB)databaseisutilizedtoperformthedosagechecks,weneedtomapourLocalMedicationRoutesinVistAtoanFDBRoute.AnewSTANDARDMEDICATIONROUTESfile(#51.23)wascreatedinVistAtoaccomplishthis.ThisfilehasbeenstandardizedbyStandardsandTerminologyService(STS)andmappedtoanFDBRoute.OptionshavebeenprovidedforsitestomapeachLocalMedicationRoutethatismarkedfor‘AllPackages’toanactiveStandardMedicationRoute.Reportshavealsobeenprovidedtoreviewthemappings.Whendosagechecksareperformed,thesoftwarewillusethismappingtopasstheequivalentFDBRoutefortheLocalMedicationRoutethatwasspecifiedinthemedicationorderforthedrugtotheinterface.IftheLocalMedicationRouteisnotmapped,dosagecheckswillnotbeperformed.Theuserenteringtheorderwillbeinformedthatthedosagecheckwasnotperformedandthereasonwhy.Inthiscase,generaldosinginformationcannotbeprovidedtotheusereither.IfaLocalMedicationRoutecannotbemappedbecauseacorrespondingStandardMedicationRouteisnotavailable,anoptiontorequestanewStandardMedicationRouteorchangeanexistingoneisprovided.

Appendix E provides examples of Local Medication Route Mappings to a Standard. When mapping, if it is not clear as to which Standard Medication Route one should map their Local Medication Route to, use the following guidelines:

(1)The first thing you should look at is the drugs being ordered with that Local Medication Route. By what route are they normally administered? For example, a Local Medication Route of ‘Affected Area’ is usually used with topical drugs. The most appropriate Standard Route to map the Local Medication Route of ‘Affected Area’ would be ‘Topical’.

(2)If you have Local Medication Routes defined that are used when ordering supplies, map to the Standard Medication Route of ‘NOT APPLICABLE’.

(3)Local Medication Routes that are combinations, i.e. Intramuscularly or By Mouth should be mapped to the Standard Medication Route of ‘NOT APPLICABLE’.

(4)In some cases, you may not find the exact Local Medication Route term in the Standard Medication Route file to map to. However, there may be a Standard Medication Route that is comparable to map to that is named differently. For example, the Local Medication Route of ‘Percutaneous’ can be mapped to the Standard Medication Route of ‘Transdermal’ and a Local Medication Route of ‘Intra-Abdominal’ can be mapped to ‘Intraperitoneal’.

(5)In some cases, there will just be no appropriate Standard Medication Route to map to. In those cases, leave the Local Medication Route unmapped. For example, it would be appropriate to leave a Local Medication Route of ‘Intrathoracic’ or ‘Intrafollicular’ unmapped. If any drugs are being ordered using that particular Local Medication Route, and you feel that it should be added to the Standard Medication Route file, please submit your request at the following website:

Someautopopulationwillbeperformedduringthepost-initofthePre-Releasepatchinstallation.ThesoftwarewillattempttomapaLocalMedicationRoutethatismarkedfor‘AllPackages’toaStandardMedicationRoutebasedondevelopedbusinessrules.Sitesneedtoreviewthisautomappingforaccuracy.

AppendixAprovidesalistofallStandardMedicationRoutesandcorrespondingFDBRoutemappinginitiallyreleasedwiththePre-Releasepatch.SincethentherehavebeenadditionspushedoutbytheNewTermRapidTurnaround(NTRT)process.ForacompletelistinguseFileMantoprinttheNAMEfield(#.01)andFIRSTDATABANKMEDROUTEfield(#1)fromtheSTANDARDMEDICATIONROUTESfile(#51.23).

Example:

ThesoftwarewilllookattheLocalMedicationRoutethatisinthemedicationorderandfindtheStandardMedicationRoutethatitismappedto.ItwillthenlookintheSTANDARDMEDICATIONROUTESfile(#51.23)tolocatetheequivalentFDBRoutetosendtotheinterface.

IfnomappingtoaStandardMedicationRouteisfound,nodosagecheckswillbeperformed,theuserwillseeamessageinformingthemandareasonwhy.

Thereis no current functionality to allow the inactivation of a Local Medication Route. If you do not want a Local Medication Route to be selectable for order entry, mark the PACKAGE USE field for ’National Drug File Only’. No further action is needed. This will also make it ineligible for mapping. You do NOT need to delete the Local Medication Route if associated with a dosage form from the DOSAGE FORM file (#50.606).

  1. LocalPossibleDosageSetup

Inordertoperformadosagecheck,aDoseUnitandNumericDosearerequired.ThesoftwarecantakeaPossibleDosageandbreakitdowntoaNumericDoseandDoseUnit;howeveritcannotdothesameforaLocalPossibleDosagebecauseitisafreetextentry. Twonewfields,NUMERICDOSE(#5)andDOSEUNIT(#4)havebeencreatedintheLOCALPOSSIBLEDOSAGEmultiple(#50.0904)oftheDRUGfile(#50).SiteswillhavetoreviewalltheirLocalPossibleDosagesandpopulatetheDoseUnitandcorrespondingNumericDosefields.

AnewDOSE UNITSfile(#51.24)wascreatedinVistAtoaccomplishthemappingtoFDB.AllentriesinthisfilehavebeenmappedtoanFDBDoseUnit.AlthoughthisfilehasnotyetbeenstandardizedbySTS,nolocaleditingwillbeallowed. WhenpopulatingtheDose UnitfieldforaLocalPossibleDosage,selectionwillbefromthisnewfile.

Anewfield,EXCLUDEFROMDOSAGECHECKS(#11),wascreatedintheDOSAGEFORMfile(#50.606)toallowadosageformtobeexcludedfromdosagechecks.Dosagecheckswillnotbeperformedonadrugthatisassociatedwithadosageformexcludedfromdosagechecks. AlistofDosageFormstobeexcludedhasbeendeterminedandalistingisprovidedinAppendixC. InsomecasesallVAproductsassociatedwithadosageformdidnotbelongtothe‘exclude’or‘notexclude’category.Inordertodealwiththeseexceptions,theNationalDrugFilepatch(PSN*4*169)whichisrequiredforthePre-Releasepatchwillcreateanewfield,OVERRIDEDFDOSECHKEXCLUSION(#31),intheVAPRODUCTfile(#50.68)toallowoverridingofthisdosageformexclusionforaVAProduct.Forexample,ifthedosageformissettobeexcludedfromdosagechecksandtheoverridefieldintheVAPRODUCTfileissetto‘Yes’,adosagecheckwillbeperformedonadispensedrugthatismatchedtothisVAProduct.If data is missing in either the EXCLUDE FROM DOSAGE CHECKS field in the DOSAGE FORM file or the OVERRIDE DF DOSE CHK EXCLUSION field in the VA PRODUCT file, dosage checks will be performed. AninitiallistofVAProductsthathavethenewOVERRIDEDFDOSECHKEXCLUSIONfield(#31)setto‘Yes’isprovidedinAppendixD.

Below is a table to describe how the values of the two new fields determine whether dosage checks will be performed on a drug.

The null values represent fields with missing data.

Dosage Form Field – Exclude from Dosage Checks / VA Product Field – OVERRIDE DF DOSE CHK EXCLUSION / Dosage Check Performed? (Y/N)
Yes / No / No
Yes / Yes / Yes
No / No / Yes
No / Yes / No
Null / No / Yes
Null / Yes / Yes
Yes / Null / Yes
No / Null / Yes
Null / Null / Yes

Someautopopulationwillbeperformedduringthepost-initofthePre-Releasepatchinstallation.ThesoftwarewillattempttopopulatetheNumericDoseandDoseUnitfieldsforLocalPossibleDosagesthataredefinedfordrugseligiblefordosingchecksbasedondevelopedbusinessrules. Sitesneedtoreviewthisautopopulationforaccuracy.DrugsthatareNOTeligiblefordosingchecksare:

(1)Inactive

(2)NotMatchedtoNDF

(3)AssociatedwithadosageformthatisexcludedfromdosagechecksandmatchedtoaVAProductthathastheOVERRIDEDFDOSECHKEXCLUSIONfield(#31)setto‘No’.

(4)Markedasasupplyitem(‘S’inDEA,SPECIALHDLGfieldorassignedaVADrugClassstartingwithan‘XA’)

(5)AssociatedwithadosageformthatisNOTexcludedfromdosagechecks,butismatchedtoaVAProductthathastheOVERRIDEDFDOSECHKEXCLUSIONfieldsetto‘Yes’.

AppendixBprovidesalistofallDoseUnitsandcorrespondingFDBDoseUnitmapping.IfaDoseUnitisnotavailableforselection,anoptiontorequestanewDoseUnitorchangeanexistingoneisprovided.VistAVAProductshavebeenmappedtoFDBdrugsusingtheGCNSEQNO.TheGCNSEQNOisanFDBdrugidentifier.Itrepresentsagenericformulation.Itisspecifictothegenericingredient(s),routeofadministration,dosageform,andstrength.TheFormulationID(GCN),insomecases,mayhavethesamevaluefordifferentdosageforms,strengths,ornon-activeingredientlistdifferencesandthereforemaybelinkedtomorethanoneGCNSEQNO.ButaGCNSEQNOisuniqueinitsassociationwitheachcombinationoffactors. TheGCNSEQNOisfoundformostProductsintheVAPRODUCTfile(#50.68)andiscurrentlyusedtomapaProducttoaPatientMedicationInstructionSheet(PMIS)thatisobtainedfromFirstDataBank(FDB).

Example1:

Inthisexample,weidentifythedrugTimololMaleate0.5%OphSolntotheFDBdatabasebypassingintheGCNSEQNOfoundfortheVAproductthatthedrugTimololMaleate 0.5%OphSolnismatchedto.FortheLocalPossibleDosageof‘2DROPS’wehaveselectedDROP(S)fromtheDOSE UNITSfileastheDoseUnitandentereda‘2’forthecorrespondingNumericDosewhichwillbesenttotheinterface. ThecorrespondingFDBDoseUnit‘DROP(S)’willbesenttotheinterface.

Example2:

Inthissecondexample,foracombinationproduct,AmlodipineBesylate10mg/Benazapril40mgcaptheGCNSEQNOthatissenttotheinterfaceidentifiesthedrugandstrength.Sowhenwesend‘2’fortheNumericDoseandCAPSULE(S)fortheDoseUnittotheinterface,itisunderstoodwhat‘2CAPSULE(S)’represents.

Example3:

AnexampleofhowadosagecheckwillbedoneonaPossibleDosageisgivenhere.IfaPossibleDosageof‘81MG’isordered,thesoftwarewillusetheunitidentifiedintheDRUGfileanddoalookupintheDOSE UNITSFileonthenameandsynonymfields.Onceamatchisfound,wewilltakethecorrespondingFDBDoseUnitandsendthattotheinterface.TheNumericDosesenttotheinterfacewillbecalculatedbymultiplyingtheDispenseUnitsperDosebytheStrengthspecifiedintheDrugFile.ThedrugwillbeidentifiedbytheGCNSEQNOoftheVAProductthatitismatchedto.

Example4:

Insomecases,morethanoneDoseUnitcanbespecifiedforaLocalPossibleDosage.Let’slookatthefirstLocalPossibleDosagedefined,‘ONETEASPOONFUL’.Inthiscasewecouldselecta‘TEASPOONFUL(S)’or‘MILLIGRAM(S)’asaDoseUnit.Eitherwouldbeacceptable,aslongastheNumericDoseisenteredcorrectlyforthatDoseUnit.Intheexampleabovewechose‘MILLIGRAM(S)’fortheDoseUnitwithacorrespondingNumericDoseof‘160’.ForthesecondLocalPossibleDosagedefined,‘ONETABLESPOONFUL’,wecouldselect‘TABLESPOONFUL(S)’or‘MILLIGRAM(S)’.Inthiscase,weselected‘TABLESPOONFUL(S)’fortheDoseUnitandassigned‘1’astheNumericDose.ForthesecondLocalPossibleDosage,since‘TABLESPOONFUL(S)’wasselected,theGCNSEQNOwillidentifythedrugandstrengthwithintheFDBdatabase,inordertobeabletoevaluatethedosageprescribed.ForthefirstLocalPossibleDosage,since‘MILLIGRAM(S)’wasselected,theGCNSEQNOisneededtoidentifythedrug,butnotthestrength.

WhateverDoseUnitisselected,shouldamessagebereturnedindicatingaproblemwiththedosageafterthedosingcheckisperformed;themessagewillcontaintheDoseUnitsentintotheinterface.Forexample,iftherewasaproblemwiththedosagesabove,seethemessagesthatwouldhavebeenreturnedanddisplayedtotheclinician:

For160MILLIGRAMS:

SingledoseamountofXXMILLIGRAMSexceedsthemaximumsingledoseamountof

XXXMILLIGRAMS.

TotaldoseamountofXXMILLIGRAMS/DAYexceedsthedosingrangeof

XXXMILLIGRAMS/DAYtoXXXMILLIGRAMS/DAY.

For1TABLESPOONFULS:

SingledoseformamountofXXTABLESPOONFULSexceedsthemaximumsingledose

formamountofXXXTABLESPOONFULS.

TotaldoseformamountofXXTABLESPOONFULS/DAYexceedsthedosingrangeof

XXXTABLESPOONFULS/DAYtoXXXTABLESPOONFULS/DAY.

ThemessagesusingtheMILLIGRAMSDoseUnitmaybemoremeaningfultotheclinicianvs.theTABLESPOONFULSDoseUnit.

Example5:

Inthefinalexampleabove,ifastrengthmismatchexistsbetweenthestrengthintheDRUGfile(#50)andthestrengthoftheVAProductthedrugismatchedto;youneedtobeverycarefulwhenpopulatingtheDoseUnitandNumericDosefields.TheNumericDoseshouldreflectthestrengththatisdefinedforthedrugintheDRUGfile.AlthoughfortheLocalPossibleDosageof‘TWOTEASPOONFULS’youcanassignaDoseUnitof‘TEASPOONFUL(S)’or‘MILLIGRAM(S)’,itisrecommendedthat‘MILLIGRAM(S)’beselectedwith‘240’enteredastheNumericDoseinordertohavethedosagecheckevaluatedcorrectly.ThereasonforthisisthattheGCNSEQNOthatispassedinfortheVAProductthatthedispensedrugismatchedtoreflectsadifferentstrength.Ifwehadassigned‘TEASPOONFUL(S)’astheDoseUnitwithacorrespondingNumericDoseof‘2’,theGCNSEQNOpassedintotheinterfacewouldidentifythedrugandstrengthasACETAMINOPHEN160MG/5MLELIXIRandevaluate‘2TEASPOONFULS’as‘320MG’insteadof‘240MG’.

3. FrequencyReview

Inordertoperformadailydoserangecheckonaprescribedmedication,thesoftwareneedstodeterminehowmanytimesperdaythesingledosageistaken.TheFREQUENCY(INMINUTES)fieldintheAdministrationScheduleandMedicationInstructionFilewillbeusedtodetermineafrequency.IfascheduleenteredforamedicationorderisnotfoundineithertheAdministrationSchedule(markedwithprefixof‘PSJ’)orMedicationInstructionfiles,orisfoundinoneofthosetwofilesbutafrequency(inminutes)doesnotexist,adailydoserangecheckwillnotbeperformed. Theuserwillbeinformedofthisandareasongivenastowhy. Amaximumsingledosecheckwillstillbeperformedandgeneraldosinginformationforthedrugwillbeprovided.

IftheTYPEOFSCHEDULEforanAdministrationSchedulewithinanorderisdesignatedasONE-TIMEorONCALL;oriftheScheduleTypeforaUnitDoseorderisONE-TIMEorONCALLonlyamaximumsingledosecheckwillbeperformedontheorderandafrequencyisnotneeded.

IftheTYPEOFSCHEDULEforanAdministrationSchedulewithinanorderisdesignatedasDAYOFTHEWEEK,thenumberofadministrationtimeswillbeusedtodeterminethefrequencyinordertoperformadailydoserangecheck.Ifnonearedefined,afrequencyof‘1’willbeassumed.

Example1:

Intheexampleabove,themedicationorderspecifiedthescheduleof‘BID’.ThesoftwarewillfirstlookattheAdministrationSchedulefiletoseeiftheentryisthere.InthiscaseBIDwasfound.Thesoftwarewillthenchecktoseeifthereisavalueinthefrequency(inminutes)field.Inthiscaseavalueof‘720’ispresent. Thesoftwarewilltakethevalue‘720’anddivideitinto‘1440’whichisthenumberofminutesfor24hourstogetthenumberofadministrationsperday. Theresultof‘1440/720’is‘2’.‘2’willbesenttotheinterfaceforfrequency.

Example2:

Inexample2,ascheduleof‘NOW’wasselectedforanorder.TheTYPEOFSCHEDULEforthisAdministrationSchedulehasbeendesignatedasaONE-TIME. Inthiscase,itdoesnotmatterifthereisafrequencydefined.Thesoftwarewillnotlookatthisfieldatall.IfanordercontainsaschedulethatisdesignatedasaONE-TIMEorONCALLinthetypeofschedulefieldorifaUnitDoseorderhasaONE-TIMEorONCALLforthescheduletype,thesoftwarewillnotbelookingforafrequency.Inthesecases,thesoftwarewillonlyperformamaximumsingledoseordercheck.Adailydoserangecheckwillnotbeperformed.Thefrequencyisneededforthedailydoserangeordercheckonly.

Example3:

Inexample3,ascheduleof‘MO-WE-FR@09-17’wasselectedforanorder.TheTYPEOFSCHEDULEforthisAdministrationSchedulehasbeendesignatedasaDAYOFTHEWEEK. Thesoftwarewilldeterminethenumberofadministrationtimesdefinedforthisscheduleandthatnumberwillrepresentthefrequency. Inthisexample,twoadministrationtimesof09and17havebeendefinedforthisDAYOFTHEWEEKschedule. Thefrequencythatwillbesenttotheinterfaceis‘2’.

4. IdentifyIVSolutionPreMixes

APreMixsolutionisanIVSolutionthatcomespreparedfromthemanufacturerwithadditives.SomeexampleswouldbeHeparin25,000unitsin5%Dextrose250mlor5%Dextrose0.45%SodiumChloridewith20MeQPotassiumChloride1000ml.CurrentlyifsuchadrugisenteredasanIVSolutionforanIVorder,itdoesnotparticipateinorderchecks(i.e.drug-druginteractions,duplicateclass,etc).IfenteredasanIVAdditiveitdoes.YoucannowenterthesetypesofpremixeddrugsasIVSolutionsandmarkthemasPreMixesandtheywillparticipateinorderchecks.OrdercheckswillbeperformedonthedispensedrugassociatedwiththeIVSolution.

IfyouhaveyourPreMixsolutionssetupasIVAdditivesorsetupasanIVAdditiveandIVSolutioninordertoparticipateinorderchecks,youdoNOThavetomakeanychangesifyoudonotwishto.TheywillcontinuetoparticipateinordercheckswhenPREV.0.5isreleased.

However,ifyouwanttoenteryourPreMixesasIVSolutionsandmarkthemasPreMixesyouhavetwooptions:

(1)MakeyourfilechangesAFTERPREV.0.5isinstalled.

(2)MakeyourfilechangesNOW,butkeeptheminactivated.OncePREV.0.5isinstalled,youcandeletetheinactivationdateandinactivatetheIVadditivesorIVAdditiveandIVsolutionentriesthatyouarereplacing.

Remember,thesechangeswillonlyberecognizedbyPREV.0.5software.

5. Enter/Edit Additive Frequency for IV Additives

To facilitate accurate daily dose checking for a continuous IV Solution with IV Additives, the software must calculate the amount of an IV Additive that is administered to a patient over a 24 hour period of time. In order to capture that information at the time the provider enters the IV order through the CPRS Continuous IV Dialog, software changes were required. PSS*1.0*147 creates a new ADDITIVE FREQUENCY (#18) field in the IV ADDITIVES (#52.6) file to provide a default value for a new additive frequency field in CPRS whencontinuous IV orders with additives are entered. The provider will have three choices for selection; ‘1 Bag/day’, ‘All bags’, and ‘See Comments’. If theprovider selects ‘See Comments’, the software will check to make sure instructions are entered in the Provider comments field.

When the pharmacist finishes the order, the value entered in the additive frequency for an IV Additive will be transferred to the IV Additive bottle field. A ‘1 Bag/day’ value will be represented as ‘1’; ‘All bags’ value will be represented as ‘All’ and ‘See Comments’ will be represented as ‘All’ with the understanding that the pharmacist will have to edit the bottle # field based on the provider instructions entered in the Provider comments.

These defaults will not start to appear in CPRSuntil Pharmacy Re-Engineering (PRE) V. 0.5 software is installed. Data for the IV Additive file will be auto-populated by a Post-Install routine for patch PSS*1*147 based on defined business rules. The selection values for the additive frequency in the IV Additive file will be ‘1 Bag/day’, ‘All Bags’ or it can be left blank. The business rules for the auto population logic are as follows:

  1. If the dispense drug associated with the IV Additive has a VA Drug Class assigned and the VA Drug Class code contains a ‘VT’, the additive frequency will be set to ‘1 Bag/day’.
  2. If the dispense drug associated with the IV Additive has a VA Drug Class assigned and the VA Drug Class code does not contain a ‘VT’, the additive frequency will be set to ‘All bags’.
  3. If the dispense drug associated with the IV Additive does not a VA Drug Class assigned, the additive frequency will be left blank.

A new IV Additive Report [PSS IV ADDITIVE REPORT] option has also been added to allow review of the Additive Frequency data. Some guidance when reviewing the auto populated additive frequency:

  1. If an IV Additive (i.e. MVI Inj) is always administered once per day, a value of ‘1 Bag/day’ should be entered for the additive frequency.
  2. If an IV Additive (i.e. Antibiotic; or Drug administered continuously such as Dopamine, Dobutamine) will always be placed in all IV Bags for an IV order, a value of ‘All Bags’ should be entered for the additive frequency.
  3. If an IV Additive (i.e. Potassium Chloride) can be placed in all bags or sometimes in 1 or 2 bags for an IV order, leave the additive frequency blank.

This new field can be editedusing the Drug Enter/Edit [PSS DRUG ENTER/EDIT] option or the AdditivesFile [PSSJI DRUG] option.

Remember, changes to the CPRS software to display the Additive Frequency field with defaults from Pharmacy in the IV Dialog will only occur when the PRE V. 0.5 software is installed.

Steps

WheninstallationofPSS*1*129iscompleteaMailmanmessageissenttothepatchinstallerandanyoneelsewhohasbeenaddedtoreceivethemessageduringpatchinstallation.Donotstartmanualmappinguntilconfirmationhasbeenreceivedthatthepost-initiscompleteandthisMailmanmessagehasbeenreceived.

Subj:PSS*1*129InstallationComplete [#43593]07/25/08@07:53 1line

From:PSS*1*129INSTALL In'IN'basket. Page1

------

TheInstallationofpatchPSS*1.0*129iscomplete.

Entermessageaction(inINbasket):Ignore//

IfyoudidnotreceivethisMailmanmessage,contactyourlocalIRMoffice.Possiblecausesfornotreceivingthemessagecouldbethattheinstallisstillrunning,youwerenotincludedasarecipientofthemessageorthereisaproblemandfurtherinvestigationisrequired.

WhatfollowsisasummaryofthestepsthatneedtobecompletedwithineachfunctionalareaforthePREV.0.5Pre-Releasepatch(PSS*1*129) and Pre-Release Enhancements patch (PSS*1*147).Thereisnospecificorderinwhichthefunctionalareasneedtobecompleted.TheworkmustbecompletedinorderforthenewdosingchecksimplementedinPREV.0.5enhancedordercheckfunctionalitytowork. Moredetailedinformationoneachoption/report mentioned in each stepisincludedlaterinthedocument.

LocalMedicationRouteMapping

Step1:UsingtheMedicationRouteMappingReport[PSSMEDROUTEMAPPINGREPORT]option,printthereportselecting“AllMedicationRoutes.”Itwillprovidealookattheautomappingthatwasperformedduringthepost-initwhenthePre-Releasepatchwasinstalled.ReviewyourLocalMedicationRoutesthatweremappedtoaStandardMedicationRouteforaccuracy.ItwillalsodisplayLocalMedicationRoutesmarkedfor“AllPackages’thatstillrequiremappingtobeperformed.SeeAppendixAforalistofStandardMedicationRoutesthatwerereleasedwiththePre-Releasepatch.SincethentherehavebeenadditionspushedoutbytheNewTermRapidTurnaround(NTRT)process.Foracompletelisting,useFileMantoprinttheNAMEfield(#.01)andFIRSTDATABANKMEDROUTEfield(#1)fromtheSTANDARDMEDICATIONROUTESfile(#51.23).

See Appendix E for sample medicationroutemappingsfrom test sites.

Step2:Afterreviewingthereport,youcanbeginmappingtherestofyourunmappedLocalMedicationRoutes.TheFindUnmappedLocalMedicationRoutes[PSSMEDROUTESINITIALMAPPING]optionwillidentifyallLocalMedicationRoutesthatrequiremappingandpresentthemonebyoneformapping.

Step3:IfwhilemappingyoudiscoverthataStandardMedicationRouteisnotavailableforuse,requestittobeaddedtotheStandardMedicationRoutelist at the following website:

Step4:UponcompletionofthemappingoranytimeyouneedtoreviewyourLocalMedicationRoutemappingsforaccuracyandcompleteness,rerunthereportinStep1.Youcanprintallmedicationroutesmarkedfor‘AllPackages’thataremappedorunmappedorjustthosethatremainunmapped.

Step5:Afterreviewing,ifchangesneedtobemadethefollowingoptionscanalsobeused:

MapLocalMedicationRoutetoStandard[PSSMAPONEMEDROUTE]option–Allowstheusertoselectasinglemedicationrouteforquickmapping or remappingtoaStandardMedicationRoute.Noothermedicationroutefieldscanbeeditedusingthisoption.

MedicationRouteFileEnter/Edit[PSSMEDICATIONROUTESEDIT]option–Allowstheusertoselectasinglemedicationrouteforeditingofallfieldspertainingtothatroute,includingthemapping/remappingtoaStandardMedicationRoute.ThisistheonlyoptionfromwhichyoucandeletethemappingtoaStandardMedicationRoute.

Step6:Ifitisnecessarytotrackmappingchanges,theMedicationRouteMappingHistoryReport[PSSMEDROUTEMAPPINGCHANGES]optionisavailable.Thisreportcanprovideallmappingchangesforallmedicationroutesorforasinglerouteoveraspecifiedtimeframe.

There is no current functionality to allow the inactivation of a Local Medication Route. If you do not want a Local Medication Route to be selectable for order entry, mark the PACKAGE USE field for ’National Drug File Only’. No further action is needed. This will also make it ineligible for mapping. You do NOT need to delete the Local Medication Route if associated with a dosage form from the DOSAGE FORM file (#50.606).

LocalPossibleDosageSetup

Step1:UsingtheLocalPossibleDosagesReport[PSSLOCALPOSSIBLEDOSAGES]option,printthereportselecting“AllLocalPossibleDosages’.ItwillprovidealookattheautopopulationoftheNumericDoseandDoseUnitfieldsthatwasperformedduringthepost-initwhenthePre-Releasepatchwasinstalled.ReviewyourLocalPossibleDosagesthatwerepopulatedforaccuracy.ItwillalsodisplayLocalPossibleDosagesthatstillrequirepopulation.SeeAppendixBforalistofDoseUnitsthatyouwillbeabletoselectfrom.An example of a Local Possible Dosage Report is provided in Appendix F.

Step2:Afterreviewingthereport,youcanbeginpopulatingtheNumericDoseandDoseUnitfieldsfortherestofyoureligibleLocalPossibleDosages.TheFindUnmappedLocalPossibleDosages[PSSLOCALDOSAGESEDITALL]optionwillidentifyallLocalPossibleDosageseligiblefordosagechecksthatrequirepopulationandpresentthemonebyoneforprocessing.

Step3:WhilepopulatingtheNumericDoseandDoseUnitfields,ifitisdiscoveredthataDoseUnitneedstobechangedoraddedtotheDOSEUNITS file,usetheRequestChangetoDoseUnit[PSSDOSEUNITREQUEST]optiontorequestittobeaddedtotheDOSEUNITS file(#51.24)equestorwillbeinformedoftheoutcome.

Step4:UponcompletionoftheLocalPossibleDosagepopulationoratanytimeifyouneedtoreviewyourLocalPossibleDosagepopulationoftheNumericDoseandDoseUnitfieldsforaccuracyandcompleteness,rerunthereportinStep(1).YoucanprintallLocalPossibleDosagesorthosejustmissingdata.

Step5:Afterreviewing,ifchangesneedtobemadethefollowingoptionscanalsobeused;

MapLocalPossibleDosages[PSSLOCALDOSAGESEDIT]option–Allowstheusertoselectasingledrugandadd/editvaluesfortheNumericDoseandDoseUnitfieldsforitsLocalPossibleDosages.Nootherdatacanbemodifiedusingthisoption.

Enter/EditDosages[PSSEDITDOSAGES]option–Allowstheusertoeditalldosagerelatedfieldsforasingledrug.TheNumericDoseandDoseUnitfieldshavebeenadded.

DrugEnter/Edit[PSSDRUGENTER/EDIT]option–Allowsusertoadd/editalldrugrelatedfieldsforasingledrug.ThisoptionwasmodifiedtoalloweditingoftheNumericDoseandDoseUnitfields.

InadditiontodrugsthatareeligibleforDosageChecks,allthreeoptionsabovewillallowausertoentervaluesintheNumericDoseandDoseUnitfieldsforaLocalPossibleDosagedefinedforaninactivedrugoronethathasnotbeenmatchedtoNDF.

Step6:Twootherreportsthatareavailable:

StrengthMismatchReport[PSSSTRENGTHMISMATCH]option–ThisreportwillprintDosageinformationforallentriesintheDRUGfile(#50)thathaveadifferentStrengththanwhatisintheVAProductfile(#50.68)match.ThisreportcanonlyidentifystrengthmismatchesifthedrugqualifiesforPossibleDosages,andastrengthhasbeendefinedintheDRUGfile(#50).

ReviewDosagesReport[PSSDOSAGEREVIEWREPORT]option–TheNumericDoseandDoseUnitfieldswereaddedtodisplayonthisexistingreport.

FrequencyReview

Step1:UsetheAdministrationScheduleFileReport[PSSSCHEDULEREPORT]optiontoreviewthatallappropriateadministrationscheduleshavetheFREQUENCY(INMINUTES)fielddefined.Thisreportallowsyoutoprintalladministrationschedulesorjustthosewithoutafrequencydefined.

Step2:UsetheStandardScheduleEdit[PSSSCHEDULEEDIT]optiontoadd/modifydataintheFREQUENCY(INMINUTES)field.

Step3: TheAdministrationScheduleFileReport[PSSSCHEDULEREPORT]optioncanbererunasmanytimesasneeded.

Step4:UsetheMedicationInstructionFileReport[PSSMEDINSTRUCTIONREPORT]optiontoreviewthatallappropriatemedicationinstructionshavetheFREQUENCY(INMINUTES)fielddefined.Thisreportallowsyoutoprintallmedicationinstructionsorjustthosewithoutafrequencydefined.

Step5:UsetheMedicationInstructionFileAdd/Edit[PSSJUMI]optiontoadd/modifydataintheFREQUENCY(INMINUTES)field.

Step6:TheMedicationInstructionFileReport[PSSMEDINSTRUCTIONREPORT]optioncanbererunasmanytimesasneeded.

IdentifyIVSolutionPreMixes

Step1:UsetheIVSolutionReport[PSSIVSOLUTIONREPORT]optiontoreviewallyourIVSolutionsandidentifytheonesthatarePreMixes.Initiallywhenprintingthisreportselecttoprint“AllIVSolutions’.ThisreportallowsonetoalsojustprintthoseIVSolutionsmarkedasPreMixes.

Step2:UsetheMarkPreMixSolutions[PSSMARKPREMIXSOLUTIONS]optiontomarkanIVSolutionasaPreMix.Otherfieldsmayalsobeeditedusingthisoption.

Step3:TheIVSolutionReport[PSSIVSOLUTIONREPORT]optioncanbererunasmanytimesasneeded.

Step4:ThefollowingoptionshavebeenmodifiedtoallowausertomarkanIVSolutionasaPreMix:

DrugEnter/Edit[PSSDRUGENTER/EDIT]option–Allowsusertoadd/editalldrugrelatedfieldsforasingledrug.

PRimarySolutionFile(IV)[PSSJISOLN]Standaloneoption–Allowsusertoadd/editallIVSolutionrelatedfields.

Enter/Edit Additive Frequency for IV Additives

Step 1:UsingtheIV Additive Report [PSS IV ADDITIVE REPORT]option,printthereportselecting“Print all IV Additives.” Itwillprovidealookattheautomappingthatwasperformedduringthepost-initwhenthe PSS*1.0*147 patchwasinstalled.Review the Additive Frequency data foraccuracy.This report allows one to also just print those IV Additives that have no value in the Additive Frequency field or those IV Additives that have a value of '1 BAG/DAY' in the Additive Frequency field.

Step 2:The following options have been modified to allow a user to edit the Additive Frequency field:

DrugEnter/Edit[PSSDRUGENTER/EDIT] option – Allows user to add/edit all drug related fields for a single drug.

Additives File [PSSJI DRUG] Stand alone option – Allows user to add/edit all IV Additive related fields.

Step 3:The IV Additive Report[PSSIVADDITIVE REPORT]option can be rerun as many times as needed.

Chapter1–LocalMedicationRouteMapping

In order to perform a dosage check, the medication route by which a medication is given must be taken into account. Since the First DataBank (FDB) database is utilized to perform the dosage checks, we need to map our Local Medication Routes in VistA to an FDB Route. A new STANDARD MEDICATION ROUTES file (#51.23) was created in VistA to accomplish this. This file has been standardized by Standards and Terminology Service (STS) and mapped to an FDB Route. Options have been provided for sites to map each Local Medication Route that is marked for ‘All Packages’ to an active Standard Medication Route. Reports have also been provided to review the mappings. When dosage checks are performed, the software will use this mapping to pass the equivalent FDB Route for the Local Medication Route that was specified in the medication order for the drug to the interface. If the Local Medication Route is not mapped, dosage checks will not be performed. The user entering the order will be informed that the dosage check was not performed and the reason why. In this case, general dosing information cannot be provided to the user either. If a Local Medication Route cannot be mapped because a corresponding Standard Medication Route is not available, an option to request a new Standard Medication Route or change an existing one is provided.