LINCOLN’S
BIRTHDAY EDITION – 16th Edition Written & Edited by Bruce Clutcher, R.Ph.,
Senior Consultant, SSG
1. The MAR/IVAR From Automated Charting has a new option
to page break for the PRN order section. The change to the programs, CHPPOC01 and CHPPOC02
is completed and was available on the 1.96 SUP/96.1 SUT (STS#: 84929). %OCPRNPG=1 will
force a page break for PRNs on both the MAR and IVAR. To take advantage of this feature,
%OCPRNPG=1 should be placed in all MAR/IVAR driver TCLs (e.g. OCPTMI01, OCDIVR01, OCDMAR01
and OCDMIV01).
2. Customer Memo #908 outlined a new Clinical Intervention
feature for INVISION Pharmacy. The software was delivered on the 12.95SUP/96.1 SUT.
However, the model ad hoc reports were sent via a fast path delivery the week of February
26, 1996. The report names are *$A2CLN1-4 (note, the last issue of the Rx-Pert newsletter
noted the report names as *$A2CON1-4).
3. An enhancement on the 4.96 SUP/96.2 SUT outlined in
Customer Memos #952/953 above provide additional functionality for both Med/IV Orders and
Install Model Physician’s View Order Entry Enhancements.
- Change IV Method Type - this feature enables the
pharmacy user to enter a non-verified IV order as a medication, using the new Meds Browse
pathway. Or, the user can enter an IV order specifying one IV Method Type with the order
later changed to a different IV Method Type. The order is entered with an
unverified/reviewed status. Using the Verify pathway, the pharmacist can change the IV
method type (C1486) or change the med order to an IV order. Previously, the user would
have to D/C and reenter the order with the new IV method type. This new feature is
intended to be used in the Physician Med/IV Orders install model. The purpose is to allow
the non-pharmacist clinician to freely express the new order without getting bogged down
with the details. For example, a physician could enter an order for ‘Gentamycin 80mg
IV’ as a med. When verifying the order the pharmacist could change the order into an
IV Piggyack order. If the physician entered the above order as an LVP, the pharmacist
could correct the order and make it an IV Piggyback order without D/Cing and Renewing the
order. Note: you must use Install Model (either the Physician version or plain Install
Model) and Meds Browse (for entering the order as a med). The order must be placed as an
unverified order.
- Fractional Hour Frequency Support - Users can now
enter a daily frequency with quarter (0.25), half (0.5) and three-quarters (0.75) hour
increments for non-pharmacy, med and intermittent IV orders. The process utilizes a new
frequency class of ‘5’, stored in the format, Qxx.yyHR where ‘xx’ is
the integer hour and ‘yy’ is the fractional hour in ‘25’,
‘50’ or ‘75’. This feature was developed because of the SMS Pharmacy
interface project. SMS Pharmacy supports fractional hour frequencies for non-alternating
continuous IV orders (e.g. LVP) with the user specifying a Rate/Run-In. A
‘frequency’ is determined by dividing the Rate or Run-In into the total volume.
Unlike the alternating IVs, the TOAs are built based on the established
‘frequency’. The frequency could be a fractional frequency, rounded to the
nearest quarter hour. This new feature is needed to accommodate these non-alternating IVs
on the Med/IV Orders Interface; however, the INVISION Pharmacy clients can take advantage
of the feature ‘stand alone’.
- Include/Exclude Order Comments In Print/Display MAR/IVAR
- this enhancements allows the hospital to place 3fields on the MAR/IVAR From Automated
Charting (both the print detail/summary and the display summary versions). The enhancement
does not apply to the MAR/IVAR For Manual Charting. A future enhancement will allow
3fields to be placed in Med/IV Charting displays. This feature was developed because of
the SMS Pharmacy interface project. Several SMS Pharmacy fields are stored on INVISION in
3fields (e.g. SMS Pharmacy Order Comments is placed in INVISION’s order comment
3fields, 3RXCMNT1-4; SMS Pharmacy Sig Aux is placed in INVISION’s 3fields,
3SIGAUX1-4; SMS Pharmacy PMP number will be stored in the 3RTIFORD; SMS Pharmacy
rate/run-in are stored in INVISION’s 3RXIVRAT and 3RXIVRUN for single AUDA IVs;
3RXIVRT1-3 and 3RXIVRN1-3 for multiple AUDA IVs). The INVISION Pharmacy clients can take
advantage of the feature ‘stand alone’
- Print/Display Patient Orders Enhancements - The
Print/Display Orders Enhancement (CHPPO477- not CHPP0400) was enhanced to include:
- A new sort of orders by the Order Status Process D/T.
- The option to include/exclude standing F/S orders.
- A new option to specify the number of comments to
print/display per line.
- The support of Generic Error TCL Processing
- enabling the user to intercept errors from CHPPO477 and
control the pathway based on the error message.
The National Coordinating Council for Medication Error Reporting
and Prevention emphasizes that illegibility of prescriptions and medication orders has
resulted in injuries to, or deaths of patients. The Council, therefore, made the following
recommendations to help minimize errors:
- All prescription documents must be legible. Prescribers
should move to a direct, computerized, order entry system.
- Prescription orders should include a brief notation of
purpose (e.g. for cough), unless considered inappropriate by the prescriber.
- All prescriptions orders should be written in the metric
system except for therapies that use standard units such as insulin, vitamins, etc. Units
should be spelled out rather than written "U".
- The medication order should include drug name, exact metric
weight or concentration, and dosage form.
- A leading zero should always precede a decimal expression
of less than one. A terminal or trailing zero should never be used after a decimal.
- Prescribers should avoid use of abbreviation including
those for drug names (e.g. MOM, HCTZ).
- Prescribers should not use vague instructions such as
‘Take as directed’.
In summary, the Council recommends:
Don’t Wait…Automate!
If In Doubt, Write It Out!
When In Doubt, Check It Out!
Lead, Don’t Trail!
Article from USA Today 1/21/97 by Tim Friend
Prescription drug errors double a person’s risk of
dying in the hospital and cost an estimated $2 billion a year, new studies show.
Prescribing errors have become such a serious problem that hospitals should invest in ways
to prevent them, the researchers say. The studies in today’s Journal of the American
Medical Association are the most rigorous in documenting drug errors and the money they
cost. Ordering prescriptions by computer dramatically reduces preventable errors.
Preventable errors include ordering doses that are too
high or prescribing drugs to which a patient is allergic. Errors most often occur in
sicker patients who take more than one drug, and they most commonly occur with antibiotics
and pain killers. Errors that cannot be prevented include reactions to chemotherapy. The
first study, led by David Classen at LDS Hospital in Salt Lake City, found that:
- 2.43 drug errors occurred for every 100 admissions.
- Drug errors doubles the risk of death for a patient.
- Each error prolonged hospital stays two days and cost an
extra $2,262 per patient.
- Preventable errors were cut by half with a computerized
system that flagged unusual doses and allergies and adjusted for a patient’s level of
kidney function to arrive at the correct dosage. Poor kidney function can turn a normal
dose into an overdose.
The second study, led by David Bates at Brigham and Women’s Hospital, Boston,
found preventable drug errors:
- Cost the hospital $2.8 million a year.
- Justify installing computerized prescribing systems,
currently used in fewer than 10% of hospitals.
Bates estimates preventable drug errors cost the healthcare system $2 billion a year.
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