(Cont...from pag 1&2)

• SMS Rx accommodates a description or take-home directions within the Latin file. For example the frequency, BIDM translates to ‘Twice Daily With Meals’. Is this accommodated on INVISION?

RESPONSE: The Latin Sig Description is not supported on the interface. If pharmacy depends on the Latin Sig Description for all pharmacy orders and expects the text to be used on INVISION, you could redundantly store the text in PRDFQ and unload the text into a 3field as the interface places the order. To cause the PRDFQ description to default in a 3field (e.g., 3LATSIGD), you must do the following:

• First, check to make sure this is a valid frequency found in PRDFQ. If it is a nonstandard frequency (C3701 valued with a time), then just move C1215 into the 3field, or if there is no frequency (e.g. continuous IV), then skip out. Create T-RXLATSI1 with the condition WHERE "C3701" IS VALUED THEN "3LATSIGD"="C1215" ELSE WHERE "C1215 IS UNVALUED THEN $R=1 ELSE $T=RXLATSI2.
• Set "PCDFQKEY"=‘ALL xxxxxxxx’ where ‘xxxxxxxx’ is the daily frequency found in C1215. To do this, create T-RXLATSI2 which contains "PCALCID"= ‘RXLATSIG’ and $PE=PCALCID, $P=CHPPDVAL, $D=PCAL????, $T=RXLATSI3.
• Create an ‘RXLATSIG’ entry in PRALC containing the "PCDFQKEY"=‘PHM’||’ ‘||"C1215" expression. Note: An alternative to using Data Evaluator is to use the Concatenation utility (AKA ‘Orders As Written’) to concatenate the above expression.
• Place T-RXLATSI1 in T-RXIFEO01 after T-RXIFEO08 (the TCL that values C1215 in the interface pathway).
• Create T-RXLATSI3 containing the following condition: WHERE ALL OF "PCDFQKEY" IS VALUED AND "PCDFQKEY" IN (PE=PCDFQKEY) THEN $PE=PCDFQKEY, $T=RXLATSI4 ELSE "3LATSIGD"= "C1215". This will unload PCDFQDSC (PRDFQ Description) in the AUDA. If it cannot locate an entry in PRDFQ, then just move C1215 into the 3field.
• Create T-RXLATSI4 which DVA’s "3LATSIGD"="PCDFQDSC".
• The "3LATSIGD" should replace C1215 on INVISION (i.e., Charting displays, etc.).
• How should INVISION be set up if SMS Pharmacy has a routine Latin Sig ‘frequency’ (e.g., ‘TID’) and a corresponding PRN Latin Sig ‘frequency’ (e.g., ‘TIDPRN’)?

RESPONSE: Add both frequencies to INVISION’s PRDFQ (the routine frequency as a Class 3 and the PRN as a Class 2 frequency). There is no need to convert the frequency in T-RXMDEO07.

• What if SMS Pharmacy uses the same Latin Sig ‘frequency’ for both a routine and a PRN priority (e.g., ‘Q8HRS’)?

RESPONSE: Set up an INVISION routine frequency (same name as on the SMS Pharmacy side [e.g., ‘Q8HRS’-Class 3]) in PRDFQ and create a corresponding PRN frequency (e.g., ‘Q8HRSPRN’-Class 2) in PRDFQ and link the two in T-RXMDEO07.

• How should an SMS Pharmacy Latin Sig such as ‘MWF’ be set up on INVISION?

RESPONSE: Add an entry to PRWFQ of ‘MWF’ (pointing to Mon, Wed, Fri) and so forth for those Latin SIGs with a Type Sig = ‘D’ (days).

• How do I find all the Latin Sigs to set up in PRDFQ on INVISION?

RESPONSE: When setting up the PRDFQ/ Latin Sig files, print the Latinex Report, as well as the Latin Sig Report off SMS Rx. The Latinex Report will show the nurse station specific frequency/TOA set ups. The nurse station exceptions should be entered into PRDFQ. Remember to download the Performing Department as ‘NRS’ for each pharmacy service in the Service Master, if nurse station specific frequencies are used. For example, if nurse station, 2NOR uses their own unique administration times, the key to PRDFQ should be ‘2NORTID’. All other units would use the standard times in the ‘ALL TID’ entry.

• When are TOAs sent over the interface, and when are the occurrences are built naturally on INVISION?

RESPONSE: Occurrences are always built on INVISION using the normal process of evaluating the frequency or Rate/Run-In for IVs. The only exception to this rule is when the occurrences are established based on TOAs passed from SMS Pharmacy when non-standard frequencies (times) are used on SMS Pharmacy. If the pharmacy user creates her own TOA during order entry, the times are passed to INVISION, stored in the Schedule Segment and used to create the occurrence times.

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3. IV Processing Considerations: IV Processing is integrated into the interface in the following manner. This sections clarifies when frequency vs. rate/run-in is used on the interface:

• SMS Pharmacy processes Alternating LVP and Alternating TPN as ‘continuous’ IVs; i.e., dividing either the Rate or Run-In into the total IV volume determines the TOAs.
• Alternating LVP and Alternating TPN orders come across the interface and are placed on INVISION as continuous IVs, with the Rate or Run-In and total IV volume determining the occurrence times (just like on SMS Pharmacy).
• SMS Pharmacy supports fractional Rate/Run-In (e.g., 10.5ml/hr). The TOAs are built on SMS Pharmacy based on the fractional rate (if applicable). The fractional Rate/Run-In values are sent across the interface and stored in INVISION 3fields:
• 3RXIVRAT - for IV rate
• 3RXIVRUN - for IV run-in
• 3RXIVRTA/B/C - for IV rates for alternating order bottles
• 3RXIVRNA/B/C - for IV run-ins for alternating order bottles
• The truncated Rate/Run-In (e.g., ‘10’ for ‘10.5’) is stored in the existing INVISION fields (C1162/C1165). The truncated rate will be used as the basis for the occurrence generation for Alternating IVs/TPNs (i.e., bottle hang times) until the new INVISION decimal Rate/Run-In fields are available in INVISION V22 (late ‘96). Therefore, the TOAs on SMS Pharmacy may be slightly different than the INVISION occurrence times (hang times) for Alternating LVP/Alternating TPN when fractional frequencies are used (until V22 is available). The 3fields above should be used to reflect the clinically correct decimal Rate/ Run-In.
• Although non-alternating continuous IV orders (e.g., LVP) are entered on SMS Pharmacy with the user specifying a Rate/Run-In, the order ultimately gets placed as an intermittent IV. A ‘frequency’ is determined by dividing the Rate or Run-In into the total volume. Unlike the alternating IVs above, the TOAs are built based on the established ‘frequency’. The frequency could be a fractional frequency, rounded to the nearest quarter hour.
• The frequency is passed over the interface and occurrences are built on INVISION, based on the frequency, not on the Rate/Run-In, and IV volume (even though this is a ‘continuous’ order) for non-alternating IVs. Theoretically, the occurrence times should match the SMS Pharmacy TOAs using this ‘frequency’ technique.
• The hospital needs to set up all possible QnnHRS (for integer hour frequencies) and Qn.nnHRS/Qnn.nHRS/Qnn.nnHR possibilities in PRDFQ (for fractional frequencies) from Q0.25HRS through Q23.75HR (and Q24HRS). These frequencies can only be entered after the refresh software is applied. The new fractional frequencies are entered as Class 5 frequencies (note the integer frequencies [e.g., Q12HRS] can be entered as Class 2 frequencies).
• When the interface encounters a non-alternating continuous IV (with established ‘frequency’), the IV order with the frequency is sent over to INVISION. The frequency on INVISION is established using the following concatenation in T-RXIFEO15: ‘Q’ + ’nn.nn’ + ’HRS’ where ‘nn.nn’ is the integer or fractional frequency number. If the total concatenation exceeds 8 characters (e.g., ‘Q23.75HRS’), the expression is truncated (e.g., ‘Q23.75HR). Please be aware of the truncation as you create fractional frequencies in PRDFQ.

4. New Programs: ICO customers should make sure the new interface programs are loaded in the PPT table:

CHPPRX89 - Pharmacy Inbound Interface Unload
CHPPRXIC - Pharmacy Inbound Interface DataManipulation
CHPPRXIA - Pharmacy Inbound InterfaceAlternating IV Data Manipulation
R2000RX1 - SMS Pharmacy Interface RTIF table
A2000TX2 - SMS Pharmacy Interface Acknowledge TIF table
A2000PX2 - SMS Pharmacy Interface Acknowledge TIF User Exit