RXPert Contents

2Q94 Pages 1 & 2

June 1994 10th Edition
Written by Bruce Clutcher and Faith Thompson
Edited by Bruce Clutcher Published by Faith Thompson

MISCELLANEOUS INSTALL TIPS

(By Bruce Clutcher)

1. The Shift Med/IV function supports printing med and IV labels. Different line 24 informational messages appear based on one of four possible scenarios when occurrences get shifted with respect to a med or IV cart:

• I100231: A verified occurrence gets shifted for a cart "in progress"; i.e. an occurrence(s) is shifted in a cart that is pulled but not acknowledged. You may need a label here if you print hang (occurrence) times on your IV label. When your original batch labels printed, the IV label may have 10:00 on it for a hang time. If the order gets shifted to, say, 11:00, you may want the new label to reflect this new time. If this is the case you will want a label to print from the shift function. Procedurally, the Rx staff needs to know to discard the old label. Note: the IVPL Update will not print a new label just because the hang time changed.
• I100230: A dispensed occurrence gets shifted within an already acknowledged cart. Again, since the IV hang (occurrence) time changed since the original label printed, you may want a new label to reflect the change.
• I100281: The hospital is numbering their IVs and they repeat the sequence every 24 hours and they shift an occurrence back into the previous 24 hours or ahead to the next so that the bottle number changes. This results in the message: "bottle number has changed".
• I100229: A verified occurrence gets shifted back into an acknowledged cart window. Doing this will flip the occurrence to dispensed and therefore acts like an initial supply situation. Charging will take place if you elect to charge on dispense.

The first three scenarios above usually do not warrant getting shift labels for meds or IVs. Most clients do not include hang time on IVs (especially continuous/large volume IVs) because either the rate/hang time changes frequently or because they do not like the way INVISION does not support hang time rounding. They usually do not know or care if the time change is reflected by a new label. Even if the hang time or bottle number is used on the label by your client, they are so inundated with the regular IV labels they do not want to bother with a replacement label for these two scenarios. For the dispensed occurrence in the acknowledged cart, chances are the bottle is already hung on the patient anyway.

The fourth scenario does warrant printing IV labels. If the cart was not pulled (therefore no label exists for the verified occurrence) and the occurrence gets shifted back into the acknowledged cart (where labels have already been printed), you will need this "initial supply" label. If you do not print the label in Shift Med/IV, the occurrence is "lost", i.e. the acknowledged cart already ran and produced its labels earlier. The next cart to be pulled will not contain the shifted occurrence.

To get a Shift med/IV label to print, you must put an entry in the IV skeleton/PCI service (for IVs - like all other IV labels) or PRDPT (for meds) with a function code of 'SHF' and a form switch of '1'. This will give a label for any scenario above when in the Shift Med/Function. To only get a label for the "initial supply" scenario above, put the following condition in the form's number of copies section:

VALUE EQ 1
WHERE ALL OF "%ORSHINO" IS VAL AND "%ORSHINO" NE 'I100229:' THEN VAL=0

Remember to include the ':' in the information message number or the condition won't be true. %ORSHINO holds the appropriate internal informational message code based on the scenarios above. You will not see the form on the stack, but it will queue up in the appropriate document group. %ORSHINO is valued by the shift update program just prior to the label printing. Note: the 'I100229:' informational number does not necessarily correspond to the actual line 24 informational number.

2. The MAR/IVAR For Manual Charting is hard coded to never include Issue Floorstock orders. For most hospitals using Issue Floorstock to charge a one time order, not including these orders on the MAR/IVAR is desired. To accomplish the same Issue Floorstock suppression on the MAR/IVAR From Automated Charting, value %OCXISSF=1 when the program runs.

JO NIEMEYER BLAZES THE TRAIL OUT WEST

(by Bruce Clutcher)

Jo Niemeyer (SMS, LA) spent the last year-and-a-half at St. Joe/Phoenix working on one of the first Med/IV Orders Interface to a foreign pharmacy system installs. The hospital contracted for INVISION's Med/IV Orders and Med/IV Charting, but wanted the applications interfaced to their existing Cerner Pharmacy system. The follow interfaces were accomplished:

• ADT from INVISION to Cerner Rx through OpenLink Level 2
• Med/IV Orders from INVISION to Cerner through OpenLink Level 1
• Med/IV Orders from Cerner to INVISION through OpenLink Level 1

According to Jo, 99% of the pharmacy orders are entered on Cerner and sent to INVISION. Currently only one time stat, discontinue and cancel orders are entered on INVISION and sent to Cerner. More orders may be entered on INVISION later as physicians progress to order entry (renew, cancel and enter order).

The hospital went live on Med/IV Charting (charge on dispense) 5/4/94 on one nurse station. They went live on the interface two weeks prior to 5/4 and only needed to monitor the interface for the two weeks before the charting live. According to Jo, the interfaces are working fine technically. The interfaces did not include alternating IVs, duplicate/interaction checking or shift Med/IV features.

Cerner only supports 2x35 character direction lines; INVISION supports 3x30, therefore, orders such as sliding scale insulin could not be interfaced because of the field discrepancies. Complex Meds are not supported on Cerner and therefore were not included in the interface. Cerner's TPN orders contain no ingredient information. Only order level data is passed to INVISION. Nursing therefore is not able to see ingredient detail for charting. This may be a moot point since the interface only allows for up to seven ingredients to be passed with all other IV orders. INVISION supports up to 19 TPN ingredients.

Cerner combines daily/ weekly frequency into one field. A look-up table was created to reference the 400+ single Cerner frequencies to INVISION's daily and weekly frequency combinations.

Cerner only supports 'routine' and 'PRN' priorities and does not support 'now & routine' priority. The hospital requested that INVISION create all orders as 'now & routine' unless there is a future start D/T. This sometimes causes an extra dose to show for nursing. Cerner's order stop time is 15:01 for all orders. INVISION's stop time is always the last occurrence stop time. This discrepancy does cause some problems when trying to establish an accurate order stop D/T.

A financial "interface" per se was not created. Instead, a charging disk transfers patient billing information from Cerner to INVISION nightly. Because no interface exists, INVISION users cannot view pharmacy charges on line.

Service master download and post download maintenance are required on both INVISION and Cerner. Perpetual (dual) maintenance will be required to keep both service masters in sync. Most of the problems so far have been procedural such as revising an order on Cerner instead of D/Cing and renewing the order, since the interface does not support any revise functions.