The MAR/IVAR For Manual Charting has a new feature allowing you to run the report before midnight. Previously, the MAR/IVAR was hard coded to be expected to run after midnight to set up and process the correct window. Running the report before midnight threw off the window by 24 hours. Now, you can optionally pass the MAR/IVAR begin date by valuing %RXBEGDT=mmddyy in CHPPRX46 (multipatient day end MAR) and CHPPRX48 (multipatient day end IVAR). One application of this new feature would be to run the

MAR/IVAR before midnight, passing the MAR/IVAR begin date as "%SYSDATE + 1" in the process TCL. You will receive the same MAR/IVAR window as if you were running the programs after midnight. Running the reports earlier is desirable should the hospital require more time to check the report before the reports are put to use or if the hospital has an extended day end outage. See Miscellaneous Install Tip #5 (page 6) in this issue for a related feature for the MAR/IVAR From Automated Charting.

Confessions of an INVISION Pharmacy Installer by Bruce

I attended the first SMS Pharmacy education class at Corporate the week of April 10th. Roger Braun and Sheila Hallett did an excellent job of putting together the material for this new product. After a few hours of class, I have to ... ah ... well ... admit there were quite a few features SMS Pharmacy had to offer over the INVISION product. I started to write down those items SMS Pharmacy enjoys that are either impossible to capture on INVISION, or would require some OAS building effort to accommodate. Here is my unofficial list:

• Differ dose support (e.g., in one order, you can specify ‘500mg in the AM and 250mg at bedtime’). *
• During order entry, you can specify extra initial supply quantities to send and charge (without ‘stealing‘ occurrences/TOAs from the next cart).
• Can build non-standard weekly frequencies during the enter order step (user specifies which combination day-of-week they need) *
• Intermittent TPNs and Alternating IVs. *
• "Cycle" IV order support (e.g., run TPN in over 12 hrs, every 24 hours). *
• Hang time less than run-in time support (e.g., 1000ml D5W at 10ml/hr, but replace bag every 24 hours). *
• Option to add the bottle run-in time to last occurrence/TOA to establish the order stop date (e.g., TPN with a 24 hours run end and the last occurrence/TOA is at 23:00 tonight, can have an order stop D/T of tomorrow night at 23:00 so the order continues to show on active displays). *
• Enter order allows user to optionally key in their own bottle number. *
• IV Run-in time and hang times are conveniently rounded to nearest 1/4 hour. *
• System allows IV rate to be changed on a verified order, adjusting future occurrence/TOAs. *
• On line non-formulary IV support.
• TPNs and Alternating IVs can be open ended. *
• Fractional IV rates and rates > 999 ml/hr supported (rate field is defined as ‘9999.99’) *
• Fractional frequencies (without converting to minutes) are available (e.g., Q7.5H). *
• Open ended orders for OP in bed processing. *
• Generic and brand name stored for each IV ingredient.
• User-defined charging algorithms.
• Nurse station-defined exceptions for drug distribution set up such as unit dose, bulk, floor stock (e.g., acetaminophen could be unit dose dispensed on all areas except ICU, where it can be floorstock, and system will process accordingly).
• Option to add an alpha character as the 12th character of the NDC number - useful for splitting out an existing drug for repackaging purposes. Future NDDF updates will process both the "parent" and "child" NDC number as the original number.
• AWP charging support with monthly updates to the AWP.
• Fractional dispense unit support with optional round-up feature.
• Expanded Order Message File including up to 99 pages x 66 lines x 73 ch/line. These messages can optionally display during the enter order step.
• Drug-specific option to charge by dose (rather than DU).
• Taper dose support using order sets and predefined common orders (PCOs), defaulting relative start/ stop D/T between unique orders within the taper dose regimen.
• On-line order entry support for documenting pharmacy interventions, complete with model-supplied reporting capabilities.
• Model pharmacy management financial reports showing Unit Cost, Hospital Cost, Pharmacy Revenue Average Pt Charge (tot pt chg/tot #DU), Cost Revenue Index (tot hosp cost/tot pt chg) and Cost/ Day (hosp cost/occ bed) to name a few.
• PRN PAR level support during order entry.
• Cart Fill List can optionally include floorstock, traditional, discontinued and/or old orders.
• The Cart Adjust function credits and/or charges against the order, not the specific daily cart. Therefore "cart returns" can be done without respect to when you need to pull the next cart. Also, this same function is used to credit/charge all types of orders regardless of how they were dispensed (traditional, F/S, unit dose, med, IV, etc.).
• Super Bed Group support, allowing multiple carts to be pulled, updated and acknowledged together.
• The multiple mnemonics associated with a given drug item are stored with the order in the Drug Master, and are displayed during alphabrowse. This training feature helps the pharmacy staff acquaint themselves with the mnemonic when using alphabrowse.
• The user can revise some fields on a verified order (e.g., dose, #DU, frequency, duration, stop D/T and initial supply).
• Enter order displays the next cart’s begin time window on the review screen.
• The nonformulary pathway prompts the user for the drug’s charge amount. Once entered, the order will charge with all other like orders (e.g., for initial supply, cart acknowledge, refill, etc.).
• Min/Max dose checking is provided including 24 hour values from FDB.
• When using the Refill function, the user is automatically shown a display of active refillable (traditional) orders.
• The user can remove (purge) a validated order. Auto crediting sets charges to $0.00.
• An historical retention feature is provided, storing all order detail for extended periods of time.
• MAR/IVAR provides an option to sort by generic name or by order (PMP) number, an optional user-defined expiration message for orders about to expire, an option to separate Push, Piggyback, Enterals and Irrigations (from meds) if optionally placed on the MAR and an option to include take home meds on the report.
• Enter Order provides a feature to send and charge for miscellaneous devices (e.g. IV tubing) once/ bottle, once/day or just one time per order.
• The Sig can be used as a either a clinical frequency (e.g., QID) or as a "Sig Mnemonic", translating the Sig into a short text (e.g., "Keep Refrigerated"). The text is included on reports, displays and labels - useful for spelling out drug storage or handling arrangements. *