# Presentation: 417078

## Drug File ManagementClass #114H

**Don Lees, R.Ph.**
**Daphen Shum, R.Ph.**
**Jeanne Tuttle, R.Ph.**

## Learning Objectives

- At the conclusion of this class students should be able to:
- List available resources for populating drug file fields
- Create a new drug entry
- Demonstrate orderable item fields associated with new drug entry
- Describe the interactive roles of the NDF manager and the manager of the local drug file
- Apply system tools to drug file entry that will enhance decision support
- Describe the PBM OnLine Product Database

## Drug File Impact.........

- Medication order entry in CPRS
- BCMA
- Drug Accountability
- Costs
- Clinical Reminders
- Quick order set-up and maintenance
- Alerts
- Interactions
- Duplicate Therapy
- Allergies/Adverse Reactions

## Gathering Information

- National Drug File
- Product packaging (e.g. manufacturer bottle, package insert)
- On line product information (e-fax, Micromedex, manufacturer website)
- FDA http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm
- Prime vendor / invoice (cost)
- Inquire to National Files
- PBM Online Product Database
- http://vaww.apps.cmop.va.gov/PBMOnlineProductDatabase/Search.aspx

## Inquire to National Files

- Option located in National Drug File Menu, under the menu “Inquiry Options....”
- Information provided:
- Proper spelling and format for drug name
- VA Print Name
- NDC
- Package size
- Package type
- Order unit
- Dispense unit

## PBM Intranet Site

- Information on :
- Drug and treatment criteria
- Drug contracts, prices
- VA do not substitute list
- ISMP medication safety Alerts
- Drug monitoring and dosing recommendations
- Closed distribution/special handling drug
- National formulary
- http://vaww.pbm.va.gov/pbm/menu.asp

## Drug Enter

- Drug Enter/Edit Option located in Pharmacy Data Management (PDM)
- Consolidates entries for all pharmacy packages  - Drug File #50
- Restrict access to option
- Need PSNMGR key to do match with NDF
- PDM Software Manuals
- http://www.va.gov/vdl/application.asp?appid=93

## PDM Software Manual

- Information and examples of all the functionality contained within the PBM package.
- Other Language Translation Set-up
- Appendices for lists of Spanish equivalents for some of the more common terms used for administration schedules, dosage forms, local possible dosages, medication instructions, and medication routes.
- Warning Labels

## Basic Information needed

- Generic name
- Brand name
- Dosage form, strength
- VA drug class
- What care setting will the drug be used (inpatient, outpatient, IV, non VA)
- Print name (40 character)
- Cost

## Let’s Get Started

- Signing In
- Everyone will sign in using the same codes:
- ACCESS CODE:  1pharmacist
- VERIFY CODE:   pharmacist1

## National Drug File Update Process

- 45 day process
- 14 days for data entry
- 7 days for data review
- 21 days for site tests
- Outlook message with changes sent to pharmacy ADPAC group
- 5 days post release CMOP installs

## National Drug File Update ProcessPatch Messages

- Product Message (National):
- New products
- Formulary changes
- CMOP change
- Interaction Changes: (National)
- New/Edited interactions
- Products unmarked for Drug-Drug interactions
- Local Message (Local)
- Products locally unmarked for from NDF
- Outlook Message (National)
- Covers edits not reported in the product message
- Inactivations, Generic Name, Dispense Units, Dosage Form etc.

## PBM Online Product Database

- A tool to submit requests to the PBM for additions/changes to the National Drug File.
- A system to store/view NDF and CMOP data including drug pictures.
- Web based: The system is open to everyone within the VA, however it was originally intended to be used by ADPAC’s.
- Search screens: These allow the user to find basic information about products.
- New requests: The ability to request new products or edits.
- Accountability: Users will know the status of requests. In addition reports can be initiated to compile statistics on requests.

## PBM Online Product Database Search Criteria

**http://vaww.apps.cmop.va.gov/PBMOnlineProductDatabase/Search.aspx**

## PBM Online Product DatabaseSearch Results

## PBM Online Product Database Search Result Detailed

## National Drug File Updates Local Responsibilities

- Monitor Outlook message before installation of patch
- Rematch and remark products as required
- Coordinate with CMOP when product names and CMOP ID’s change.
- Edit formulary status
- Report errors
- Request new products

## Enhancing Your Entry

- OI-DRUG TEXT ENTRY
- Drug information
- Dosing guidelines
- Restrictions
- Criteria for use
- MESSAGE Field
- Limited to 68 characters
- Warnings for high alert medications, sound alike/look alike, tablet splitting
- QUANTITY DISPENSE MESSAGE field
- PATIENT INSTRUCTION field

## Drug Text

- May be used to enter information on drugs, restrictions, guidelines, ordering protocols
- Some entries are populated by the National Drug File
- May be tied to dispense drug or pharmacy orderable item
- Viewable through CPRS and Pharmacy
- Provides decision support in real time

## Drug Text Options

- There are 2 options in the PDM option “Drug Text”:
- Select Pharmacy Data Management Option: Drug Text
-     1    Drug Text Enter/Edit
-     2    Drug Text File Report
- CHOOSE 1-2: 1  Drug Text Enter/Edit
- This option enables you to edit entries in the DRUG TEXT file.
- CHOOSE 1-2: 2  Drug Text File Report
- This report shows each selected drug text entry and lists all drugs
- and orderable items linked to it.

## Slide 21

## Provider sees the message when ordering the medication

## Slide 23

## Screen capture showing disp quantity message

## Slide 25

## Drug Interaction Management

- PDM sub menu “Drug Interaction Management”
- Composed of 2 options:
- _Enter/Edit Local Drug Interaction_
- _Report of Locally Entered Interactions_
- Not a substitute for duplicate therapy alerts.
- Interactions entered should be evidenced based.

## Drug Interaction Management

- Interactions are sent out by the NDF
- Sites may change a significant interaction to critical but they cannot change a critical to significant
- Sites may enter additional interactions locally
- All locally entered interactions are evaluated by the NDF Support Group (NDFSG).

## Drug Interaction Management

- Critical interaction requires the pharmacist to document an intervention before proceeding
- Significant interactions ask a pharmacist if they want to document an intervention but allows the pharmacist to proceed with prescription processing if no intervention is documented
- Local sites and pharmacy users cannot turn off the drug interaction portion of the pharmacy package
- In CPRS it is possible to turn off the alerts at both the facility and user level.

## Your Impact......

- Patient safety
- Patient’s overall health and wellness
- Patient satisfaction
- Staff satisfaction
- Operational efficiencies
- Performance measures
- Quality monitors