# Presentation: 690919

## 214 Bridging Pharmacy and Clinical Informatics (Tightrope)

- Dan Papell

## Why Bridge?

- Old time paper Medication Orders
- Intervention **after** the order is written
- Computerized Provider Order Entry
- Intervention **before** the order is created

## One Mission of the Pharmacy ADPAC

- Assist Pharmacy Service in shepherding providers to utilize medications effectively, safely and in a cost conscious manner through adept manipulation of clinical software tools.

## Clinical Application Coordinators (CACs)

- Clinical CACs
- Nurses
- Dieticians
- Pharmacists

## Clinical Application Coordinators (CACs)

- Clinical CACs
- Nurses
- Dieticians
- Pharmacists
- Technical CACs
- Folks with IT background
- IRM Programmers wearing CAC hat

## Preferred Contact Method

- Initial Outlook e-mail with brief summary of project requested

## Preferred Contact Method

- Initial Outlook e-mail with brief summary of project requested
- Cold phone calls are very disruptive

## Responses to Expect

- Outlook E-mail with request for details
- May include an official request form to fill out
- Phone call asking for details
- No Response

## Official Request Form

## Detailed Electronic Request

- Word Document with details of project
- Spelling out all the requirements leaves nothing to chance

## Requested vs. Coded Template

## CPRS View of Final Template

## CPRS View of Final Template -Continued

## Usual  Course of Project

- Go over details of the project in person or by phone
- Create first draft in CPRS/VistA
- Contact by E-mail, phone or in person for Tweaking
- Iterations as needed

## Quick Orders

- Outpatient RXs
-     “Azithromycin 250MG 6/CARD
-     Take two tablets by mouth daily for 1 day then
-      take one tablet by mouth everyday for 4 days”

## Outpatient RX Quick Orders 

- Outpatient RX Quick Orders

## Creating RX Quick Orders in Order Management

## Quick Orders

- Outpatient RXs
- Inpatient Medications
- Unit Dose
-      “OSELTAMIVIR CAP,ORAL
-       75MG PO BID for 5 days For Influenza
-       Treatment”

## Unit Dose Quick Order

## Quick Orders

- Outpatient RXs
- Inpatient Medications
- Unit Dose
- Simple Intravenous (IV) Solution
-       “DEXTROSE 5% IN 1/2NS W 10MEQ KCL
-         INJ,SOLN”

## Simple Intravenous (IV) Solution

## Quick Orders

- Outpatient RXs
- Inpatient Medications
- Unit Dose
- Simple Intravenous (IV) Solution
- Compound Intravenous (IV) Solution
-     “Norepinephrine 4MG in D5W 250ML
-       Titrate to MAP >60”

## Compound Intravenous (IV) Solution

## Quick Orders

- Outpatient RXs
- Inpatient Medications
- Unit Dose
- Simple Intravenous (IV) Solution
- Compound Intravenous (IV) Solution
- Intravenous Piggyback (IVBP)
-     “ERTAPENEM INJ,PWDR 1GM IVPB DAILY”

## Intravenous Piggyback (IVPB)

## Quick Orders

- Outpatient RXs
- Inpatient Medications
- Unit Dose
- Simple Intravenous (IV) Solution
- Compound Intravenous (IV) Solution
- Intravenous Piggyback (IVBP)
- Syringe
-     “Vancomycin 25MG/Gentamicin 10MG/Heparin 25000 UNITS/0.9% Saline/Vol 5ML MO/WE/FR”

## Syringe

## Limiting Medications to Quick Order

## Synonym Placeholders

## Synonym Placeholders – Dummy Drug File Entry

## Medication Limited to Quick Order Menu

## Flagging New Medication Orders to Send an Alert

## Menu Paths

- Available from the CPRS Meds and Orders Tabs

## Menu Paths

## Simple Menu of Quick Orders

## Orderset on a Menu

## All the Quick Orders from an Orderset Fire in a Row

## Specialty (Theme) Menu

## Decision Tree Menu

## Template Fields

## Template Fields

- Combo Box

- Edit Box

## Template Fields

- Button

## Template Fields

- Radio Buttons

## Template Field Editor

## Template Fields

## Template Fields

- Hyperlink

## Template Fields

- Text

## Reason for Request in Quick Orders

## Reason for Request appears

## Reason for Request – Medication Order Dialog

## Reason for Request - Setup

## CPRS Template Drawer

## CPRS Template Drops into Note

## Consults

## Completing Consults with Note

## Clinical Reminders

- done in the past six months

## Clinical Reminders – Logic Definition

## Clinical Reminders – Logic Definition

## Clinical Reminders – Logic Definition

## Clinical Reminder – Due Now

## Clinical Reminders - Resolution

## Reminder Dialog Template

- Not a “Clinical Reminder”
- Available only from the CPRS Notes Tab
- Can not be accessed from order menu structure

## Reminder Dialog Templates – Menu Guiding Suggestion

## Reminder Dialog Templates – Menu Guiding Suggestion

## Reminder Dialog Template

## Reminder Dialog Template

## Reminder Dialog Template – Finding Item Orderset

## Clinical Reminder using a Health Factor

## Clinical Reminder using a Health Factor

## Reminder Dialog Template – Specialty Clinic

## Reminder Dialog Template – Specialty Clinic

## Reminder Dialog Template – Specialty Clinic

## Reminder Dialog Template – Specialty Clinic

## Reminder Dialog Template – Specialty Clinic

## One Mission of the Pharmacy ADPAC

- Assist Pharmacy Service in shepherding providers to utilize medications effectively, safely and in a cost conscious manner through adept manipulation of clinical software tools.

## Questions?