Transcript Vancouver 2009 – Black Box Warning

The IN Group
www.theingroup.com
•
•
•
•
•
•
Steve Botwinski
573-651-4420 office
573-651-0066 cell
[email protected]
Worked Magic Hospital for 22 years
Worked with The IN Group for 1 year.
BLACK BOX WARNING
How do we get the information
past pharmacy order entry to
other users?
I guess this is one of those new drugs that has a Black
Box Warning Associated with it!
Getting Information to
Pharmacy
• 1. Set up CDS with button for BBW
• 2. Set up in CDS short text box to type in
short warning for pharmacists.
• 3. Write Global rule that if BBW warning
exists then warn pharmacists and display
message.
• 4. Can have rule to remind Pharmacist to
print monograph to patient location.
http://www.formularyproductions.com
Click on Pharmacy Resources
Click on Drugs With Black Box Warnings
Click on Preference of Lookup
Class, Alpha etc,
Choose Drug Searching For
In Example Promethazine
Click onDrug
Now we must get the
information out to other care
providers
•
•
•
•
In Magic and Client Server
1. Using PCS, POM, BMV rules
(Magic must be at least 5.6)
Will continue in Client Server 5.6 and
afterwards look at other client server
versions and Magic.
• ***Word of Warning****
• In Client Server 5.6 PCS rules and Magic
MAR ADMIN must and only can be written
in the line editor in the rules dictionary, you
cannot write a NPR rule.
• Currently several problems exist in PCS
rule writing and are currently in
development to fix. ( I will explain issues
as we get to them)
PCS RULE
FILL IN PAGE 1
GO TO EDITOR SCREEN
TYPE: LINE
• IN MOST CASES YOU WANT THE BBW
TO POP UP ANY TIME THE
MEDICATION IS ADMINISTERED FOR
THE NURSE TO SEE.
• BUT IN SOME CASES SUCH AS
PROMETHAZINE IF THE PATIENT IS
OVER 2 YEARS OLD THERE IS NO
REASON TO WASTE THE NURSES
TIME.
SHOW BBW ALL TIMES GO TO DATA
FIELD RX MEDICATION
CHOOSE rx med
COMPARISON IS “EXISTS”
so if medication exits activate rule
FIRST PCS RULE ISSUE
• *LINK
• Choices are “AND” “OR” “ELSE”
• CURRENTLY YOU CAN ONLY USE THE
ELSE LINK FOR PCS RULES, IF YOU
TRY AND USE THE AND or OR WILL
NOT WORK. SO YOU CAN ONLY HAVE
ONE COMPARITIVE STATEMENT
BUTTONS
• HAVE CHOICE OF “CLOSE” “ERASE”
• OR “OVERRIDE”.
• If you choose close the warning pops up and the nurse
clicks on close and the box goes away with no record
that nurse saw or acknowledged the warning.
• If you choose override they have to choose a override
comment then hit override button and that will get
recorded in the order history.
CREATING OVERRIDE
BUTTON (MIS DICTIONARY)
CREATE OVERRIDE
CATEGORY
CREATE OVERRIDE COMMENT AND
LINK TO CATEGORY
PCS RULE ISSUE 2
• When the override box appears the nurse
• will hit the up or down arrow to pull up the
correct response. IF THERE IS ONLY
ONE OVERRIDE COMMENT IT DOES
NOT WORK AND THE USER IS STUCK
IN AN ENDLESS LOOP AND CANNOT
ESCAPE FROM THE RULE BOX.
• IN DEVELOPMENT AT MEDITECH
• SO ALWAYS HAVE MORE THAN ONE COMMENT
ASSOCIATED WITH A CATEGORY
CREATE SECOND COMMENT
ADD BUTTON AND ATTACH
CORRECT CATEGORY
NEXT WE ADD THE MESSAGE THE NURSE WILL SEE.
THIS IS WHY IT HAS TO BE DONE IN THE LINE EDITOR BECAUSE YOU MUST PUT MESSAGE
IN THE LINE EDITOR MESSAGE BOX
• Best way to accomplish is to copy and
paste from BBW source. Edit to the way
you would like it to be seen.
• YOU ARE NOT LIMITED TO THE THREE
LINES YOU SEE. THE BOX WILL
EXPAND SO YOU COULD PASTE A
LARGE AMOUNT OF INFORMATION.
• **IF IT’S GETS TO LARGE WILL THEY
REALLY READ IT???**
• Since you can only have one comparative
your LINK line will for now be ELSE
AND YOUR RULE MUST END WITH THE “END” LINE WITH OUTCOME OF
“OK”
SO THE RULE LOOKS LIKE:
AND WHEN THE NURSE
ADMINISTERS THE MED:
Nurse must now choose a override comment, then hit the override button to
continue
THERE IS A WARNING NOT TO TAKE THE
DRUG IF YOUR BLOOD PRESSURE IS TOO
LOW.
• SINCE THIS DRUG’S BBW IS FOR
CHILDREN ONLY UNDER AGE 2, WHY
WOULD WE WANT TO SEE IT FOR AN
OLDER PATIENT.
• IF YOU HAVE A SINGLE COMPARATIVE
WE CAN CHANGE THE RULE TO MAKE
THE RULE ONLY SHOW IF THE
PATIENT IS UNDER 2 YEARS OLD.
• NURSES DON’T NEED TO SEE THINGS
THAT ARE NOT RELAVENT TO THEIR
PATIENTS.
FUTHER IDEAS
• FOR DRUGS THAT THE BBW WARNS TO CHECK,
SUCH AS A LAB VALUE OR RESPIRATORY RATE.
• YOU CAN CREATE A ASSESMENT SO THE NURSE
HAS TO ENTER THE CURRENT RESP RATE.
• CREATE A LAB VIEW SO THE NURSE CAN SEE THE
CURRENT LAB LEVEL THAT MIGHT BE AFFECTED
AND NOTE LAB WAS CHECKED.
• YOU CAN ALSO CREATE SPECIALIZED QUERIES IF
YOU DESIRE.
• THESE ARE ALL ATTACHED TO THE DRUG ON THE
PCS TAB OF THE DRUG DICTIOANRY
RULE FOR MAGIC (5.6)
MAGIC MAR ADM RULE
USE ALL THE POSSIBLE CLINICAL TOOLS YOU
CAN SO YOU DON’T GET EXPOSED TO
PROBLEMS