Drug File – IV Additives and Solutions June 2011.

Drug File – IV Additives and SolutionsDrug File – IV Additives and Solutions

June 2011

IV Drugs

• Entry in the Drug File as usual– NDC, match to NDF, Dosages, etc– Use Tall-Man naming as appropriate

• Mark the drug as IV

• This is where you get access to the Additives and Solutions files

This entry is marked for the following PHARMACY packages: Outpatient Unit Dose IV

MARK THIS DRUG AND EDIT IT FOR: O - Outpatient U - Unit DoseI - IVW - Ward StockC - Controlled SubstancesX - Non-VA Med

Enter your choice(s) separated by commas : II – IV** You are NOW editing IV fields. **

AN IV ITEM? Yes// (Yes) Edit Additives or Solutions:

Select one of the following:

A ADDITIVES S SOLUTIONS

Enter response:

This is where we’re going to be working

IV Additives and Solutions Files• 2 files

– IV Additives File– IV Solutions File

• They are their own files, but I find it helpful to think of them as “subfiles” of the main drug file

Additives FileEnter response: a ADDITIVESSelect IV ADDITIVES PRINT NAME: AMP 5 AMPICILLIN - AMP16 - - AMP14 - - AMP24 - - AMP26 - - AMP0.5 -PRINT NAME: AMPICILLIN//GENERIC DRUG: AMPICILLIN SODIUM 1GM INJ//USED IN IV FLUID ORDER ENTRY: YES//DRUG UNIT: GM//NUMBER OF DAYS FOR IV ORDER: 30//USUAL IV SCHEDULE: Q6H//ADMINISTRATION TIMES:Select QUICK CODE: AMP0.5// QUICK CODE: AMP0.5// STRENGTH: 0.5 GM// USUAL INFUSION RATE: 30//

OTHER PRINT INFO: USUAL IV SCHEDULE: Q6H// ADMINISTRATION TIMES: 0500-1100-1700-2300// USUAL IV SOLUTION: SODIUM CHLORIDE 0.9% 50 ML// MED ROUTE: IV PIGGYBACK//Select QUICK CODE:AVERAGE DRUG COST PER UNIT: 10//Select ELECTROLYTE:Select SYNONYM: AMP//DRUG INFORMATION: No existing text Edit? NO//INACTIVATION DATE:CONCENTRATION:MESSAGE:

Solutions File PRINT NAME: SODIUM CHLORIDE 0.9% ReplacePRINT NAME {2}:GENERIC DRUG: SODIUM CHLORIDE 0.9% 1000ML INJ//VOLUME: 1000 ML//Select ELECTROLYTES:Select SYNONYM: NS//DRUG INFORMATION: No existing text Edit? NO//AVERAGE DRUG COST:INACTIVATION DATE:USED IN IV FLUID ORDER ENTRY: YES//Edit Additives or Solutions:

Clean Up

• Run Fileman reports

• Look For:– Duplicate Entries– Drugs you don’t actually have– Inconsistent Print Names (e.g. Normal Saline

and Sodium Chloride for different entries)

Solutions File

• What do you want in this file?– Only solutions that you have at your facility– Each volume/bag size that you have (use

same print name)– Premixed solutions

ExamplePrint Name Generic DrugDEXTROSE 10% DEXTROSE 10% 1000ML INJ DEXTROSE 25% DEXTROSE 25% 500ML INJ DEXTROSE 5% DEXTROSE 5% 250ML INJ DEXTROSE 5% DEXTROSE 5% 500ML INJ DEXTROSE 5% DEXTROSE 5% 1000ML INJ DEXTROSE 5% DEXTROSE 5% 50ML INJ DEXTROSE 5% DEXTROSE 5% 100ML INJ DEXTROSE 5% 0.45% NS DEXTROSE 5% 1/2NS 1000ML DEXTROSE 5% 1/2 NS W 20KCL DEXTROSE 5% IN 1/2NS W 20MEQ K

DEXTROSE 5% and 0.9% NS DEXTROSE 5% and 0.9% NS 1000ML

DEXTROSE 5% and 1/2NS DEXTROSE 5% and 1/2 NS 500ML I DEXTROSE 5% and 1/4 NS DEXTROSE 5% and 1/4 NS 1000ML

Same print name but different volumes

Premixed Solutions

Note on Premixed Solutions

• Example – Ranitidine premixed bag– Most correct to make an orderable item like

RANITIDINE 50MG IN NORMAL SALINE 50 ML, INJ SOLN

• Put in IV solutions file – This is instead of having ranitidine as an

Additive like any other type of piggyback you actually make on site in the pharmacy

IV Solutions File – Print NamePRINT NAME: SODIUM CHLORIDE 0.9%

– This is what prints on the IV label– Don’t want to be too descriptive here, makes

for a confusing label– Use “name” (with the quotes) to enter the

same Print Name for more than one item

PRINT NAME {2}:– Leave this blank

IV Solutions File – tie to drug file

GENERIC DRUG: SODIUM CHLORIDE 0.9% 100ML INJ//– Put in drug from drug file entry– Will want separate entries for different

volumes you carry

IV Solutions File

VOLUME: 100 ML// – Volume of your bag

Select ELECTROLYTES: – Used in TPNs

Select SYNONYM: SALINE//– Synonym that will pull up this drug

IV Solutions File

DRUG INFORMATION:

No existing text

Edit? NO//– Shows in Drug Inquiry option in IV menu, not in EHR

AVERAGE DRUG COST: 5//– Cost per ml

IV Solutions File

INACTIVATION DATE:– Use to inactivate obsolete entries

USED IN IV FLUID ORDER ENTRY: YES//– Only effects EHR

Used in IV Fluid Order Entry?

Used in IV Fluid Order Entry?

• This controls what shows on these 2 lists in the EHR Order dialog

• Relatively few orders in EHR are done through this type of dialog– Basically only IV maintenance fluids and IV

drips– More later, in EHR Quick Order presentation

Additives File

• What do you want in this file?– Only those drugs that you have at your facility– May want different print names for pediatric

use (mg instead of grams)– Will need separate entries with the same print

name for different strengths ?

Example

Select IV ADDITIVES PRINT NAME: AMPICILLIN 1 AMPICILLIN (PEDS PIGGYBACK) - MG UNITS - 2 AMPICILLIN (PEDS SYRINGE) - 30 MG/ML – 3 AMPICILLIN 500mg vial 4 AMPICILLIN 1g vial

Additives File

PRINT NAME: AMPICILLIN//– Keep this simple– Do not include strength here

GENERIC DRUG: AMPICILLIN SODIUM 500MG INJ//– Will want an entry for each of your strengths

Additives File

USED IN IV FLUID ORDER ENTRY:– As before, only effects EHR– Do not need all your piggyback additives here– There are very few Additives that you will

mark “Yes” here– EX: KCL, Insulin

DRUG UNIT: MG//– Can use different units to help with peds IVs

Additives File

NUMBER OF DAYS FOR IV ORDER: 7//

USUAL IV SCHEDULE: Q6H//

ADMINISTRATION TIMES: 01-07-13-19//– Each of these can be overridden by other files

or parameters– Don’t worry much about setting it up here

Additives File

Select QUICK CODE:– Quick Codes pre-fill some fields in the order

entry process for pharmacists– Not to be confused with Quick Orders– Not a good mix with EHR– Causes new order to be created during med

processing – confusing for providers and nursing

– Probably won’t be fixed in the near future– So, please DO NOT USE

Additives File

AVERAGE DRUG COST PER UNIT: .025//– Cost per unit you selected (mg, grams, mEq)

Select ELECTROLYTE:– For TPNs

Select SYNONYM: AMP//– Synonym to pull up drug

Additives File

DRUG INFORMATION:

No existing text

Edit? NO//– Shows in Drug Inquiry in IV menu– Does not show in EHR

INACTIVATION DATE:– For obsolete entries

IV Additives File

CONCENTRATION: //– ?

MESSAGE:– Will show on IV Label

Same Print Name, Multiple Entries

• In Solutions File, it is the Volume field that helps describe the entry

6 SODIUM CHLORIDE 0.9% 500 ML

7 SODIUM CHLORIDE 0.9% 50 ML

8 SODIUM CHLORIDE 0.9% 100 ML

9 SODIUM CHLORIDE 0.9% 250 ML

10 SODIUM CHLORIDE 0.9% 1000 ML

Same Print Name, Multiple Entries• For Additives File, use Message field in

Drug Enter/Edit to describe the entry

GENERIC NAME: AMPICILLIN SODIUM 500MG INJ ReplaceVA CLASSIFICATION: AM111//DEA, SPECIAL HDLG: 6//

NATIONAL FORMULARY INDICATOR: YESLOCAL NON-FORMULARY:VISN NON-FORMULARY:Select DRUG TEXT ENTRY:Select FORMULARY ALTERNATIVE:Select SYNONYM: 000015740320// SYNONYM: 000015740320// INTENDED USE: DRUG ACCOUNTABILITY// NDC CODE: 000015-7403-20//Select SYNONYM:MESSAGE: 500mg vial//

IV Additives File

Select IV ADDITIVES PRINT NAME: AMPICILLIN 1 AMPICILLIN (PEDS PIGGYBACK) - MG UNITS - 2 AMPICILLIN (PEDS SYRINGE) - 30 MG/ML – 3 AMPICILLIN 500mg vial this is from the drug file 4 AMPICILLIN 1g vial

Used in IV Fluid Order Entry?