Enter A Drug

Written by Sam Habiel. Questions? Post on the hardhats Google group: http://groups.google.com/group/hardhats.

Prerequisites
In order to enter drugs, you need to have access to the menu Drug Enter/Edit through PSS MGR (Pharmacy Data Management). This menu comes by default in WorldVistA XUCORE (Core Menu).

Even though the menu is not locked, the entry routine checks for a bunch of security keys.

They are:
 * PSNMGR                   is needed to match/rematch to NATIONAL DRUG file
 * PSORPH or PSXCMOPMGR     is needed for OUTPATIENT drugs; PSORPH for non-VA drugs
 * PSJU MGR                 is needed for UNIT DOSE drugs
 * PSJI MGR                 is needed for IV drugs
 * PSGWMGR                  is needed for WARD STOCK drugs
 * PSAMGR or PSA ORDERS     is needed for DRUG ACCOUNTABILITY usage
 * PSDMGR                   is needed for CONTROLLED SUBSTANCES usage

What you really need is the following for a typical hospital implementation:
 * PSNMGR (to match the drug)
 * PSORPH (to mark drugs for outpatient and non-VA)
 * PSJU MGR (to mark drugs for Unit Dose)
 * PSJI MGR (to mark drugs for IV)

If you cannot match/rematch a drug; AND/OR get the following message:

 You do not have the proper keys to continue. Sorry, this concludes your editing session.

then you are missing security keys.

IF YOU DO NOT MATCH A DRUG, IT WILL NOT PARTICIPATE IN DRUG-DRUG, DRUG-FOOD, AND DRUG-Allergy INTERACTIONS

Here are two sessions on entering a drug. The first is when you are entering a drug marketed in the US; and second is in a case you are using VISTA outside of the US and entering a drug not found in the US. Because I am lazy, the first example has most of the annotations.

Entering a Drug marketed in the US
 '''' Select DRUG GENERIC NAME: LEVETIRACETAM 500MG TAB ORAL Are you adding 'LEVETIRACETAM 500MG TAB ORAL' as   a new DRUG (the 4857TH)? No// Y (Yes) DRUG NUMBER: 94695// DRUG VA CLASSIFICATION: DRUG FSN: DRUG LOCAL NON-FORMULARY: DRUG INACTIVE DATE: DRUG MESSAGE: DRUG RESTRICTION: GENERIC NAME: LEVETIRACETAM 500MG TAB ORAL Replace VA CLASSIFICATION: DEA, SPECIAL HDLG: DAW CODE:

NATIONAL FORMULARY INDICATOR: Not Matched To NDF LOCAL NON-FORMULARY: VISN NON-FORMULARY: Select DRUG TEXT ENTRY: Select FORMULARY ALTERNATIVE: Select SYNONYM:  MESSAGE:  RESTRICTION: FSN: NDC:  INACTIVE DATE: 

If you are planning to match to a NDF entry later or have no plan of using the external billing function, you may skip the Service Code entry. SERVICE CODE:

WARNING LABEL SOURCE is not 'NEW'. WARNING LABEL will be used until the WARNING LABEL SOURCE is set to 'NEW'. WARNING LABEL: Current Warning labels for LEVETIRACETAM 500MG TAB ORAL No warnings from the new data source exist for this drug. Verify that the drug is matched to the National Drug File.

Would you like to edit this list of warnings? N// O ORDER UNIT: If you enter this, price and the Dispense Unit Per Order Unit, the Price Per Dispense Unit field will be calculated for you. Physicians using CPRS can then see how much each pill costs. PRICE PER ORDER UNIT: DISPENSE UNIT: TAB  DISPENSE UNITS PER ORDER UNIT:

Note:    Defaulting the NCPDP DISPENSE UNIT to EACH and the NCPDP QUANTITY MULTIPLIER to 1 (one).

NCPDP DISPENSE UNIT: EACH// NCPDP QUANTITY MULTIPLIER: 1// PRICE PER DISPENSE UNIT:

Next is the matching process. If you have an NDC, your drug may be matched right away; if not, it will try brand names (usually that never works); then it tries the first word of the Generic Name. This is what it will do here. Remember, if you don't match the drug, you don't get Allergy or drug interactions. Matching involves several steps before it's completed. Make sure to do them all.

Do you wish to match/rematch to NATIONAL DRUG file? Yes//  (Yes)

Deleting Possible Dosages...

Match local drug LEVETIRACETAM 500MG TAB ORAL ORDER UNIT: DISPENSE UNITS/ORDER UNITS: DISPENSE UNIT: TAB No NDC to match...

I will attempt to match the NDCs from your SYNONYMS.

No match by Synonym NDC... now first word

Match made with LEVETIRACETAM 500MG TAB ORAL Now select VA Product Name

1 LEVETIRACETAM 1000MG TAB   TAB  CN400  L0410 2 LEVETIRACETAM 100MG/ML INJ   INJ,SOLN  CN400  L0384 3 LEVETIRACETAM 100MG/ML SOLN,ORAL   SOLN,ORAL  CN400  L0321 4 LEVETIRACETAM 250MG TAB   TAB  CN400  L0266 5 LEVETIRACETAM 500MG TAB   TAB  CN400  L0267 6 LEVETIRACETAM 750MG TAB   TAB  CN400  L0268

Enter your choice: 5 Is this a match < Reply Y, N or press return to continue > :  Y

CHOOSE FROM: 1   120  BOTTLE 2   OTHER  OTHER Enter Package Size & Type Combination: 1

Local drug LEVETIRACETAM 500MG TAB ORAL matches   LEVETIRACETAM 500MG TAB PACKAGE SIZE: 120 PACKAGE TYPE: BOTTLE

< Enter "Y" for yes > < Enter "N" for no >                             OK? : Y LOCAL DRUG NAME: LEVETIRACETAM 500MG TAB ORAL ORDER UNIT: DISPENSE UNITS/ORDER UNITS: DISPENSE UNIT: TAB

VA PRODUCT NAME: LEVETIRACETAM 500MG TAB VA PRINT NAME: LEVETIRACETAM 500MG TAB                  CMOP ID: L0267 VA DISPENSE UNIT: TAB                                   MARKABLE FOR CMOP: YES PACKAGE SIZE: 120 PACKAGE TYPE: BOTTLE VA CLASS: CN400 ANTICONVULSANTS CS FEDERAL SCHEDULE: INGREDIENTS: LEVETIRACETAM NATIONAL FORMULARY INDICATOR: YES NATIONAL FORMULARY RESTRICTION:

< Enter "Y" for yes, "N" for no >

Is this a match ? Y

You have just VERIFIED this match and MERGED the entry.

Resetting Possible Dosages..

Press Return to continue: Just a reminder...you are editing LEVETIRACETAM 500MG TAB ORAL.

Strength from National Drug File match => 500   MG Strength currently in the Drug File    => 500    MG

Strength => 500  Unit => MG

Make sure to clean up the dosages. 1000mg is not a valid dose for Levetiracetam. So I remove it. This makes it not selectable as a dose in CPRS. If you don't do that, you open yourself to the possiblity of a lot of medication errors. POSSIBLE DOSAGES: DISPENSE UNITS PER DOSE: 1        DOSE: 500MG           PACKAGE: IO   DISPENSE UNITS PER DOSE: 2         DOSE: 1000MG          PACKAGE: IO

LOCAL POSSIBLE DOSAGES:

Do you want to edit the dosages? N// YES

Changing the strength will update all possible dosages for this Drug.

STRENGTH: 500//

Select DISPENSE UNITS PER DOSE: ? Answer with POSSIBLE DOSAGES DISPENSE UNITS PER DOSE Choose from: 1    500    IO   2     1000    IO

You may enter a new POSSIBLE DOSAGES, if you wish Type a Number between 0 and 99999999, 4 Decimal Digits

Select DISPENSE UNITS PER DOSE: 2   1000    IO

DISPENSE UNITS PER DOSE: 2// @ SURE YOU WANT TO DELETE THE ENTIRE '2' DISPENSE UNITS PER DOSE? Y (Yes)

Select DISPENSE UNITS PER DOSE:

Enter/Edit Local Possible Dosages? N//   O

This next section is to help you tell how the drug is going to be used. The options that you see depend on what security keys you have.</i>

MARK THIS DRUG AND EDIT IT FOR: O - Outpatient U - Unit Dose I - IV X  - Non-VA Med

Enter your choice(s) separated by commas : O,U,X O - Outpatient U - Unit Dose X - Non-VA Med
 * You are NOW editing OUTPATIENT fields. **

AN Outpatient Pharmacy ITEM? No// Y (Yes) CORRESPONDING INPATIENT DRUG: MAXIMUM DOSE PER DAY: LOCAL NON-FORMULARY: NORMAL AMOUNT TO ORDER: SOURCE OF SUPPLY: CURRENT INVENTORY: Action PROFILE MESSAGE (OP): MESSAGE: QUANTITY DISPENSE MESSAGE: OP EXTERNAL DISPENSE:

Do you wish to mark/unmark as a LAB MONITOR or CLOZAPINE DRUG? Enter Yes or No: NO
 * You are NOW editing UNIT DOSE fields. **

AN Unit Dose ITEM? No// Y (Yes) CORRESPONDING OUTPATIENT DRUG: ATC MNEMONIC: Select WARD GROUP FOR ATC CANISTER:
 * You are NOW Marking/Unmarking for NON-VA MEDS. **

A Non-VA Med ITEM? No// Y (Yes)

Orderable items are what the physician/provider sees in CPRS. You need to match each drug to an orderable item. Multiple drugs can be matched to a single Orderable Item, giving the Physician a view of multiple available dosages in CPRS.</i>


 * You are NOW in the ORDERABLE ITEM matching for the dispense drug. **

Dosage Form -> TAB

Match to another Orderable Item with same Dosage Form? NO//

Dosage Form  -> TAB Dispense Drug -> LEVETIRACETAM 500MG TAB ORAL

Orderable Item Name: LEVETIRACETAM//

Matching LEVETIRACETAM 500MG TAB ORAL to LEVETIRACETAM TAB

Is this OK? YES// Match Complete!

Now editing Orderable Item: LEVETIRACETAM  TAB

FORMULARY STATUS: Select OI-DRUG TEXT ENTRY: This lets you put a Drug Text (like a dosing table) INACTIVE DATE: This lets you inactivate the orderable item and remove it from view DAY (nD) or DOSE (nL) LIMIT: This lets you limit the dosage of the drug MED ROUTE: PO ORAL      PO  This is the default route for the physician and pharmacist> SCHEDULE TYPE: ''Unless drug typical use is PRN or ONE TIME leave this blank. When blank, the default SCHEDULE TYPE in Inpatient is CONTINUOUS.'' SCHEDULE: BID This is the typical dosing interval

Outpatient Expansion: TWICE A DAY

PATIENT INSTRUCTIONS: FOR SEIZURES This will show up as default instructions on labels

FOR SEIZURES

Select SYNONYM: KEPPRA These synonyms are what the provider can search by in CPRS Are you adding 'KEPPRA' as a new SYNONYM? No// Y (Yes)

SYNONYM: KEPPRA//

Select SYNONYM:

Entering a Drug not marketed in the US
There are a few things to notice about this example. Most importantly, you may need to do exotic matches; and you may need to change the strength to match what you get in your country. <pre style="padding:1em;border:1px dashed #2f6fab;color:black;background-color:#f9f9f9;line-height:1.1em"> <Enter drug as Name conc dosage form route size. You only have 30 characters, so you may need to omit some stuff> Select DRUG GENERIC NAME: AMBROXOL 15MG/2ML SOLN 50ML BOTTLE Are you adding 'AMBROXOL 15MG/2ML SOLN 50ML BOTTLE' as   a new DRUG (the 1669TH)? No// Y (Yes) DRUG NUMBER: 3372// DRUG VA CLASSIFICATION: <Leave all of these blank> DRUG FSN: DRUG LOCAL NON-FORMULARY: DRUG INACTIVE DATE: DRUG MESSAGE: DRUG RESTRICTION: GENERIC NAME: AMBROXOL 15MG/2ML SOLN 50ML BOTTLE Replace VA CLASSIFICATION: DEA, SPECIAL HDLG: DAW CODE:

NATIONAL FORMULARY INDICATOR: Not Matched To NDF LOCAL NON-FORMULARY: VISN NON-FORMULARY: Select DRUG TEXT ENTRY: Select FORMULARY ALTERNATIVE: Select SYNONYM:   <These synonyms are what pharamcists can search by> MESSAGE: RESTRICTION: FSN: NDC: INACTIVE DATE:

If you are planning to match to a NDF entry later or have no plan of using the external billing function, you may skip the Service Code entry. SERVICE CODE:

WARNING LABEL SOURCE is not 'NEW'. WARNING LABEL will be used until the WARNING LABEL SOURCE is set to 'NEW'. WARNING LABEL: Current Warning labels for AMBROXOL 15MG/2ML SOLN 50ML BOTTLE No warnings from the new data source exist for this drug. Verify that the drug is matched to the National Drug File.

Would you like to edit this list of warnings? N// O ORDER UNIT: PRICE PER ORDER UNIT: DISPENSE UNIT: BOTTLE <Very important field--prints on label> DISPENSE UNITS PER ORDER UNIT:

Note:    Defaulting the NCPDP DISPENSE UNIT to EACH and the NCPDP QUANTITY MULTIPLIER to 1 (one).

NCPDP DISPENSE UNIT: EACH// NCPDP QUANTITY MULTIPLIER: 1// PRICE PER DISPENSE UNIT:

<Always try to match to the National Drug file> Do you wish to match/rematch to NATIONAL DRUG file? Yes//  (Yes)

Deleting Possible Dosages...

Match local drug AMBROXOL 15MG/2ML SOLN 50ML BOTTLE ORDER UNIT: DISPENSE UNITS/ORDER UNITS: DISPENSE UNIT: BOTTLE No NDC to match...

I will attempt to match the NDCs from your SYNONYMS.

No match by Synonym NDC... now first word

Match on first word failed...

No match. . . attempting to match by Trade Name There are no Trade Names...unable to match

Do you want to attempt to match by NDC or UPN:

Select one of the following:

N        NDC U        UPN

Enter response: NDC//

Please enter NDC Code <WITH DASHES>:

Unable to match by Name, Trade Name or NDC Code/UPN

Select VA GENERIC NAME:   GUAIFENESIN ...OK? Yes//  (Yes)

Match made with AMBROXOL 15MG/2ML SOLN 50ML BOTTLE Now select VA Product Name

1 GUAIFENESIN 100MG TAB   TAB  RE302  G0079 2 GUAIFENESIN 100MG/5ML (AF) LIQUID   LIQUID,ORAL  RE302  G0218 3 GUAIFENESIN 100MG/5ML (SF & AF) LIQUID   LIQUID,ORAL  RE302  G0130 4 GUAIFENESIN 100MG/5ML (SF & AF) LIQUID,5ML   LIQUID,ORAL  RE302  G0261 5 GUAIFENESIN 100MG/5ML (SF) LIQUID   SYRUP  RE302  G0106 6 GUAIFENESIN 100MG/5ML SYRUP   SYRUP  RE302  G0035 7 GUAIFENESIN 1200MG TAB,SA   TAB,SA  RE302  G0161  **INACTIVE** 8 GUAIFENESIN 200MG CAP   CAP,ORAL  RE302  G0092 9 GUAIFENESIN 200MG TAB   TAB  RE302  G0107 10 GUAIFENESIN 200MG/5ML (SF & AF) LIQUID   LIQUID  RE302  G0125

Enter your choice or press return to continue: 2 Is this a match < Reply Y, N or press return to continue > :  y

CHOOSE FROM: 1   120 ML  BOTTLE 2   240 ML  BOTTLE 3   3840 ML  BOTTLE 4   480 ML  BOTTLE 5   OTHER  OTHER Enter Package Size & Type Combination: 5

Local drug AMBROXOL 15MG/2ML SOLN 50ML BOTTLE matches   GUAIFENESIN 100MG/5ML (AF) LIQUID PACKAGE SIZE: OTHER PACKAGE TYPE: OTHER

< Enter "Y" for yes > < Enter "N" for no >                             OK? : y LOCAL DRUG NAME: AMBROXOL 15MG/2ML SOLN 50ML BOTTLE ORDER UNIT: DISPENSE UNITS/ORDER UNITS: DISPENSE UNIT: BOTTLE

VA PRODUCT NAME: GUAIFENESIN 100MG/5ML (AF) LIQUID VA PRINT NAME: GUAIFENESIN 100MG/5ML (AF) LIQUID        CMOP ID: G0218 VA DISPENSE UNIT: ML                                    MARKABLE FOR CMOP: YES PACKAGE SIZE: OTHER PACKAGE TYPE: OTHER VA CLASS: RE302 NON-OPIOID-CONTAINING ANTITUSSIVES/EXPECTORANTS CS FEDERAL SCHEDULE: INGREDIENTS: GUAIFENESIN 100 MG/5ML NATIONAL FORMULARY INDICATOR: YES NATIONAL FORMULARY RESTRICTION:

< Enter "Y" for yes, "N" for no >

Is this a match ? y

You have just VERIFIED this match and MERGED the entry.

Resetting Possible Dosages..

Press Return to continue: Just a reminder...you are editing AMBROXOL 15MG/2ML SOLN 50ML BOTTLE.

Strength from National Drug File match => 100   MG/5ML Strength currently in the Drug File   => 100

Strength => 100  Unit =>

POSSIBLE DOSAGES: DISPENSE UNITS PER DOSE: 1        DOSE: 100MG/5ML       PACKAGE: I   DISPENSE UNITS PER DOSE: 2         DOSE: 200MG/10ML      PACKAGE: I

LOCAL POSSIBLE DOSAGES:

Do you want to edit the dosages? N// y YES

Changing the strength will update all possible dosages for this Drug.

<May need to change dosage> STRENGTH: 100// 37.5

Resetting possible dosages: Possible Dosage = 37.5MG/1.875ML Possible Dosage = 75MG/3.75ML

Select DISPENSE UNITS PER DOSE: ? Answer with POSSIBLE DOSAGES DISPENSE UNITS PER DOSE Choose from: 1    37.5    I   2     75    I

You may enter a new POSSIBLE DOSAGES, if you wish Type a Number between 0 and 99999999, 4 Decimal Digits

Select DISPENSE UNITS PER DOSE: 1   37.5    I

DISPENSE UNITS PER DOSE: 1// @ SURE YOU WANT TO DELETE THE ENTIRE '1' DISPENSE UNITS PER DOSE? y (Yes)

Select DISPENSE UNITS PER DOSE: 2   75    I

DISPENSE UNITS PER DOSE: 2// @ SURE YOU WANT TO DELETE THE ENTIRE '2' DISPENSE UNITS PER DOSE? y (Yes)

Select DISPENSE UNITS PER DOSE: ? You may enter a new POSSIBLE DOSAGES, if you wish Type a Number between 0 and 99999999, 4 Decimal Digits

Select DISPENSE UNITS PER DOSE:

Strength: 37.5               Unit: MG/5ML

Select LOCAL POSSIBLE DOSAGE: ? You may enter a new LOCAL POSSIBLE DOSAGE, if you wish Answer must be 1-60 characters in length.

Select LOCAL POSSIBLE DOSAGE: ? You may enter a new LOCAL POSSIBLE DOSAGE, if you wish Answer must be 1-60 characters in length.

Select LOCAL POSSIBLE DOSAGE: 5 ML Are you adding '5 ML' as a new LOCAL POSSIBLE DOSAGE (the 1ST for this DRUG)? No// Y (Yes)

LOCAL POSSIBLE DOSAGE: 5 ML// PACKAGE: IO Both DOSE UNIT: ML MILLILITER(S) NUMERIC DOSE: 5

Strength: 37.5               Unit: MG/5ML

Select LOCAL POSSIBLE DOSAGE:

MARK THIS DRUG AND EDIT IT FOR: O - Outpatient U - Unit Dose I - IV X  - Non-VA Med

Enter your choice(s) separated by commas : X                                          X - Non-VA Med
 * You are NOW Marking/Unmarking for NON-VA MEDS. **

A Non-VA Med ITEM? No// Y (Yes)


 * You are NOW in the ORDERABLE ITEM matching for the dispense drug. **

Dosage Form -> LIQUID,ORAL

Match to another Orderable Item with same Dosage Form? NO//

Dosage Form  -> LIQUID,ORAL Dispense Drug -> AMBROXOL 15MG/2ML SOLN 50ML BOTTLE

Orderable Item Name: GUAIFENESIN// AMBROXOL

Matching AMBROXOL 15MG/2ML SOLN 50ML BOTTLE to AMBROXOL LIQUID,ORAL

Is this OK? YES// Match Complete!

Now editing Orderable Item: AMBROXOL  LIQUID,ORAL

FORMULARY STATUS: Select OI-DRUG TEXT ENTRY: INACTIVE DATE: DAY (nD) or DOSE (nL) LIMIT: MED ROUTE: PO ORAL      PO SCHEDULE TYPE: R  FILL ON REQUEST SCHEDULE: TID PATIENT INSTRUCTIONS:

Select SYNONYM: MYCOSOLVAN Are you adding 'MYCOSOLVAN' as a new SYNONYM (the 1ST for this PHARMACY ORDER ABLE ITEM)? No// Y (Yes)

SYNONYM: MYCOSOLVAN//

Select SYNONYM: