[MT-L] FSV Loads inactivating RXM drugs inappropriately
Ventura, Andrew
Hi Folks,
Heads up if you haven't seen this, and input welcome if you have:
We've run into an issue where dozens upon dozens of our RXM drugs are inactivated, inappropriately, with each FSV load by meditech. We have finally traced it down and gotten development to agree that it requires a DTS, however no DTS submission number is available yet for me to share.
The scenario is that the system is not removing the alpha suffix from an RXM drug's NDC when checking it against the NDCs in the FSV suspense file.
Because meditech says the best way to "map" an inpatient drug to convert to the desired rxm drug at discharge/convert is by using the PHA Drug field in rxm, a large number of our rxm drugs all have NDCs with alpha suffixes.
Nothing like filing a FSV load and hearing from ER docs that Percocet and Bactrim are no longer orderable from the RXM "Common" list.
Has anyone else run into this or have any thoughts on cleaning it up? I've already asked meditech to identify drugs inappropriately inactivated by this bug, but I'm not optimistic they'll have a way to do that, especially considering this has been happening for FSV loads going back who knows how long.
Thanks,
Andrew Ventura, Pharm.D, MBA
Pharmacy Informaticist
Augusta Health, Fishersville VA
C/S 5.66pp8
Gast, Judith A., R.N.
is this a new finding…or has this been happening all along, because we also use alpha at end of NDC but I have not heard of this problem so far…so worried it might be a new bug…
Have a Great Day!
Judi Gast RN, BSN
IT Analyst/Programmer
Information Management and Technology
P: 912-287-4241
F: 912-287-2579
__________________________________________
Mayo Clinic Health System in Waycross
1900 Tebeau Street
Waycross, GA 31501
Carrie N. Jarvis
I’ve been seeing this…although I couldn’t pinpoint what the problem was. Now at least it makes sense. I have just been fixing them as they are reported to me. I think what I will do now is go back through my “inactivated NDC” reports from previous loads and filter out the ones with alpha suffixes so I can fix them. Hopefully it won’t go back too far. I haven’t been hearing about issues until the last few months, but that doesn’t necessarily mean it didn’t start sooner…
Thanks for the heads-up, at least I know what the issue is now!
Carrie Jarvis, RPh.
Licking Memorial Hospital
1320 W. Main St.
Newark, OH 43055
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Ventura, Andrew
We have gone back several loads and see that we routinely had 10-20 alpha suffixed drugs inactivated, sometimes without obvious reason. Meditech so far has stated that they don’t think something else changed to cause this, we may have just hit the FSV load lottery. However they continue to review, and just tell us that they acknowledge a DTS needs to be submitted for this.
274 drugs with suffixes were inactivated with April’s MediSpan load.
Andrew Ventura, Pharm.D, MBA
Pharmacy Informaticist
Augusta Health, Fishersville VA
C/S 5.66pp8
From: Gast, Judith A., R.N. [mailto:Gast....@mayo.edu]
Sent: Thursday, May 14, 2015 11:07 AM
To: Ventura, Andrew; medit...@mtusers.com
Subject: RE: FSV Loads inactivating RXM drugs inappropriately
is this a new finding…or has this been happening all along, because we also use alpha at end of NDC but I have not heard of this problem so far…so worried it might be a new bug…
Have a Great Day!
Judi Gast RN, BSN
IT Analyst/Programmer
Information Management and Technology
P: 912-287-4241
F: 912-287-2579
__________________________________________
Mayo Clinic Health System in Waycross
1900 Tebeau Street
Waycross, GA 31501
From: Meditech-l [mailto:meditech-...@mtusers.com]
On Behalf Of Ventura, Andrew
Sent: Thursday, May 14, 2015 10:58 AM
To: medit...@mtusers.com
Subject: [MT-L] FSV Loads inactivating RXM drugs inappropriately
Hi Folks,
Griffin, Paul
There is a DTS for this. It’s in DEV status.
DTS: PHA #13167
Description: Inactive drug created after FSV load for Medi-Span
Release: 5.66
P
Please consider the impact to the environment before printing this
email.
P Please consider the impact to the environment before printing this
email.
Gast, Judith A., R.N.
Thanks Paul…that helps knowing it is Medispan only…
Have a Great Day!
Judi Gast RN, BSN
IT Analyst/Programmer
Information Management and Technology
P: 912-287-4241
F: 912-287-2579
__________________________________________
Mayo Clinic Health System in Waycross
1900 Tebeau Street
Waycross, GA 31501
Paul Goedicke
We’re Magic and use MediSpan. This has been happening several years for us. I can’t remember if it started with the RXM Drug Dictionary expunge/clean-up or was happening prior. We have had to schedule and switch to off-hours filing of formulary in RXM due to specific high volume (i.e. pediatric vaccines) getting inactivated every time we file. We schedule it so a Pharmacist has a chance to reactivate drugs prior to our (LSS) employed physician clinics opening for patients.
Meditech has not been able to resolve the issue so far.
Thanks to Paul Griffin for the proposed DTS information.
Paul Goedicke
Clinical Analyst III
Jackson County Memorial Hospital
1200 East Pecan
Altus, OK 73521
I hope to be the kind of person my dog thinks I am.
- anonymous
From: Meditech-l [mailto:meditech-...@mtusers.com] On Behalf Of Ventura, Andrew
Sent: Thursday, May 14, 2015 11:20 AM
To: Gast, Judith A., R.N.; medit...@mtusers.com
The documents accompanying this transmission contain confidential information, belonging to the sender, that is legally privileged. This information is intended only for the use of the individual or entity named above. The authorized recipient of this information is prohibited from disclosing this information after its stated need has been fulfilled.
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Ventura, Andrew
Thanks Paul! It’s unfortunate that you’re able to provide us with more information than meditech! We were hoping it was MediSpan only, since we go FDB this summer.
--Andrew
From: Griffin, Paul [mailto:PGri...@emersonhosp.org]
Sent: Thursday, May 14, 2015 12:42 PM
Griffin, Paul
This issue is so strange I don’t know who to blame….
Last week (now I can’t find it) I saw this (it was a real NDC, not a mockup as below)
00000-0000-00A
00000-0000-00B
00000-0000-00C
00000-0000-00D
00000-0000-00E
00000-0000-00F
00000-0000-00G
00000-0000-00H
00000-0000-00I
00000-0000-00J
00000-0000-00K
00000-0000-00L
00000-0000-00M
00000-0000-00N
00000-0000-00O
00000-0000-00P
All inactive. We only use “F” as a suffix on any formulary medications, so who is creating these?
Paul E. Griffin, R.Ph.
Pharmacy Informatics
Emerson Hospital
Ventura, Andrew
Well that sounds like your “inactive drug created after FSV load for Medi-Span” which could be different than my issue. No new drugs are improperly created for us, just existing ones improperly inactivated.
I’ll post the DTS # and anything useful when programming decides to share it with us. I wasn’t able to find any info on the DTS you posted. We had issues with RXM 6431 Medispan: Drugs not updated with new NDC numbers but those were resolved. As well as RXM 6173 MEDI-SPAN: FSV Update creates duplicate in RXM Drug Dx for NDC with suffix however that is still in development and did not discuss a problem with inactivating suffixed NDCs. Plus, we’re not even getting duplicates made. Some drugs have no active mnemonic at all after an FSV load… those hurt the worst for home med list and prescribing issues.
Ventura, Andrew
Apparently this is a new problem, and not limited to MediSpan.
DTS: CS RXM 6970 “RXM Drugs with Suffixed NDCs inactivated when PHA Drug with same NDC is edited”
No timeframe, but they are going to try to work on a way for me to tell which RXM drugs I can go back and reactivate amongst all the many inactive RXM drugs we have.
Thanks,
Andrew Ventura, Pharm.D, MBA
Pharmacy Informaticist
Augusta Health, Fishersville VA
C/S 5.66pp8
Carpenter, Michael
Andrew, are you magic or 6.# c/s or c/s? At what release? Txs!
Charles Downs
| Dose Range Duration Can Load Incorrectly (FDB) | ||
| Dose Range Duration Can Load Incorrectly (FDB) | ||
| FDB Created Units Of Measure Can Exceed 10 Character Mnemonic Limit |
From: Meditech-l [meditech-...@mtusers.com] On Behalf Of Ventura, Andrew [AVen...@AugustaHealth.com]
Sent: Thursday, May 14, 2015 1:40 PM
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Dana Olson
Our site is CS 5.66 PP8 and I believe this started at our site with our 5.66 PP4 delivery. We’ve had a task open for more than a year. We also use Medispan.
Meditech originally felt this was due to having a lower case alph character on the PHA drug. We fixed this issue and it had no effect on our issue. We continued to see common drugs inactivated with every load. (Maintenance nightmare and physician irritator!!).
We have received RXM 5906 and RXM 6309 – the issue continued…
Programming tells us, and I quote – “If there is an entry on the RXM.DRUG.gpi.gcn.status.x index, even if inactive entry, the system will not create a new drug entry with the same raw brand name and GPC.”
We are sure wondering what kind of sense that makes! If the drug was inactivated due to NDC changes, the system will not create a new one???
Latest thing done that has helped with this issue is that programming reviewed the HXDGGS index in saw that there were multiple entries with the same GPC and trade name for different drugs, when there should be 1 to 1 ratio. Programming ran a clean-up loop of the HXDGGS index (removed any inactive entry from the HXDGGS index) and reset our FSV number so we could reload our FSV content. We saw lots and lots of new drugs created after running this clean-up and so far our latest run did not inactivated an drugs that I could find inappropriately.
I am concerned that this issue will recur. So, our specialist has submitted RXM 6946 “Inactivate AND Deindex via the EXPUNGE prevent new drug entries being created”
Hope this helps other CS sites!
Dana Olson, RN
Clinical Systems Coordinator
315 W. 15th
Liberal, KS 67901
620-629-6338, Fax: 620-629-6352
Confidential: This electronic message and all contents contain information from Southwest Medical Center which may be privileged, confidential or otherwise protected from disclosure. This information is intended to be for the addressee only. If you are not the addressee, any disclosure, copy, distribution or use of the contents of this message is prohibited. If you have received this electronic message in error, please notify the sender and destroy the original message and all copies. Thank you.
Ventura, Andrew
Oh I just meant that we may map RXM Lisinopril 5mg and 2.5mg on page 5 to our inpatient drug LISINU2.5 but we wouldn’t want both of those RXM entries having the same PHA drug of LISINU2.5, it gives meditech more than one option for discharge mapping and I think it just uses the first one it comes across. For each PHA drug we use for inpatients, we try to assign it to only 1 RXM mnemonic in the PHA drug field so we always know which RXM drug the discharge module to jump to if an inpatient med is converted at discharge.
Maybe someday it’ll get easier. Or we’ll abandon mnemonic mapping altogether and get some kind of system that limits us to one entry per RxNorm.
From: Betit, Christina [mailto:Christi...@svhealthcare.org]
Sent: Friday, May 15, 2015 9:13 AM
To: Ventura, Andrew; 'Charles Downs'; Griffin, Paul; Gast, Judith A., R.N.; medit...@mtusers.com
Subject: [TAGGED] RE: FSV Loads inactivating RXM drugs inappropriately
It’s funny that you mention that…….I just tested the CFA field (and updated my list of common meds) using different strengths and it works as long as it’s a medication that can be either split or use multiples of to make up the dose. This seems to work without a problem.
|
|
Christina Betit |
From: Ventura, Andrew [mailto:AVen...@AugustaHealth.com]
Sent: Friday, May 15, 2015 9:08 AM
To: Betit, Christina; 'Charles Downs'; Griffin, Paul; Gast, Judith A., R.N.;
medit...@mtusers.com
Subject: RE: FSV Loads inactivating RXM drugs inappropriately
Christina,
How does that impact your mapping for what RXM mnemonics are used when an inpatient med is converted to an rxm script during the discharge process?
We did what you first did, and continue to do so, which allows for our discharge mapping to function as desired. We also map the CFA piece of page 5 so that the reverse maps appropriately, although the mapping between those two fields is not interchangeable, due to the difference in strengths that we do and do not carry.
Andrew
From: Betit, Christina [mailto:Christi...@svhealthcare.org]
Sent: Friday, May 15, 2015 8:50 AM
To: 'Charles Downs'; Ventura, Andrew; Griffin, Paul; Gast, Judith A., R.N.;
medit...@mtusers.com
Subject: [TAGGED] RE: FSV Loads inactivating RXM drugs inappropriately
When I took this position, I was originally told by a consultant that the correct place to put our formulary mnemonic was in the “PHA Drug” field on page 1, then I learned later that the correct place to associate our formulary medication was actually on page 5 at the bottom. During a long and tedious process, I had to remove our formulary item from page 1 and replace it with a correct NDC from the retail environment for all of our common meds. I haven’t seen this issue since they’ve been replaced with the retail NDCs. Hope this helps.
|
|
Christina Betit |
From: Meditech-l [mailto:meditech-...@mtusers.com]
On Behalf Of Charles Downs
Sent: Friday, May 15, 2015 8:25 AM
To: Ventura, Andrew; Griffin, Paul; Gast, Judith A., R.N.;
medit...@mtusers.com
Subject: Re: [MT-L] FSV Loads inactivating RXM drugs inappropriately
There was a priority event (PE: Dose Range Duration Can Load Incorrectly (FDB) which may be causing this. It had to do with RXM NDC's with alpha suffixes not being inactivated when they become obsolete. However, this just applied to FDB. I wonder if Medispan had a similar issue?
Related DTS:
|
[VM/PHA 12118] |
|
Dose Range Duration Can Load Incorrectly (FDB) |
|
[PHA 12971] |
|
Dose Range Duration Can Load Incorrectly (FDB) |
|
[PHA 12548] |
Charlie Downs
DISCLAIMER: The information contained in this electronic message is
legally privileged and confidential under applicable law and is intended
for a particular addressee(s). If it is not clear that you are the intended
recipient, you are hereby notified that you have received this transmittal
in error; any review, copying or distribution or dissemination is strictly
prohibited. If you suspect that you have received this transmittal in
error, please notify Southwestern VT Health Care Corporation
immediately by return email reply to (help...@phin.org), and
immediately delete the transmittal and any attachments without making
any copy or distribution. Thank you.
DISCLAIMER: The information contained in this electronic message is
legally privileged and confidential under applicable law and is intended
for a particular addressee(s). If it is not clear that you are the intended
recipient, you are hereby notified that you have received this transmittal
in error; any review, copying or distribution or dissemination is strictly
prohibited. If you suspect that you have received this transmittal in
error, please notify Southwestern VT Health Care Corporation
immediately by return email reply to (help...@phin.org), and
immediately delete the transmittal and any attachments without making
any copy or distribution. Thank you.
Charles Downs
From: Betit, Christina [Christi...@svhealthcare.org]
Sent: Friday, May 15, 2015 8:49 AM
To: Charles Downs; Ventura, Andrew; Griffin, Paul; Gast, Judith A., R.N.; medit...@mtusers.com
Subject: RE: FSV Loads inactivating RXM drugs inappropriately
When I took this position, I was originally told by a consultant that the correct place to put our formulary mnemonic was in the “PHA Drug” field on page 1, then I learned later that the correct place to associate our formulary medication was actually on page 5 at the bottom. During a long and tedious process, I had to remove our formulary item from page 1 and replace it with a correct NDC from the retail environment for all of our common meds. I haven’t seen this issue since they’ve been replaced with the retail NDCs. Hope this helps.
|
|
|
Christina Betit |
Sent: Friday, May 15, 2015 8:25 AM
To: Ventura, Andrew; Griffin, Paul; Gast, Judith A., R.N.; medit...@mtusers.com
Subject: Re: [MT-L] FSV Loads inactivating RXM drugs inappropriately
There was a priority event (PE: Dose Range Duration Can Load Incorrectly (FDB) which may be causing this. It had to do with RXM NDC's with alpha suffixes not being inactivated when they become obsolete. However, this just applied to FDB. I wonder if Medispan had a similar issue?
Related DTS:
|
[VM/PHA 12118] |
|
Dose Range Duration Can Load Incorrectly (FDB) |
|
[PHA 12971] |
|
Dose Range Duration Can Load Incorrectly (FDB) |
|
[PHA 12548] |
Charlie Downs
DISCLAIMER: The information contained in this electronic message is
legally privileged and confidential under applicable law and is intended
for a particular addressee(s). If it is not clear that you are the intended
recipient, you are hereby notified that you have received this transmittal
in error; any review, copying or distribution or dissemination is strictly
prohibited. If you suspect that you have received this transmittal in
error, please notify Southwestern VT Health Care Corporation
immediately by return email reply to (help...@phin.org), and
immediately delete the transmittal and any attachments without making
any copy or distribution. Thank you.
Betit, Christina
When I took this position, I was originally told by a consultant that the correct place to put our formulary mnemonic was in the “PHA Drug” field on page 1, then I learned later that the correct place to associate our formulary medication was actually on page 5 at the bottom. During a long and tedious process, I had to remove our formulary item from page 1 and replace it with a correct NDC from the retail environment for all of our common meds. I haven’t seen this issue since they’ve been replaced with the retail NDCs. Hope this helps.
|
|
Christina Betit |
From: Meditech-l [mailto:meditech-...@mtusers.com]
On Behalf Of Charles Downs
Sent: Friday, May 15, 2015 8:25 AM
To: Ventura, Andrew; Griffin, Paul; Gast, Judith A., R.N.; medit...@mtusers.com
Subject: Re: [MT-L] FSV Loads inactivating RXM drugs inappropriately
There was a priority event (PE: Dose Range Duration Can Load Incorrectly (FDB) which may be causing this. It had to do with RXM NDC's with alpha suffixes not being inactivated when they become obsolete. However, this just applied to FDB. I wonder if Medispan had a similar issue?
Related DTS:
|
[VM/PHA 12118] |
|
Dose Range Duration Can Load Incorrectly (FDB) |
|
[PHA 12971] |
|
Dose Range Duration Can Load Incorrectly (FDB) |
|
[PHA 12548] |
Charlie Downs
DISCLAIMER: The information contained in this electronic message is
Betit, Christina
It’s funny that you mention that…….I just tested the CFA field (and updated my list of common meds) using different strengths and it works as long as it’s a medication that can be either split or use multiples of to make up the dose. This seems to work without a problem.
|
|
|
Christina Betit |
From: Ventura, Andrew [mailto:AVen...@AugustaHealth.com]
Sent: Friday, May 15, 2015 9:08 AM
To: Betit, Christina; 'Charles Downs'; Griffin, Paul; Gast, Judith A., R.N.; medit...@mtusers.com
Subject: RE: FSV Loads inactivating RXM drugs inappropriately
Christina,
How does that impact your mapping for what RXM mnemonics are used when an inpatient med is converted to an rxm script during the discharge process?
We did what you first did, and continue to do so, which allows for our discharge mapping to function as desired. We also map the CFA piece of page 5 so that the reverse maps appropriately, although the mapping between those two fields is not interchangeable, due to the difference in strengths that we do and do not carry.
Andrew
From: Betit, Christina [mailto:Christi...@svhealthcare.org]
Sent: Friday, May 15, 2015 8:50 AM
To: 'Charles Downs'; Ventura, Andrew; Griffin, Paul; Gast, Judith A., R.N.;
medit...@mtusers.com
Subject: [TAGGED] RE: FSV Loads inactivating RXM drugs inappropriately
When I took this position, I was originally told by a consultant that the correct place to put our formulary mnemonic was in the “PHA Drug” field on page 1, then I learned later that the correct place to associate our formulary medication was actually on page 5 at the bottom. During a long and tedious process, I had to remove our formulary item from page 1 and replace it with a correct NDC from the retail environment for all of our common meds. I haven’t seen this issue since they’ve been replaced with the retail NDCs. Hope this helps.
|
|
Ventura, Andrew
Christina,
How does that impact your mapping for what RXM mnemonics are used when an inpatient med is converted to an rxm script during the discharge process?
We did what you first did, and continue to do so, which allows for our discharge mapping to function as desired. We also map the CFA piece of page 5 so that the reverse maps appropriately, although the mapping between those two fields is not interchangeable, due to the difference in strengths that we do and do not carry.
Andrew
From: Betit, Christina [mailto:Christi...@svhealthcare.org]
Sent: Friday, May 15, 2015 8:50 AM
To: 'Charles Downs'; Ventura, Andrew; Griffin, Paul; Gast, Judith A., R.N.; medit...@mtusers.com
Subject: [TAGGED] RE: FSV Loads inactivating RXM drugs inappropriately
When I took this position, I was originally told by a consultant that the correct place to put our formulary mnemonic was in the “PHA Drug” field on page 1, then I learned later that the correct place to associate our formulary medication was actually on page 5 at the bottom. During a long and tedious process, I had to remove our formulary item from page 1 and replace it with a correct NDC from the retail environment for all of our common meds. I haven’t seen this issue since they’ve been replaced with the retail NDCs. Hope this helps.
|
|
Charles Downs
From: Ventura, Andrew [AVen...@AugustaHealth.com]
Sent: Friday, May 15, 2015 9:21 AM