[MEDITECH-L] IV Doses on MG eMAR Desktop 5.62

[Schloyer, Bryce A]

Hi All,

The day is approaching that we are going to be bringing up eMAR Desktop
here, and Pharmacy has a few concerns with the way the eMAR displays
doses for IVs.

What is the consensus on how to enter an IVPB order? I'll give a few
options...

Nitropress 25 mg/ml in D5W 250

1. Nitropress 50 grams

D5W 250 mls

Total Volume: 250

Calculated Volume: 252

2. Nitropress 50 grams

D5W 250 mls

Total Volume: 252

Calculated Volume: 252

3. Nitropress 50 grams

D5W 248 mls

Total Volume: 250

Calculated Volume: 250

The concerns Pharmacy has is that nursing won't agree with the order
regardless of how pharmacy enters it based on the eMAR display of the
Dose:

In Option 1 the eMAR displays: Nitropress 2
ml (50 grams)

D5W
250 ml

____________

Total Volume: 250 mls

In Option 2 the eMAR displays: Nitropress 2
ml (50 grams)

D5W
250 ml

____________

Total Volume: 252 mls

In Option 3 the eMAR displays: Nitropress 2
ml (50 grams)

D5W
248 ml

____________

Total Volume: 250 mls

The Doctor ordered 250 mls of D5W but Pharmacy truly only used 248. How
is that best represented to Pharmacy and Nursing?

Thanks!

Bryce A. Schloyer

IS Applications Specialist

Providence Health & Services, California Region

501 S. Buena Vista St.

Burbank, CA 91505

bryce.s...@providence.org

(818) 847-4823 - (Office)

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[Lanoue, Ed T]

For continuous drips we strive for an even number in the final volume.
Clinically I would not be concerned with 2 ml from a 250 ml which is
probably closer to 275 ML if the overfill is factored with the bags. I
think 2 ml is not significant but we pull out and then put in an
equivalent amount of the drug for consistency. Make the final volume
appear to make sense to nursing.

The bigger question is when will Meditech fix the premix problem!!?

Thanks,
Ed

Edward Lanoue, RPh
Informatics Pharmacist
Southwestern Vt Medical Center
100 Hospital Drive East
Bennington, VT 05201
phone: 802-447-5370
e...@phin.org

Hi All,

1. Nitropress 50 grams

D5W 250 mls

Total Volume: 250

Calculated Volume: 252

2. Nitropress 50 grams

D5W 250 mls

Total Volume: 252

Calculated Volume: 252

3. Nitropress 50 grams

D5W 248 mls

Total Volume: 250

Calculated Volume: 250

D5W
250 ml

____________

Total Volume: 250 mls

D5W
250 ml

____________

Total Volume: 252 mls

D5W
248 ml

____________

Total Volume: 250 mls

Thanks!

Bryce A. Schloyer

IS Applications Specialist

Burbank, CA 91505

bryce.s...@providence.org

(818) 847-4823 - (Office)

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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.

[Schloyer, Bryce A]

Hi All,

The day is approaching that we are going to be bringing up eMAR Desktop
here, and Pharmacy has a few concerns with the way the eMAR displays
doses for IVs.

What is the consensus on how to enter an IVPB order? I'll give a few
options...

Nitropress 25 mg/ml in D5W 250

1. Nitropress 50 grams

D5W 250 mls

Total Volume: 250

Calculated Volume: 252

2. Nitropress 50 grams

D5W 250 mls

Total Volume: 252

Calculated Volume: 252

3. Nitropress 50 grams

D5W 248 mls

Total Volume: 250

Calculated Volume: 250

The concerns Pharmacy has is that nursing won't agree with the order
regardless of how pharmacy enters it based on the eMAR display of the

Dose (see attached).

[Lanoue, Ed T]

Hi Hollie and others,

Terry: I didn't get your message. Angeloni, Terry"
<Terry.A...@provena.org> has tried to send you a message that
included an attachment that was blocked. We do not allow attachments of
type "None". If you were not expecting this file, please disregard this
notice and do not contact the sender.

I wanted to treat all of my IVs as IV type and put everything in IV
order strings. On eMAR when you are documenting IV types of orders only
the volume is displaying as a dose. During eMAR implementation, nursing
was dismayed to see cefazolin 1 gm/50 ml NS displaying as 50 ml for the
dose and not as 1 GM/50 ML which would have made sense to them. There is
an option to display the additive dose and units of the 1st ingredient
which is what I did but it is far from ideal.

The big issue is when it comes to items like Levofloxacin 500 MG/100
ML IV. I need to be able to treat this as an IV type and not a MED. If I
put this in the carrier field then the strength is stripped away and all
I see is LEVOFLOXACIN 100 ML and the nurse is documenting that. You look
in PCI and it's a mess for the physicians. The only way I could even get
close to fixing this was to incorporate the strength into the generic
name like this: Levofloxacin (500 mg), then it looked "okay". I know
some sites incorporate a dummy carrier and treat the premix like an
additive. That is wrong especially with BMV and Meditech should fix
this. The items should be treated almost as a "med" in terms of
dispensing and documentation of dose. I can manipulate the rx.id.text
and that works fine. The dose documented is still in ml but the full
description is available and it is consistent with all the other IV
types.

Then the real problem is with KCL bolus meds. In this case if you
build the drug as a string then dosing in ML becomes VERY confusing for
nursing and pharmacy as well. If they take the med out on Pyxis and need
to give 40 mEQ and the volume is 200 ml, how are they going to know
this? We use the MED type for these orders or I would create an order
string with a dummy carrier since the RX number would be used to scan
the IV (cover up the manufacturer label on the IV bag).
I cannot create a system that requires additional steps for nursing such
as scanning a dummy carrier barcode label to complete the compound
verification steps. We have ADDVantage and the nurse scans the vial and
the bag.

I believe Meditech should create the option to have orders entered in
a "premix mode" that will display both the strength and volume and
retain all the functionality of the IV function. Sometimes this should
extend to cefazolin 1 gm/50 ml; the dose/volume should be able to be
displayed together as a "dose": 1 GM/50 ML. If you have multiple
ingredients, then display only in ML. Give us the option on how to
display/document this information. If anyone who has BMV and is not
entering premixes as a med type and has a better way of setting these
orders up in the system (especially those with CPOE), I'd be grateful.
Meditech needs to fix this as this one size fits all doesn't work with
premixes.

Thanks for listening,
Ed

Edward Lanoue, RPh
Informatics Pharmacist
Southwestern Vt Medical Center
100 Hospital Drive East
Bennington, VT 05201
phone: 802-447-5370
e...@phin.org

-----Original Message-----
From: Teitzel, Hollie S [mailto:Hollie....@ministryhealth.org]
Sent: Friday, March 13, 2009 9:51 AM
To: Lanoue, Ed T
Subject: RE: [MEDITECH-L] IV Doses on MG eMAR Desktop 5.62

Hello Ed,
What premix problem????? We are Magic 5.62.

Hollie Teitzel
Clinical Analyst
Door County Memorial Hospital
X3720

Thanks,
Ed

Hi All,

1. Nitropress 50 grams

D5W 250 mls

Total Volume: 250

Calculated Volume: 252

2. Nitropress 50 grams

D5W 250 mls

Total Volume: 252

Calculated Volume: 252

3. Nitropress 50 grams

D5W 248 mls

Total Volume: 250

Calculated Volume: 250

D5W
250 ml

____________

Total Volume: 250 mls

D5W
250 ml

____________

Total Volume: 252 mls

D5W
248 ml

____________

Total Volume: 250 mls

Thanks!

Bryce A. Schloyer

IS Applications Specialist

Burbank, CA 91505

bryce.s...@providence.org

(818) 847-4823 - (Office)

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[George W. Carrico]

I'm with you..premixes do not display properly on eMAR. None of them.
Our workaround was to create a 'dummy' carrier like Premixed IV Bag 100 ml and add the drug premixed bag as an additive. Funny, MT wanted by help to create a DTS to address this issue.
Premix drips are really a problem on eMAR...when entering rates when charting, ml/hr rates will not calculate unless you make the premix an additive as above.
All these years and MT still hasn't gotten this right.
We are CS 5.62 so we're new at the game, but some of you folks have been dealing with this for years.

George Carrico, RPh
Paradise Valley Hospital Pharmacy
gcar...@primehealthcare.com

[Roger Beverly]

We just went live with 5.62 sr 14. Here is the way premix iv's display
for us:

The Levaquin 500mg/100ml near the bottom is the default label comment
that we added in the drug dictionary.

Roger

-----Original Message-----
From: meditech-...@mtusers.com
[mailto:meditech-...@mtusers.com] On Behalf Of Lanoue, Ed T

Sent: Friday, March 13, 2009 11:53 AM
To: Teitzel, Hollie S; Medit...@MTUsers.com;
Terry.A...@provena.org

[Lanoue, Ed T]

Hi Roger,

Thanks for sharing. How does this show up in PCI? Do you see the
500 MG anywhere without drilling into the order? Do you feel the current
premix setup given to us by Meditech is okay or am I all wet to expect
additional functionality? I've been working with nurses too much over
the last year and I'm developing a "that's stupid" attitude instead of
just tolerating and working around the shortcomings of the system as I
know we must.

Thanks!
Ed

[Sarah Nash]

I am struggling with this right now as well. An additional problem with
this is when the order is generated via PWM-POM-OM. : The notification
that prints to the nursing stations just reads Levofloxacin IV with no
dose defined and a volume of 100 ml. The nurse doesn't know what she
should be giving dose-wise.
Sarah Nash R Ph
Brooks Memorial Hospital

[Charlie Downs]

We've had this problem for years in PCI. What we have had to do is to create
a specific name such as Levoflxacin 500 mg Premix. Meditech really does need
to fix the problem.
Charlie

Charles Downs PharmD
Washington County Hospital
251 E. Antietam Street
Hagerstown, MD, 21740
301-790-8904

Roger

Hi Hollie and others,

Thanks for listening,
Ed

Thanks,
Ed

Hi All,

1. Nitropress 50 grams

D5W 250 mls

Total Volume: 250

Calculated Volume: 252

2. Nitropress 50 grams

D5W 250 mls

Total Volume: 252

Calculated Volume: 252

3. Nitropress 50 grams

D5W 248 mls

Total Volume: 250

Calculated Volume: 250

D5W 250
ml

____________

Total Volume: 250 mls

D5W 250
ml

____________

Total Volume: 252 mls

D5W
248 ml

____________

Total Volume: 250 mls

Thanks!

Bryce A. Schloyer

IS Applications Specialist

Burbank, CA 91505

bryce.s...@providence.org

(818) 847-4823 - (Office)

====================================

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[Roger Beverly]

This is how it displays in PCI for Medications w/Admins summary:

Name Dose Sig Route Date/Time Start
Stop
Levaquin 500MG Bag 100 ML Q24H IV
03/16/09 03/23/09

I checked PCI in 5.61 and it displays the same way. Even in the
medication order history it displays as Levaquin 500mg Bag. I am
actually not sure where that description comes from. I may be the trade
name - both of the drugs I have set up with the mg in the trade name.
See below:

Mnemonic LEV500PB Active Y Usage Type Formulary
Other
Mnemonics Admin Routes
FSV Generic
IV
Trade Name Levaquin 500MG Bag
XX
Brand Name Levaquin 500MG/100ML Bag
Generic Equiv Levofloxacin 500/100ML MG Bag NDC/DIN #
00045006801
Carrier?
Y Ck Int?Y
Print # 4870 Pre-mix
Y
Generic LEVOFL Levofloxacin Hemihydrate Additive?
Strength 500 MG/100 ML Ord Daily?
Admin Form IV INTRAVENOUS Drip Unit
/kg/
Dispense Form PREMIX PREMIX BAG Compound?
Order Size 500 (MG ) Ord: by
OE? by OR?
Dispense Size 100 (ML )

Drug ID Levofloxacin Hemihydrate 500 MG/100 ML PREMIX

Roger

-----Original Message-----
From: Lanoue, Ed T [mailto:e...@phin.org]

[Chicoine, Doris]

Do you feel the current premix setup given to us by Meditech is okay or
am I all wet to expect additional functionality?

The current set up is NOT okay when it comes to creating a concentration
in order to use dosing such as 20 mcg/kg/min.
For dopamine and Dobutamine premixes, for instance, I have to have a
dummy IV fluid with 0 ml, then the premix fluid is the additive with
total vol. Correct in order to use weight based dosing.

Doris

-----Original Message-----
From: meditech-...@mtusers.com
[mailto:meditech-...@mtusers.com] On Behalf Of Lanoue, Ed T

Sent: Monday, March 16, 2009 9:09 AM

[Charlie Downs]

What you are seeing is the trade name. However, if you display the generic
name, unless you have built a specific generic name (Levofloxacin 500 mg
Premix), you will only see Levofloxacin, and this is where the problem is.
I've harped on this before to Meditech, but to no avail. However, because of
the problem with e-MAR and POM, maybe they need to reconsider and look at
fixing this by creating some additional fields in the drug dictionary where
you can enter strengths and percentages to the generic name without creating
a new generic name. Plus, if you create a new generic name, there is no way
to update the AHFS codes in the generic dictionary except manually or if you
set the parameter to update them on existing generic name, then it will
change your trade names to what the FSV has.
Charlie

Charles Downs PharmD
Washington County Hospital
251 E. Antietam Street
Hagerstown, MD, 21740
301-790-8904

Roger

Hi Roger,

Thanks!
Ed

Roger

Hi Hollie and others,

Thanks for listening,
Ed

Thanks,
Ed

Hi All,

1. Nitropress 50 grams

D5W 250 mls

Total Volume: 250

Calculated Volume: 252

2. Nitropress 50 grams

D5W 250 mls

Total Volume: 252

Calculated Volume: 252

3. Nitropress 50 grams

D5W 248 mls

Total Volume: 250

Calculated Volume: 250

D5W 250
ml

____________

Total Volume: 250 mls

D5W 250
ml

____________

Total Volume: 252 mls

D5W
248 ml

____________

Total Volume: 250 mls

Thanks!

Bryce A. Schloyer

IS Applications Specialist

Burbank, CA 91505

bryce.s...@providence.org

(818) 847-4823 - (Office)

====================================

====================================

====================================

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[Jeff Lee]

I was waiting to post, but I'll do a snapshot teaser now and try to
update everyone later when we get this fixed...

In 5.6, if you load all generics and create the full RXM dictionary,
you'll likely have the same major file structure problem that we
currently have.

MEDITECH doesn't recommend (allow) you to OVERWRITE FSV Generics and
Classes. We went live with our first load in 1992. We maintained our
own generics and classes since then. Once you load RXM from FDB, you
now have a problem. FDB has modified classes along the way. You now
need to update your ~4000 Formulary drugs with the ~ 33,000 new RXM
drugs if you expect duplicate checking to occur, and maintain this
process with each new load...something not quite doable. MEDITECH is
currently in the process of a 1x overwrite for us, where all our old
class data is blown away and updated with the current FDB classes. They
are also working on a process that maintains the overwrite/update of the
classes for all new/changed drugs.

Check out your systems and see if you don't have the same problem or are
setup to have the same problem when you load RXM. We first noticed this
when Bystolic didn't interact with our older beta blockers.

Jeff Lee
Assistant Director of Pharmacy, Support Services
DCH Regional Medical Center
809 University Blvd E.
Tuscaloosa, AL 35401

(205) 750-5323
jl...@dchsystem.com

The information contained in this e-mail message is confidential
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[Chicoine, Doris]

Throwing this out there:
We are C/S 5.5.4
Build the pre-mix and on Dispensing Tab say yes it can be an IV fluid
and Yes,check for interactions,make sure the Trade name has the dose,
and also the Generic. Build NO Order Strings on the Order Strings tab.,
make POM order type IV.
Now, build a new site specific Order Type (I call mine PBPM) and make it
a Meditech Order Type IV (although 5.4 and higher releases don't require
the distinction, it's all one look-up in POM). Make sure your charging
is appropriate as well.
Build it in the Order Strings Dict. for POM users.
Mine displays w/ the dose on the eMAR this way.

Doris

-----Original Message-----
From: meditech-...@mtusers.com
[mailto:meditech-...@mtusers.com] On Behalf Of Sarah Nash
Sent: Monday, March 16, 2009 1:40 PM

[Jeff Lee]

We are doing very nearly what Roger listed, except that we have created
a new Generic Name with the premix dose included:
"Cefazolin 1 Gram / "

Strength, Order Size and Form are the same as listed below. For POM,
you need to deal with the "Pre-mix" and "POM Type" fields as well (MAGIC
5.62).

I would caution about using workarounds like adding dummy drugs to
orders. These may work okay if PHA is putting in all your orders, but
if NUR or MDs are entering any orders, they're not likely to "go along"
with your custom solutions.

Jeff Lee
Assistant Director of Pharmacy, Support Services
DCH Regional Medical Center
809 University Blvd E.
Tuscaloosa, AL 35401

(205) 750-5323
jl...@dchsystem.com

The information contained in this e-mail message is confidential
information intended only for the use of the individual or entity named
above. If the reader of this message is not the intended recipient or
the employee or agent responsible to deliver it to the intended
recipient, the reader is hereby notified that any dissemination,
distribution or copying of this communication is strictly prohibited.

[Carpenter, Michael--IRM]

Charlie and l'ers: Because of pom/rxm/retail drugs/linx order sets, etc,
the good goal is to standardize to the first databank name. Here is a
possible magic work around:

User embeds a tilde ~ in the drug dictionary's drug id field between the
generic name(s) specifying the concentrations and the packaging info,
ie:
Custom generic: DOPAMINE 400 MG IN D5W 250 ML
FDB desc : DOPAMINE HCL/DEXTROSE 5%-WATER
Original Drug Id : DOPamine 400 MG IN D5W 250 ML 250 ML BAG
Modified Drug Id : DOPamine 400 MG IN D5W 250 ML~250 ML BAG

Then have Meditech modify their @PHA.DRUG.generic.name 'macro' used
everywhere:
Current: @PHA.DRUG.generic.name = @PHA.GENERIC.name[@PHA.DRUG.generic]
Proposed: IF{L(@drug.id,"~")'=L(@drug.id)
@drug.id#"0~";@PHA.GENERIC.name[@PHA.DRUG.generic]}
If tilde present @PHA.DRUG.generic.name would return "DOPamine 400 MG IN
D5W 250 ML" custom generic name ,from custom drug.id, for
reports/views,etc
If tilde not present it would return the 'FDB standardized' generic
name of DOPAMINE HCL/DEXTROSE 5%-WATER, assuming you have replaced your
generics with the fdb generics.

But heck Meditech can eliminate this tilde work around by providing an
additional generic desc field in the drug dictionary ,as Charlie
proposes,
And modify the same @PHA.DRUG.generic.name 'macro' similar to what I
have done here.

I'd like to win powerball too!

Michael D. Carpenter
Senior Systems Analyst, Meditech Clinicals
Inland Northwest Health Services
601 W. First Avenue
Spokane, Wa 99201
509-232-8340
car...@inhs.org

Have meditech modify the @PHA.DRUG.generic.name dpm macro to first test
for the 0~

[Carpenter, Michael--IRM]

L'ers: Because of pom/rxm/retail drugs/linx order sets, etc, the good

goal is to standardize to the first databank name. Here is a possible
magic work around:

User embeds a tilde ~ in the drug dictionary's drug id field between the
generic name(s) specifying the concentrations and the packaging info,
ie:
Custom generic: DOPAMINE 400 MG IN D5W 250 ML
FDB desc : DOPAMINE HCL/DEXTROSE 5%-WATER
Original Drug Id : DOPamine 400 MG IN D5W 250 ML 250 ML BAG Modified
Drug Id : DOPamine 400 MG IN D5W 250 ML~250 ML BAG

Then have Meditech modify their @PHA.DRUG.generic.name 'macro' used
everywhere:
Current: @PHA.DRUG.generic.name = @PHA.GENERIC.name[@PHA.DRUG.generic]
Proposed: IF{L(@drug.id,"~")'=L(@drug.id)
@drug.id#"0~";@PHA.GENERIC.name[@PHA.DRUG.generic]}
If tilde present @PHA.DRUG.generic.name would return "DOPamine 400 MG IN
D5W 250 ML" custom generic name ,from custom drug.id, for
reports/views,etc If tilde not present it would return the 'FDB
standardized' generic name of DOPAMINE HCL/DEXTROSE 5%-WATER, assuming
you have replaced your generics with the fdb generics.

But heck Meditech can eliminate this tilde work around by providing an
additional generic desc field in the drug dictionary ,as Charlie
proposes, And modify the same @PHA.DRUG.generic.name 'macro' similar to
what I have done here.

Your thoughts? Any other ideas?

TIA!

Mike

[Lanoue, Ed T]

We use Micromedex and we haven't set up RXM/POM yet so I am not sure of
any of these ramifications but as a general rule I am attempting to
retain the FSV generic name as much as possible. Still there are times
as we all know where that generic name must be changed. There is a
dictionary field where there is an FSV GENERIC NAME defined (at least
with MDX). I have Dopamine set up as follows:

Mnemonic DOPA400IV Active Y Usage Type Formulary
Other
Mnemonics Admin Routes
FSV Generic DEXTROSE/DOPAMINE HYDROCHLORID
IV
Trade Name DOPamine Premix 800 mcg/mL
NR
Brand Name
Generic Equiv NDC/DIN #
00074414103
Carrier?
Y Ck Int? Y
Print # 36130 Pre-mix
Y
Generic DOPAPREMIX DOPamine (800 MCG/ML) PREMIX Additive?
N
Strength 400 MG/500 ML Ord Daily?
Admin Form INJ INJECTION Drip Unit
/kg/
Dispense Form BAG BAG Compound?
Order Size 400 (MG ) Ord: by
OE? by OR?
Dispense Size 500 (ML )

Drug ID DOPamine (800 MCG/ML) PREMIX 400 MG/500 ML BAG

========================================================================
===

This custom generic is far more descriptive than the FSV supplied
generic.