Microsoft Access Pharmacy Database Free Download

[Kerrie Gingrich]

We've got an old Microsoft Access pharmacy application which acts as a front-end to a SQL Server 2016 database. Periodically the application will just start running slowly. We're working on a modern replacement app, but that won't be available for months. In the meantime, what can we do about this application suddenly running slowly?

Here's what I did. I got into SSMS and ran both sp_who and sp_who2, to find out what was hanging and to see if any session was blocking any other session. Nothing was hung and none of the sessions were blocking any other sessions.

Now I'm going to speculate and I could be entirely wrong and off base. I know that when SQL Server reboots, it replenishes a pool of new IDs for identity columns. The Pharmacy gets kinda bent out of shape when they see a "gap" in those numbers. (I think their practice is to print out a long list of labels, based upon those identity values, then apply those to bottles, containers, etc., anything that holds what the pharmacy houses. To have an interruption in the list of labels they've printed really torques them.) If that pool of identity values runs out, could that cause the application to run slow?

The absence of evidence is not evidence of absence

- Martin Rees

The absence of consumable DDL, sample data and desired results is, however, evidence of the absence of my response

- Phil Parkin

I ran into this myself when we migrated to SQL2012 with an app that the identity value meant something to the users and they were not happy with gaps in the sequence. So the developer and myself worked up an Agent job to run when SQL restarts to check the last identity value in the table, then run DBCC CHECKIDENT( table, RESEED, value)

Rod: Not sure if having the current batch of identity values "run out" would cause a slow down. I'm pretty sure at one time I found something on HOW SQL handles identity values in the cache and refreshing, but it was a while back and I'm not sure I could find it again.

The absence of evidence is not evidence of absence

- Martin Rees

The absence of consumable DDL, sample data and desired results is, however, evidence of the absence of my response

- Phil Parkin

Your list of other things to check I think is very good. There are about 8 databases on that server, of which I know of 3 and only have access to one of them. There very well might have been something else going on with one of the other applications. I got one of the official DBAs onto it. However about 2 hours after posting my original post the decision was made to reboot the server. This application I help support is too critical to let it languish too long. So we rebooted the server. Once it came up the users of the application that was running slow, reported that it was responding normally again. Congratulations all around, people slapping one another on the back. But I still have the feeling that all we've done is kicked the can down the road.

I don't like MS Access, so my nature inclination is to blame Access for any problems. Its really hard for me to ignore my prejudice against Access. It really may be Access. We're working on replacing that Access app with a more modern app, but it won't be ready for months.

I haven't used Access as a front end for SQL for a long time but I remember that it used to get slower over time. I had to make sure the Access application was closed every so often. We had people leaving themselves logged into their workstation and leaving the Access application open so it was never, or rarely, closing. As soon as it got closed regularly (I get remember the exact timescales) the speed problem went away. I never worked out why.

WOW! That's interesting. I suppose that could be happening in this case. I certainly can see how just starting logged in and in the app for days on end, could cause that. Then when we reboot the server, we tell them to get out of the app. So, in actual fact we have be inadvertently resolving the issue, then they get out of the app, waiting for the server to reboot.

Thanks for the reply. One detail I forgot - if I remember correctly it didn't have to be the same user logged in. As long as there was always someone logged in then, at some point, the Access application would slow down. In case it's relevant the application was being run from a mapped network drive and the SQL Server was on the same local lan.

Not seen any mention, but more than likely this may be a bad plan from executed sql. Run sp-whoisactive, or download Brent Ozar's blitzcache. Start there as soon as it gets slow, look for blocking etc. Also if all your stuff is on prem this setup may work, but using Citrix would also help alot.

The Prescription Safety Acts and TN Together Legislation represented a significant effort by the General Assembly to address the problem of prescription drug abuse. These Acts have significantly changed the regulations related to the CSMD. Before opioids are prescribed or dispensed, please refer to the TN Together Laws and Policies website to understand when an ICD-10 code or a finding of medical necessity may be and/or must be added to a prescription or when partial fills are allowed on certain opioid prescriptions.

All healthcare practitioners with DEA numbers who prescribe or dispense controlled substances in a practice providing direct care to patients in Tennessee on more than fifteen (15) days in a calendar year must be registered in the CSMD. Licensed veterinarians who never prescribe or dispense a controlled substance in an amount intended to treat a non-human patient for more than five (5) days are not required, but are encouraged to register. It is vital that each registrant provides and maintains a unique and valid e-mail address within the CSMD so that the CSMD may communicate with the registrant to ensure continued access to the database.

Healthcare practitioners or persons under the supervision and control of the practitioners, pharmacists or pharmacies who are legally authorized to dispense a schedule II, III, IV, or V controlled substance are required to submit certain data to the CSMD.

If required to register as set out above, a Healthcare Practitioner, both prescribers and dispensers, or their agents must register within 30 days of receiving a DEA number or becoming an agent of a Healthcare Practitioner with a DEA number.

Yes, if you are authorized to practice in TN and otherwise qualified to register in TN you can register. Otherwise, you should register with home state PDMP and TN has agreements to share with the majority of states.

In order to assure you maintain access to the system, you must always keep a unique active email address. Please be sure to update your account as needed by navigating to the My Account link after successfully logging in at www.tncsmd.com.

A new episode of treatment means a prescription for a controlled substance that has not been prescribed by that healthcare practitioner within the previous six (6) months. A new episode of treatment includes not only changes to specific drugs but also all changes to dosage and frequency of the drugs prescribed.

Healthcare practitioners are required to check the CSMD before dispensing an opioid, benzodiazepine or Schedule II amphetamines as a new episode of treatment to a human patient: (1) for the first time at that practice site and (2) every six (6) months thereafter if that treatment is continued.

However, healthcare practitioners are not required to check, pursuant to statute, if: (a) the controlled substance is prescribed or dispensed for a patient who is currently receiving hospice care; ; (b) the quantity of the controlled substance which is prescribed or dispensed does not exceed an amount which is adequate for a single, three-day treatment period and does not allow a refill; or (c) the controlled substance is prescribed for administration directly to a patient during the course of inpatient or residential treatment in a hospital or nursing home licensed under title 68.

Before prescribing or dispensing, a healthcare practitioner is also required to check the database if the healthcare practitioner is aware or reasonably certain that a person is attempting to obtain a Schedule II-V controlled substance, identified by the committee or commissioner as demonstrating a potential for abuse, for fraudulent, illegal, or medically inappropriate purposes, in violation of 53-11-402.

Licensed veterinarians are not required to check the database before prescribing a controlled substance to a non-human patient. However, changes to the scheduling of certain drugs, most pertinently gabapentin, may affect the requirements related to the treatment of non-human patients.

A certified registered nurse anesthetist (CRNA) as described in Section 63-7-103 of the Tennessee Code Annotated. Tennessee is one of the first states to allow direct access for CRNAs without a DEA Registration.

Additionally, the law allows a number of other state and federal officials to register with the database including, certain law enforcement officers, medical examiners, drug court judges, and others. For more information regarding such registration please refer to Tenn. Code Ann. 53-10-306.

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