CPRS Medication Management For any questions not answered here, call Inpatient Pharmacy x61601 or walk down to the Pharmacy on the 4 th floor

Transcription

1 CPRS Medication Management For any questions not answered here, call Inpatient Pharmacy x61601 or walk down to the Pharmacy on the 4 th floor General Tips - If you want a patient to receive the first dose of a medication now, regardless of the remaining schedule, click the First Dose Now box at the bottom of the medication order - If you are unsure what times a medication will be given, the administration times for a given schedule are given just above the comments box when you choose a schedule - If you have special requests about a specific medication order (e.g. a particular schedule, a specific end date for therapy, or a volume at which to end mivf), use the Comments section of the order to outline the schedule you would like and/or call the pharmacy and the pharmacist will help set the schedule for you To list all inpatient and outpatient medications for medication reconciliation Go to Reports à Health Summaries à Med Recon Nat l (couplet). Medications will appear alphabetically. INP indicates an inpatient medication, OPT indicates an outpatient medication. - Don t forget to look at the bottom of the list for any non-va medications, which includes OTC, supplements, and medications from non-va providers - Also look at expired medications, as patients may still be taking these - Right click on the page to print the list so you can review medications with patients in the ER (many ER computers do not work) 1

2 To transfer medications from outpatient to inpatient (and vice versa) Go to Medications and right-click the desired medications, then going to Actions (in the menu at the top left of the screen) à Transfer to Inpatient - May use Shift+click or Ctrl+click to select multiple medications at once - Still need to modify, accept, and sign the orders one by one (the medication order window will pop up sequentially for each medication transferred) - If the patient is still in the ER, you need to have at least basic holding orders in place to transfer medications, and the medications will need to be attached to your delayed order set for admission - The same process in reverse (i.e. click on inpatient medications and select Actions à Transfer to Outpatient) will allow you to transfer medications to outpatient for discharge To see medications given in the ER Go to Notes à Emergency Department Nursing Assessment Note and scroll down to the most recent addendum. This is where any medications given, vitals taken, or procedures performed in the ER are recorded in a stream of consciousness format by time performed/administered. - Medications given in the ER will also show up in the orders under Clinic Administered Medications, but if you click on this order, there will not be recorded administrations even if the medications have been given ER nursing note showing stream of consciousness event & medication administration recording 2

3 To order pain medications Go to Orders à Medications and search for the medication desired. When putting in pain medications, you must put in a pain scale for each pain medication and dose (even non-narcotics). EXAMPLE: morphine 2.5-5mg q4hrs PRN For pain >4/10 give 2.5mg For pain >7/10 give 5mg - If transferring an opiate prescription from inpatient to outpatient, you will need your PIV card and pin to sign the opiate prescription. With very rare exceptions, there are no hardcopy prescriptions at the VA. If patients are on chronic controlled substances, you can check the upper right corner of their Cover Sheet to see if they have a narcotic care plan. - Remember to still look patients up in the Washington State Prescription Monitoring Program (PMP), as they may be receiving opiates and other controlled substances from sources other than the VA The button for patient postings (red, top image) and the resulting list produced when you click it (bottom image) click the first Narcotic Med Plan in the list for the newest version of their care plan To order warfarin or insulin through the Quick Orders menu Please note, this is the ONLY way to order insulin and warfarin in CPRS. The menu also contains helpful standard dosing orders for many other common medications. Go to Orders à Medications à Inpatient Med Quick Orders. 3

4 A portion of the Inpatient Med Quick Order menu Ordering Insulin: When ordering insulin, you will be asked to first note your patient s nutrition (e.g., NPO, eating, tube feeds) and then presented different basal and prandial insulin options. - Clicking an option will also add orders for regular glucose checks and anti-hypoglycemic medications before you order insulin - If want to order only correctional insulin, click Next to skip these orders. Insulin options for patients who are eating or on bolus tube feeds You will then be presented with choices for insulin correction based on patients insulin daily dose. These orders only cover mealtime correction; there is a separate Optional Bedtime Correction order below the other options on the page to order additional correction at bedtime You can also order insulin through Orders à Admission Orders, where you will find Insulin Subcutaneous Orders in the far-right column. 4

5 To order IV antibiotics by indication To order IV antibiotics, go to Orders à Sepsis IV Antibiotics by Suspected Source and click on the indication for antibiotics (see below). These antibiotic orders provide regimens accounting for the local antibiogram, weight-based dosing, and renal function. Antibiotic orders by indication Sample antibiotic dosing options for sepsis of unknown source 5

6 To set complex medication schedules (e.g. alternate day dosing or tapers) To set a complex medication schedule such as alternate dosing for warfarin or a steroid taper, start by searching for and starting the medication order as usual. Once in the order screen for the specific medication, click the Complex tab on the upper left of the screen (red circle). Complex medication orders using the then command for a taper The column on the right (green circle) specifies how the medications listed should be combined. There are two options: the then command shown in the example above, which will have the medications listed given in order (as in a taper), or the and command, shown below, which allows for medications of differing doses to be given on different days. Complex medication orders using the and command for alternating dosing The Day-Of-Week link (red circle) allows you to check off specific days and times for a medication to be given instead of having to find them in a drop-down menu. 6

7 To order non-formulary or restricted medications To order non-formulary medications (denoted in the medication list by a NF after their names), go to Orders à Medications à Non-Formulary/Restricted Drug Requests. You will need to place a non-formulary or restricted medication consult request detailing the reason the medication is necessary and duration of treatment, then place the order for the medication through the same menu. Medications will only be filled after the non-formulary consult is approved. Two formats of the restricted/non-formulary drug request consult order 7

8 To see medications administered while in the hospital To view administrations for a single medication, double click the order for the medication To view administrations for all medications, go to Reports à Med Admin History (BCMA). There s a lot of good stuff in here, but it takes a little unpacking. - Admin Times are the scheduled administration times not the actual times given - The code (red circle) signifies the status of the medication administration, the time it was administered, and who gave the medication: o The first letter is the status of the medication o o The numbers are the time given (24-hour format) The next letters are the initials of the nurse who administered the medication To visualize start and end dates for all medications, go to Reports à Inpt & Outpt Meds - Please note this chart does not change based on whether a medication was given or held it only charts start and discontinuation dates 8

9 To check & confirm final discharge medication reconciliation After transferring all desired medications from inpatient to outpatient, go to Reports à Pharmacy à Active Outpatient Medications and check the new list with your desired list for discharge to ensure all medications have been ordered - Make sure to also discontinue any outpatient medications that you do not want continued on discharge Other Helpful Hints: - Make sure you are only viewing active or pending orders by going to Orders, then selecting View à Current Orders (you can make this your default view from the same menu) - If you aren t sure about a medication or are having difficulty with the system, ask your senior or go down to the satellite pharmacy (ext , room on the 4th floor by the MICU team room open from 0800 to 1600) and the pharmacists can run through medications with you o If the satellite pharmacy is not open, you can call the main inpatient pharmacy line at any time. Current staffing is 3 pharmacists for the whole hospital after 1630 and 1 pharmacist for the whole hospital after midnight. - Performing in-patient medication reconciliation the day before can often speed up complex discharges o o If you think a patient may discharge the next day, write a discharge order. Put in the expected date and time. This notifies the pharmacy that they should start to prepare the discharge medications. If you re still making changes to a medication immediately prior to discharge (titrating a medication, unsure on exact days of antibiotic due to variable discharge date, etc.), notify the pharmacy who will hold off on filling that medication until the final dose is ordered. 9