Pharmacy collection

• New Drugs Collected for critical care patients admitted started after midnight 2012-01-01 and entered into the Pharm_Flow sheet tab in CCMDB.mdb.
• Stop collecting pharmacy the old way at the same time.
• If a profile has some collected by the old method and some by the new method that is OK. Consolidation, if required, will happen behind the scenes.
• For HSC where no manual collection was done prior, the new admissions starting Jan 1, 2012 will have manual pharmacy collection with the new Pharm_Flow sheet.
• As of Jan 1, 2012 @ 0001 hrs, only the new Pharm Flow sheet for pharmacy will be used.
• values entered over multiple lines will be added up before sending; a listing for the sum wasn't included due to space restrictions

The Data Collector in the Medicine Program do not collect any pharmacy information.

How to enter the data

In the Patient viewer, go to the Pharm_Flow tab. Enter the number of days for which a drug was given (not collecting doses any longer).

You don't need to list entries for a given day, the lines are there only allow you to break down your work if a patient stays for a long time.

Hints

• double-click into a cell to up it by 1 (or in case of 0/1 drugs, to toggle between 0 and 1
• hover over a cell to get a popup with the drugs that are part of any of the groups we collect
• When reviewing the MAR for all drugs or flow sheets for infusions you may find it helpful to make a pencil mark after the drugs you have counted up to so that when you look at it again, the same drugs are not duplicate counted.
• The date automatically is put into the line when you enter a number under the specific drugs. This also helps to keep track of when you last counted drugs.
• For the blue colored drugs you only need to put a "1" in the box (or double-click the box) if it ever was used during the patient stay. If it is left blank it means it was not used. We do not need the number of days for these specific drugs.

Drugs Collected

see Drugs Collected for list

Be sure to collect all intravenous and oral preparations for each drug unless otherwise noted. For example, if it only calls for intravenous infusion of opioids or lasix, etc.

TISS / Pharm correlation

The following items on your pharmacy form should be confirmed against the corresponding items on the TISS:

• vasoactive drugs, heparin, antiarrythmic marked in your history notes and pharmacy form (Tiss items 67, 68& 69 )
• check that TISS # 76 or 77 is marked against the antibiotics on the MAR
• check that Tiss 71 is marked when pt had potassium via central line;
• check #70 is marked if patient is on Vasopressin.

discussion

Template:Discussion which of these are still relevant? pls. just remove ones that no longer are.Ttenbergen 19:02, 8 December 2011 (CST)

• What do we do if a person is on a IV PPI and an oral is a double count or a single? The same for any drug in the same category given the same day.
  • We just need the number of days for a category regardless of which drugs were given. If they were on one PPI or two it doesn't matter, just count the days on any PPI.--LKolesar 15:40, 20 December 2011 (CST)
  • IV and oral are collected unless specifically indicated like IV infusion of opioids for example.--LKolesar 15:40, 20 December 2011 (CST)

• You do not need to change any prior entries for patients admitted prior to Jan 1, 2012, but stop collecting the old way on everyone after Jan 1. Any pharmacy collection after Jan 1 on all patients should be the new way. Some patients will end up having a portion of old entries (up to Jan 1) and new pharmacy entries after this. That is OK, the data will be cumulative. I hope this helps to clarify.--LKolesar 12:54, 23 December 2011 (CST)

January 26, 2012 Feedback New Pharmacy collection

• 7 people's comments

Pros

• amount of time collecting has diminished with not having to count exact doses.
• Quicker and easier than previous process.
• Helpful that drugs are categorized rather than alphabetized
• Helpful that list include both generic and trade names
• Very helpful to have printed list as reference.
• Date plus and minus is great additional makes adjusting date much more simple and quick

Concerns

• transition to new process took some time and still taking time to learn all the new drugs that we are not familiar with.
• more training about new drug list before implementation
• not enough support for question related to drugs themselves.
• workload increase at HSC site with the ADDITION of drug collection
• in total there is approx. 175 drugs potentially being looked for in charts, however with not having to tally each one separately because they are in one category, once you learn the list it is much quicker than old process. You still have to look all over pharmacy sheets including ICU Flow sheet to find them all. IV Antibiotics given may not be charted in drug sheets, only on flow sheet in some ICU's.
• can be confusing for those individual drugs in categories that have both IV and PO. Not sure if some are available both IV and PO.
• a number of drug names not familiar. Never see them at some sites.

• Entry on laptop most difficulties
  • area of entry so very small
  • very easy to inadvertently enter the count under wrong drug and not notice
  • font quite small and subsequently is gets tiring on eyes
  • poor visibilty on screen of entered data hard to QA check therefore increased collection errors
  • multiple entries on different days is a problem. The viewing screen rolls so that you cannot see the drug name, this creates another potential for entry error.
• allowed to only view one previous entry/row.
  • that is not true, just the mouse scroll wheel doesn't work; use the scroll barTtenbergen 12:51, 27 January 2012 (CST)
• when hovering over the box to find the drugs included in the identifier - only see generic name and not trade name. Drugs may be ordered by trade name and one cannot remember both trade and generic name many of these drugs.
• pharmflow sheet on the database had two half pages on - Request to have each half page maximized in order to see more ROWS for entry or change format to dropdown list like prev pharm but having trade and generic names in two separate rows and be able to sort in order as needed.
• Long term patients - files can be difficult to collect especially when the MAR has been recopied several times. The flow of MARS become disjointed, confusing and time consuming. Takes extra time and ensure accuracy.

• use paper collection form for long stay patients - after 3-4 weeks.
  • Since IICU patients can stay 6 months or so that's alot of doses of coumadin or whatever to add up.
• hard to see lighter shades. Make drug list one color.
  • made all either black or dark blue; kept that distinction because the blue ones are 0/1 only rather than counts Ttenbergen 12:51, 27 January 2012 (CST)

• would a "find next" window option be of benefit to help find drugs? The trade names also should be included on the "find next" helper

• Please continue to add any other information. Thanks for all the feedback. Will evaluate next again at next Steering Meeting in early April.

Data Integrity Checks

• each patient has to have at least one line of no entries

• Tina-Do you have and check before sending that pharmacy so that value does not exceed LOS? This one is an error in Pharmacy.mdb. Pts LOS is 25 calendar days.
  • Pat_ID -26658
  • site STB
  • location CCU
  • send_dttm 2/15/12
  • Heparin cont inf 1125

• Suggest error check for Pharmacy.mdb: LOS=(disch-admit) +2 days. improvment requests Trish Ostryzniuk 18:14, 2012 March 7 (CST)

Date within admission

• considering how everyone uses the dates in Pharm_Flow, would it make sense to restrict them to only during admission? Would that help make collection more reliable? I don't want to add a check that makes things worse. Ttenbergen 11:58, 27 January 2012 (CST)