Are you taking advantage of the clinical pharmacy features in CPR+ that streamline and automate many aspects of the prescription filling process?

Would you like CPR+ to:

• Auto-generate the Rx Description and the Compounding Instructions on the Pharmacy Work Order (PWO) and IV label

• Auto-populate the ingredients on the Compounding Record

• Auto-generate a detailed Medication Review of the compounded product, including final concentration, total mg or mls per day, per Kg or per M2

• Calculate the number of Cans per Day needed to satisfy an enteral order

• Track each drug’s Therapeutic Range and report if the final dose is outside this range

• Auto-generate Stability dating based on three different storage methods (Room Temperature, Refrigerated and Frozen)

• And much more!

CPR+ can automatically perform all of these functions and calculations and many more -- all you need to do is invest a little time to setup your inventory items correctly. As many of you know, over the past two years, D.H.S. acquired SCS and MBI and one of the primary benefits we saw was to be able to incorporate the best features of each company’s software into CPR+. Following the SCS acquisition, we worked closely with the SCS staff to transfer many of their best clinical pharmacy features into CPR+.

This article will describe the initial setup that is required so that CPR+ can perform these functions. Next week, we’ll describe how the system uses this information to carry out these functions and automatic calculations.

Inventory Setup and the Clinical Info Tab

In order to take advantage of these clinical enhancements, we’ll start on the Clinical Info tab on the Drug Item Information screen, but first, a few important definitions:

Container:
On tab 1 of the PWO, you’re prompted to select the prescription’s “Container”. The container is the inventory item that the primary drug therapy is contained in. For example, if the Rx is for Vancomycin 1 Gm Everyday, the container could be a 250 ml bag of D5W. If the Rx is for Cefazolin 1 Gm Every 8 Hours, the container could be a 100 ml CADD Prizm cassette. In the latter example, the container is “empty” -- it contains no solution. For empty containers, CPR+ will in the next field give you the option to enter the “Vehicle”.

Vehicle:
Directly below Container on tab 1 of the PWO is a field labeled Vehicle. If the container selected is empty, the vehicle field will be enabled, allowing you to select the inventory item that will be added to the container. The vehicle is the solution that carries the primary drug therapy into the patient’s body.

Dispensing Unit:
This field is used to calculate the number of vials of drug needed on the Compounding Record to satisfy the order. For a Cefazolin 10 Gm vial, the dispensing unit could correctly be “mg” or “Gm”. CPR+ can do the metric conversion from mg to Gm, ml to L, etc. The field is also used as the base unit of measure for describing and calculating concentrations and therapeutic ranges of the drug.

Disp. Unit/Each:
Once CPR+ knows how many dispensing units there are in each vial, it can calculate the number of vials needed on the CR to satisfy the order. In our Cefazolin 10 Gm vial example above, if the Dispensing Unit was “mg”, the Dispensing Units per Each would be 10,000.

The Drug Item Clinical Info Tab

Product Type:    
The Product Type field is used to identify which drugs can be used as a “Primary drug” which are those used for a primary drug therapy, “Container” which are those drugs that are used to “contain” the primary drug therapy (D5W 100 ml mini-bag), “Diluent” which are those drugs that are used to reconstitute other drugs that are in powder form and “Multi-Use”, or drugs that could be used for any of the above purposes.

Dosage Form:     
If the drug item is identified as a Primary Drug in the Product Type field, select whether the drug is a “Powder”, “Solution”, a “Tablet/Capsule” or an “Enteral Product”.

Solution Volume:
If the drug item is identified as a Primary Drug in the Product Type field and Solution in the Dosage Form field, the “Solution Volume” field is used to tell the system the volume in “mls” that are in each vial. For example, Gentamicin Sulfate is available in 2 ml vials, 40 mg/ml. 2 mls is the correct “Solution Volume”.

Concentration:   
If the drug item is identified as a Primary Drug in the Product Type field and a Solution in the Dosage Form field, the “Concentration” field tells the system how many “dispensing units” are in each ml of solution.

Diluent:   
If the dosage form of a primary drug is identified as a “Powder”, CPR+ displays a screen at the bottom of the Clinical Info tab that is used to document how the powdered drug is reconstituted. For any powder, the user must identify the “Diluent”, or reconstituting agent. The Diluent is the substance that will be injected into the vial of powder which puts the drug in solution form so that it may be administered intravenously.

Reconstituted Concentration:
The “Reconstituted Concentration” is the number of Dispensing Units per ml of Diluent in the vial after the powder has been reconstituted. Users can enter multiple “Reconstituted Concentrations” and select one as the Default Concentration.

Therapeutic Range:
The Therapeutic Range area on the Clinical Info tab allows you to enter Adult and Pediatric Min and Max values for each drug.

Days Stable:     
You can now enter the number of Days Stable based on how the item will be stored - Frozen, Refrigerated and Room Temperature.

Disease State Management:      
While not used for any of the clinical pharmacy features, this field allows you to link a Custom Assessment to each drug. Once linked, CPR+ will automatically pull the linked Assessment into the patient’s Assessment file and add it to the patient’s calendar.

Supply Item Info:
For any Supply Item that could be used as a “Container”, (see definition above), there are two fields on the HCPC / Add’l Info tab that must be completed. For “empty containers” such as cassettes, elastomeric devices or empty solution bags, click the checkbox labeled IV Container and indicate the Container Volume in “mls” in the field below.

Non-Empty Containers:
For non-empty containers that you have entered in your inventory as Drug Items (for example, D5W 100 ml, D5W 250 ml, 0.9% NS 100 ml, 0.9% 250 mls mini-bags, etc.), be sure the Dispensing Unit and Dispensing Units / Each are correct. Next add a “Default Rx Description” on the HCPC / Add’l Info tab. This field is used to enter a short description of the drug that CPR+ will use when formatting the Rx Description. As you know, the Rx Description is displayed on the first tab of the PWO and carries over to the IV label. It is also displayed in the Prescription File (I.) screen, the Prescriptions Dispensed Log and is carried over to the Delivery Ticket. For example, if the brand name of the item is “Dextrose Intravenous Solution 5% 100 mls”, you could enter a Default Rx Description of “D5W”. Some “Non-Empty Containers” could be used as Primary Drugs (i.e., 0.9% Sodium Chloride 1 Liter bags) as well as a “Container” (or even as a Diluent). In cases such as this, select “Multi-Use” as the Product Type. Select “Solution” as the Dosage Form and enter the Solution Volume as the number of mls in each bag.

Enteral Products:
For Enteral products, On the Clinical Info tab, set the Dispensing Unit as ml, the Dispensing Units / Each as the number of mls per can, the Product Type as “Primary Drug” and the Dosage Form as “Enteral”.  When you select the Dosage Form as “Enteral”, CPR+ will prompt you for the Volume / Can which is entered in mls and a “Kcal / ml” which you will enter based on the caloric value of the product.  With this information in place, CPR+ will be able to calculate the number of cans per day and per month you will need to dispense to satisfy the order, regardless of how the order is entered (“X” mls / hour x “X” hours per day, “X” cans per day, “X” cal/kg/day, etc.). 

Well, that’s about it. Like I said, there is some initial setup that’s required, but next week, we’ll discuss the automated pharmacy calculations and clinical features that will make it all worthwhile.  If you want to take advantage of these features, but don’t have the time to setup your inventory database, just let us know, we have a solution for that too. As always, if you have any questions about this information contact a CPR+ trainer today.

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