In last week’s article, we explained the Inventory setup necessary to begin using many of the clinical pharmacy features in CPR+. I’m sure that you’ve all spent the last 7 days busily updating your Inventory tables and now you’re ready to start taking advantage of these features in order to streamline and automate filling prescriptions in CPR+ .

This week, we’ll explain how CPR+ uses this information to auto-generate your Rx Description and Compounding Instructions, auto-populate your Compounding Record Ingredients and their Quantities, determine the Final Concentration of the compounded product and whether or not the prescription is within that drug’s Therapeutic Range, auto-generate Stability Dating based on your chosen storage method, and more. CPR+ will automatically perform all of these functions and calculations -- if you’ve loaded the information the system needs to get the job done. To review last week’s article on Inventory Data Setup, click here to access the Newsletter archives.

How It All Works

Auto-generation of the “Rx Description” on the Pharmacy Work Order (PWO) and IV Label

The “Rx Description” is an important field in CPR+. It is used on the IV label, the Prescription File (I.) screen, the Prescriptions Dispensed Log and it is carried over to the Delivery Ticket. Prior to these enhancements, the system would combine the name, dose and unit of measure of the ordered drug with the word “in” and allow the user to select or type in a volume and the solution that the drug was mixed in. This was a very “free form” process . . . it was flexible in that you could make it say whatever you wanted it to say, space permitting. However, it was basically manual and there was no logic to automatically create the description and nothing to prevent a “mistake” of ordering one drug and overwriting it with something else.

Now, CPR+ will auto-generate the Rx Description by combining the Brand Name of the ordered drug (or "Default Rx Description" if this field is entered into Inventory), Total Amount (amount of each dose times the number of doses per container) and the Unit of Measure of the ordered drug with the total Container Volume, Unit of Measure and “Default Rx Description” name and Total Volume of the Vehicle on the initial fill if/when the Rx Description is empty. 

For example, if the order was Cefazolin 1 Gm Every 8 Hours and you wanted to put 3 doses in a CADD Prizm cassette (the empty Container), you might specify the Volume Per Dose as 25 mls and decide to add another 25 mls of Vehicle solution as Overfill to allow for priming the tubing and the KVO infusion rate. CPR+ adds the Volume Per Dose and the Overfill Volume to derive the total “Container volume”, resulting in an accurate Rx Description of the finished product - “Cefazolin 3 Gm in 100 mls 0.9% NS CADD Cassette.” 

NOTE:
If you create a new prescription based on a Prescription Template (or based on a previously created prescription) and the “Rx Description” field is pre-populated, CPR+ will NOT overwrite the Rx Description.

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Auto-population of the CPR+ Compounding Record 

CPR+ will also auto-populate the Compounding Record with all of the items previously selected on page 1 of the PWO. This includes the ordered drug and any associated diluents, the Container and drug selected as the Vehicle. In addition, CPR+ will automatically calculate the quantity needed for non-Lot tracked items and enter that quantity into the Compounding Record. If you are tracking Lot Numbers for a particular drug, the system will calculate the quantity of vials/bags needed when you click the F8 - Select Drug button. You are free to add, edit or delete additional ingredient items on the Compounding Record. 

Auto-generation of the Compounding Instructions on the PWO

In earlier versions of CPR+, the Compounding Instructions were free-form text. You could enter whatever you wanted into the memo field or import the text from a Prescription Template. CPR+ can now auto-generate the Compounding Instructions for each drug selected on the Compounding Record. For all Primary Drugs in powder form, CPR+ will include the reconstitution formula you set up on the Clinical Info tab.  Using our earlier example, the order was for Cefazolin 1 Gm TID administered via a CADD Prizm pump. We specified a Vehicle solution of 0.9% Sodium Chloride, with a Solution Volume of 25 mls Per Dose and 25 mls of Overfill and a CADD cassette as your Container. The Reconstituted Concentration formula from the Cefazolin 1 Gm Clinical Info tab specified 9.6 mls of Sterile Water for Injection for concentration of 0.1 Gm per ml. CPR+ would auto-generate the following Compounding Instructions:

“Cefazolin 1 Gm: Reconstitute each vial with 9.6ml Sterile Water for a resulting concentration of 0.1 Gm / ml.  Add 30ml (3Gm) reconstituted solution to each CADD Cassette.

QS with Sodium Chloride for a total volume of: 100 ml”.

We have also included a “free-form” memo field for any additional Compounding Instructions you may wish to add.  When the Pharmacy Work Order is printed, any text in both boxes will be printed. If you do not wish to print the auto-generated Compounding Instructions, uncheck the “Include on Work Order” box.

Click the Above Figure to View a Full-screen Version

Auto-generation of the detailed “Medication Review” and Therapeutic Range

On the bottom-half of the Compounding Instructions tab, you’ll see the Medication Review. The Medication Review consists of numerous calculations that are based on the medication(s) being dispensed and the solution used to administer the medication(s). The left side of the Medication Review begins with the patient’s Weight and Body Surface Area, pulled from the Patient Stats box on the Medical Information tab of the patient’s Demographic/Financial screen. The number of containers comes from the first tab of the Pharmacy Work Order. The Quantity/Container followed by the Volume Totals are all calculated based on the amount of solution being used to administer the medication.

The right side of the Medication Review, the program will calculate the Final Concentration, Amount/Dose, Amount/Day, Amount/M2/Day and the Amount/Kg/Day.

The Adult and Pediatric Minimum and Maximum values are pulled from the ordered Drug’s Clinical Info tab and are displayed for easy viewing. If the amount of medication being dispensed exceeds the Adult Max, then the Adult Max amount and the appropriate amount being dispensed (Amount/Dose, Amount/Day, Amount/M2/Day or Amount/Kg/Day) will be displayed in a bold, red font. If the patient is 16 years of age or younger, the Pediatric Max will be checked and if exceeded will be displayed in a bold, red, font.

Stability Dating Based on Storage Instructions

Earlier versions of CPR+ included a Number of Days Stable (pulled from the HCPC/Additional Info tab) for each drug item.  We expanded this by creating three separate fields for the Number of Days Stable. You can assign a unique Number of Days Stable for three unique fields: Frozen, Refrigerated and Room Temperature. On the Compounding Record tab of the PWO, the Storage Instructions/Stability area allows you to select the Storage Method, which then populates the “# of Days Stable” field by adding the number of days stable for the selected storage method to the Compounding Date.

These are a few of the clinical pharmacy features available in CPR+. We hope that you’ll take advantage of them. To download a reference document on these and other CPR+ features (including using the Dose Calculator and Enteral Calculator), click here.

If you’d like to schedule time with a CPR+ Trainer who can further explain the Inventory setup and use of these automated Pharmacy Calculations, call at 866-277-4876. Thanks for being our customer.

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