“But I haven’t even seen v8.1a yet…”

I know that most of you haven’t had time to download and review v8.1a yet, and last week on December 11th, we released v8.1b. After several months in beta, v8.1a was made available for General Release on November 26th. The beta version of 8.1a had been in use by over 50 customers - many for several months, however, after v8.1a was released, we became aware of certain scenarios which could lead to incorrect system-generated compounding instructions.

We took this very seriously and we immediately notified every customer who had downloaded v8.1a. We also removed the update from our download page. We were disappointed that this action was necessary, but we all agreed that it was necessary.

Auto-generated Compounding Instructions is a popular CPR+ feature that was initially released with v8.0a. The purpose is to automatically build precise reconstitution and preparation instructions for the medications selected on the Compounding Record. Based on the logic in SCS’s The Specialized Clinician system (which we acquired in June 2006), we extended the functionality to allow you to select multiple vial sizes and/or different concentrations of the same medication on the Compounding Record - something SCS did not allow. In trying to improve the auto-generated instructions when multiple vial sizes and/or different concentrations were used for a compound, we overlooked certain scenarios which generated inaccurate instructions. As you can imagine, building compounding instructions for different types of medications – powders, solutions, etc., with empty and non-empty containers, multiple doses per container, different concentrations of generically equivalent drugs - is very tricky stuff. We recognize however, that it is critically important that we get it right.

To meet this challenge, we gathered our best designers, developers and QA staff to analyze the problem and design the solution. We decided to take the opportunity to significantly improve the overall functionality of this feature. Our sincere thanks go out to Brian Sweeney, Clinical Pharmacist with WellSpan Infusion Service in Pennsylvania for his help in the identification of this issue and for testing the enhancement. To eliminate any possible confusion, we made these changes (and only these changes) to what was the v8.1a update and released the new code set as v8.1b.

As contained in PDL #27462, CPR+ v8.1b now generates even more detailed, clear and complete Compounding Instructions. The enhanced functionality includes reconstitution instructions for each generically equivalent medication linked to the order, the total medication that will be derived from all ingredients selected on the Compounding Record, specific instructions indicating the precise volume of medication needed to prep each container / dose, specific fluid volumes needed to QS up to the dosing volume (with overfill) and, as needed, instructions to waste excess medication from the batch if more is prepared than needed to fulfill the order.

Changes in functionality include:

A. The reconstitution directions for each medication are now clearly stated at the top of the section (separated from the rest of the compounding instructions), with the format “For each vial of XXX, …”.  Each generically equivalent medication that is linked to an order will have reconstitution instructions.

B. Next is a sentence labeled “Total Prep: …”. The purpose of this sentence is to describe the resulting quantity of medication (total strength and volume) that will be derived from the total number of vials selected on the Compounding Record, giving the user a total picture of how much drug they will have following reconstitution.

C. The final section is container preparation. This section begins by indicating the number of doses per container. Recall that in CPR+, the container is the item that contains one or more doses of the prescribed medication. Containers may be empty (cassettes, elastomeric pumps, etc.) or non-empty (D5W 100 ml bags, etc.). Formatted as “For each container: Add XX mls to …”, this section generates specific instructions indicating the precise volume of medication that is needed to prepare each container / dose. If more medication has been prepared than is needed to fulfill the total number of doses being dispensed, CPR+ will indicate this excess amount to waste.

D. The final enhancement to this feature is that the system now specifies the amount of solution needed to QS up to the dosing volume with overfill. In v8.0, the system instructed the user to “QS with 0.9% Sodium Chloride for a total volume of XXX mls”. In v8.1, the instructions read “QS with 76 mls of 0.9% Sodium Chloride for a total volume of 105 mls”.

Again, thanks to Brian Sweeney, R.Ph and the many other customers who provided guidance on this enhancement and to D.H.S. veterans Darren Young, Ted McGraner, John Mathis, Scott Adkins, Tom Rooker and Lisa Kibe for their outstanding efforts to make it happen.