Скачать презентацию Omnicell Pyxis BOP Interface Update November 14 2006 Скачать презентацию Omnicell Pyxis BOP Interface Update November 14 2006

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Omnicell/Pyxis (BOP) Interface Update November 14, 2006 Omnicell/Pyxis (BOP) Interface Update November 14, 2006

l l l 2 Claremore Indian Hospital Lawton Indian Hospital Choctaw Nation Health Care l l l 2 Claremore Indian Hospital Lawton Indian Hospital Choctaw Nation Health Care Center Santa Fe Indian Hospital Phoenix Indian Medical Center

Presenters l l l 3 Carlene Mc. Intyre, Pharm. D. Pharmacy Consultant, OIT Jeff Presenters l l l 3 Carlene Mc. Intyre, Pharm. D. Pharmacy Consultant, OIT Jeff Walling, Pharm. D. Pharmacy Applications Coordinator, PIMC John Coleman, Pharm. D. Chief Pharmacist, SFIH Dan Diggins, Pharm. D. Inpatient Pharmacy Director, PIMC Adrian Lujan Third Party Billing IT Specialist, OIT

BOP Update Overview l l l 4 Introduction – Carlene Mc. Intyre Preparation – BOP Update Overview l l l 4 Introduction – Carlene Mc. Intyre Preparation – Jeff Walling Outpatient Pharmacy – John Coleman Inpatient Pharmacy – Dan Diggins Third Party Billing – Adrian Lujan

Introduction l l l 5 BOP v 1. 0 was released in July, 2005 Introduction l l l 5 BOP v 1. 0 was released in July, 2005 Initial BOP interface is one-way only Sends ADT information from RPMS to the Automated Dispensing System (ADS) Saves nursing time Increases accuracy of patient information in the ADS

Introduction (cont. ) l l l 6 Patch 1 adds new functionality for Pyxis Introduction (cont. ) l l l 6 Patch 1 adds new functionality for Pyxis systems Patch 2 will add the same for Omnicell systems 2 -way transfer of info between RPMS and the ADS Specified drugs will show up as non-verified Rxs for pharmacist review UD orders entered in RPMS are sent to the ADS info on drug removals and returns is sent to RPMS and is available for pharmacy & billing

Introduction (cont. ) Patient Name, HRN Patient Location Allergies Inpatient UD Orders Charges (Removals) Introduction (cont. ) Patient Name, HRN Patient Location Allergies Inpatient UD Orders Charges (Removals) RPMS 7 Credits (Returns) ADS

Introduction (cont. ) l l l 8 Outpatient sites must be using Pharmacy v Introduction (cont. ) l l l 8 Outpatient sites must be using Pharmacy v 7. 0 before installing the patch You must contact Omnicell or Pyxis to get their side of the interface set up correctly In order to use profiling, inpatient sites must be using the RPMS Unit Dose package v 5. 0 to enter orders and the Automatic Replenishment/Ward Stock package must be set up

BOP Update Overview l l l 9 Introduction – Carlene Mc. Intyre Preparation – BOP Update Overview l l l 9 Introduction – Carlene Mc. Intyre Preparation – Jeff Walling Outpatient Pharmacy – John Coleman Inpatient Pharmacy – Dan Diggins Third Party Billing – Adrian Lujan

BOP Interface Set Up l l Identify meds in Pyxis/Omnicell by RPMS IENs (internal BOP Interface Set Up l l Identify meds in Pyxis/Omnicell by RPMS IENs (internal entry numbers) Designate Inpt Pyxis/Omnicell Meds as Ward Stock – 10 AUTO Automatic Replenishment [PSGWMGR] **> Locked with PSGWMGR

BOP Interface Set Up l 11 BOP Menu Options BOP Interface Set Up l 11 BOP Menu Options

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BOP Update Overview l l l 19 Introduction – Carlene Mc. Intyre Preparation – BOP Update Overview l l l 19 Introduction – Carlene Mc. Intyre Preparation – Jeff Walling Outpatient Pharmacy – John Coleman Inpatient Pharmacy – Dan Diggins Third Party Billing – Adrian Lujan

Prior to interface Pharmacists collected night charts from UCC l Pharmacists reviewed charts comparing Prior to interface Pharmacists collected night charts from UCC l Pharmacists reviewed charts comparing Pyxis report to medical chart l Pharmacists entered prescriptions in RPMS l Time consuming l 20

After Interface queues orders into RPMS l Pharmacists review and verify orders using verification After Interface queues orders into RPMS l Pharmacists review and verify orders using verification option in RPMS l Add provider l Edit quantity and days supply l Dosing instructions l 21

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Interface Options in RPMS List non-verified scripts - quick view of patients and meds Interface Options in RPMS List non-verified scripts - quick view of patients and meds l Non-verified counts - shows number of Rx’s in queue l Rx verification by clerk - verification and completion of order by pharmacist l 23

Time saving advantages Order is already partially entered in RPMS l Medication removed is Time saving advantages Order is already partially entered in RPMS l Medication removed is entered, decreased risk of selecting wrong med during rx entry l Issue date and fill date, already entered l 24

Lessons learned l l l 25 Important to have Pyxis loaded correctly with correct Lessons learned l l l 25 Important to have Pyxis loaded correctly with correct RPMS medication ID number No multiplier for 1 item removed to equal grams or number of tablets removed Decide if pharmacy will continue to review medical chart or have the nurses keep a yellow copy of the PCC for pharmacy

Lessons Learned l 26 BOP Drug File selection - medications taken home by patient Lessons Learned l 26 BOP Drug File selection - medications taken home by patient - avoid one time, unit dose meds and injections incident to the providers visit

BOP Update Overview l l l 27 Introduction – Carlene Mc. Intyre Preparation – BOP Update Overview l l l 27 Introduction – Carlene Mc. Intyre Preparation – Jeff Walling Outpatient Pharmacy – John Coleman Inpatient Pharmacy – Dan Diggins Third Party Billing – Adrian Lujan

Inpatient Pharmacy Interface Features l Real time Admission/Disch/Transfer info – – l Allergies from Inpatient Pharmacy Interface Features l Real time Admission/Disch/Transfer info – – l Allergies from Allergy Reaction Tracking pkg. – – l – 28 If mechanism “allergy” or “unknown” – will display If mechanism is “pharmacologic” i. e. ADR – will not Medication orders from RPMS Inpt Order Entry – l Virtually eliminates need to manually enter patients ADT entry into RPMS must be prompt Entered, edited, or discontinued in real time “Profile” – displays only those meds ordered for patient Eliminates cart fill – yea!!

Inpatient Interface Early considerations l ADS meds must be entered as Ward Stock – Inpatient Interface Early considerations l ADS meds must be entered as Ward Stock – l Still need to run daily Pick List – l Multi-dose containers, bulky items Evaluate inpatient order entry work flow – – 29 Can print “to screen” Keep u/d cart with drawer for each patient – l This is essentially all oral solids! One time and stat orders Meds available for over-ride status

ADS Display of Meds (Patient Profile) l ADS screen shows list of meds for ADS Display of Meds (Patient Profile) l ADS screen shows list of meds for each patient – – – l Lead/Lag Time (defined in ADS) – – – 30 Black text indicates med is available in cabinet “Grayed out” = med is in the Pyxis formulary, but not in the cabinet on that unit Med not appearing = med not in Pyxis formulary* Allows nurse to remove dose early or late e. g. lead time = 4 hours, RN can get 9 am dose at 5 am *If first dose of new order is not due till 9 am tomorrow, med will not display on screen until 5 am tomorrow!

ADS Display of Meds (continued) l Dispense drug/strength is displayed – May not be ADS Display of Meds (continued) l Dispense drug/strength is displayed – May not be the same as dosage required! LORAZEPAM 2 MG SYRINGE ATIVAN DOSE: 1 -2 MG RT: IV LAST: MON, NOV 13 2006 21: 03 ORDER # 285 -7154 FREQ: Q 4 H PRN NOTES: FOR ANXIETY POTASSIUM CHLORIDE 10 MEQ U/D TAB K-DUR DOSE: 20 MEQ RT: ORAL LAST: MON, NOV 13 2006 08: 37 ORDER # 285 -7154 FREQ: TID W/ MEALS NOTES: 2 X 10 MEQ TABS TACROLIMUS 1 MG CAP 31 PROGRAF ORDER # 285 -7155

Special Cases Range Orders l Morphine 2 to 10 mg IV prn – – Special Cases Range Orders l Morphine 2 to 10 mg IV prn – – Can enter multiple dispense drugs; e. g 4 mg and 10 mg Nurse can choose either MORPHINE 4 MG SYRINGE MORPHINE DOSE: 2 -10 MG RT: IV LAST: MON, NOV 13 2006 21: 03 ORDER # 285 -7154 FREQ: Q 4 H PRN NOTES: FOR PAIN MORPHINE 10 MG SYRINGE MORPHINE DOSE: 2 -10 MG RT: ORAL LAST: MON, NOV 13 2006 08: 37 32 ORDER # 285 -7154 FREQ: Q 4 H PRN NOTES: FOR PAIN PROMETHAZINE 25 MG AMPULE PHENERGAN ORDER # 285 -7155

Special Cases Oddball Dosages, e. g. Prednisone 8 mg l Requires two different dispense Special Cases Oddball Dosages, e. g. Prednisone 8 mg l Requires two different dispense drugs – Use “Special Instructions” field to alert nursing staff PREDNISONE 1 MG TAB DELTASONE DOSE: 8 MG RT: ORAL LAST: MON, NOV 13 2006 08: 37 ORDER # 285 -7138 FREQ: QDAY NOTES: 1 X 5 MG + 3 X 1 MG TABS PREDNISONE 5 MG TAB DELTASONE DOSE: 8 MG RT: ORAL LAST: MON, NOV 13 2006 08: 37 ORDER # 285 -7139 FREQ: QDAY NOTES: 1 X 5 MG + 3 X 1 MG TABS PROMETHAZINE 25 MG AMPULE 33 PHENERGAN ORDER # 285 -7155

Problem Issues l IV Push Vials (e. g. Lasix 20 mg/2 m. L) – Problem Issues l IV Push Vials (e. g. Lasix 20 mg/2 m. L) – – – l Formulary issue – – 34 Default VA dosages: 10 mg/1 ml; 20 mg/2 ml Choosing default dose of 20 mg/2 ml causes Pyxis to prompt nurse to remove “ 2 vials” (40 mg!) Solution: change default doses to eliminate “ / 2 ml “ When new drug added to RPMS drug dictionary, write down IEN and enter into Pyxis formulary at same time Otherwise, “Unknown” drugs will appear in Pyxis formulary when order entered into RPMS inpt package

BOP Update Overview l l l 35 Introduction – Carlene Mc. Intyre Getting Ready BOP Update Overview l l l 35 Introduction – Carlene Mc. Intyre Getting Ready – Jeff Walling Outpatient Pharmacy – John Coleman Inpatient Pharmacy – Dan Diggins Third Party Billing – Adrian Lujan

Third Party Billing Screens Third Party Billing Screens

Data Flow 37 Data Flow 37

Claim Editor l l 38 Changes released in Patch 8 Billing clerk must have Claim Editor l l 38 Changes released in Patch 8 Billing clerk must have access to claim editor to view charges. Billing clerk reviews items and decides which ones to populate in the Claim Editor Billing clerk approves a bill to the appropriate third party payer

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Billing Responsibility l Knowing what payer processes. – l l l 48 Not all Billing Responsibility l Knowing what payer processes. – l l l 48 Not all supplies covered. Ensure items come across Ensure date of service is entered. Ensure charge is populated.

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Issues l Data not completely populated – – 50 Items not ‘uploaded’ to claim Issues l Data not completely populated – – 50 Items not ‘uploaded’ to claim editor Manual entry of items by billing clerk

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Questions? 52 Questions? 52