Tricks of the Trade: Pharmacy Rules

Contributed by: Dan Hawrot, RPh, Assistant Director of Pharmacy, Trinity West.

Here are a couple of processes we have implemented:

1. We have a Pharmacy rule in place that prohibits the pharmacist from entering outpatient orders with an incorrect service date, thus eliminating one reason for billing problems.
   
   
2. We changed our cart fill method. The refill lists were changed so that only one patient's meds printed per page (if there is more than 1 page for a patient, the 2 pages are stapled together). We divided the cart fill area into 4 alphabetical sections. The first tech is responsible for filling the meds that are in one alphabetical section. The patient drawer with the refill list is then passed on to the next tech in the next section, until the drawer is completed in the 4th section. This method has decreased the time it takes to fill the carts and has improved the attitude of the techs filling the carts.

Dan Hawrot, RPh, is the Assistant Director of Pharmacy at Trinity West. Dan has a B.S. in Pharmacy and over 22 years of hospital experience. He is responsible for MEDITECH-related issues in the Pharmacy. Trinity West is a member of Trinity Health System, a hospital system in eastern Ohio with a combined capacity of over 471 beds and 1800 employees.

Contributed by: Anita Bonds, RPh, Pharmacist / Systems Analyst, Greater South East Community Hospital.

Here are some rules that I have created at my facility:

1. Rule to Check Pregnancy, Breast Feeding and Age in Tetracycline Use. This rule is attached to all active tetracycline drugs in the dictionary. This rule uses queries attached to the PHA Pat Cus Def Screen in the Customer Defined Parameters.

          [q OEPREG2]="Y"^A,
          [q OELAC]="Y"^B,
           "IF PREGNANT OR BREAST FEEDING, ADMINISTER ALTERNATIVE ANTIBIOTIC!"^C,
            "NOT RECOMMENDED IN CHILDREN < 8 Y.O. ADMINISTER ALTERNATIVE ANTIBIOTIC!"^D,
            IF{(A="Y")!(B="Y") [f rx msg](C);
            IF{([f pt cur age]<8) [f rx msg](D);
             [f rx ok]}};
   

2. This is a general rule to check pregnancy and breast feeding status. This rule uses queries attached to the PHA Pat Cus Def Screen in the Customer Defined Parameters. This rule is attached on page of the CDPs.

   	"PLEASE VERIFY DRUG USE IN PREGNANCY & BREAST FEEDING."^A,
   	 IF{([q OEPREG2]![q OELAC]="Y") [f rx msg](A);[f rx ok]};
   

3. This rule was written to check a patient’s location during order entry. If continuous orders are entered on an outpatient emergency room location, Pharmacy orders will not be sent to Robot Rx to fill. Only inpatient locations will send orders to Robot Rx.

   	[f pt location]="ERG"^A,
   	[f pt location]="EFG"^B,
   	[f pt status]="REG ER"^C,
   	"Pt status is OUTPATIENT. Only enter a 1 time order."^M,
   	 IF{([f pt location]=A!B) [f rx msg](M);
   	  [f rx ok]};
   

Anita Bonds, RPh, has over 15 years of clinical experience. She holds a Masters degree in Information Technology, and B.S. degrees in Pharmacy and Biology. Anita is a Pharmacist / Systems Analyst with Greater South East Community Hospital in Washington, D.C.