Prescription Entry

PiMS Pharmacy functions and features allow prescription entry by pharmacists and pharmacy technicians for an ambulatory clinical patient set. The Add New Prescription (RPH) and Add New Prescription (TECH) are the functions used to enter new prescriptions. A prescription entered by the technician is in Pending status until the pharmacist Dispenses the prescription.

To enter prescriptions for a patient, a current registration and visit for the patient must exist.

If a patient has had prescriptions dispensed in the past, at Add Prescription by RPH or TECH, the Patient Medication Record, (PMR), is displayed prior to the prescription entry screen. The PMR is a list of all the prescriptions dispensed for a patient. The last dispense date, RX number, medication label name, patient instructions, remaining refill count and the dispensed quantity are listed.

When selecting drugs for a prescription, selection can be made by entering a partial Brand, Generic or Label name. Only items that are active in the Pharmacy Service Master are available for prescription entry.

After the drug is selected, an Ordering Quantity (OQty) and Dispense Quantity (DQty) are required when adding a prescription. The maximum value is 99999 in whole numbers.

If clinical edits were found, the warning screen(s) will be presented.

The Sig or instructions are required fields for pharmacist entry and can be entered on one of two fields. From the Sig field, a code can be selected from the SIG code profile, a code can be typed in (bid or tid) or the actual patient instructions can be keyed in. The Instructions field also allows the entry of patient instructions either by typing the actual instructions or by entering a valid Sig code.

Label Warnings maintained by the NDDF are displayed on the prescription entry screens and printed on patient labels. The client may create additional Label Warnings.

Multiple dates are maintained for each prescription. The Written Date is the date the prescription was written by the prescriber. When entering a prescription it is defaulted with the current date but can be changed. The Entered Date is the date it is entered into the computer. The Dispensed Date is the date the prescription is dispensed, if being entered by a technician, the date field is blank. The Last Fill Date is the last date this prescription was dispensed, for a new prescription it defaults to current date. The Next Fill Date is based on the Dispense Date and the Days Supply field. The RX Expired Date is the prescription expiration date. This date determines the last date the prescription may be refilled.

The number of labels to be printed is defaulted from one of the user profiles, normally it is set to print one label. You can print multiple, split or reprint patient labels. To split or divide labels, you can split the dispense units into the number of labels you want to print. For example, if you have 100 tablets and you need three labels for three bottles, you enter 40, 30, 30 in the divide labels field to print duplicate and or split labels.

Clinical Edits

Clinical Edit Warning screens for Allergy, Drug-Drug Interaction and Therapeutic Duplication are displayed during the Add New prescription, Dispense and Refill functions when encountered. This checking is done as soon as the medication is selected, prior to the detail screen display. If multiple warnings are found for one prescription, the Allergy screen is displayed first, the Drug-Drug Interaction and then the Therapeutic Duplication. All warnings are color-coded based on severity. Danger-Red; Caution-Yellow; Alert-Blue; Informational-Green.

Clinical Edits can be overridden and PIMS maintains an audit trail. The View Clinical Edits function is used to see all the edits that were overridden when the warnings were displayed.

The Allergy edit functionality uses patient allergy information, the clinical information in the Pharmacy Service Master updated First DataBank and parameters in the User Profile to determine when the allergy screen is displayed. To add patient allergies, you can select multiple allergies, record the patient’s reaction and any verification of the information. The allergy list displays each time the patient is selected.

The Drug-Drug Interaction functionality provides for online screening of potential problems caused by administering 2 drugs concurrently. PIMS uses the First DataBank Drug-Drug Interaction functionality to determine when an interaction occurs and the severity level. Monographs detailing the mechanism of action, clinical effects, patient management and references can be viewed and printed.

Duplicate Therapy edits are displayed based on the parameters set in the User Profiles. Selection for duplicate therapy can be very broad or very specific based upon the options selected.

Claims Adjudication

Claims Adjudication is a direct electronic link to an electronic payer. The transmit takes place when the pharmacist dispenses the prescription. When the payer accepts the transaction, a message is immediately presented to the pharmacist that the medication is accepted/paid. If there are any fields that are transmitted that are not compatible to the payer requirements and the payer does not accept, there are code messages sent back immediately and the prescription can be corrected and retransmitted or it can be placed on a Pending Transmit worklist for transmitting at a later date.

First DataBank's National Drug File (NDDF)

All items dispensed by the pharmacy must be defined in the Pharmacy Service Master. The PiMS Pharmacy system uses First DataBank’s National Drug Data File (NDDF) and the international subset as a source for clinical and pricing information. An updated file with new drugs, formulations, package sizes as well as new drug interactions, patient education, clinical and pricing data is provided on a bi-monthly basis. The NDDF database contains over 100,000 items and is maintained online for access when adding new medications to the Service Master. When a new drug is added, all the related clinical data such as Therapeutic Classes, Drug-Drug Interactions and Patient Education information is retrieved from the First DataBank database.