Thanks for the reply. I don't have access to a working CPRS, so I don't really know what all it can do. Are you saying that even if the drug displays as, for example 80 mg, you can write text instructions to take only 1/2 tablet daily, and then save this as a quick order? Does this mess up the pill counting system, whereby it knows whether #30 tablets is a 30 vs. 60 day supply?
Thanks Kevin On 7/3/06, Mike Schrom <[EMAIL PROTECTED]> wrote: > No one seems to have mentioned this, so forgive the late reply, I was in > the wilds of eastern Quebec last week. > > We received instructions at the VA, probably two years ago, to do > exactly that: Issue (reliable!) patients pill splitters and prescribe > 1/2 pill QD. It was for a drug I don't use, so I haven't done that, but > I do frequently give out eye drops for external otitis (ear infections). > Yes, you need to use a text order, but you can save it as a "quick > order" and once it's saved it becomes very easy to order. Same thing > with steroid tapers, since Medrol dosepaks aren't on formulary here. > > Mike Schrom > > Kevin Toppenberg wrote: > > One of the doctors in our group used VistA while in residency at the > > VA, and he has expressed his dislike of CPRS drug prescribing. He > > described having to "stand on one's head" to prescribe drugs the way > > one wants to. I didn't understand what he was talking to until now. > > > > I am finding that one can only dispense tablets in quantities that are > > in the database, and this is a big hassle. > > > > For example, for cost savings, I have at times had patients take Zocor > > 80 mg tablet, 1/4 daily. To allow this for flexibility and for other > > possible doses, the Zocor entry in file# 50 would have to this: > > > > 903-POSSIBLE DOSAGES : > > Multiple Entry #1 > > .01-DISPENSE UNITS PER DOSE : 0.25 > > 1-DOSE : 20 > > Multiple Entry #2 > > .01-DISPENSE UNITS PER DOSE : .5 > > 1-DOSE : 40 > > Multiple Entry #3 > > .01-DISPENSE UNITS PER DOSE : 1 > > 1-DOSE : 80 > > > > With a Zocor 80, it wouldn't be approprite to give 2 pills, but with > > some drugs it would be appropriate, or perhaps even more (i.e. > > ibuprofen 200 mg * 4 tablets) > > > > So my plan has been to put the FDA drug data into VistA and let the > > doctor use his medical training to write out the correct prescription, > > to be submitted to an outpatient pharmacist for dispensing. It looks > > like to do this I need to add the following possible dosing allowances > > for EACH drug: > > 0.25, 0.5, 1, 2, 3, 4 > > Of course this is just for pills. What about creams, IV solutions? > > The FDA database does not contain any information about typical > > dosing, maximum daily dose, toxicity etc > > > > In summary, the VistA system seems designed to allow a pharmacist to > > put in the appropriate dosing for a particular drug, and it is > > difficult for a physcian to be more creative with dosing that was not > > anticipated. But this approach makes the system nearly impossible to > > completely fill with ALL possible medications due to the huge amount > > of time this would take to put in each drug individually. I would > > stongly suspect that this is why no one already has a complete > > formulary. > > > > In CPRS there is a "complex dosing" tab. I wish there was a > > multiplier column. This would allow a doctor to write: > > Zocor 80 mg * [0.25] PO QHS. > > > > I just realized another limitation is the allowed frequencies. There > > are the usualy Q1h, Q2h, even QOD, etc. But there is no allowance for > > 1x/month, 1x/week, 2x/wk, 4x/wk etc. > > It looks like there are some free text fields that allow me to get > > around some of this. But it does feel strongly like "standing on > > one's head" to get the job done. And it looses the quantitated data > > in fields that allow future data manipulation. > > > > Hmmm... I'll have to think about this.. > > > > Kevin > > > > Using Tomcat but need to do more? Need to support web services, security? > > Get stuff done quickly with pre-integrated technology to make your job > > easier > > Download IBM WebSphere Application Server v.1.0.1 based on Apache Geronimo > > http://sel.as-us.falkag.net/sel?cmd=lnk&kid=120709&bid=263057&dat=121642 > > _______________________________________________ > > Hardhats-members mailing list > > Hardhats-members@lists.sourceforge.net > > https://lists.sourceforge.net/lists/listinfo/hardhats-members > > > > Using Tomcat but need to do more? Need to support web services, security? > Get stuff done quickly with pre-integrated technology to make your job easier > Download IBM WebSphere Application Server v.1.0.1 based on Apache Geronimo > http://sel.as-us.falkag.net/sel?cmd=lnk&kid=120709&bid=263057&dat=121642 > _______________________________________________ > Hardhats-members mailing list > Hardhats-members@lists.sourceforge.net > https://lists.sourceforge.net/lists/listinfo/hardhats-members > Using Tomcat but need to do more? Need to support web services, security? Get stuff done quickly with pre-integrated technology to make your job easier Download IBM WebSphere Application Server v.1.0.1 based on Apache Geronimo http://sel.as-us.falkag.net/sel?cmd=lnk&kid=120709&bid=263057&dat=121642 _______________________________________________ Hardhats-members mailing list Hardhats-members@lists.sourceforge.net https://lists.sourceforge.net/lists/listinfo/hardhats-members
