I think that might be a good idea. I am testing 5.6 and had to have a DTS added
because with the user set to "C" things were sorting very badly.
Now they are sorting similarly to the way Charlie has described. One thing I
thought that I had figured out is that they sort alphabetically by mnemonic,
because ours were sorting numerically in correct order by mnemonic as well.
However, if you look at Charlie's example, in the Sinequan sort,
DOXE10C is listed before DOXE100C and in the DOXEPIN sort DOXE100C is listed
before the DOXE10C mnemonic - so even that idea isn't consistent.
We also used to put our own short mnemonics into the generic equivalent field -
i.e. FUR20, DIG25, to help make look ups easier, but those are slowly being
removed because they make the length of the lookup list longer and the
duplication are more confusing to look at.. Our users seem to be more
comfortable
just putting in the first 3 or 4 letters of the trade or generic and hitting
[lookup]. Apparently, with one of the upgrade, the formulary service will no
longer allow the user to create their own mnemonics for the drugs they pull in
from the suspense file. I am afraid this could create problems also, as most
of these FSV mnemonics are worthless. So sorting by strength would be something
worthwhile to look into.
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"Charlie Downs" <[EMAIL PROTECTED]>
Sent by: [EMAIL PROTECTED]
To
"'Howes, Lori'" <[EMAIL PROTECTED]>, <[email protected]>
07/05/2007 04:53 AM
cc
Subject
Re:
[MEDITECH-L] MIX Request PHA - ISMP NOTICE LARGE DOSE AT TOP MIX
Lori - With the brand name, using the default of C in the access dictionary,
here is what I get:
1 SINEQUAN 10 MG CAP Doxepin HCl 10 MG CAP
DOXE10C
2 SINEQUAN 100 MG CAP Doxepin HCl 100 MG CAP
DOXE100C
3 SINEQUAN 25 MG CAP Doxepin HCl 25 MG CAP
DOXE25C
4 SINEQUAN 50 MG CAP Doxepin HCl 50 MG CAP
DOXE50C
5 SINEQUAN 75 MG CAP Doxepin HCl 75 MG CAP
DOXE75C
6 SINEQUAN ORAL CONC 1 ML Doxepin HCl 10 MG/ML ML
DOXEL120
Entering the generic name – I get this:
1 DOXEPIN HCL Doxepin HCl 100 MG CAP
DOXE100C
2 DOXEPIN HCL Doxepin HCl 10 MG CAP
DOXE10C
3 DOXEPIN HCL Doxepin HCl 25 MG CAP
DOXE25C
4 DOXEPIN HCL Doxepin HCl 50 MG CAP
DOXE50C
5 DOXEPIN HCL Doxepin HCl 75 MG CAP
DOXE75C
6 DOXEPIN HCL Doxepin HCl 10 MG/ML ML
DOXEL120
So, it doesn’t even seem to be consistent as to which is first between a brand
name look-up and a generic name look-up. But I do agree that this is a safety
issue and makes sense. Furthermore, if Meditech and the formulary service
vendors could get their dose range checking working correctly, it would be less
of
an issue. I’ve built a lot of my own dose ranges because the ones with FDB give
too many worthless alerts. I believe that the bigger issue here is that a
dose range check would have caught this.
Charlie
Charles Downs PharmD
Washington County Hospital
251 E. Antietam Street
Hagerstown, MD, 21740
301-790-8904
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Howes, Lori
Sent: Tuesday, July 03, 2007 4:20 PM
To: [email protected]
Subject: [MEDITECH-L] MIX Request PHA - ISMP NOTICE LARGE DOSE AT TOP MIX
Hello,
Our Pharmacy department has created a MIX request, and is hoping to get other
Meditech PHA users to join us to convince Meditech that this is something we
need them to look at. Here is our request;
Brief Description/Synopsis of Request
When selecting a Drug, we would like the lowest strength to be the first
selection.
How are you currently handling this now?
We have no workaround.
What problem will be resolved?
Our system has the potential to contribute to a similar error like the one
below that happened at another hospital;
In an outpatient pharmacy located in a hospital, a prescription for SINEQUAN
(doxepin) 100 mg was entered into the computer and dispensed instead of the
correct strength of 10 mg. Neither the technician who pulled the 100 mg
strength from the shelf nor the verifying pharmacist caught the error. The
patient
took 500 mg of doxepin daily for one month before the error was corrected. The
error was discovered when the prescription was transferred to another
pharmacy and the receiving pharmacist expressed concern about the high dosage.
Since the error, the patient has been experiencing residual drowsiness and
fatigue. The physician is now slowly decreasing the dosage. The pharmacy
software system may have played a role in the error. Upon entering Sinequan on
the product line, the list of matching results placed Sinequan 100 mg on the
first line followed by Sinequan 10 mg. It is believed that the sequential
listing of both strengths, with a ten-fold difference, contributed to the
selection of the wrong strength, as did the listing of the higher
strength first.
Proposed Solution
Describe in detail how you think the system could be changed, considering
Dictionaries Parameters, Input and Output Screens, and Reports.
When selecting a Drug, we would like the lowest strength to be the first
selection.
System Impact
Describe why this enhancement is important.
How does it improve the MEDITECH system?
What impact will it have on users?
It will lessen the impact of user error.
Although neither is acceptable, user error is inevitable and the thought
process is that underdosing is less dangerous than overdosing.
Lori Howes
Business Systems Analyst - Clinical Support
Niagara Health System - Cecil G Shaver Data Centre
541 Glenridge Avenue
St. Catharines, ON
L2T 4C2
905-378-4647 X44857
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