36C24419R0052-028.pdf

Department of Veterans Affairs Medical Center Medical Center Policy 119-01 Wilkes-Barre, Pennsylvania December 3, 2018

MEDICATION RECONCILIATION

I. CHANGES: Minor changes have been made to inpatient and outpatient procedures to include changing the suggestion for patients to bring a list of all medications to all outpatient appointments, Medical Support Assistant provision of a medication list upon to the patient upon check-out, and Burse provision of education on discharge medications to make sure the patient has an understanding of their medications.

II. RESCISSION: Medical Center Policy (MCP) 119-15-205, dated August 14, 2015, same subject.

III. NEXT REVIEW DATE: November 2021

IV. AFFECTED SERVICES: This MCP affects all clinical staff.

V. PURPOSE: To establish a consistent process for accurately and completely reconciling patient medications for inpatients and outpatients at Wilkes-Barre Veterans Affairs Medical Center (VAMC).

VI. POLICY:

A. Medication reconciliation is a process of identifying the most accurate list of a patient’s medication. It requires comparing a patient’s existing medication with those physicians might order. Reconciliation will occur whenever our facility transfers a patient to another setting, service, practitioner or level of care within or outside the organization.

B. In order to ensure there are essential medication standards necessary for review, management and communication it is Wilkes-Barre Department of Veterans Affairs Medical Center (WBVAMC) policy to adhere to guidance set forth in the national directive (see Appendices A, B, and C).

VII. RESPONSIBILITIES:

A. Service Chiefs are responsible for communicating policy content to staff members and monitoring compliance with processes.

B. All providers who prescribe drug treatments for Medical Center patients are responsible for medication reconciliation.

C. All Medical Center healthcare workers involved in ordering, preparing, and dispensing, administering drug treatments to patients are responsible for medication reconciliation outlined in this policy and compliance with same.

VIII. PROCEDURE:

Wilkes-Barre VAMC MCP 119-01 December 3, 2018

A. Outpatient procedures:

1. The patient will be educated during his initial outpatient visit and returning visits regarding:

a. The patient is expected to be a responsible partner in his/her health care.

b. The patient should bring a list of medications to all outpatient appointments. This should include medications the patient receives from doctors outside the WBVAMC, over the counter medication, vitamins, herbal supplements and or diet supplements.

c. The Medical Support Assistant will provide the patient with a medication list upon check-out.

2. Provider will address the clinical reminder by opening a new note, selecting the clinical reminder (Medication Reconciliation) and completing the medication reconciliation reminder (Attachment A). The clinical reminder has an optional selection for reviewing current medications while responding to the reminder.

3. Pharmacist will verify medication orders.

4. Services will monitor Medication Reconciliation and report this through

National Patient Safety Goals Compliance Dashboard for compliance.

B. Inpatient Procedures:

1. On admission the provider will interview patient and verify the medication the patient is taking. This will include VA medications, non-VA medications, vitamins, herbals, remedies, over the counter medications and medications prescribed by other VA facilities. The provider will complete the admission medication review clinical reminder and order the appropriate medication according to his plan of care (Attachment B).

2. On admission the pharmacist will:

a. Compare admission orders against outpatient medication profile.

b. Communicate with provider any discrepancies between inpatient orders and outpatient profile.

3. On transfer the provider will complete the transfer medication review clinical reminder and order the appropriate medication according to his plan of care (Attachment C).

4. On discharge the provider will:

a. Review inpatient medications to determine the patient’s discharge regimen. The provider will review the active medication profile comparing this health summary with inpatient profile for accuracy. The provider will complete the discharge medication clinical reminder and order the appropriate medication according to his plan of care (Attachment D).

b. Written discharge instruction will be given to the patient. On the discharge instruction provider will include an accurate list of VA, non-VA, vitamins, herbals, over-the-counter or medication prescribed by another VA as appropriate.

c. Provider will dictate a stat discharge summary for patients going to long term care.

5. On discharge the pharmacist will:

a. Compare discharge orders with inpatient profile.

b. Communicate any discrepancies to provider. If discrepancies are found, the pharmacist will request that the provider makes the changes and document changes for the patient.

i. Pharmacy will provide patient education upon discharge as requested.

ii. If patient refuses education it will need to be documented by the pharmacist.

6. On discharge the nurse will:

a. Provide education on discharge medications to make sure the patient has an understanding of their medications.

IX. CUSTOMER SATISFACTION: This policy memorandum impacts patient and family satisfaction, as it directly addresses the quality of care and services provided to our patients.

X. REFERENCES National Patient Safety Goals Goal 8:

Accurately and Completely Reconcile Medications Across Continuum of Care IHI Institute for Healthcare Improvement

Prevention of Adverse Drug Events Essential Medication Standards

12/3/2018

X Russell E. Lloyd

Medical Center Director

Signed by: Russell E Lloyd 118065

MCP 119-01 Appendix A

Essential Medication Information

This Appendix is intended to be updated between concurrence cycles and represents the minimal or essential elements necessary to review, manage, and communicate medication information among healthcare teams, Veterans, and caregivers. This medication information is exchanged verbally, in print, and via digital processes and tools

Refer to:

http://vaww.infoshare.va.gov/sites/MedRecon/Essential%20Medication%20Information

%20Standards%20Directi/Forms/AllItems.aspx for the most current version of the appendices.

A. The Essential Medication Information must consist of the following elements:

1. Medication Information:

(a) All medication entries include the following:

(1). Name of drug.

(2). Strength/dosage of drug.

(3). Instructions/Directions for use.

(4). Notes: Section or white space to allow patients to write any information they need to help them manage their medications (indication, description of medication, etc.).

(b) Source of Medication Information:

(1). Local Active Medications. The active medications ordered and/or administrated by the treating Veterans Administration (VA) facility in the Computerized Patient Record System/Veterans Health Information Systems and Technology Architecture pharmacy package must reflect what the Veteran has been prescribed and has been dispensed by the local VA Pharmacy.

(2). Remote Medications. Remote medications are medications ordered and dispensed from any other VA facility and/or Department of Defense (DoD) facility (if applicable).

(3). Non-VA medication. Non-VA medications are medications obtained outside VA (with the exception of DoD medications, which are viewed as Remote Medications)

(i). Non-VA provider prescribed medications filled at non-VA pharmacies.

(ii). VA provider prescribed medication filled at non-VA pharmacies.

http://vaww.infoshare.va.gov/sites/MedRecon/Essential%20Medication%20Information%20Standards%20Directi/Forms/AllItems.aspx http://vaww.infoshare.va.gov/sites/MedRecon/Essential%20Medication%20Information%20Standards%20Directi/Forms/AllItems.aspx

(iii). Other medications, such as sample prescription medications provided from a non-VA provider’s office.

(iv). Medications obtained from family or friends.

(v). Herbals, over-the counter-medications, nutraceuticals, and alternative medications not dispensed through VA.

(c). For the purpose of reviewing medications with patients, a list of local VA medications with the following prescription status is important in determining what medications a patient may be taking:

(1). Recently discontinued (90-180 days)

(2). Recently expired (90-180 days)

(3). Pending where relevant (e.g., where patient is being seen by multiple providers in the same day)

(4) Note: Recently changed doses may not be reflected in the VA Electronic Health Record pharmacy orders package and may be found upon progress note review.

2. Identification

(a). Patient demographic information including the following:

(1). Full Name of Patient as recognized by VA standards

(2). Full Date of Births recognized by VA standards

(3). Other patient identifiers as needed

(4). Known Patient Allergies/Adverse Drug Reactions

(b). Prescriber and Pharmacy Information in structured fields or allow white space on the medication list so patients may record this to help them coordinate and manage their care. See Appendix C for details on patient medication information display standards.

(c). Facility contact information (for example: facility name, phone number or Patient Aligned Care Team contact information for each institution that the patient has active, suspended, or pending medications) so that a patient and/or caregiver may contact the facility with any questions regarding their medications.

3. Additional Information to include:

(a). Time and date the medication list was printed/published to help patients keep their information updated.

(b). Documentation of Veteran/family/caregiver education and verbalization of their understanding of the medication information will be completed in accordance with relevant facility level requirements.

(c). Instructions to the patient regarding the importance of their role in keeping this information maintained, updated, and to share those updates with their health care team.

(d). A glossary of pharmacy prescription status (i.e. active, hold, suspend, expired, discontinued, pending, remote, non-VA, etc) should be available on any print or electronic medication lists that includes the pharmacy prescription status to help staff and Veterans/caregivers understand how these terminologies affect the availability of their prescriptions, and their medication use. (See Table One Below)

B. Additional Recommended Information

(a). Documentation via white space, structured fields and/or text of patient specific information that may impact medication treatment planning such as whether or not a patient has a caregiver managing their medications, cultural, educational considerations, any cognitive or physical impairment, whether a female patient may be pregnant and/or lactating, elderly, has a chronic illness such as kidney or liver disease, and so forth.

Table One Glossary of Prescription Status

STATUS Staff Facing Explanation of Status Veteran Facing Explanation of Status:

All Veterans facing medication information should contain the general statement "You should take these medications as your provider told you to. The words Active, Hold, Pending, Discontinued, and Expired refer to your VA pharmacy’s work on your prescription":

Active Prescription available to be filled at the local

VA pharmacy

If you have refills, you may request a refill of this prescription from your VA pharmacy.

Pending

Prescription signed by physician, awaiting pharmacy review, not yet dispensed

Your VA provider ordered this prescription. It may not be ready for pick up at the VA pharmacy window or to be mailed to you. Contact your VA pharmacy if you need this prescription now.

Suspense

Active prescription waiting to be mailed to the patient on the appropriate date

You requested this prescription too early. It will be sent to you before you run out. Contact your VA pharmacy if you need this prescription now.

Hold Active prescription that will not be filled until pharmacy resolves the hold.

Call your VA pharmacy when you need more of this prescription.

Expired

Prescription no longer active due to passage of time

This prescription is too old to fill. Call your VA healthcare team if you need more. (This does not refer to the expiration date of the medication in the bottle.)

Discontinued Prescription no longer active due to explicit action of provider

Prescriptions your provider has discontinued and are no longer available to be sent to you or pick up at the VA pharmacy window

Non-VA

Any medication obtained, dispensed or purchased outside a VA pharmacy (Prescribed by VA or non-VA providers, over the counter

(OTC), Herbal, samples etc)

Medications you do not get from a VA pharmacy that your provider recorded in your medical record. This includes medication prescribed by VA or non-VA providers, over the counter medications, herbals, samples or other medications you take.

Remote meds

Prescription dispensed from a different VA pharmacy or the Department of Defense. (will not include prescriptions on HOLD at remote site)

Prescriptions you get from a different VA or the Department of

Defense.

MCP 119-01 Appendix B

Pharmacy Data: VistA/CDW File Structure

This Appendix is intended to be updated between concurrence cycles and includes the data files needed in building medication information tools. This defines the authoritative sources of medication information to promote standardization and reduce the likelihood that incomplete and/or incompatible data are displayed in different patient and provider facing venues.

Refer to:

http://vaww.infoshare.va.gov/sites/MedRecon/Essential%20Medication%20Information

A. Overview:

Pharmacy data are available from multiple sources within the Department of Veterans Affairs (VA), including the Health Data Repository (HDR), Corporate Data Warehouse (CDW), Veterans Health Information Systems & Technologies Architecture (VistA) and VistAWeb. VistA is the pharmacy data source for HDR, Pharmacy Benefits Management (PBM, and CDW data. VistAWeb data are collated from all VistA systems, Department of Defense (DoD), and data-sharing partners through the eHealth Exchange.

PBM is the authoritative body for interpretation of all pharmacy related data and standards. Developers will adhere to VA and federally-approved standards for terminology and structure to ensure consistency of information being provided to the health care team, patient, and/or caregiver.

Because of periodic changes and updates within VistA pharmacy and the evolving functionalities linking Veterans Health Administration (VHA), DoD, and other Federal and private entities, this version of Appendix B should be considered accurate as of publication of this directive. Updated versions of this document will be available on the PBM National Web site in Links and Other Resources (http://www.pbm.va.gov/PBM/LinksAndOtherResources.asp ) under the topic “Essential Medication Information Appendix B.” Specific questions should be addressed to the VHA Med Info VistA/CDW (VHAMedInfoVistA_CDW@va.gov) mail group.

B. Operational Guidance:

1. All applications must meet current VA security and electronic data interchange standards (HL7, NCPDP, RxNorm, or other PBM endorsed standards). Depending on application functionality, different standards may apply.

2. The drug entry will include drug name, drug strength and drug dosage form of VA originated data. Using the term “drug strength” is preferred over “drug dosage”.

a. Use the VA Print Name (File 50.68/Field 5) if available.

b. Refer to numerical dosing (e.g., 40 mg) as “drug strength.”

http://vaww.infoshare.va.gov/sites/MedRecon/Essential%20Medication%20Information%20Standards%20Directi/Forms/AllItems.aspx http://vaww.infoshare.va.gov/sites/MedRecon/Essential%20Medication%20Information%20Standards%20Directi/Forms/AllItems.aspx http://www.pbm.va.gov/ http://www.pbm.va.gov/PBM/linksotherresources.asp http://www.pbm.va.gov/PBM/LinksAndOtherResources.asp mailto:VHAMedInfoVistA_CDW@va.gov

c. Use the Local Drug File Generic Name if a VA Print Name is unavailable

3. When ordering a medication INSIDE VistA/CPRS, the Orderable Item Name is selected. The Orderable Item is linked to the Dispense Drug, which in turn is mapped to a VA Product Name.

4. When patient medications are already listed in the patient’s VistA/CPRS medication profile, the patient should be able to access individual prescription entries using the name of the medication which should be displayed as the VA Print Name (see Item 2 above).

5. A VA Product Name is the term used for accessing or entering medication information into a patient facing or provider facing system OUTSIDE of CPRS/VistA. The VA Product Name is mapped to RxNorm and contained within the RxNorm Terminology System, and it is linked to the VA Unique Identifier (VUID).

If no VA Product Name exists for the medication, the system should provide the user with a medication term from the VA copy of the RxNorm File.

C. Pharmacy Data Not Found in VistA:

1. Pharmacy Product System. The VA Pharmacy Product System (PPS-N) is the authoritative source of patient medication information and hosts the National Drug File

(NDF).

2. Patient Medication Information (PMI). The PMI is the VA medication information that is printed for the Veteran each time a prescription is filled or refilled. Any PMI generated outside the VistA electronic health record (i.e., My HealtheVet or other patient facing apps) must use the VA Product Name. The VA Product Name links the drug to the VA version of RxNorm. The VA version of RxNorm is associated with a version control mechanism that tracks the date of updates, which is of value when the Food and Drug Administration (FDA) makes changes on patient warnings, side effects, and adverse drug effects of medications. PBM updates, manages, and queries those changes and reports them to RxNorm to ensure the most accurate PMI is available to VA Patients.

3. FDA Medication Guides. These are required documents that must be issued with each prescription fill of selected medications. Please refer to the attached consumer medication information (CMI) Table PDF for additional information on PMI, and FDA medication guides, http://vaww.national.cmop.va.gov/FDAMedGuides/Forms/AllItems.aspx http://vaww.national.cmop.va.gov/FDAMedGuides/Forms/AllItems.aspx

Patient (or Consumer) Medication Information

(PMI/CMI)

Medication Guide Patient Package

Insert (PPI)

What kind of information is in it?

Specific information on the safe and effective use of a medicine

Specific information on the safe and effective use of a medication

Specific information on the safe and effective use of a medication

Which medicines have it?

All prescription medicine filled for the first time.

Certain prescription medicines with serious and significant public health concerns as decided by the FDA

Oral contraceptives and medicines with estrogen and other medicines as decided by the FDA or the drug company

Is the Pharmacist required to give it?

Provided voluntarily by pharmacies to meet goals established by Congress. It is usually included with the prescriptions when dispensed to the patient.

Yes, for all new and refilled prescriptions that are required by FDA to have a Medication Guide

No, except for oral contraceptives and medicines with estrogen where the information is usually part of a unit-of-use package.

Who writes it? Pharmacy or outside company

Drug company Drug company

Is it reviewed by the FDA?

No Yes Yes

4. Patient Facing Alerts. Contact PBM for latest guidance on Alerts VHA Med Info VistA/CDW (VHAMedInfoVistA_CDW@va.gov )

5. Medication Images- Accessible through Corporate Data Warehouse (CDW).

a. Medication Image Library (MIL) displays dispensed prescription medication

b. The NDC used to associate the MIL database with a patient’s profile is field #27 from the Prescription File #52. Requests for VA-sponsored projects must come from the Project Manager to MIL Pharmacist, VHACMOPMedicationImageLibrary@va.gov

c. To request credentials for use in a server (AITC) to access MIL/SQL Server visit:

http://vaww.vhadataportal.med.va.gov/DataAccess/OperationsAccess.aspx

5. Remote Data Interoperability (RDI) for Remote Medication.

mailto:VHAMedInfoVistA_CDW@va.gov mailto:VHACMOPMedicationImageLibrary@va.gov http://vaww.vhadataportal.med.va.gov/DataAccess/OperationsAccess.aspx

a. RDI is a VistA enhancement designed to retrieve selected prescription information from other VistA instances at other VA facilities. This feature was originally introduced as a method by which a prospective order could be checked for drug-drug interaction or drug-allergy interaction against orders at the local VA as well as any other remote VA station, plus Department of Defense data. RDI data would only display as part of these order checks.

b. The Medication Reconciliation Tool #1 (MedRecon Profile) leveraged the availability of RDI data to create a patient-centric VA-wide medication profile, and displays this information as part of a combined report of inpatient, outpatient, non-VA and remote medications.

c. This method is known to have certain gaps and issues, including unusual expiration dates displayed on retail Rx's reported through DoD data [to be fixed in GMTS*2.7*94] and lack of reporting for medications not matched to National Drug File.

For the short term, until these issues are resolved, PBM recommends that the RDI not be used as the sole source of remote information. For more information contact Pharmacy Benefits Management (10P4P) and Web/Mobile Solutions (10P2A).

6. Patient Generated Data. Patient generated medication data is considered any Veteran-furnished medication or allergy information collected using existing or future technologies. This constitutes a new stream of pharmacy data and, as such, is governed by the PBM Program Office. Any new applications designed and intended to collect said information must be reviewed and approved by PBM to ensure design preserves the consistency, integrity, and durability of information and adheres to aforementioned standards for data exchange and storage. For more information contact Pharmacy Benefits Management (10P4P) and Web/Mobile Solutions (10P2A).:

A. VistA Pharmacy Files:

The authoritative source of medication information for all VA digital medication information tools, including mobile, Web, and point of service (POS) applications, will include the following elements, with the data extracted from the indicated fields within the VistA pharmacy package.

The following tables identify the data files for presentation in any project that displays pharmacy data. The following information is arranged in columns that are extracted from the permanent VistA Pharmacy drug files. Each table header contains the following information.

Field Name- Contains the VistA pharmacy name as displayed in the data sets

File, Field # Contains the VistA data file number

Description Contains information pertinent to the developer

CDW

Contains references to corresponding fields in the CDW database

B. Patient, Facility, Provider Files:

File 2 - Patient This file contains information about the Patient. Patient demographics and identifying information are located in the parent File 2 and several multiples. For patient identifier, please use the Master Veteran Index Patient Integrated Control Number, found on the Veteran’s card, or secondarily, their SSN.

Field Name File, Field # Description CDW

Name 2,.01 Patient Name Patient Name

Date of Birth 2,.03 Patient Date of Birth DateOfBirth

Sex 2,.02 Patient Sex Gender

Social Security Number

2,.09 Patient Social Security Number

PatientSSN

Integration Control Number

2,999.01 Patient Integrated Control Number (PatientICN)

PatientICN

ICN Checksum 2,991.02 The checksum for the PatientICN (Integration Control Number) (recommended for interacting with the Master Veteran Index

(MVI))

PatientICNChecksum

Subfile (Multiple) 2.06 – Patient Ethnicity

This file contains the patient ethnicity corresponding to the Bureau of the Census ethnicity at time of enrollment. By the way the question is asked, a patient can have 0, 1, or more than 1 ethnicity.

Method of Collection

2.06,.02 Collection Method for Race (see Veteran Health Administration Data Quality (VHA DQ) paper on Patient Race and Ethnicity for further details)

Collection Method

Ethnicity Information

2.06, .01 Patient Ethnicity Ethnicity

Subfile (Multiple) 2.02 – Patient Race

This file contains the patient race corresponding to the Bureau of the Census ethnicity at time of enrollment. By the way the question is asked, a patient can have 0, 1, or more than 1 race.

Race Information 2.02,.01 Patient Race Race

Method of Collection

2.02,.02 Collection Method for Race (see VHA DQ paper on Patient Race and Ethnicity for further details)

Collection Method

File 4 – Institution

This file contains information related to the medical center where the patient was treated. Each institution has a physical address.

Official VA Name

4,100 The institution name in VA rules

OfficialVAName

(Optional) Short Name

4,.05 The official abbreviation of the Institution Name

InstitutionShortName

Street Addr. 1 4,1.01 Street Address StreetAddress1

Street Addr. 2 4,1.02 Street Address StreetAddress2

City 4,1.03 City City

Zip 4,1.04 Zip Zip

State 4,.02 State StateAbbrev

File 44 – Location

Name 44,.01 Location Name (Clinic Name in most cases)

Location Name

File 200 – New Person (“Staff”) This file contains identifying information about the prescribing Staff member.

Field Name File, Field

Description CDW

Name 200,.01 Staff Name StaffName

Office Phone 200,.132 Office Phone and Extension

OfficePhone

Service/Section 200,29 Service Section of Provider

ServiceSection

C. Medication Information Files

File 50 – Drug (“Local Drug”)

This file contains information about the drugs from the local pharmacy perspective.

GENERIC NAME 50,.01 Generic Name of the medication (2nd preference in Outpatient Prescription, (VA Print Name (50.68,5) is the 1st preference))

LocalDrugNameWithD ose

DEA, SPECIAL

HDLG

50,3 Indicates whether the drug had been designated a controlled substance by the Drug Enforcement Administration (DEA) or otherwise restricted, or if it is a supply item, compounded, etc.

requiring special handling (HDLG)

NEW WARNING

LABEL LIST

50,8.1 Contains the drug warning labels generate with the printed prescription label

SYNONYM 50.1,.01 May contain the trade or brand name, common abbreviation, etc. for the drug

NDC CODE 50.1,2 The 11-digit universal Food and Drug Administration (FDA) code to match to other databases

(XXXXX-XXXX-

XX=manufacturer-drug-package size)

NATIONAL DRUG

FILE ENTRY

50,20 POINTER TO VA

GENERIC (Drug) FILE (#50.6) (generic=non-brand name drug)

VA PRODUCT

NAME

50,21 May be different from the generic name, contains extended information including dosage form and strength

PSNDF VA

PRODUCT NAME

ENTRY

50,22 Foreign key to File

50.68. If not null, this

foreign key can retrieve the preferred name of the drug (Pharmacy Service National Drug File)

VADrugPrintName

NATIONAL DRUG

CLASS

50,25 POINTER TO VA

DRUG CLASS FILE

(#50.605)

File 50.68 – VA Standardized National Drug File – VA Product (“National Drug”) The source of VA Product Names

Description CDW

VA Print Name 50.68,5 The NDF standard print name (The 1st preferred drug name for Outpatient Pharmacy)

VADrugPrintName

Strength 50.68,2 The dosage or strength of the medication. PBM advises to use the word “strength” over dosage.

Strength

CS Federal Schedule

50.68,19 If the medication happens to be a DEA scheduled medication (Controlled Substance), the schedule will be here

CSFederalSchedule

GCNSeqNo 50.68,11 The Generic Code Number Sequence is used as a foreign key to

GCNSeqNo

Description CDW

File 50.623 to retrieve the PMI

File 50.7 – Orderable Item (“Pharmacy Orderable Item”)

Description CDW

Name 50.07,.01 This is the Pharmacy Orderable Item name.

This is the preferred name for Non-VA Medications

PharmacyOrderableIte m

DosageForm 50.07, .02 This is the dosage form.

Instead of using this word, use “strength”.

DosageForm AS Strength (resolved value)

D. Patient Medication Information (PMI):

PMI is a VA term and is synonymous to the term Consumer Medication Information (CMI). File 50.621 contains the English PMI sheets. File 50.622 contains Spanish PMI sheets. The current VA supplier for PMI information is First DataBank (FDB). Identical PMI information can be found in the Drug Information Framework Servers (FDB-DIF) as Patient Education Monographs (PEM). PMI inserts include information about a particular medication, i.e., lisinopril. Occasionally, a medication does not have a PMI, as in the cases of new or investigational medications. VA Outpatient Pharmacy Policy requires a PMI be furnished with every new prescription. This includes the first time a patient receives the medication, renewals, and when the medication prescription changes (i.e., dose changes). Many facilities furnish PMIs with every dispensed medication.

File 50.623 – PMI Map – English

GCNSeqNo 50.623,.01 The GCNSeqNo for the

PMI

No Corresponding File in CDW

English PMI Entry 50.623,1 The foreign key to File

50.621 to retrieve the

PMI

No Corresponding File in CDW

File 50.621 – PMI English

TITLE 50.621,0.01 Generic name of the drug

No Corresponding File in CDW

COMMON BRAND

NAMES

50.621,1 Common brand names of the drug

No Corresponding File in CDW

BLANK LINE 50.621,2 Blank Line No Corresponding File in CDW

PHONETICS 50.621,3 phonetic pronunciation of the drug name

No Corresponding File in CDW

HOW TO TAKE 50.621,4 Dosing instructions No Corresponding File in CDW

USES 50.621,5 Common indications for the drug

No Corresponding File in CDW

SIDE EFFECTS 50.621,6 Possible side effects associated with the drug

No Corresponding File in CDW

WARNINGS 50.621,7 Common warnings associated with the drug

No Corresponding File in CDW

OVERDOSE 50.621,8 Instructions on what to do in the case of taking too much of the drug

No Corresponding File in CDW

MISSED DOSE 50.621,9 Instructions on what to do if a dose is missed

No Corresponding File in CDW

DRUG

INTERACTIONS

50.621,10 List of other drugs that may interact with the drug

No Corresponding File in CDW

PRECAUTIONS 50.621,11 List of what to avoid while taking the drug

No Corresponding File in CDW

STORAGE 50.621,12 How to store the drug No Corresponding File in CDW

MEDIC ALERT 50.621,13 What a first responder needs to know if the drug is being used

No Corresponding File in CDW

NOTES 50.621,14 Space for written notes No Corresponding File in CDW

DISCLAIMER* 50.621,15 Legal notice No Corresponding File

Patient Medication Information – Spanish Mapping

File 50.624 – PMI Map – Spanish

GCNSeqNo 50.624,.01 The GCNSeqNo for the

PMI

No Corresponding File in CDW

Spanish PMI Entry 50.624,1 The foreign key to File

50.621 to retrieve the

PMI

File 50.622 – PMI Spanish

TITLE 50.622,0.01 Generic name of the drug

No Corresponding File in CDW

COMMON BRAND

NAMES

50.622,1 Common brand names of the drug

No Corresponding File in CDW

BLANK LINE 50.622,2 Blank Line No Corresponding File in CDW

PHONETICS 50.622,3 phonetic pronunciation of the drug name

No Corresponding File in CDW

HOW TO TAKE 50.622,4 Dosing instructions No Corresponding File in CDW

USES 50.622,5 Common indications for the drug

No Corresponding File in CDW

SIDE EFFECTS 50.622,6 Possible side effects associated with the drug

No Corresponding File in CDW

WARNINGS 50.622,7 Common warnings associated with the drug

No Corresponding File in CDW

OVERDOSE 50.622,8 Instructions on what to do in the case of taking too much of the drug

No Corresponding File in CDW

MISSED DOSE 50.622,9 Instructions on what to do if a dose is missed

No Corresponding File in CDW

DRUG

INTERACTIONS

50.622,10 List of other drugs that may interact with the drug

No Corresponding File in CDW

PRECAUTIONS 50.622,11 List of what to avoid while taking the drug

No Corresponding File in CDW

STORAGE 50.622,12 How to store the drug No Corresponding File in CDW

MEDIC ALERT 50.622,13 What a first responder needs to know if the drug is being used

No Corresponding File

NOTES 50.622,14 Space for written notes No Corresponding File in CDW

DISCLAIMER* 50.622,15 Legal notice No Corresponding File

E. Outpatient Pharmacy (Prescription) Files:

File 52 – Prescription

At the top level, this file contains the prescription information necessary to dispense a prescription. The fill information is more complicated.

Description CDW

RX # 52,.01 This is the prescription number.

RxNumber

ISSUE DATE 52,1 Date when doctor wrote prescription.

IssueDate

PATIENT 52,2 POINTER TO PATIENT

FILE (#2)

The patient receiving treatment.

PatientIEN

PATIENT STATUS 52,3 POINTER TO RX

PATIENT STATUS

FILES (#53)

This field is used to show the status of the patient at the time the medication was filled.

PatientStatus

PROVIDER 52,4 POINTER TO NEW

PERSON FILE (#200)

The clinician who wrote the prescription

ProviderIEN

CLINIC 52,5 POINTER TO HOSPITAL

LOCATION FILE (#44))

Clinic where treatment was given and prescription was written.

LocationIEN

DRUG 52,6 POINTER TO DRUG

FILE (#50)

The actual medication.

NationalDrugIEN if known, LocalDrugIEN otherwise

TRADE NAME 52,6.5 May contain the brand name of the drug if the pharmacist included it on

STATUS 52,100 The designation of the prescription as to whether the prescription is active, discontinued, expired, on hold, suspended, etc.

Often confusing for patient and staff.

RxStatus

DISCONTINUE

TYPE

52,100 This field is used to distinguish what type of external discontinue action occurred. (Only visible if Status is Discontinued)

DiscontinueType

VERIFYING

PHARMACIST

52,104 This field is used to show the pharmacist that verified the prescription

VerifyingStaffIEN the original prescription (Rx)

QTY (Quantity) 52,7 Quantity of tablets/capsules/drops dispensed

DAYS SUPPLY 52,8 Number of days’ supply of drug dispensed

# OF REFILLS 52,9 The number of refills ordered by the clinician and allowed per prescription.

MaxRefills

SIG 52,10 Prescription Instructions for the patient

FILL DATE 52,22 Date prescription was filled by pharmacy

PHARMACIST 52,23 POINTER TO NEW

PERSON FILE (#200)

(Links Rx # to pharmacist)

LOT # 52,24 Lot number of medication dispensed to fill Rx

DISPENSED

DATE

52,25 Date the prescription was filled

EXPIRATION

DATE

52,26 Expiration date of the prescription (usually 365 days)

NDC 52,27 National Drug Code

COSIGNING

PHYSICIAN

52,109 This field identifies the cosigning physician for prescriptions written by a provider for whom a counter signature is required, for example a nurse practitioner.

CosigningStaffIEN

SERVICE

CONNECTED

52,116 During Outpatient Pharmacy order entry, a pharmacist may be asked if the medication being prescribed is for a service connected condition. This field will store the pharmacist's response to this question. The value in this field will be used to evaluate whether or not a copay should be applied to the prescription. This value will also be used as a default should this question be raised again during the life of the prescription when a prescription fill is being released, or as the default for the question upon renewal of the prescription through CPRS or Outpatient Pharmacy.

ServiceConnectedFlag

CANCEL DATE 52,26.1 This date is used to indicate when the medication was cancelled.

CancelDate

HOLD DATE 52,99.2 This field is used to indicate the date that a prescription was placed on hold.

HoldDate

F. Prescription Fill Information:

1. Outpatient Pharmacy (RxOut).

This domain is defined from the records brought over from File 52 in VistA. Within the CDW, this is the RxOut schema.

A prescription fill is when a quantity of medication is dispensed to the patient. Original fill information can be found in File 52. Partial Fill (when a fill cannot be completed totally in one session) can be found in 52.2. Refills (when a fill is redone) can be found in 52.1.

The CDW presents all fills as one data structure with types O for Original, P for Partial, and R for Refill. The file and field targets are the equivalents in each table. No field data types are suggested as this is a concatenation (linking of data files).

File 52 - Original Fill

Description CDW

ISSUE DATE 52,1 Date when doctor wrote prescription.

IssueDate

STATUS 52,100 This field represents the current status of the prescription.

RxStatus

MAIL/WINDOW 52,11 Indicates if the medication will be picked up or mailed to the patient.

MailWindow

REMARKS 52,12 Any additional comments.

FillRemarks

PATIENT 52,2 The patient receiving treatment.

PatientIEN

LOGIN DATE 52,21 The date the prescription was entered.

LoginDate

FILL DATE 52,22 The date the prescription was filled.

FillDateTime

PHARMACIST 52,23 This field is used to identify the pharmacist that filled the medication request.

PharmacistIEN

LOT # 52,24 The vendor code for this product. It is required to be on the label if the medication is sent to a nursing home.

LotNumber

DISPENSED

DATE

52,25 This field will be used to show the

DispensedDate

Description CDW actual date the medication was dispensed.

NDC 52,27 This field is used for the National Drug Code.

NDC

MANUFACTURE

R

52,28 This field is used to enter the manufacturer of the drug issued.

Manufacturer

DRUG

EXPIRATION

DATE

52,29 This date is used to show the expiration date of the medication. The date reflects the manufacturer's expiration date, not the date the Rx can no longer be filled.

ExpirationDate

RELEASED

DATE/TIME

52,31 This field is used to show the actual date and time the medication was released for inventory purposes and copay Pbilling if applicable.

ReleaseDateTime

RETURNED TO

STOCK

52,32.1 This field is used to show when and if the medication was returned to stock because the patient did not pick up the meds or it was not mailed.

ReturnedToStockDateTime

FILLING

PERSON

52,38.1 The name of the pharmacist who scanned the barcode before filling the medication request.

FilledByStaffIEN

CHECKING

PHARMACIST

52,38.2 The name of the pharmacist that checked the medication request.

CheckingPharmacistStaffI

EN

Description CDW

PROVIDER 52,4 Doctor who wrote the prescription.

ProviderIEN

CLINIC 52,5 Clinic where treatment was given and prescription was written.

PrescribingDivisionIEN

DRUG 52,6 The actual medication.

NationalDrugIEN

DRUG 52,6 to 50, The actual medication.

LocalDrugIEN

QTY 52,7 This field is used to show the amount of medication that was dispensed.

Qty

DAYS SUPPLY 52,8 A whole number between 1 and 90.

The maximum upper limit is 90, but may be lower based on the maximum specified for this patient status. This parameter is defined in the RX PATIENT STATUS file.

DaysSupply

DAW CODE 52,81 Dispensed As Written (DAW) code.

This information is used for electronic claim transmission to third party payers (insurance companies).

DAWCode

RE-TRANSMIT

FLAG

52,82 This field is used to indicate that a claim should be electronically re-transmitted to the 3rd party insurance. It will be primarily used by CMOP and local mail prescriptions.

RetransmitFlag

DATE NDC

VALIDATED

52,83 This field contains the date and time

ValidatedDateTime

Description CDW that the NDC was validated prior to release of the prescription fill.

NDC

VALIDATED BY

52,84 This field will contain the user ID of the person who validated the NDC prior to release of the prescription fill.

ValidatedByStaffIEN

BILLING

ELIGIBILITY

INDICATOR

52,85 This field is set when a prescription is third party insurance billable and will contain T for TRICARE, V for VETERAN or C for

CHAMPVA.

BillingEligibility

EPHARMACY

SUSPENSE

HOLD DATE

52,86 This field is defined when a host reject error is received as a result of an ePharmacy claims submission. The prescription fill will be held on suspense until the next day.

SuspenseHoldDate

File 52.1 – Refill

REFILL DATE 52.1,0.01 This is the date the prescription is refilled.

FillDateTime

ISSUE DATE 52.1,1 Date when doctor wrote prescription.

IssueDate

QTY 52.1,7 Number of units (tablets, capsules, etc.) dispensed

Qty

DAYS SUPPLY 52.1,1.1 This field is used to show days of supply of refill.

DaysSupply

DISPENSED

DATE

52.1,10.1 This field is used to show date/time the medication was placed into packaging.

DispensedDate

STATUS 52.1,100 This field represents the current status of the prescription.

RxStatus

NDC 52.1,11 This field is used for the National Drug Code for the issued drug.

NDC

MANUFACTURE

R

52.1,12 This field is used to show the manufacturer of the drug issued.

Manufacturer

DRUG

EXPIRATION

DATE

52.1,13 This field is used to show the date that the medication expires for this refill.

ExpirationDate

RETURNED TO

STOCK

52.1,14 This field is used to indicate when and if the medication was returned to inventory due to the prescription not being picked up or mailed to the patient.

ReturnedToStockDateTim e

RELEASED

DATE/TIME

52.1,17 This field is used to show the date/time the medication was released for inventory purposes and copay billing if applicable.

ReleaseDateTime

FILLING

PERSON

52.1,19 The name of the person who scanned the barcode before refilling the medication request.

FilledByStaffIEN

MAIL/WINDOW 52.1,2 This field contains 'M' if the refill is to

MailWindow be mailed to the patient and 'W' if the refill is to be picked up at the pharmacy window.

PATIENT 52.,2 The patient receiving treatment.

PatientIEN

CHECKING

PHARMACIST

52.1,20 The name of the pharmacist that checked the medication refill request.

CheckingPharmacistStaffI

EN

REMARKS 52.1,3 This field contains comments as deemed necessary by the pharmacy staff.

FillRemarks

PHARMACIST

NAME

52.1,4 This field contains the name of the pharmacist responsible for this Rx.

PharmacistIEN

PROVIDER 52,4 Doctor who wrote the prescription.

ProviderIEN

CLINIC 52.1,5 Clinic where treatment was given and prescription was written.

PrescribingDivisionIEN

LOT # 52,5 This field contains the lot # of the prescription.

LotNumber

DRUG 52,6 to 50, The actual medication.

NationalDrugIEN

DRUG 52,6* The actual medication.

LocalDrugIEN

CLERK CODE 52.1,6 This field contains the NEW PERSON File entry number of the clerk (pharmacy technician) who filled the prescription.

ClerkStaffIEN

LOGIN DATE 52.1,7 This is the date the refill request was entered.

LoginDate

DIVISION 52.1,8 This field contains the Pharmacy Division associated with this Rx.

PharmacySiteIEN

DAW CODE 52.1,81 Dispensed As Written code. This information is used for National Council for Prescription Drug Programs (NCPDP) electronic claim transmission to third party payers (insurance companies).

DAWCode

RE-TRANSMIT

FLAG

52.1,82 This field is used to indicate that a claim should be electronically re-transmitted to the 3rd party insurance.

It will be primarily used by VA’s Consolidated Mail Out Pharmacy (CMOP) and local mail prescriptions.

RetransmitFlag

DATE NDC

VALIDATED

52.1,83 This field contains the date and time that the NDC was validated prior to release of the prescription fill.

ValidatedDateTime

NDC

VALIDATED BY

52.1,84 This field contains the user identity (ID) of the person who validated the NDC prior to release of the prescription fill.

ValidatedByStaffIEN

BILLING

ELIGIBILITY

INDICATOR

52.1,85 This field is set when a prescription is third party insurance billable and will contain T for TRICARE, V for VETERAN or C for

CHAMPVA.

BillingEligibility

EPHARMACY

SUSPENSE

HOLD DATE

52.1,86 This field is defined when a host reject error is received as a result of an ePharmacy claims submission. The prescription fill will be held on suspense until the next fill date.

SuspenseHoldDate

File 52.2 – Partial Fill

Description CDW

PARTIAL DATE 52.2,0.01 This is the date the partial was made.

FillDateTime

MAIL/WINDOW 52.2,0.02 This field tells whether the medication was picked up or mailed to the patient.

MailWindow

REMARKS 52.2,0.03 These are any additional comments.

FillRemarks

QTY 52.2,0.04 This field is used to show the amount of medication that was dispensed.

Qty

DAYS SUPPLY 52.2,0.041 This field is used to indicate the days of supply for partial RX fill.

DaysSupply

PHARMACIST

NAME

52.2,0.05 This is the name of the pharmacist.

PharmacistIEN

Description CDW

LOT # 52.2,0.06 This field shows the vendor's lot number.

LotNumber

CLERK CODE 52.2,0.07 This is the user number of the clerk that keyed in the prescription.

ClerkStaffIEN

LOGIN DATE 52.2,0.08 This is the date that the prescription was entered.

LoginDate

DIVISION 52.2,0.09 This field contains the Pharmacy Division associated with this

RX.

PharmacySiteIEN

ISSUE DATE 52,1 Date when doctor wrote prescription.

IssueDate

NDC 52.2,1 This field is used to show the National Drug Code of the drug issued.

NDC

FILLING

PERSON

52.2,10 The name of the person who scanned the barcode before dispensing a partial medication request.

FilledByStaffIEN

STATUS 52.2,100 This field represents the current status of the prescription.

RxStatus

CHECKING

PHARMACIST

52.2,11 The name of the pharmacist that checked the partial medication request.

CheckingPharmacistStaffI

EN

DRUG

EXPIRATION

DATE

52.2,12 This field is used to show the date that the medication expires for this partial fill.

ExpirationDate

PATIENT 52,2 The patient receiving treatment.

PatientIEN

MANUFACTURE

R

52.2,2 This field is used to store the name of the manufacturer of the drug being dispensed.

Manufacturer

RETURNED TO

STOCK

52.2,5 This field is used to show when and if the

ReturnedToStockDateTim e

Description CDW medication in the prescription was returned to inventory due to not being picked up or mailed.

CLINIC 52,5 Clinic where treatment was given and prescription was written.

PrescribingDivisionIEN

PROVIDER 52,6 This field is used to show the provider that is currently seeing the patient.

ProviderIEN

DRUG 52.2,6 to 50, 3

The actual medication.

NationalDrugIEN

DRUG 52.2,6 The actual medication.

LocalDrugIEN

DISPENSED

DATE

52.2,7.5 This field is used to indicate the date the partial medication was dispensed.

DispensedDate

RELEASED

DATE/TIME

52.2,8 This field is used to show the date the medication was released.

ReleaseDateTime

G. Pharmacy Patient Files (#55):

This file contains all the inpatient medication and provider entered non-VA Medication. It also includes the narrative that pharmacy includes on a particular patient, i.e. (“USA Mail Only, “Must include Desiccants” “No boxes”). It includes pharmacy patient status, which may or may not include eligibility, i.e., service connection ratios.

File 55 contains inpatient medication pharmacy processing orders, and File 53 series contains Bar Code Medication Administration (BCMA) information on what medications are actually administered to the patient. Because the files contain data and business logic for several different workflows, care should be used to differentiate the different aspects of the table. There are differences between what a pharmacy will prepare, what is sent to a ready area, and what is administered to the patient. If inpatient pharmacy information needs to be presented to a mobile app, Pharmacy Benefits Management (PBM) does not have general recommendations as the use cases can heavily influence what is shown. PBM requests applications that want to use inpatient pharmacy data to directly contact the office for a Subject Matter Expert consult.

As a topical presentation, the Files can be thought of in the following way: there is a subfile for inpatient admixtures (55.01) further divided into subfiles for solute additive (55.02) and vehicle solution (55.11). There is a subfile for administered medications (BCMA). Finally, the one of relevance is a file for Non-VA Medications.

NAME 55,.01 POINTER TO PATIENT

FILE (#2)

(Links to patient demographics in VistA)

DIALYSIS

PATIENT

55,.04 SET FOR YES/NO

ACTIVE SCRIPTS 55,50 COMPUTED

PRESCRIPTION

PROFILE

55.03,.01 POINTER TO

PRESCRIPTION FILE

Links to all prescriptions for the particular patient

DRUG 55.03,1 The generic (non-trade) name of the medication ordered

STATUS 55.03,2 The designation the whether it is active, discontinued, expired, on hold, suspended, etc.

Often confusing for patient and staff…

ACTIVE 55.03,3 Designates that the prescription is presently available to be filled/refilled

NON-VA MEDS 55,52.2 Any medication, herbal product, supplement, etc. not dispensed by VA pharmacies. May also include VA prescribed medications that a patient chooses to have filled at a local pharmacy.

ORDERABLE

ITEM

55.05,.01 POINTER TO

PHARMACY

ODERABLE FILE

(#50.7)

The name of the drug that matches the name in the National Drug File (NDF) and allows for order checks.

DISPENSE DRUG 55.05,1 POINTER TO DRUG

FILE (#50)

The name of the medication drawn from the local drug file (may be the same as the VA Print Name)

DOSAGE 55.05,2 The amount (usually in milligrams, grams, milliliters, etc.) of the medication that the prescriber orders for the patient

MEDICATION

ROUTE

55.05,3 How the patient is to take the medication (i.e.

by mouth, in the right eye, etc.)

SCHEDULE 55.05,4 How often the patient is to take the medication (i.e. once a day, twice a day)

STATUS 55.05,5 The designation of the whether it is active, discontinued, expired, on hold, suspended, etc.

Often confusing for patient and staff…

UNIT DOSE 55,62 A form of medication packaging usually used in inpatient units only where one dose (pill, capsule) is packaged, labeled and dispensed to the patient.

PATIENT NAME 55.06,.5 POINTER TO PATIENT

FILE (#2)

The name of the patient connected with the prescription

DISPENSE DRUG 55.06,2 MULTIPLE

DISPENSE DRUG 55.07,.01 POINTER TO DRUG

FILE (#50)

The medication used to fill the prescription

MED ROUTE 55.06,3 POINTER TO

MEDICATION ROUTES

(#51.2) How the patient is to take the medication (i.e.

by mouth, in the right eye, etc.)

START

DATE/TIME

55.06,10 DATE

Element of the inpatient order to tell the nurse and pharmacy when the first dose of the medication is to be administered.

STATUS 55.06,28

BCMA ID 55,105 MULTIPLE

BCMA STATUS

DATE/TIME

55.0105,1 DATE

BCMA STATUS 55.0105,2 SET

File 55.05 – Non-VA Medications If outpatient medications are to be presented, this subfile is required from the File 55 Series.

ORDERABLE

ITEM

55.05,0.01 This is the orderable item that represents the Non- VA Med being taken by the patient.

No Corresponding File in CDW

DISPENSE DRUG 55.05,1 This is the dispense drug that represents the Non- VA Med being taken by the patient.

No Corresponding File in CDW

DOSAGE 55.05,2 This is the dosage of the Non-VA Med being taken by the patient.

No Corresponding File in CDW

MEDICATION

ROUTE

55.05,3 This is the route of the Non-VA Medication being taken by the patient.

No Corresponding File in CDW

SCHEDULE 55.05,4 This is the schedule of the Non-VA Medication being taken by the patient.

No Corresponding File in CDW

STATUS 55.05,5 This is the status of the Non-VA Med order.

No…