============================================================================= Run Date: JUL 15, 2019 Designation: OR*3*427 Package : OR - ORDER ENTRY/RESULTS REPORTING Priority: Mandatory Version : 3 SEQ #426 Status: Released Compliance Date: AUG 15, 2019 ============================================================================= Associated patches: (v)OR*3*243 <<= must be installed BEFORE `OR*3*427' Subject: MENTAL HEALTH NCC PROJECT 5.01 Category: - Routine - Enhancement (Mandatory) Description: ============ This patch will add enhancements to the Inpatient Order Entry routines for the National Clozapine Coordination project. Below is a list of all the applications involved in this project along with their patch numbers: APPLICATION/VERSION PATCH --------------------------------------------------------------- MENTAL HEALTH (MH) V. 5.01 YS*5.01*122 OUTPATIENT PHARMACY (OP) V. 7.0 PSO*7*457 INPATIENT MEDICATIONS (IP) V. 5.0 PSJ*5*327 ORDER ENTRY/RESULTS REPORTING (OR) V. 3.0 OR*3*427 The patches (YS*5.01*122, PSO*7*457, PSJ*5*327, and OR*3*427) are being released in the Kernel Installation and Distribution System (KIDS) multi-build distribution MENTAL HEALTH NCC PROJECT 5.01. Abbreviations for terms used in the multi-build patch descriptions include the National Clozapine Coordinating Center (NCCC) located in Dallas, Texas; Absolute Neutrophil Count (ANC); White Blood Cells (WBC); Initial Operating Capability (IOC); and Computerized Patient Record System (CPRS). The purpose of this software package is to maintain compliance with legislative and federal mandates, as well as to add Clozapine Order Checking to the Inpatient Pharmacy application. In addition, this package replaces the weekly roll-up functionality and now transmits data to the National Clozapine server nightly. This specific patch contains the following functionality: --------------------------------------------------------- The ORDER CHECK RULE file (#860.2) and the ORDER CHECK ELEMENT file (#860.3) need to be modified to meet the new FDA Clozapine reporting guidelines. 1. The CLOZAPINE entry in the ORDER CHECK RULE file (#860.2) will be modified to: a. Remove the WBC order checks b. Modify the ANC order check values to meet new FDA guidelines 2. Add new entries to the ORDER CHECK ELEMENT file (#860.3) a. ELEMENT NAME: CLOZAPINE ANC >= 1.0 & < 1.5 c. ELEMENT NAME: CLOZAPINE ANC < 1.0 3. Modify the ^ORALWORD routine to display the appropriate order check message based on: a. The new ANC (Absolute Neutrophil Count) values b. Outpatient *** Permission to dispense clozapine has been denied based on the available lab tests related to the clozapine treatment program. *** For a National Override to dispense at the patient's normal frequency, contact the NCCC. A local override for an Outpatient can be approved for: (1) weather-related conditions, (2) mail order delays of clozapine, or (3) inpatient going on leave. For an Outpatient Special Conditions Local Override, a written prescription from the provider with documentation to the pharmacist is required to dispense a one-time emergency 4-day supply. c. Inpatient *** Permission to dispense clozapine has been denied based on the available lab tests related to the clozapine treatment program. *** For a National Override to dispense at the patient's normal frequency, contact the NCCC. A local emergency override for an Inpatient can be approved for: IP Order Override with Outside Lab Results. For a Special Conditions Local Override, a written order from the provider with documentation to the pharmacist is required to dispense a one-time emergency 4-day supply. The provider must record the ANC from another facility including date/time in both the Provider Progress Note and Comment field in CPRS. Message will be added and enforce a hard stop on the order. Before: ORDER CHECK RULE LIST FEB 16,2016 14:29 PAGE 1 ------------------------------------------------------------------------- NUMBER: 57 NAME: CLOZAPINE LABEL: NO WBC W/IN 7 DAYS ELEMENT NAME: CLOZAPINE NO WBC W/IN 7 DAYS TYPE: SIMPLE DEFINITION LABEL: WBC < 3.0 ELEMENT NAME: CLOZAPINE WBC < 3.0 TYPE: SIMPLE DEFINITION LABEL: ANC < 1.5 ELEMENT NAME: CLOZAPINE ANC < 1.5 TYPE: SIMPLE DEFINITION LABEL: 3.0 <= WBC < 3.5 ELEMENT NAME: CLOZAPINE WBC >= 3.0 & < 3.5 TYPE: SIMPLE DEFINITION LABEL: NO ANC W/IN 7 DAYS ELEMENT NAME: CLOZAPINE NO ANC W/IN 7 DAYS TYPE: SIMPLE DEFINITION LABEL: CLOZAPINE ELEMENT NAME: CLOZAPINE DRUG SELECTED TYPE: SIMPLE DEFINITION LABEL: ANC >= 1.5 ELEMENT NAME: CLOZAPINE ANC >= 1.5 TYPE: SIMPLE DEFINITION LABEL: WBC >= 3.5 ELEMENT NAME: CLOZAPINE WBC >= 3.5 TYPE: SIMPLE DEFINITION LABEL: 1.5 <= ANC < 2.0 ELEMENT NAME: CLOZAPINE ANC >= 1.5 & < 2.0 TYPE: SIMPLE DEFINITION STATUS: ACTIVE RELATION INDEX: 1 ORDER CHECK: CLOZAPINE APPROPRIATENESS RELATION EXPRESSION: CLOZAPINE AND (NO WBC W/IN 7 DAYS OR NO ANC W/IN 7 DAYS) ORDER CHECK MESSAGE: Clozapine orders require a CBC/Diff within past 7 days. Please order CBC/Diff with WBC and ANC immediately. Most recent results - |CLOZ LAB RSLTS| RELATION INDEX: 2 ORDER CHECK: CLOZAPINE APPROPRIATENESS RELATION EXPRESSION: CLOZAPINE AND (WBC < 3.0 OR ANC < 1.5) ORDER CHECK MESSAGE: WBC < 3.0 and/or ANC < 1.5 - pharmacy cannot fill clozapine order. Most recent results - |CLOZ LAB RSLTS| RELATION INDEX: 3 ORDER CHECK: CLOZAPINE APPROPRIATENESS RELATION EXPRESSION: CLOZAPINE AND 3.0 <= WBC < 3.5 AND ANC >= 1.5 ORDER CHECK MESSAGE: WBC between 3.0 and 3.5 with ANC >= 1.5 - please repeat CBC/Diff including WBC and ANC immediately and twice weekly. Most recent results - |CLOZ LAB RSLTS| RELATION INDEX: 4 ORDER CHECK: CLOZAPINE APPROPRIATENESS RELATION EXPRESSION: CLOZAPINE AND 1.5 <= ANC < 2.0 ORDER CHECK MESSAGE: ANC between 1.5 and 2.0 - please repeat CBC/Diff including WBC and ANC immediately and twice weekly. Most recent results - |CLOZ LAB RSLTS| AFTER: ORDER CHECK RULE LIST FEB 16,2016 14:29 PAGE 1 -------------------------------------------------------------------------- NUMBER: 57 NAME: CLOZAPINE LABEL: NO WBC W/IN 7 DAYS ELEMENT NAME: CLOZAPINE NO WBC W/IN 7 DAYS TYPE: SIMPLE DEFINITION ELEMENT EXPRESSION: CLOZAPINE AND NO WBC W/IN 7 DAYS LABEL: ANC < 1.0 ELEMENT NAME: CLOZAPINE ANC < 1.0 TYPE: SIMPLE DEFINITION LABEL: NO ANC W/IN 7 DAYS ELEMENT NAME: CLOZAPINE NO ANC W/IN 7 DAYS TYPE: SIMPLE DEFINITION LABEL: CLOZAPINE ELEMENT NAME: CLOZAPINE DRUG SELECTED TYPE: SIMPLE DEFINITION LABEL: 1.0 >= ANC < 1.5 ELEMENT NAME: CLOZAPINE ANC >= 1.0 & < 1.5 TYPE: SIMPLE DEFINITION STATUS: ACTIVE RELATION INDEX: 1 ORDER CHECK: CLOZAPINE APPROPRIATENESS RELATION EXPRESSION: CLOZAPINE AND (NO WBC W/IN 7 DAYS OR NO ANC W/IN 7 DAYS) ORDER CHECK MESSAGE: Clozapine orders require a CBC/Diff within past 7 days. Please order CBC/Diff with WBC and ANC immediately. Most recent results - |CLOZ LAB RSLTS| RELATION INDEX: 2 ORDER CHECK: CLOZAPINE APPROPRIATENESS RELATION EXPRESSION: CLOZAPINE AND ANC < 1.0 ORDER CHECK MESSAGE: Moderate/Severe Neutropenia - please repeat CBC/Diff including WBC and ANC tests immediately and Daily until ANC stabilizes to greater than or equal to 1000. Most recent results - |CLOZ LAB RSLTS| RELATION INDEX: 3 ORDER CHECK: CLOZAPINE APPROPRIATENESS RELATION EXPRESSION: CLOZAPINE AND (1.0 >= ANC < 1.5) ORDER CHECK MESSAGE: Mild Neutropenia - please repeat CBC/Diff including WBC and ANC tests immediately and 3X weekly until ANC stabilize to greater than or equal to 1500. Most recent results - |CLOZ LAB RSLTS| EFFECT ON BLOOD BANK FUNCTIONAL REQUIREMENTS: Patch OR*3*427 contains changes to a package referenced in ProPath standard titled: BBM Team Review of VistA Patches. This patch does not alter or modify any VistA Blood Bank software design safeguards or safety critical elements functions. RISK ANALYSIS: Changes made by patch OR*3*427 have no effect on Blood Bank software functionality, therefore RISK is none. Patch Components ================ Files & Fields Associated: File Name (Number) Field Name (Number) New/Modified/Deleted -------------------- ------------------- N/A Forms Associated: Form Name File # New/Modified/Deleted --------- ------ -------------------- N/A Mail Groups Associated: Mail Group Name New/Modified/Deleted --------------- -------------------- N/A Options Associated: Option Name Type New/Modified/Deleted ----------- ---- -------------------- N/A Protocols Associated: Protocol Name New/Modified/Deleted ------------- -------------------- N/A Security Keys Associated: Security Key Name New/Modified/Deleted ---------------------- -------------------- N/A Templates Associated: Template Name Type File Name (Number) New/Modified/Deleted ------------- ---- ------------------ -------------------- N/A Additional Information: New Service Requests (NSRs): ---------------------------- Request Name: National Clozapine Coordination Project Request ID: 20100703 Patient Safety Issues (PSIs): ----------------------------- N/A Defect Tracking System Ticket(s) & Overview: ------------------------------------------- N/A Test Sites: ----------- Battle Creek VA Medical Center VA Black Hills Health Care System Software and Documentation Retrieval Instructions: -------------------------------------------------- Software being released as a host file and/or documentation describing the new functionality introduced by this patch are available. The preferred method is to retrieve files from download.vista.domain.ext. This transmits the files from the first available server. Sites may also elect to retrieve files directly from a specific server. Sites may retrieve the software and/or documentation directly using Secure File Transfer Protocol (SFTP) from the ANONYMOUS.SOFTWARE directory at the following OI Field Offices: Hines: domain.ext Salt Lake City: domain.ext Documentation can also be found on the VA Software Documentation Library at: http://www.domain.ext/vdl/ -------------------------------------------------------------------------- Title File Name FTP Mode -------------------------------------------------------------------------- MENTAL HEALTH NCC PROJECT 5.01 MH_NCC_PROJ_5_01.KID (ASCII) MENTAL HEALTH NCC PROJECT 5.01 MH_NCC_Proj_5_01_UG_R0719.PDF (binary) User Guide CPRS cprsguium.PDF (binary) Deploy Install BO RB Guide MH_NCC_Proj_5_01_IG_R0719.PDF (binary) Patch Installation: Pre-Install/Installation Instructions ------------------------------------- The components sent with this patch OR*3*427 have been included in the host file MH_NCC_PROJ_5_01.KID. Please follow the (pre/install/post) installation instructions listed in the patch description for patch YS*5.01*122. Post-Installation Instructions ------------------------------ This patch will run the following post install routines. These routines will not be removed by the patch and should be removed after successful installation of the patch. ORY4270,ORY42701,ORY42702,ORY42703,ORY42704,ORY42705,ORY42706,ORY42707 ORY42708,ORY4271,ORY4272,ORY4273,ORY4274,ORY427ES Routine Information: ==================== The second line of each of these routines now looks like: ;;3.0;ORDER ENTRY/RESULTS REPORTING;**[Patch List]**;Dec 17, 1997;Build 105 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: ORALWORD Before: B47499175 After: B87912660 **243,427** Routine Name: ORY4270 Before: n/a After: B16073184 **427** Routine Name: ORY42701 Before: n/a After: B71203449 **427** Routine Name: ORY42702 Before: n/a After: B78453694 **427** Routine Name: ORY42703 Before: n/a After: B78751328 **427** Routine Name: ORY42704 Before: n/a After: B84076912 **427** Routine Name: ORY42705 Before: n/a After: B62931901 **427** Routine Name: ORY42706 Before: n/a After: B67973600 **427** Routine Name: ORY42707 Before: n/a After: B69950041 **427** Routine Name: ORY42708 Before: n/a After: B34877645 **427** Routine Name: ORY4271 Before: n/a After: B41095023 **427** Routine Name: ORY4272 Before: n/a After: B28301234 **427** Routine Name: ORY4273 Before: n/a After: B13307046 **427** Routine Name: ORY4274 Before: n/a After: B13859060 **427** Routine Name: ORY427ES Before: n/a After: B12947340 **427** ============================================================================= User Information: Entered By : Date Entered : JAN 06, 2016 Completed By: Date Completed: JUL 15, 2019 Released By : Date Released : JUL 15, 2019 ============================================================================= Packman Mail Message: ===================== No routines included