# Ordering Outpatient Medications (Complex Dose)

In a complex dose order, the user must define specific characteristics for the order. Because the dose can affect the quantity, for example, changing certain fields may cause the quantity field to either recalculate or reset to zero to force the user to enter the quantity.

To write a new Out patient Medication order with a complex dose, follow these steps:

1. Select the Meds tab and select Action | New Medication…

-or-

select the Orders tab and select the appropriate item under t he Write Orders list box. CPRS will display the Medication Order dialog.

Note : If encounter information has not been entered, the encounter information dialog will appear before the Medication Order dialog. You must complete the encounter information dialog before proceeding.

2. Locate the medication name or quick order name in the list box by typing characters in the Medication field.

Note: CPRS now only auto-selects (highlights in blue and places that entry in the field) a medication, dosage, route, or schedule if the user types enough characters to uniquely identify an item in the list. If the user does not enter enough characters to uniquely identify an item, CPRS waits until the user manually selects an item using the mouse or the keyboard.

3. Select a medication or quick order from the list box.

Once the name is selected, CPRS displays a second dialog to select the items for the rest of the order. In the top field of the second dialog, the generic medication name and the synonym (usually a brand name) are displayed.

The lab results for the most recent lab test associated with the selected medication are displayed in the Information field, if an associated lab test was performed within the last 365 days.

Note: A CAC or ADPAC will need to set the OR CPRS LAB DISPLAY ENABLED parameter to ON to activate the lab results display at a site.

To view associated lab results for Quick Orders, a TIU OBJECT must be inserted into the Quick Order. For more information, refer to the Text Integration Utility (TIU) Clinical Coordinator & User Manual. This functionality will work for generalized Quick Orders only (orders assigned to Order Menus). It is not currently implemented for personal Quick Orders.

The lab results functionality will not work properly for multi-divisional facilities or any sites that use different lab test names at different sites, as only one lab test name can be associated with each drug. To successfully implement this functionality, all facilities/divisions that share a VistA system must use the same name for each monitored lab test.

Note : If the selected medication is a controlled substance that requires the signature of a provider with a DEA or VA number, the DEA# Required dialog displays. Before an order for a controlled substance can be entered, the provider selected for the encounter must be able to sign the order. You may need to exit the Medication Order dialog, change the provider, and then reenter the Medication Order dialog.

4. Select the Complex dose tab.

Note : Once you begin a complex medication order, you must remain on the Complex tab until you finish the order. If you switch tabs, all complex dosages will be erased, and you will be forced to start the order again.

Once a dosage is selected, any lab test results displayed in the Information field are replaced by the National Standard Orderable Item information.

5. Select the Dosage field and select the appropriate dosage.

The dosage may not begin with a decimal, for example .5; it must begin with a numerical value, 0.5 for example. Also, the character "^" may not be entered in the Dosage field. (The associated cost is displayed to the right of the dosage.)

6. Select the Route field and enter a route.

Note: Outpatient orders for supply items do not require a route.

CPRS displays unit dose routes based on the following rules:

a) If a default medication route is defined in the orderable item file, CPRS displays only the default medication route for the Unit Dose orderable item in the medication route selection list.

b) If there is no default medication route defined for the orderable item, CPRS displays all possible medication routes for the dosage form to the provider for selection.

c) If there is only one possible medication route, it will be used as the default.

d) If a medication route name or its abbreviation is not included in the selection list, a user may type it in.

7. Enter a schedule in the Schedule field. (Select PRN if desired).

Note: When selecting the PRN checkbox, the quantity and say supply are zeroed out and will need to be adjusted manually. If the checkbox was accidentally selected, de-selecting it corrects the quantity and day supply.

8. Select the Duration cell and enter a number and select units (days is the default) a patient should use the specified dose.

9. Add the appropriate conjunction: And, Then, or no conjunction for the final line.

Note: The conjunction "Then" requires a duration to be added.

10. Select the dosage field in the next row and select a dosage.

The dosage may not begin with a decimal, for example .5; it must begin with a numerical value, 0.5 for example. Also, the character "^" may not be entered in the Dosage field. (The associated cost is displayed to the right of the dosage.)

11. CPRS will fill in the Route and Schedule fields. If necessary, select and change the Route and Schedule cells.

12. Select a duration and a conjunction (no conjunction on the final line).

13. Repeat steps 5-9 until you have completed the complex dose.

Note: You can add or remove a row in the complex dosage. To add a row, click the gray area in front of the row and click Add Row . (The new row will be placed above the selected row.) To delete a row, click the gray area in front of the row to be deleted and click Delete Row .

14. CPRS will display a default value in the Days Supply and Quantity fields. The quantity is calculated based on the formula Days Supply x Schedule = Quantity. If necessary, you can change the value in these fields.

Note : If you change a number, CPRS will attempt to recalculate the other field.

15. Enter the number of refills.

16. Select the location where the patient should pick up the medication from the Pick Up field.

17. Enter an Indication. If indications are defined, you can choose one from the drop-down list. If none are defined or the correct indication is not in the list, type in the appropriate indication.

18. Add comments if necessary.

19. Under certain circumstances, a check box may appear under the Days Supply field. If the medication is service-connected, make sure the box is checked.

20. Select Accept Order .

21. (Conditional) If the medication ordered may be contraindicated because of allergies, drug interactions, or duplicate orders, CPRS will display the Order Check window. Carefully review all order checks and decide if the medication should be ordered. Do one of the following:

o To proceed, select Accept Order.

o To stop the ordering process and return to the dialog, Cancel Order.

22. If you are finished ordering outpatient medications, select Quit .

Note: The order must be signed before it is sent. You can either sign the order now or wait until later.

Related Topics

Viewing Medications

Sorting the Medications View

Ordering Inpatient Medications (Simple Dose)

Ordering Outpatient Medications (Simple Dose)

Park a Prescription

Change Medication Order

Discontinue Medication Order

Hold Medication Order

Renew Medication Order

Other Medication Actions (popup menu)