$TXT Created by CASTLE,JOHN at INOCACHE.FO-BIRM.MED.VA.GOV (KIDS) on Thursday, 12/11/08 at 14:44 ============================================================================= Run Date: APR 01, 2009 Designation: PSJ*5*213 Package : PSJ - INPATIENT MEDICATIONS Priority: Mandatory Version : 5 SEQ #189 Status: Released Compliance Date: MAY 02, 2009 ============================================================================= Associated patches: (v)PSJ*5*134 <<= must be installed BEFORE `PSJ*5*213' (v)PSJ*5*203 <<= must be installed BEFORE `PSJ*5*213' Subject: CPRS GUI V27 FOLLOW UP - INPATIENT MEDICATIONS Category: - Routine - PATCH FOR A PATCH Description: ============ This patch contains four Inpatient Medications V. 5.0 fixes that sites logged during the compliance date period for the CPRS (Computerized Patient Record System) GUI v27 release. 1. The first issue, Remedy Ticket HD280022, pertains to Day of Week schedules entered for IV Piggyback orders via the CPRS IV Fluids Dialog. If the user creates a schedule using the schedule builder, and uses the new format of Day of Week@Schedule (example: MO-WE-FR@BID), and if the root schedule (MO-WE-FR) exists in the ADMINISTRATION SCHEDULE File (#51.1), when the order is viewed in backdoor pharmacy, the administration time(s) for the order will be null. Problem: -------- Admin times are null if a Day of Week schedule created via the schedule builder in CPRS exists in the ADMINISTRATION SCHEDULE File (#51.1). Resolution: ----------- In PSGS0, do not QUIT before the admin times are set if the schedule is a Day of Week schedule, even if it exists in the schedule file. 2. The second issue, Remedy Ticket HD246438 and its duplicates, is also logged as Patient Safety Issue PSI-08-068,PSPO #782. This is an issue with an invalid frequency for IV Piggyback orders. This issue has existed prior to the release of CPRS GUI v27, but the sites are reporting an increase in the occurrence of the problem after the install of CPRS GUI v27. For unknown reasons, the frequency of some IV Piggyback orders is null when it should contain a value. No site or developer has been able to reproduce this issue at-will, and there does not appear to be any pattern to the processes or procedures that precede the occurrence of this problem. With this patch, if the frequency for an IV Piggyback order is null, and it should contain a value, the code will attempt to directly set an appropriate frequency into the PHARMACY PATIENT File (#55) upon verification of the order, and upon the order becoming active. Problem: -------- The frequency is being set to null very sporadically for IV Piggyback orders. No root cause is known. Resolution: ----------- During the verification process, if the IV is intermittent, and the frequency is null, attempt to re-set the frequency based on the name of the schedule as well as other variables that should contain the value of the frequency. These changes are in routine PSIVORFB. 3. The third issue, Remedy Ticket HD274682 and its duplicates, is an undefined variable error in the new Meds Tab sort for CPRS. The root cause of the problem is that a pointer to the PHARMACY ORDERABLE ITEM File (#50.7) is missing in either the NON-VERIFIED ORDERS File (#53.1) or the PHARMACY PATIENT File (#55). Because the pointer does not exist, when a temporary global is being built to display the orders for the patient, an undefined variable error occurs. Problem: -------- Very old orders exist in the system that do not contain a pointer to the orderable item. When the new Meds Tab sort routines attempt to use the pointer value as a subscript in a ^TMP global setting, and the pointer's value is null, a null subscript error occurs. This causes a hard error in CPRS and shuts CPRS down. Resolution: ----------- If the pointer to the orderable item does not exist, the routines will use the phrase "Orderable Item Not Found" as the subscript value in place of what should be the name of the orderable item. This allows the Meds Tab sort routines to process without error, and the patient's medications appear without problems on the CPRS Meds tab. The updated routines are PSJORRO, PSJORRN, and PSJORRN1. 4. The fourth issue addressed by this patch is Remedy Ticket HD280040, which deals with an inconsistency between CPRS and backdoor pharmacy with respect to continuous IV orders. If the IV order originates from CPRS, a fractional infusion rate of < 1 ml/hr (0.9 ml/hr for example), backdoor pharmacy allows the infusion rate, and the order can be finished and verified without issue. However, if the order originates from backdoor pharmacy, a fractional infusion rate < 1 ml/hr is not accepted, and the user is presented an error message stating, "Your infusion rate is in an invalid format." The user is not allowed to finish and verify the order. This patch will make backdoor pharmacy behave consistently with CPRS. Problem: -------- If an order is entered via backdoor pharmacy for a continuous IV, and the order is created with a fractional infusion rate of < 1 ml/hr, the system presents the user with the error message, "Your infusion rate is in an invalid format", and the order cannot be completed. Resolution: ----------- If the order has a fractional infusion rate < 1 ml/hr, the order must contain a leading zero, and the system will view the infusion rate as valid. (example - infusion rate must be 0.9 ml/hr to be valid) The coding will affect routines PSIVSP, PSIVCHK, and PSIVORE. Associated New Service Request (NSR): ===================================== N/A Associated PSI's: ================= PSI-08-017 PSI-08-068, PSPO #782 Associated Remedy Ticket(s): ============================ HD0000000246438 (Original) - Invalid Frequency HD0000000276568 (Duplicate) HD0000000276777 (Duplicate) HD0000000277053 (Duplicate) HD0000000277834 (Duplicate) HD0000000278157 (Duplicate) HD0000000281443 (Duplicate) HD0000000281995 (Duplicate) HD0000000286640 (Duplicate) HD0000000288911 (Duplicate) HD0000000274682 (Original) - Meds Tab Sort Error HD0000000275268 (Duplicate) HD0000000275842 (Duplicate) HD0000000276659 (Duplicate) HD0000000276670 (Duplicate) HD0000000279275 (Duplicate) HD0000000280609 (Duplicate) HD0000000281898 (Duplicate) HD0000000284406 (Duplicate) HD0000000284736 (Duplicate) HD0000000296817 (Duplicate) HD0000000280022 (Original) - Null Admin Times for IVPB HD0000000280040 (Original) - Infusion Rate < 1 ml/hr Inconsistency Associated E3Rs: ================ N/A Test Sites: =========== New York Harbor HCS - New York, NY Oklahoma City, OK Spokane, WA Installation Instructions: ========================== It is recommended that this patch be installed after normal business hours while no Inpatient Pharmacy users are processing orders. Installation will take no longer than 2 minutes. 1. Use the INSTALL/CHECK MESSAGE option on the PackMan menu. 2. From the Kernel Installation & Distribution System (KIDS) menu, select the Installation menu. 3. From this menu, you may select to use the following options (when prompted for INSTALL NAME, enter PSJ*5.0*213): a. Backup a Transport Global - this option will create a backup message of any routines exported with the patch. It will NOT backup any other changes such as DDs or templates. b. Compare Transport Global to Current System - this option will allow you to view all changes that will be made when the patch is installed. It compares all components of the patch (routines, DDs, templates, etc.). c. Verify Checksums in Transport Global - this option will ensure the integrity of the routines that are in the transport global. d. Print Transport Global - this option will allow you to view the components of the KIDS build. 4. Use the Install Package(s) option and select the package PSJ*5.0*213. 5. When prompted "Want KIDS to INHIBIT LOGONs during the install? NO//" respond NO. 6. When prompted "Want to DISABLE Scheduled Options, Menu Options, and Protocols? NO//" respond NO. Routine Information: ==================== The second line of each of these routines now looks like: ;;5.0; INPATIENT MEDICATIONS ;**[Patch List]**;16 DEC 97;Build 8 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: PSGS0 Before: B51528600 After: B50790637 **12,25,26,50,63,74,83,116,110, 111,133,138,174,134,213** Routine Name: PSIVCHK Before: B15887140 After: B15710201 **54,58,81,111,213** Routine Name: PSIVORE Before: B41482525 After: B41910420 **18,29,50,56,58,81,110,127, 133,157,203,213** Routine Name: PSIVORFB Before: B50190472 After: B55183274 **3,18,28,68,58,85,110,111,120, 134,213** Routine Name: PSIVSP Before: B37490534 After: B38850432 **30,37,41,50,56,74,83,111,133, 138,134,213** Routine Name: PSJORRN Before: B60756345 After: B61459384 **134,213** Routine Name: PSJORRN1 Before: B54888629 After: B55578785 **134,213** Routine Name: PSJORRO Before: B61708639 After: B62410106 **134,213** ============================================================================= User Information: Entered By : CASTLE,JOHN Date Entered : OCT 03, 2008 Completed By: FARMER,LINDA Date Completed: MAR 31, 2009 Released By : CAMPBELL,THOMAS Date Released : APR 01, 2009 ============================================================================= Packman Mail Message: ===================== $END TXT