$TXT Created by DANG,CHAU at CHEY20.FO-BAYPINES.MED.VA.GOV (KIDS) on Thursday, 04/16/09 at 13:35 ============================================================================= Run Date: SEP 28, 2009 Designation: PSJ*5*193 Package : PSJ - INPATIENT MEDICATIONS Priority: Mandatory Version : 5 SEQ #193 Status: Released Compliance Date: OCT 29, 2009 ============================================================================= Associated patches: (v)PSJ*5*183 <<= must be installed BEFORE `PSJ*5*193' Subject: ERROR IN INPATIENT ORDER ENTRY Category: - Routine Description: ============ When an Inpatient Medication Order is created or renewed in CPRS from the Orders tab between midnight and 12:30 a.m. and the schedule on the order is ONCE, in pharmacy the start time was stored in the database as nulls. This caused 2 problems in the VistA system: 1. The start time is blank in Pharmacy and Bar Code Medication Administration (BCMA) packages. This could cause a patient to miss a medication. 2. The Missed Medications [PSBO MM] report errors out when it encounters one of these records with nulls in the start time. ASSOCIATED NSR(S): ================== N/A ASSOCIATED REMEDY TICKETS: ========================== 1. HD0000000220544 - PSI 07-222 -1 Start and Stop Times Duplicates: HD0000000179104 - CPRS INPATIENT ORDER HD0000000205281 - Start/Stop dates of //1699 HD0000000210073 - Start/Stop dates //1699 2. HD0000000225731 - MISSED MED OR PRN EFFECTIVENESS REPORTS Duplicates: HD0000000240989 - Missed Medication Report HD0000000289160 - Missed Medication report Errors Out HD0000000289960 - $ZE= EN1+62^PSBOMM HD0000000304095 - <>EN1+62^PSBOMM *PSBSTXT HD0000000327061 - Missed Medication Report keeps erroring out HD0000000335893 - SUBSCRIPT>EN1+62^PSBOMM PATIENT SAFETY ISSUE: ===================== PSI 07-222, PSPO #818, Assessment >24 PARTICIPATING TEST SITES: ========================= Boston HCS Bronx VAMC Providence VAMC Remedy Ticket Overview: ======================= 1. HD0000000220544 - PSI 07-222 -1 Start and Stop Times Problem: -------- When an Inpatient Medication Order is created or renewed in CPRS from the Orders tab between midnight and 12:30 a.m. and the schedule is Once, and the DEFAULT START DATE CALCULATION field (#.05) of the INPATIENT WARD PARAMETERS file (#59.6) is set to USE CLOSEST ADMIN TIME AS DEFAULT, the START DATE/TIME (sub-field #10) of the UNIT DOSE (sub-file #62) of the PHARMACY PATIENT file (#55) is set to null. This null value in the START DATE/TIME field would cause the start time to be blank in Pharmacy or BCMA resulting in missed medications for patients. 2. HD0000000225731 - MISSED MED OR PRN EFFECTIVENESS REPORTS Problem: -------- The null value in the START DATE/TIME field also caused the MISSED MEDICATIONS [PSBO MM] report to error out. Resolution: ----------- This resolution will address both problems listed above and will be accomplished in 2 steps: 1. Routine PSGNE3, which is used to retrieve the START DATE/TIME from FileMan, assumes this field is a valid value but occasionally this routine can return a null value. The routine will be modified to use LOG-IN DATE (field # 27.1) if the returned value is null. 2. Post-Install routine PSJ5P193 will take a look at orders with a STOP DATE/TIME (field #34) not greater than 30 days from the START DATE/TIME. If a null START DATE/TIME is found, the routine will plug in the value from the LOG-IN DATE field. The post-install routine will start when the patch is installed. The installer of the patch will see the message, 'YOU WILL RECEIVE A MAILMAN MESSAGE WHEN TASK #6311994 HAS COMPLETED. IF ERRORS ARE DETECTED, THE VERIFYING PHARMACIST WILL RECEIVE A MESSAGE INDICATING CLEANUP HAS COMPLETED.' When the routine finishes, it will send a MailMan message to the person who installed the patch titled, "INPATIENT MEDS ORDER CHECK COMPLETED". If the routine encounters any bad START DATE/TIME fields, it will plug in the value found in the LOG-IN DATE field. It will also send a second MailMan message, "INPATIENT MEDS ORDER CLEANUP COMPLETED", to ALL verifying pharmacists indicating that cleanup is complete, with a listing of the affected patients and the orders. The list is provided so that personnel can ensure the patients received their medications. See the example MailMan message below: Subj: INPATIENT MEDS ORDER 1-2 CLEANUP COMPLETED [#537827] 05/18/09@15:46 6 lines From: INPATIENT,MEDICATIONS In 'IN' basket. Page 1 -------------------------------------------------------------------------- The cleanup of Inpatient Medication orders (1-2) of 2 orders with invalid dates completed as of MAY 18,2009@15:46:35. INPATIENT-1,TEST 101016289 Unit Dose WARFARIN Start: MAY 18,2009@00:05 Stop: MAY 19,2009@13:47:44 INPATIENT-2,TEST 101066460 Unit Dose INTERFERON BETA-1A Start: MAY 14,2009@00:05 Stop: MAY 15,2009@15:19:25 Enter message action (in IN basket): Ignore// INSTALLATION INSTRUCTIONS: ========================== ****************************** NOTE ******************************* IF A USER IS ON THE SYSTEM AND USING THESE PROGRAMS AN EDITED ERROR WILL OCCUR. The patch should be installed when NO Inpatient Pharmacy users are on the system. ******************************************************************* Installation will take less than 1 minute. The post-install routine PSJ5P193 will take between a few seconds to several minutes to complete depending on how many orders have to be processed and may be deleted upon successful installation of the patch. Suggested time to install: non-peak requirement hours. 1. Use the INSTALL/CHECK MESSAGE option on the PackMan menu. 2. From the Kernel Installation & Distribution System 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*193): a. Verify Checksums in Transport Global - This option will allow you to ensure the integrity of the routines that are in the transport global. b. Print Transport Global - This option will allow you to view the components of the KIDS build. c. Compare Transport Global to Current System - This option will allow you to view all changes that will be made when this patch is installed. It compares all components of this patch (routines, DD's, templates, etc.). d. Backup a Transport Global - This option will create a backup message of any routines exported with this patch. It will not backup any other changes such as DD's or templates. 4. Use the Install Package(s) option and select the package PSJ*5.0*193. 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. Example Installation: ===================== Select Installation Option: 6 Install Package(s) Select INSTALL NAME: PSJ*5.0*193 Loaded from Distribution 2/2/09@11:30:31 => PSJ*5.0*193 V6 02/02/2009 This Distribution was loaded on Feb 02, 2009@11:30:31 with header of PSJ*5.0*193 V6 02/02/2009 It consisted of the following Install(s): PSJ*5.0*193 Checking Install for Package PSJ*5.0*193 Install Questions for PSJ*5.0*193 Want KIDS to INHIBIT LOGONs during the install? NO// Want to DISABLE Scheduled Options, Menu Options, and Protocols? NO// Enter the Device you want to print the Install messages. You can queue the install by enter a 'Q' at the device prompt. Enter a '^' to abort the install. DEVICE: HOME// TELNET TERMINAL Install Started for PSJ*5.0*193 : Feb 02, 2009@11:33:10 Build Distribution Date: Feb 02, 2009 Installing Routines: Feb 02, 2009@11:33:11 Running Post-Install Routine: ^PSJ5P193 PSJ*5.0*193 -------------------------------------------------------------------------- The check of existing Pharmacy orders is queued (to start NOW). YOU WILL RECEIVE A MAILMAN MESSAGE WHEN TASK #53018 HAS COMPLETED. IF ERRORS ARE DETECTED, THE VERIFYING PHARMACIST WILL RECEIVE A MESSAGE INDICATING CLEANUP HAS COMPLETED. Updating Routine file... Updating KIDS files... PSJ*5.0*193 Installed. Feb 02, 2009@11:33:11 Install Message sent -------------------------------------------------------------------------- +------------------------------------------------------------+ 100% | 25 50 75 | Complete +------------------------------------------------------------+ Install Completed Routine Information: ==================== The second line of each of these routines now looks like: ;;5.0; INPATIENT MEDICATIONS ;**[Patch List]**;16 DEC 97;Build 16 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: PSGNE3 Before: B30386162 After: B30964253 **4,26,47,50,63,69,105,80,111, 183,193** Routine Name: PSJ5P193 Before: n/a After: B42787380 **193** Routine list of preceding patches: 183 ============================================================================= User Information: Entered By : WILLIAMS,BRIAN Date Entered : MAY 07, 2007 Completed By: WERNER,GARY Date Completed: SEP 24, 2009 Released By : TEAGUE,LYN Date Released : SEP 28, 2009 ============================================================================= Packman Mail Message: ===================== $END TXT