$TXT Created by at CLN1G2.AAC.DOMAIN.EXT (KIDS) on Friday, 04/17/20 at 15:14 ============================================================================= Run Date: JUL 09, 2020 Designation: PSJ*5*397 Package : PSJ - INPATIENT MEDICATIONS Priority: Mandatory Version : 5 SEQ #342 Status: Released Compliance Date: AUG 08, 2020 ============================================================================= Associated patches: (v)PSJ*5*146 <<= must be installed BEFORE `PSJ*5*397' (v)PSJ*5*370 <<= must be installed BEFORE `PSJ*5*397' Subject: INVALIDATED LABELS & NURSE RE-VERIFICATION AFTER SPECIAL INSTRUCTIONS EDIT Category: - Routine Description: ============ This patch will resolve the following issues: INC6081255 - Bar Code Medication Administration (BCMA) scanning Intravenous (IV) medication as invalid lookup INC6231181 - Over the last several months, there has been at least 5 times HITPS-6742 that I am aware of where Computerized Patient Record System (CPRS) and BCMA aren't communicating on verification of order. Patient Safety Issues (PSIs): HITPS-6742 Defect Tracking System Ticket(s) & Overview: 1) INC6081255 - BCMA scanning IV medication as invalid lookup Problem: ------- The Veteran's Administration (VA) Sierra Nevada Health Care System (HCS) reported that BCMA IV piggyback label scanned as invalid look up when they should be valid. This happened when, for example, an edit on the Volume of the solution on the order should have caused the previously printed label(s) to be invalidated and new label(s) generated according to the BCMA Parameters. New label(s) were generated for the edited order, however all labels (old and new) were being erroneously invalidated. Resolution: ---------- This problem happened because the software performs a date/time comparison between the Volume edit and the label creation to determine whether a label is valid or not. If the label was printed before the Volume edit the label is considered invalid. The problem is that it was using the format YYYMMDD.HHMMSS for the Volume edit date/time and the format YYYMMDD.HHMM for the Label creation date/time. So, if the new label(s) where printed within the same minute of the Volume edit the software mistakenly assumed the new labels were printed before the Volume edit. Technical Resolution: -------------------- Changed the code at EN+61 in the routine PSIVBCID to truncate the order edit date/time to YYYMMDD.HHMM format when doing the comparison with the label print date/time. This way labels printed after the order edit should never be considered invalid. 2) INC6231181 - Over the last several months, there has been at least 5 times that I am aware of where CPRS and BCMA aren't communicating on verification of order. Problem: ------- The Madison VA Hospital reported that the BCMA nurse verification information was not being properly reset (removed) after the field SPECIAL INSTRUCTIONS was edited by Inpatient Pharmacy users through the Inpatient Order Entry [PSJ OE] option. In CPRS the nurse verification is correctly being reset (removed) after this field is edited in Inpatient Pharmacy. According to the site this poses the risk of medication being administered through BCMA without the proper re-review and re-verification. This issue is also being considered a Patient Safety Issue (PSI) and the number assigned by the Patient Safety team is HITPS-6742. Resolution: ---------- Every time the SPECIAL INSTRUCTIONS field is edited for an inpatient unit dose order the nurse verification information (if any) will be invalidated/removed, which will be reflected in the BCMA application. Depending on how the site BCMA parameters is set it will require a re-verification of the order in CPRS before it can be administered through the BCMA application. Technical Resolution: -------------------- Created a new line tag in the routine PSJBCMA2 called RESETNV responsible for removing the nurse verification information in the PHARMACY PATIENT (#55) file, UNIT DOSE (#55.06) sub-file, VERIFYING NURSE (#16) field and DATE VERIFIED BY NURSE (#17) field and setting the NV FLAG (#51) field to 0 (NO). These fields are used by BCMA to determine whether an order has been verified or not by a nurse. Test Sites: ----------- Captain James A. Lovell Federal HCS (North Chicago, IL) Sierra Nevada HCS (Reno, NV) Software and Documentation Retrieval Instructions: -------------------------------------------------- The software for this patch is being released in a PackMan message. Patch Installation: ------------------- Pre/Post Installation Overview: It is not necessary to disable any options. Pre-Installation Instructions: This patch should be installed during non-peak hours to minimize potential disruption to users. This patch should take less than 2 minutes to install. Installation Instructions: 1. Choose the PackMan message containing this build. Then select the INSTALL/CHECK MESSAGE PackMan option to load the build. 2. From the Kernel Installation and Distribution System Menu, select the Installation Menu. From this menu, A. Select the Verify Checksums in Transport Global option to confirm the integrity of the routines that are in the transport global. When prompted for the INSTALL NAME enter the patch. (ex. PSJ*5.0*397) NOTE: Using will not bring up a Multi-Package build even if it was loaded immediately before this step. It will only bring up the last patch in the build. B. Select the Backup a Transport Global option to create a backup message of any routines exported with this patch. It will not backup any other changes such as DDs or templates. C. You may also elect to use the following options: i. Print Transport Global - This option will allow you to view the components of the KIDS build. ii. 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 of the components of this patch, such as routines, DDs, templates, etc. D. Select the Install Package(s) option and choose the patch to install. i. If prompted 'Want KIDS to Rebuild Menu Trees Upon Completion of Install? NO//', answer NO. ii. When prompted 'Want KIDS to INHIBIT LOGONs during the install? NO//', answer NO. iii. When prompted 'Want to DISABLE Scheduled Options, Menu Options, and Protocols? NO//', answer NO. iv. If prompted 'Delay Install (Minutes): (0 - 60): 0//', answer 0. Back-out/Rollback Strategy: --------------------------- Back-out will be done only with the concurrence and participation of development team and appropriate VA site/region personnel. The decision to back-out or rollback software will be a joint decision between development team, VA site/region personnel and other appropriate VA personnel. Prior to installing an updated KIDS package, the site/region should have saved a backup of the routines in a mail message using the Backup a Transport Global [XPD BACKUP] menu option (this is done at time of install). The message containing the backed up routines can be loaded with the "Xtract PackMan" function at the Message Action prompt. The Packman function "INSTALL/CHECK MESSAGE" is then used to install the backed up routines onto the VistA System. The back-out plan is to restore the routines from the backup created. No data was modified by this patch installation and, therefore, no rollback strategy is required. Validation of Roll Back Procedure: ---------------------------------- The Roll Back Procedure can be verified by printing the first 2 lines of the PSJ Routines contained in this patch using the option First Line Routine Print [XU FIRST LINE PRINT]. Once the routines contained in the PSJ*5.0*397 patch have been rolled back, the first two lines of the routines will no longer contain the designation of patch PSJ*5.0*397 in the patch list section on line 2. Routine Information: ==================== The second line of each of these routines now looks like: ;;5.0;INPATIENT MEDICATIONS;**[Patch List]**;16 DEC 97;Build 7 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: PSIVBCID Before: B6780776 After: B6703839 **58,80,146,397** Routine Name: PSJBCMA2 Before: B58323287 After: B62768742 **32,41,54,56,81,267,370,397** Routine list of preceding patches: 146, 370 ============================================================================= User Information: Entered By : Date Entered : NOV 20, 2019 Completed By: Date Completed: JUL 09, 2020 Released By : Date Released : JUL 09, 2020 ============================================================================= Packman Mail Message: ===================== $END TXT