$TXT Created by F at CLN1G1.AAC.DOMAIN.EXT (KIDS) on Thursday, 07/29/21 at 09:38 ============================================================================= Run Date: NOV 29, 2021 Designation: PSJ*5*420 Package : PSJ - INPATIENT MEDICATIONS Priority: Mandatory Version : 5 SEQ #366 Status: Released Compliance Date: DEC 30, 2021 ============================================================================= Associated patches: (v)PSJ*5*318 <<= must be installed BEFORE `PSJ*5*420' (v)PSJ*5*364 <<= must be installed BEFORE `PSJ*5*420' Subject: WRONG INFO SENT TO PADE & WRONG DRUG NAME FOR PENDING CLINIC ORDER Category: - Routine Description: ============ This patch resolves the following issues: 1) INC17689657 - Schedule of SUPPER looks correct in VistA, but the HL7 message for medication order is for Sundays only instead of daily 2) INC17223279 - Duplicate clinic order alert without dispense drug shows random drug Additional Information: ----------------------- Patient Safety Issues (PSIs): HITPS-7946 (INC17689657) Defect Tracking System Ticket(s) & Overview: 1) INC17689657 - Schedule of SUPPER looks correct in VistA, but the HL7 message for medication order is for Sundays only instead of daily Problem: -------- The Wm. Jennings Bryan Dorn VA Medical Center reported that whenever they enter an inpatient order with the schedule SUPPER, it looks and behaves correctly in VistA; however, the HL7 message sent to Pharmacy Automated Dispensing Equipment (PADE) contains the wrong value for the 8th field in the RXE segment that is used for 'Day-of-Week' schedules. Each digit represents one day of the week starting with Sunday and ending with Saturday. The code wrongly interprets SUPPER as SU (short for Sunday) and sets the first digit to 1 which is then interpreted by the automated dispensing cabinet as once every Sunday. Below is a capture of the RXE segment showing the problem: ... ORC|NW|100034|27U||CM||||202105280839|520824666~TEST~OUTPAT~F|520824666 RXE|240~SUPPER&1900~~2021052808~20210627180~~0~10000000|841~DOCUSATE CA RXR|PO~ORAL~99PSR ... Resolution: ----------- Patch PSJ*5.0*405 addressed a similar issue for schedules WEEKLY and MONTHLY, which were interpreted as WE (for Wednesday) and MO (for Monday), respectively. Instead of just fixing specific instances of samples that can create the problem, the solution will not try to translate any other schedule that does not match one of the following: SU, MO, TU, WE, TH, FR and SA. In addition, it will require that all parts of dash-separated- schedules (e.g., MO-WE-FR) match one of the weekday abbreviations. If this condition is not met, the software will send all zeros (00000000) to PADE for the order. Technical Resolution: --------------------- The logic for the $$DOWSTR Application Programming Interface (API) in the routine PSJPDCLV was completely re-written to exclude any schedule as 'Day-of-Week' unless all the dash pieces in the schedule match one of the seven weekday abbreviations: SU, MO, TU, WE, TH, FR and SA. If any value is different than one of these abbreviations the processing stops and "00000000" is returned. 2) INC17223279 - Duplicate clinic order alert without dispense drug shows random drug Problem: -------- The Martinez VA Medical Center reported that when finishing a clinic order without a chosen dispense drug, the duplicate drug alert is randomly selecting a dispense drug associated with the Orderable Item and displaying it as the dispensed drug associated with the pending order, which is incorrect. In other words, when you have a pending clinic order that does not have a dispense drug selected, and you try to finish or enter a new order via the Inpatient Order Entry [PSJ OE] option that will cause a duplicate order check or a drug-drug order check, the pending clinic order's displayed drug name is an arbitrarily selected drug associated with the Orderable Item on the order. In the example below, when the user tries to enter or finish an order for WARFARIN 2MG TAB U/D, the pending clinic order in the duplicate drug check shows the dispense drug WARFARIN 7.5MG TAB U/D; however, the pending clinic order does not have a dispense drug selected. ... Now Processing Enhanced Order Checks! Please wait... Press Return to continue... ========================================================================= This patient is already receiving the following INPATIENT and/or OUTPATIENT order(s) for a drug in the same therapeutic class(es) as WARFARIN 2MG TAB U/D: Clinic Order: WARFARIN 7.5MG TAB U/D (PENDING) Schedule: BID Dosage: 7MG Requested Start Date: JUN 05, 2021@09:00 Stop Date: ******** Class(es) Involved in Therapeutic Duplication(s): Oral Anticoagulants, Antiplatelet Drugs-excluding ASA 325 mg and below, Antiplatelet and Antithrombotic Drugs (Selected Group 2) ========================================================================= ... Resolution: ----------- The display of a pending clinic order has been changed to show only the Orderable Item name and its dosage form when the order does not have a dispense drug selected. Below is how the same duplicate order check above will display after the patch is installed: ... Now Processing Enhanced Order Checks! Please wait... Press Return to continue... ========================================================================= This patient is already receiving the following INPATIENT and/or OUTPATIENT order(s) for a drug in the same therapeutic class(es) as WARFARIN 2MG TAB U/D: Clinic Order: WARFARIN TAB (PENDING) Schedule: BID Dosage: 7MG Requested Start Date: JUN 05, 2021@09:00 Stop Date: ******** Class(es) Involved in Therapeutic Duplication(s): Oral Anticoagulants, Antiplatelet Drugs-excluding ASA 325 mg and below, Antiplatelet and Antithrombotic Drugs (Selected Group 2) ========================================================================= ... Technical Resolution: --------------------- First created a local API called $$CLNORDDN in routine PSJCLNOC to return the drug name for a pending clinic order. If the clinic order has a selected dispense drug, the name of the dispense drug will be returned by the API; if not, the API will retrieve the Orderable Item name and dosage form, concatenate them, and return them as the name to be used in the drug-drug or duplicate order check messages. Then changed code in DISP2+13 to use this API for displaying the clinic order drug name. Test Sites: ----------- Wm. Jennings Bryan Dorn VAMC (Columbia, SC) VISN 2 North - Albany VAMC: Samuel S. Stratton (Albany, NY) Software and Documentation Retrieval Instructions: -------------------------------------------------- The software for this patch is being released in a PackMan message. Patch Installation: ------------------- Pre-Installation Instructions: This patch should be installed during non-peak hours to minimize potential disruption to users. This patch should take less than 5 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 or build name. (ex. PSJ*5.0*420) 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. You must use this option and specify what to backup; the entire Build or just Routines. The backup message can be used to restore the routines and components of the build to the pre-patch condition. i. At the Installation option menu, select Backup a Transport Global. ii. At the Select INSTALL NAME prompt, enter your build PSJ*5.0*420. iii. When prompted for the following, enter "R" for Routines or "B" for Build. Select one of the following: B Build R Routines Enter response: Build iv. When prompted "Do you wish to secure your build? NO//", press and take the default response of "NO". v. When prompted with, "Send mail to: Last name, First Name", press to take default recipient. Add any additional recipients. vi. When prompted with "Select basket to send to: IN//", press and take the default IN mailbox or select a different mailbox. 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. Back-Out/Roll Back Plan: ------------------------ 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. If the patch was backed up for the build, from the Kernel Installation and Distribution System Menu, select the Installation Menu. Then select the Install Package(s) option and choose the patch (PSJ*5.0*420b) to install. The back-out plan is to restore the routines or build from the backup created. No data was modified by this patch installation and, therefore, no rollback strategy is required. Validation of Back-Out Plan: ---------------------------- The back-out plan can be verified by printing the first two lines of the routines contained in this patch using the First Line Routine Print [XU FIRST LINE PRINT] option. After the routines contained in this patch have been backed out, the second line of the routines will no longer contain the designation of this patch in the patch list section. Routine Information: ==================== The second line of each of these routines now looks like: ;;5.0;INPATIENT MEDICATIONS ;**[Patch List]**;16 DEC 97;Build 2 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: PSJCLNOC Before: B86118340 After: B90570093 **260,257,299,318,420** Routine Name: PSJPDCLV Before: B10648289 After: B10763445 **405,364,420** Routine list of preceding patches: 318, 364 ============================================================================= User Information: Entered By : Date Entered : MAY 18, 2021 Completed By: Date Completed: NOV 29, 2021 Released By : Date Released : NOV 29, 2021 ============================================================================= Packman Mail Message: ===================== $END TXT