Record

• EMP = Template record
• ECL = Security record
• E2R = Roles
• LRP = Print Group-based Reports--> LPG=Print Group record
• LPR = Profile
• LPF = Preference List
• PHR = Pharmacy
• EFY = Medication List
• EAP = Procedure master file

Charging

• Unit Dose Compound = Choose a charge method of eg.“Unit Dose Standard”
  
  
  

• Configuring Charging for Premixes
  Configure charging for premix IV fluids the same way you would for any simple ERX record. In particular:
  • Charge method: In the Foundation System, the “IV” charge method is assigned in the ERX record.
  • Linked procedure:
  o For IV fluid premixes that you consider “supplies” (such as D5NS), use HC RX 258.
  o For IV fluids premixes that you consider “medications,” (such as D5NS with KCL), use the linked procedure HC RX 250 W HCPCS (ALT 636 for OP/ED).
  
  
  

• Configuring Charging for Mixtures
  Epic will generate a separate charge for each ingredient in a mixture. It uses the charge method, linked procedure, and cost of each ingredient. There is no special configuration required to charge for a mixture.

IV piggyback premix is similar to configuring an injection, with a few differences:

• Indicate “Premix” Include “premix” in the Order Display Name, Product-Specific Admin Instructions, and Label Comments.
• Order Composer Age-based contexts typically not used.
  Dose field matches dose of premix. Not editable.
  Administer Over field & buttons. Requires a new OCC.
• Labels Dispense code: “IVPB Premix”. No production labels.
• Med Lists / Preference Lists
  Add to central pharmacy and formulary med lists.
  Do not add to preference lists (no green dot).
• Task Template Adds infusion group to I/O Flowsheets. Use same task template for almost all IVPBs.
• Charge Method = IV

Mini-bag and Add-vantage Mixture
In Epic, each component of a Mini-Bag Plus or ADD-Vantage mixture is a simple ERX record. Each combination of these ingredients is a main ingredient mixture ERX with a few differences:

Prep type Leave blank. Nurses prepare these mixtures on the floor.**

Prod. Admin. Inst.
& Label Comments
Use the RX MINI-BAG PLUS or RX ADD-VANTAGE
SmartTexts.
• Indicates that pharmacy isn’t preparing the
mixture, tells nurse what to look for.

Specific
Ingredients &
Packages
Mini-Bag Plus mixtures require a specific NDC for the
base.
ADD-Vantage require specific NDCs for both the base and the main ingredient.

Lock Ingredients Users should not change ingredients or doses.Important for interfacing with ADS systems.
This has three effects:
• Prevents users from changing doses or ingredients, even in Verify Orders(Components locked in verification is automatically set to “yes”). -->This is an exception to the rule! Normally, Epic checks for only the ingredients on med list (and whether the pharmacy supports the mixture’s prep type). By setting Components and doses locked to “yes,” you tell Epic to check for either the mixture or the ingredients.
• Epic sends an order’s mixture ID to the ADS profile instead of just the ingredients’ IDs.
o Makes 1 line-item on the ADS profile.
• Epic dispenses orders for this mixture from any Pharmacy that has the mixture ERX OR both of the specific ingredients on its medication list.
o You can stock the components in separate pockets or pre-
assembled in one pocket.

Dispense Components
Set to “Yes” on Mixture Setup 2; allows nurses to scan
each ingredient for administration.

Dispense Code IVPB Premix

Adding to Formulary & Central Pharmacy
Mixture ERX Add to formulary and central pharmacy. Remove the green dot on both lists.
Ingredient ERXs Add ingredients to formulary and central pharmacy. Make sure you add the specific Mini-Bag Plus or ADD-Vantage ERXs and NDCs to the list.
• Remove the green dot (unless it’s orderable on its
own, such as ceFAZolin for injections).

Loading in an ADS To use the “Load to ADS” workflow, add the mixture ERX to the Load to ADS medication list. This avoids triggering the “load” workflow for orders for an individual component, while making sure the mixture gets loaded if ordered.

Allowing Nurses to Scan Each Ingredient Dispense component....= YES

Charging for Mini-bag and ADD-Vantage Mixtures
Epic will generate a separate charge for each ingredient in a mixture. It uses the charge method, linked procedure, and cost of each ingredient. There is no special configuration required to charge for a mixture.

Key Takeaways: Ratio-based mixtures

• Template Type= Mixture
• Prep Type= IV Admixture
  
  

Order Display Name
Use extension: <generic medication> (<BRAND NAME>) IV syringe <concentration> in <BASE> (<population>)
• If there’s a choice between bases, use the default one
• For <population>, substitute “pediatric,” “neonate,” etc. If not meant for a specific population, omit.
- Order name suffix: IV Syringe

-Suggested doses Unit: mg/kg/day for mixture record (the "mg" in ingredient came from ERX ingredient)

• Ratio based mixture? = Yes-->under Mixture Setup 2
  • What was the concentration of this mixture (as shown in the dosing calculations?
  __20 mg / 1mL
  • What was the ratio between the ceFAZolin and the D5W?
  _740 mg : 37__ mL
  
  

🚩Naming Extension (under Inpatient Med. Order Name Options
34915-IP RXNAME STANDARD (MAIN INGREDIENT WITH BASE DISPLAYED AND NO BASE QUANTITY) because this is weight-based dosing
• Includes the base in Order Name, but not the amount of base

Dispense Code
Syringe

Order Composer Configuration
Either:
• RX MAIN INGREDIENT MIXTURE DISPLAYING BASE [4080200014]>>o If there’s a choice between bases
• RX MAIN INGREDIENT MIXTURE NO COMPONENT DISPLAY [4080200015] >o If only one option for base

IMS Orderable for IV Piggybacks: KEY TAKEAWAY pg 9-61
For the most part, the dosing units of an order will be driven by the dispensables. But since users enter the dose on the IMS orderable, the system needs to know what unit to simplify the dose to. That’s what these fields are doing. **

If you leave the Medication Unit blank in an IMS orderable record, you won’t be able to map it to your dispensables!

• Set the OCC to RX SIMPLE MED [4080200001].
  • IMS makes ordering IVs as simple as possible. Users just need to enter the dose and the system figures out the rest.
  • Even if you used an OCC like RX MAIN INGREDIENT MIXTURE DISPLAYING BASE, the base section would be hidden. The base used comes from the default within the dispensable record and cannot be edited by the user when entering orders.
  • Additionally, the Administer Over and Rate fields are not editable by default when using an orderable because they are determined by the dispensable. Later, you’ll see how to change this behavior if desired.
  □ Page down once. In the IP report generating extension field, enter “18817” (Creatinine Clearance Medication Report).
  • This will display the patient’s current CrCl at the top of the order
  composer.

-- IMS DRIP Orderable: On the Order Composer Configuration screen, set the OCC to “RX IMS ORDERABLE DRIP

IMS Note: Go to the Medication Order Name Text screen. Configure:
• Short name: trn### DOBUTamine
• Brand name: DOBUTREX
• Suffix: infusion
• The order name at the top of the Order Composer will NOT come from these fields; it will come from the naming configuration of whichever dispensable IMS chooses to use.

• If there’s only one concentration, handle that with Mixture Setup 2:If this mixture will be part of an IMS orderable drip (see page 22), the Units must be “…/mL” (such as “mcg/mL” or “mg/mL”) instead of just a simplified unit (mcg, mg, etc.).

Order Name Example:

• Multi-use Products: Order name= generic name>brand>strength if applicable>form>dose; if order Display name= form come before strength
• IMS for Solid Order Display Name" = e.g metoprolol tartrate (LOPRESSOR) tablet AND No strength: - Don't include strength "NO" for "Include Strength in order name" field- Order Display name has NO strength in it
  
  
  

IVPB

• Premix IVPB: Order display name now Shows in "Dispensable" drop down during verifying details
• Main Ingredient IVPB: Order display name of each dispensable (important for it to show on dispensable drop down during verifying): <generic medication> (<BRAND NAME>) IVPB in <base volume> <BASE>; ORDER Name: By default: <short name of main ingredient> (<BRAND NAME of main ingredient>) <dose> <suffix of mixture>.
• Ratio-based mixtures (very similar to main ingredient mixtures): <short name of main ingredient> (<BRAND NAME OF MAIN INGREDIENT>) <dose> <mixture suffix>; Order Display Name <generic medication> (<BRAND NAME>) IV syringe <concentration> in <BASE> (<population>) • If there’s a choice between bases, use the default one • For <population>, substitute “pediatric,” “neonate,” etc. If not meant for a specific population, omit. - Order name suffix: IV Syringe
• IMS Orderables Order display name (appear on preference list): <generic medication> (<BRAND NAME>) IV ; Order name (top of order composer, on MAR, etc).= from dispensable chosen by IMS; and display name for orderable on Smartgroups for order sets or panels came from • Short name: <generic medication> • Brand name: <BRAND NAME> • Suffix: “IV”
  
  

Medication Drips
Mixture

• Record Name If mixture is for a general population: • <MEDICATION> INFUSION IN <BASE> If meant for a specific population/use, add that to end: • <MEDICATION> INFUSION (NEO/PED)
• Order Display Name
  -- If mixture allows multiple concentrations: • <generic medication> (<BRAND>) infusion in <base>
  -- If mixture allows only one concentration: • <generic medication> (<BRAND>) infusion <concentration> in <base>
  -- If meant for a specific population/use, add that to end: • <generic medication> (<BRAND>) infusion <concentration> in <base> (neo/ped)
• Order Name ->
  -- Desired appearance: <short name of medication> (<BRAND NAME of medication>) <amount of medication> in <short name of base> <amount of base> <concentration> infusion
  -- Order Name Suffix: infusion
  -- Add Order Entry and After Ordering extension: 4083492101 - IP RXNAME DOSE WITH BASE, STRENGTH, AND TOTAL VOLUME o Includes short name, brand name, and amount of Concentration Dosed Ingredient o Includes base name and volume o Includes concentration (e.g. 1 mg/mL)
• Order Composer Configuration If there are multiple available bases: • RX CONCENTRATION DOSED MIXTURE DISPLAYING BASE [4080200009] If there is only one base: • RX CONCENTRATION DOSED MIXTURE [4080200012] Both display the Concentration field.
  
  

Premix Medication drips

• Order Display Name <generic name> (<BRAND NAME>) infusion <concentration> If it’s part of an IMS orderable drip, consider including “premix” in the Order Display Name.
• Order Name Inpatient Order Entry & Inpatient After Ordering Extension: 34918 – IP RXNAME ORDER DISPLAY NAME
  -- The dose of a medication drip can change without creating a new order, meaning the order name could contradict the MAR.
  This extension sets the Order Name to the Order Display Name, which does not include the dose.
• **OCCThe appropriate Order Composer Configuration is RX SIMPLE MED. **
• Configure Dosing Units ** Configure the Rx Unit Equivalence screen much like you would for an IV piggyback. The key points are: - Medication Unit= mg - Equiv Qty/Unit= 2/mg and 1/mL