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Willow Fundamental - Coggle Diagram
Willow Fundamental
RXAMB100 Willow Ambulatory Fundamentals MISTRAL v1
Introduction
How to Use This Training Companion
For use with other course materials
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Steps to request access
Study and Project environments
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Technical requirements
Access a Study Environment
Study environments refresh every Friday at 10:00 PM Central Time
Access steps
Reviewing and Filling New Prescriptions
Introduction
New scripts progress through discrete steps
Scripts vs fills
By the End of This Lesson
Navigate and read work queues
Identify work needing completion
Use work requests
Navigate patient chart
Identify fill label information
Explain barcoding use
Explain POS system messages
Review fill details via prescription history
Workflow for New Prescriptions
Process Steps
Script Received
Status: Pending Fill
Electronic from EpicCare or e-prescribing service
Paper script transcription
Prescription numbers assigned on save
First Fill Review
Status: Pending Fill
Check for missing information
Check for dispensing issues
NDC in stock verification
Completion triggers Adjudication
NDC Definition
Manufacturer-specific
Medication-specific
Package size and type
Registered with FDA
Must be printed on bottle label
Must be sent on claim for adjudication
Different NDCs can have different costs
Changing NDC triggers re-adjudication
Adjudication
Status: Pending Fill
Send claim to Pharmacy Benefits Manager (PBM)
Determines patient co-pay
Determines covered amount
Profit calculation
Acquisition cost vs Covered amount + Patient charge
Clinical Review
Status: Ready to Fill
Pharmacist only
Checks sig
Checks interactions
Checks appropriateness
Required once per script
Re-adjudicates if changes made
Request Revision button
Discontinue button
Print the Label
Status: Fill Initiated
Print from work queue
Complete the Fill
Status: Ready to Verify
Scan Rx # and bulk package's NDC barcode
NDC mismatch handling
Manual completion option
Verify the Fill
Status: Ready to Dispense
Scan Rx # to select fill
Visually inspect product
Scan user badge to confirm
Manual verification option
Dispense Fill
Status: Dispensed
Sell fill to patient
Workflow Diagram
Script Received
First Fill Review
Adjudication
Clinical Review
Filling
Fill Verify
Point of Sale
Flags
Purpose
Indicate next task
Drive workflow
Types
Red Flags
Block immediately
Examples
First Fill Review
Charging Rejected
Needs Clinical Review
Blue Flags
Blocks Dispensing
Consult Patient
Does Not Block
Patient Pay Amount Change
Behavior
Red flags block fill or work request
Blue flags may block dispensing or not block
Flag removal advances workflow
Workflow Review
Table: Step Completion vs Status vs Work Queue
Finding and Reviewing New Orders
Work Queues
Purpose
Tasks needing completion
Configuration
Configurable per user
Different for different user types
Customization
Drag and drop to change order
Right-click for favorites
Right-click to set default on login
Initial Review Queue
First Fill Review tasks
Columns
Priority
Delivery
Patient
MRN
DOB
Due
Reason
Due Time
Configurable system-wide or per pharmacy
Removed if over 4 hours overdue
Reviewing Scripts
Marking a Patient as Arrived
Delivery info pencil icon
Select Waiting status
Add Comment
Work Request Comments
Appear in work queues
Removed when work request complete
Work Requests
Purpose
Group patient's prescriptions
Virtual representation of physical baskets
Characteristics
Multiple scripts for same patient
Same work request if received at same time
Includes due time and delivery method
Workflow Behavior
Fills advance together
Blocking flags affect entire work request
First Fill Review
Needs Clinical Review
Charging Rejected
All fills must be Filled before verification
All fills must be Verified before dispensing
Views
Flagged Prescriptions view
Easy to resolve flags
Accessed from work queue
Cannot split work requests
Cannot manage multiple work requests
Front Counter view
Manage anything for patient
Accessed from Open Patient button or Front Counter activity
Can split work requests
Can manage multiple work requests
Splitting Work Requests
From Work Queue
Single-click to select patient
Click Open Patient
In Front Counter view
Work Requests section at bottom
Click Move Fills
Move fill to new work request
Create blank work request option
Flags and Work Requests
First Fill Review blocks work request
Charging Rejected blocks work request
Needs Clinical Review blocks work request
Pending Refill Approval blocks individual fill
Completing First Fill Review
Technician or pharmacist
Confirm no obvious errors
Provider Prescribed section
Read-only until edit
Edits for correcting mistakes
Rx origin
Electronic when from EpicCare, Surescripts, or interface
Comment fields
Provider comments
Entered by ordering provider
Appear for all fills
Easily seen by provider
Used for special requests
Pharmacy prescription-level comments
Appear for all fills for pharmacy staff
Used for special requests heard by pharmacy staff
Work Request comment
Only persist for current fill
Highly visible to pharmacy staff
Appear in Work Queue
Adjudication
Claim sent to PBM
Determines coverage and patient charge
Profit calculation
Acquisition cost vs Covered amount + Patient charge
Profit and Cash price can be hidden for users
Completing Clinical Review
Pharmacist only
Checks for errors and safety issues
Same view as First Fill Review
Adjudication re-runs if changes made
Request Revision button
Sends script back to technicians
Discontinue button
Cancels fill
Discontinues prescription in EpicCare
Reviewing Medication Warnings
Types
Drug-Allergy
Drug-Drug
Over or Under Dosing
Duplicate Therapy
Age/gender precautions
Pregnancy/lactation precautions
Source
Third-party medication data vendor
Filters
Determine which warnings appear
Beyond the Basics: Evaluating Sex and Gender
Filtering and rule-based evaluations
Epic's default sex logic
Sex-based filtering
Reviewing the Patient's Chart
Visit Summary
Most relevant information
Links to more information
SnapShot tab
Recent patient encounters
Chart Review
Comprehensive medical history
Contacting a Provider to Clarify an Order
Provider contact information
Click provider name
Secure Chat
Fastest way for internal providers
Automatically attached to patient chart
Consult Physician flag
Add if provider not immediately available
Filling Some of a Patient's Scripts
Split work requests
When one script has blocking flag
When patient needs some scripts now
Front Counter view required
Filling
After all review and adjudication complete
Filling via Pill Counters
Automated prescription filling system (APFS)
Willow checks if medication loaded
Interface message to pill counter
Pill counter takes over
Pill counter labels fills
No need to print label from Willow
Workflow variable by make/model and regulations
Filling Manually
Willow prints fill label
Immediate Printing
Labels print automatically
Technicians watch printer
Common for waiting patients, off-shifts, small pharmacies
Ready to Fill Queue
Fills appear with Ready to Fill status
Technician selects work request
Double-click to print labels
Fill Labels
Print at nearest workstation
Status changes to Fill Initiated
Sections
Bottle label
Warning labels
Image Description
Script label
Patient instructions
Flags
Fill log label
Fill priority
Delivery label
Counseling label
Partial fill label
Preparation instructions
Receipt
Foundation System label
Contains all available sections
Customizable by organization
Completing the Fill
Barcode-enabled workflow
Scan fill label barcode
Opens Rx Management tab
Selects fill
Scan manufacturer package barcode
Checks NDC match
Status changes to Filled
Error if NDC mismatch
Option to change NDC
Triggers re-adjudication
Triggers label reprint
Must scan NDC again
Prepare fill
Count pills
Affix label to container
Repeat for each fill
Last fill in work request
Status changes to Ready to Verify
Patient chart closes
Manual completion
Double-click patient from Ready to Fill queue
Manually select fill
Click Mark as Filled
Verifying Fills
Each fill must be checked by pharmacist
Pharmacist responsibilities
Right product verification
Double-check dispense amount for controlled substances
Review script
Process
Scan fill label
Rx Management appears
Visually inspect product
Reference product image and description
Perform clinical review if needed
May reprint label and re-adjudicate
Scan ID badge to verify
Status changes to Verified
Or click Reject Fill
Status changes to Fill Rejected
Returns to Ready to Fill queue
Repeat for each fill
After last fill verified
Patient chart closes
Return to Ready to Verify queue
Fills' status becomes Ready to Dispense
Manual Verification
From Ready to Verify queue
Double-click patient
Click fill to select
Click Fill verified checkbox
Click Accept to close chart
Bagging Fills
Bag label prints
Monograph prints
Med Guide prints
Dispensing Fills
After verification complete
Mail order or courier
Packaging and delivery begins
Pickup
If patient not arrived
Place in holding bin
If patient arrived
Process sale using POS
POS Activity
Access to patient prescription history
Access to medication list
Access to other medical information
Last-minute safety reminders
Up-to-date billing information
Sell prescriptions
Record patient counseling
Sell non-prescription merchandise
Dispense prescriptions for multiple patients in one transaction
Benefits of Integrated POS
Access to patient information
Safety reminders
Billing information
Pseudoephedrine Sales
Query and report to NPLEx database
Real-time results
Automatically require ID collection
Reviewing the Med Profile
Three views
Recent Rx profile
Everything due or in progress
All other active scripts owned by Willow Ambulatory pharmacy
Entire Rx profile
Everything that could have been filled
Includes discontinued and transferred scripts
Medical record
All scripts recorded in system
Includes scripts ordered in Epic and sent to outside pharmacies
Reviewing Prescription History
Access
From Med Profile
Double-click script
Views
Report view
Top part of screen
View information
Prescription Event Details view
Bottom part of screen
Take action
Information Levels
Script level
Fill level
Adjudication level
Order Audit Trail
Shows all changes to order over time
Example Questions
Who prescribed the medication?
What did patient have to pay?
Who did first fill review?
At what time did filling begin?
Did tech barcode scan when marking fill complete?
At what time was fill sold?
Who sold the fill?
Were changes made to script?
What printed for this fill?
What printed when order entered?
Did patient's MRN print on bottle label?
What to click to cancel fill and return to inventory?
Workflow Variations
Configuration choices
Require clinical review before filling?
Queue fill labels to be printed on demand?
Sell fills in Epic's POS or non-Epic POS?
User-specific changes
Pharmacist completing first fill review
Counts as First Fill Review and Clinical Review
No Needs Clinical Review flag added
Pharmacist completing filling
Counts as Filled and Verified
Allows fill to advance to Verified or Ready to Dispense
Exercise 1: Review and Fill as a Pharmacist
Steps
Log in as pharmacist
Find Claire patient in Initial Review queue
Click Review
First Fill Review flag resolved
Adjudication successful
Next step: Clinical Review (if pharmacist) or Needs Clinical Review (if tech)
Close payment summary
Open Claire's chart from Front Counter
Find Lexapro prescription
Status check
Workflow step verification
Ready to Fill queue
Fill and Verify button
Comparison to technician view
Fill and Verify Claire's Lexapro
Jump to POS via cash register icon
Enter postal code
Select Lexapro
Counseling links
Complete Counseling
Document payment
Complete Sale
Reviewing the Chapter
Review Questions
If fill has status of Pending Fill, what needs to happen next?
Pharmacist review timing advantages/disadvantages
Script reviewed by pharmacist but status still Pending Fill, why?
Where to put comment to appear in work queues?
What always happens after first fill review for insured patient?
Fill's status is Filled, what next?
Review Key
All blocking flags must be resolved
Pharmacist review before filling vs during verification
Script in work request with other scripts not ready
Work request comment
Claim sent for adjudication
Mark other fills in work request as complete
Study Checklist
Key Terms
Work queue
Flagged Prescription view
Work request
Blocking flag
First Fill Review
Adjudication
Clinical Review
Front Counter view
Ready to Fill queue
NDC
Status
POS
Fill
Tasks
Review a script or fill
Move scripts between work requests
Add a comment that appears in work queue
Add a flag to a fill
Initiate a fill
Document completing a fill
Verify a fill
Dispense a fill using POS
Navigate to Prescription History
Identify information on Med Profile
Fill just some scripts in work request
Concepts
Difference between Flagged Prescription and Front Counter views
How work request affects fill movement
Difference between comment types
Reason Willow uses flags
Flags can block fill or work request
Effects of flag on fill and work request
Options for when flag blocks
Flag color indications
How blocking behavior affects workflows
Different statuses and meanings
Identify key fill information
Predict status after task completion
Determine script status from Med Profile
Entering New Prescriptions
Introduction
Most prescriptions arrive electronically
Paper prescriptions still necessary
EMC Prescription South vs North
South: POS turned ON
North: POS turned OFF
Fills move from Verified to Dispensed
Skips Ready to Dispense
By the End of This Lesson
Enter new prescriptions into Willow Ambulatory
Use inline prescription entry
Enter prescriptions for mixtures
Enter prescriptions with non-English sigs
Entering Paper Prescriptions
Front Counter access
Pharmacists default to Medication Profile
Rx Management tab
Work Requests section
Customer is waiting checkbox
Entering a Simple Script
Rx Management tab
New Rx field
Search for medication
Finding Medications on a Preference List
Preference list
List of medications available in pharmacy
All medications
Every medication in database
In US: all FDA approved medications
Where Does the Medication Come From?
Medications (ERX) master file
Simple ERX records
Specific combination of drug, strength, form
Third-party vendors
Medi-Span
FDB (First Databank)
Multilex
G-Standaard
ERX record information
Clinical information
DEA schedule
Product index
Medication warnings
Where Do the NDCs Come From?
NDC master file
Record for every NDC available
Inactive NDCs maintained
Why is This NDC Selected?
Pharmacy keeps list of stocked NDCs
Preferred NDC for each ERX
Medication List (EFY) master file
Entering a Script's Details
Tab navigation
Alt key navigation
Sig field
Adding to the Sig
Composed sig
Automatically built from dose, route, frequency
Free-text sig
Edit composed sig directly
Warning if dose/route/frequency changed
Adding text after composed sig
Does not activate warning
Using Inline Prescription Entry
Medication name first
Additional instructions last
Order doesn't matter
Prescription entry shortcuts
Common Latin abbreviations
PO: oral
PRN: as needed
Q4H: every 4 hours
BID: twice per day
TID: three times per day
QID: four times per day
Forbidden abbreviations
QD, Q1D, QID
ISMP recommendations
Standard frequency tip
Use period before frequency name
Example: .bid for scheduled 2 times daily
Entering a Free-Text Provider
Other option for non-system providers
Entering a Script That Will Not Be Filled Now
In-Class Exercise
Exercise 1: Entering Mixtures
Part 1: Enter a Mixture ERX
Part 2: Entering a Mixture on the Fly
Part 3: Explore the Effects of Ingredient Types
Document Your Findings
Exercise 2: Entering Brand Name and Partially Filled
Part 1: Enter a Brand Name Prescription
Part 2: Indicate a Partial Fill
Part 3: Completing a Partial Fill
Document Your Findings
If You Have Time: More Prescription Entry Practice
Enter Scripts as Technician
Review Scripts and Print Labels as Pharmacist
If You Still Have Time: Complete Fill Verification
If You STILL Have Time: Do the Completion Fill
Key Takeaways
Entering Mixtures
Entering Brand Name Scripts
Dispensing a Partial Fill
Reviewing the Med Profile
Completing the Partial Fill
Translating Sigs
Reviewing the Chapter
Transferring Prescriptions
Refilling Prescriptions
Day 1 Lab
Registering New Patients
Managing Adjudication Issues
Clinician Interactions
Reporting
Day 2 Lab
Appendix A: Do This Next
Appendix B: Reviews