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wAM Mistral v2
RXAMB100 Willow Ambulatory Fundamentals
Introduction
Document Details
Version: February 2026
Last Revised: March 27, 2026
Request project specification by: October 23, 2026
Submit project by: November 27, 2026
Request exam by: October 19, 2026
Next version materials available: October 26, 2026
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Reviewing and Filling New Prescriptions
Introduction
Purpose: Learn pharmacy workflow
Reviewing prescriptions
Filling prescriptions
Dispensing fills
Transferring prescriptions
Managing adjudication issues
Learning expectations
Use tools and complete workflows with help
Not expected to complete every workflow from memory
Support contact
Email
WillowTrainingSubmission@Epic.com
Include: companion/chapter/page, environment, user ID, patient name/MRN, configuration, troubleshooting tried
How to Use This Training Companion
Training companion types
Critical Box
Contains critical information
Example Box
Provides scenario for following content
Beyond the Basics Box
Additional helpful information
Not critical for course assessments
Write-It-Down Box
Write down information or answer questions
Foundation System FYI Box
How Foundation System handles workflow
Other Foundation considerations
SetUp Box
More information about system configuration
Real World Context Box
Clarifies industry-standard terminology or practice
Generative AI Box
More information about AI features, tools, and usage
Workflow for New Prescriptions
Key concept: Scripts vs fills
Scripts can have multiple fills (with refills)
Script gets reviewed
Fill gets verified and sold
Focus switches from script to fill when filling begins
Process steps
Script Received
Status: Pending Fill
Electronic script
From EpicCare or e-prescribing service
Paper script
Transcribe in Willow to receive
Saving transcription counts as First Fill Review
Prescription numbers assigned immediately
First Fill Review
Status: Pending Fill (no change)
Performed by: Usually technician
Actions
Check for missing information
Check for potential dispensing issues
Verify NDC is in stock
Completion
Automatically triggers Adjudication
NDC Definition
National Drug Code
Registered with FDA
Specific to manufacturer, medication, package size, package type
Example: 0378-7185-05 = Metformin 500 mg PO tablets, 500-count bottle by Mylan
Must be printed on bottle label
Must be sent on claim for adjudication
Different NDCs can have different costs
Changing NDC triggers automatic re-adjudication and label reprint
Adjudication
Status: Pending Fill (no change)
Process
Send claim to Pharmacy Benefits Manager (PBM)
Real-time processing
Determines patient co-pay
Determines covered amount
Outcomes
Success: Script and fill move to next stage
Failure: Charging Rejected flag added
Profit calculation
Profit = Acquisition cost - (Covered amount + Patient charge)
Can be hidden for users/groups
Clinical Review
Status: Ready to Fill
Performed by: Pharmacist only
Actions
Check sig (directions)
Check interactions
Check appropriateness
Requirements
Required once per script (not per fill)
Special functions
Changes trigger re-adjudication
Request Revision button
Sends script back to technicians
Discontinue button
Cancels fill
Discontinues prescription in EpicCare (not just pharmacy)
Print the Label
Status: Fill Initiated
Performed by: Usually technician
Actions
Print fill label from work queue
Complete the Fill
Status: Ready to Verify (after all fills in work request completed)
Performed by: Usually technician
Actions
Count/measure medication
Barcode scanning workflow
Scan Rx # barcode
Opens Rx Management tab
Selects fill
Scan bulk package NDC barcode
Verifies NDC match
Status changes to Filled
On mismatch: Error message with options
3 more items...
Prepare fill (outside Willow)
Count pills
Affix label to container
Repeat for each fill
Manual completion (without barcode)
Double-click patient from Ready to Fill queue
Manually select fill
Click Mark as Filled
Barcode Scanning Warning in production
Requires override reason
In training: Can select Don't Show Again for session
Verify the Fill
Status: Ready to Dispense (after all fills in work request verified)
Performed by: Pharmacist
Actions
Barcode scanning workflow
Scan fill label
Opens Rx Management for fill
Visually inspect product
Reference product image and description
Perform clinical review if needed
Changes may trigger label reprint and re-adjudication
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
All fills' statuses become Ready to Dispense
Manual verification (without barcode)
From Ready to Verify queue
Double-click patient
Click fill to select
Click Fill verified checkbox
Click Accept to close chart
Dispense Fill to Patient
Status: Dispensed
Performed by: Cashier, tech, or pharmacist
Actions
Mail order/courier: Begin packaging and delivery
Pickup
If patient not arrived: Place in holding bin
If patient arrived: Process sale via POS
Flags
Purpose
Drive Willow Ambulatory workflows
Indicate next task that needs to be done
When removed, script/fill moves to next step
Types and behavior
Red Flags
Block immediately
Block fill or work request from advancing
Called blocking flags
Examples
First Fill Review
Charging Rejected
Needs Clinical Review
Blue Flags
May block dispensing or not block at all
If blocks at Ready to Dispense: Must be resolved before dispensing
If does not block: Can be resolved anytime, even after dispensing
Can be added early and remain through many steps
Examples
Blocks Dispensing: Consult Patient
Does Not Block: Patient Pay Amount Change
Workflow Review
Table: When step completed → Status updates to → Found in work queue
New Script Received → Pending Fill → Initial Review
First Fill Review → (no change) → n/a
Adjudication → (no change) →
Clinical Review → Ready to Fill →
Print the Label → Fill Initiated →
Complete the Fill → Ready to Verify → n/a
Fill ALL Fills → Ready to Verify →
Verify the Fill → Ready to Dispense → n/a
Verify ALL Fills → Ready to Dispense →
Dispense the Fill → Dispensed → n/a
Finding and Reviewing New Orders
Role: Technician
Task: Review new prescriptions sent to pharmacy
Example: Start with First Fill Review for Jamal
Work Queues
Purpose: Show tasks needing completion
Location: Left column of pharmacy homepage
Characteristics
Configurable per user
Can differ for different user types
Customization
Drag and drop to change order
Right-click options
Control favorites
Set default queue on login
Initial Review Queue
Shows First Fill Review tasks
Columns
Priority
Delivery
Patient
MRN
DOB
Due
Reason (shows tasks and number of scripts)
Due time configuration
Set system-wide or per pharmacy
Configurable minutes for different situations
Waiting patients: 10 minutes
Discharge scripts: 45 minutes
Removed from queue if >4 hours overdue
Reviewing Scripts
Action: Double-click patient row to open chart
Example: Jamal's chart review questions
How old is Jamal?
How many refills was atorvastatin written for?
What is cash price of lisinopril?
Marking a Patient as Arrived
Location: Flagged Prescriptions tab
Steps
Click pencil icon next to Delivery info
Select Waiting status
Makes patient a waiter
Prioritizes patient in work queues
Appears in Waiting Patients at top of queues
Add Comment
Example: Needs to catch bus in 15 minutes
Called Work Request Comments
Appear in work queues
Removed when work request complete (after dispensing)
Work Requests
Purpose
Group patient's prescriptions together
Virtual representation of physical basket process
Characteristics
Multiple scripts for same patient
Same work request if received at same time
Includes due time and delivery method
Workflow behavior
Fills typically advance together
Blocking flags affect entire work request
First Fill Review
Needs Clinical Review
Charging Rejected
All fills must be Filled before any can be Verified
All fills must be Verified before any can be Dispensed
Pending Refill Approval blocks individual fill only
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
Harder to resolve flags
Can split work requests
Can manage multiple work requests
Splitting Work Requests
Required when: One script has blocking flag but others don't
Required when: Patient needs some scripts now, others later
Cannot be done from Flagged Prescriptions view
Must use Front Counter view
Steps
From Work Queue: Single-click to select patient
Click Open Patient (opens Front Counter view)
At bottom: Work Requests section
Click Move Fills
Select fills to move
Create new work request (with or without original info)
Original info copied by default
Click down arrow for blank work request
Accept changes
Example: Jamal's atorvastatin now, lisinopril tomorrow
Flags and Work Requests
Flags can block individual fills
Flags can block other fills in same work request
Example: Both of Jamal's fills have First Fill Review flags
Must review both scripts before either can be filled
Completing First Fill Review
Performed by: Technician or pharmacist
Purpose: Confirm script has no obvious errors or missing information
Provider Prescribed section
Read-only until pencil icon clicked
Edits typically for correcting mistakes
Example: Typos in patient instructions
Rx origin
Electronic: From EpicCare, Surescripts, or other 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
Work Request comment
Only persists for current fill
Highly visible to pharmacy staff
Appears in Work Queue
Action: Click Review to mark as reviewed
Example: Jamal's atorvastatin (Lipitor)
Review details
When was fill requested?
What is frequency?
How to edit sig
Which NDC will be used?
What language is Translated sig?
What coverage will be used?
Adjudication trigger
Automatically sends claim to PBM when Review clicked
Payment Summary window appears
Shows insurance coverage amount
Shows patient payment amount
Shows profit amount
Adjudication
Purpose
Pharmacy wants to know it will get paid
Need to know patient co-pay
Process
Click Review for insured fill
System submits claim to Pharmacy Benefits Manager (PBM)
Real-time adjudication
Success or failure message within seconds
Outcomes
Success: Script and fill advance to next stage
Failure: Charging Rejected flag added to fill
Payment Summary
Insurance coverage amount
Patient charge amount
Profit amount
Can be hidden for users/groups
Completing Clinical Review
Performed by: Pharmacist only
Purpose: Check prescription for errors, appropriateness, safety issues
View: Same as First Fill Review
Key considerations
Adjudication already completed
Changes to medication/dispense amount/NDC trigger re-adjudication when Review clicked
Special buttons
Request Revision
Sends script back to technicians for corrections
Discontinue
Cancels fill
Discontinues prescription in EpicCare
Example: Jamal's atorvastatin
Click Review to complete clinical review
Example: Jamal's lisinopril
Medication Warning appears when attempting to review
Warning types
Drug-Allergy
Drug-Drug
Over/Under Dosing
Duplicate Therapy
Age/gender precautions
Pregnancy/lactation precautions
Source: Third-party medication data vendor
Filters: Can determine which warnings appear
Action: Do NOT mark as clinically reviewed
Action: Click Cancel to close warning window
Research needed before proceeding
Reviewing Medication Warnings
Trigger: When pharmacist clicks Review
Types
Drug-Allergy
Drug-Drug
Over or Under Dosing
Duplicate Therapy
Age/gender precautions
Pregnancy/lactation precautions
Source: Third-party medication data vendor
Configuration: Filters determine which warnings appear
Beyond the Basics: Evaluating Sex and Gender
Filtering and rule-based evaluations leverage Epic's default sex logic
Default sex logic examines clinical and demographic data
Stops at first indication patient is not cisgender
If no indication of transgender/intersex/nonbinary: Applies sex-based logic
Purpose: Hide sex-specific tools and warnings to reduce alert fatigue
Ensures all needed clinical tools available
More info: Sex, Gender, and Names Setup and Support Guide on Galaxy
Understand System's Sex-Based Filtering
Build Rules that Filter by Sex or Gender
Understand When OB/GYN Tools Are Available
Reviewing the Patient's Chart
Purpose: Access more patient information
Methods
Visit Summary
Most relevant information
Links to more information
SnapShot tab
Recent patient encounters
Chart Review
Comprehensive medical history
All encounters
Reordered prescriptions: Visible in Provider Prescribed section
Contacting a Provider to Clarify an Order
Provider contact information
Access: Click provider name
Secure Chat
Fastest method for internal providers
Automatically attached to patient chart when opened from chart
Example: Message to Marty Seeger, MD about lisinopril
Consult Physician flag
Add if provider not immediately available
Helps find script when provider calls back
Filling Some of a Patient's Scripts
Scenario: Patient needs some scripts now, others later
Example: Jamal needs atorvastatin now, will return for lisinopril
Requirement: Split into separate work requests
Process
Cannot split from Flagged Prescriptions view
Must use Front Counter view
Move lisinopril to new work request
Indicate fill Ready tomorrow at 11:00 am
Add comment: Reached out to Dr. Seeger for clarification
Confirm only one script needs Clinical Review
After clarification received: Merge work requests back together
Filling
Trigger: After all review and adjudication complete for work request
After all blocking flags removed
Methods
Filling via Pill Counters
Automated Prescription Filling System (APFS)
Used by larger, busier pharmacies
Used for high-volume medications
Workflow
Willow checks if medication loaded in pill counter
If loaded: Automatically tries to fill from pill counter
Interface message sent to pill counter
Pill counter takes over filling process
Labeling
Pill counters label their fills
No need to print label from Willow
Workflow variability
Depends on pill counter make/model
Depends on local regulations
Filling Manually
Willow prints fill label
Label used to complete, verify, and sell fill
Printing options
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 (usually due soonest)
Double-click to print fill labels
Fill Labels
Print location: Nearest workstation
Status change: Fill Initiated
Foundation System label 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
Customization
Foundation System contains all sections
Organizations customize by picking/arranging desired sections
Completing the Fill
Barcode-enabled workflow
Step 1: Get NDCs from shelves
Ensure workstation shows Ready to Fill queue or patient chart
Step 2: Scan fill label barcode
Opens Rx Management tab
Selects scanned fill
Step 3: Scan manufacturer package barcode
System checks NDC match
If match: Status changes to Filled
If mismatch: Error message
Options
Return to shelves for correct package
Click icon to change NDC
Triggers automatic re-adjudication
Triggers fill label reprint
Must scan NDC again to complete
Step 4: Prepare fill (outside Willow)
Count pills
Affix fill label to patient container
Step 5: Repeat steps 2-4 for each fill
After last fill in work request
Status changes to Ready to Verify
Patient chart closes
Manual completion (without barcode)
Double-click patient from Ready to Fill queue
Manually select fill in patient chart
Click Mark as Filled
Barcode Scanning Warning
In production: Requires override reason
In training: Can select Don't Show Again for session
Verifying Fills
Requirement: Each fill must be checked by pharmacist
Purpose
Ensure fill accuracy
Verify right product
Double-check dispense amount for controlled substances
Review script
Typical setup
Verification station focuses on verification
Works from Ready to Verify work queue
Barcode-enabled workflow
Step 1: Pick basket and scan fill label
Rx Management for fill appears
Step 2: Visually inspect product
Reference product image and description in Willow
Step 3: Perform clinical review if needed
Changes may trigger label reprint and re-adjudication
Step 4: Verification options
Scan ID badge to verify
Status changes to Verified
Or click Reject Fill
Status changes to Fill Rejected
Returns to Ready to Fill queue
Step 5: Repeat steps 1-4 for each fill
After last fill verified
Patient chart closes
Return to Ready to Verify work queue
All fills' statuses become Ready to Dispense
Manual verification (without barcode)
From Ready to Verify queue
Double-click patient to open Rx Management
Click fill to select
Click Fill verified checkbox
Click Accept to close chart
Training resource
Verify Fills [RXAMB002] on welearning.epic.com
Bagging Fills
Purpose: Move fills to patient package
Trigger: When verification complete
Printed items
Bag label
Monograph (typically)
Med Guide (typically)
Can print with fill label instead
Dispensing Fills
Trigger: After all fills in work request verified
Status: Ready to Dispense
Methods
Mail order or courier
Packaging and delivery process begins
Pickup
If patient not arrived: Place in holding bin
If patient arrived: Process sale
Point of Sale (POS) Activity
Purpose
Sell prescriptions
Record patient counseling
Features (since May 2019)
Sell non-prescription merchandise
Features (since August 2021)
Dispense prescriptions for multiple patients in one transaction
Benefits of integrated POS
Access to patient prescription history
Access to medication list
Access to other medical information
Last-minute safety reminders
Newer interactions
NDC substitutions
Up-to-date billing information
Co-pay changes
Pseudoephedrine Sales (since May 2024)
Query and report to National Precursor Log Exchange (NPLEx)
Real-time results
Automatically requires patient ID collection
Example: Jamal's prescriptions
Role: Tech at pickup window
Steps
Log in as technician to EMC South Pharmacy
Click Point of Sale activity under Epic button
Add Patient: Select Jamal from Recent Patients tab
Enter postal code: 53593
Select Jamal's atorvastatin and lisinopril
Add non-prescription item
Find Merchandise field in bottom left
Search for lint roller
Add to sale items
Patient requests pharmacist consultation
Call pharmacist over
Click Start Counseling
Counseling resources appear under prescription
Med guides
Monographs
Counseling Comments for documentation
Click Complete Counseling
Enter pharmacist User ID and password
User Authentication allows counseling without logout/login
Payment
Jamal pays with cash: $30.00
Under Payments: Tender $30.00 cash payment
Click Complete Sale
Cash drawer opens
Close any open patient charts
Reviewing the Med Profile
Purpose: Review script history and details
Access: From Front Counter
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 in pharmacy
Includes discontinued and transferred scripts
Medical record
All scripts recorded in system
Includes scripts ordered in Epic and sent to outside pharmacies
Usage: Hold mouse over information for more details
Example: Pharmacy manager checking who worked with Jamal
Open Jamal's chart
Check Med Profile
View atorvastatin and lisinopril received today
Reviewing Prescription History
Purpose: Zoom in on script details
Access: Double-click script in Med Profile
Views
Report view (top)
View information
Prescription Event Details (bottom)
Take action
Information levels
Script level
Fill level
Adjudication level
Order Audit Trail
Shows all changes to order over time
Example questions for Jamal's atorvastatin
Who prescribed?
What did patient 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 fill to patient?
Were changes made to script by pharmacy?
What printed for this fill today?
What printed when order entered?
Did patient's MRN print on bottle label?
What to click to cancel fill and return to inventory?
Hint: Click today's dispense date under Dispense History
Workflow Variations
Organizational 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 system?
User-specific workflow changes
Pharmacist completes first fill review
System counts as First Fill Review AND Clinical Review
No Needs Clinical Review flag added
Fill can advance to Ready to Fill (if no other blockers)
Pharmacist completes filling process
System marks as Filled AND Verified
Fill advances to Verified or Ready to Dispense
Exercise 1: Review and Fill as a Pharmacist
Steps
Log in as pharmacist to EMC Prescription South Pharmacy
Find Claire patient in Initial Review queue
Double-click to open chart in Flagged Prescriptions view
Click Review
First Fill Review flag resolved
Adjudication successful
Next step: Clinical Review (if pharmacist) or Needs Clinical Review flag (if tech)
Close Payment Summary window
Open Claire's chart from Front Counter button
Find Lexapro prescription at top of Med Profile
Status: Ready to Fill
Expected? Yes, because pharmacist completed First Fill Review
Skipped step: Clinical Review (pharmacist review counts as both)
Based on status: Find in Ready to Fill queue
Close Claire's chart
Open Ready to Fill Queue
Double-click to open Claire's chart
Click on Lexapro fill in work request
Fill and Verify button appears
Different from technician view (tech sees Mark as Filled)
Fill and Verify Claire's Lexapro
Pharmacist completes both filling and verification
Jump to POS via cash register icon next to Claire's photo
Enter postal code: 53703
Select Lexapro
Counseling links appear immediately
Available automatically for pharmacist in POS
Tech must click Start Counseling first
Click Complete Counseling
No user authentication required (pharmacist is current user)
Document payment: $10.00 cash
Complete Sale
Click Done
Reviewing the Chapter
Review Questions
If fill has status of Pending Fill, what needs to happen next?
For pharmacy, can have pharmacists review clinical details before filling or during verification. What are advantages/disadvantages of each?
A script has been reviewed by pharmacist. All blocking flags resolved but status still Pending Fill. Why?
Where can you put comment so it appears in work queues?
What always happens after first fill review for patient with insurance?
A fill's status is Filled. What next workflow step to advance? (Choose one: A. Mark fill as complete, B. Mark other fills in work request as complete, C. Verify fill, D. Verify other fills in work request)
Review Key
If fill has status of Pending Fill, what needs to happen next?
All blocking flags need resolved for all fills in work request
Includes: First Fill Review, Needs Clinical Review, Charging Rejected, others
Pharmacist review timing advantages/disadvantages
Before filling
Advantage: Fewer returns and wasted products
During verification
Advantage: Pharmacist interacts with script only once, increasing efficiency
Script reviewed by pharmacist, all blocking flags resolved, status still Pending Fill. Why?
Script in work request with other scripts not ready
If any script has First Fill Review, Needs Clinical Review, Charging Rejected, or other blocking flag, all scripts must wait
Where to put comment to appear in work queues?
Work request comment
What always happens after first fill review for insured patient?
Claim sent for adjudication
Fill's status is Filled. Next workflow step?
B. Mark the other fills in the work request as complete
Filled status means fill already marked complete
Other scripts in work request not yet completed
After all fills filled: Status changes to Ready to Verify
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 activity
Navigate to Prescription History
Identify information on patient's Med Profile
Fill just some scripts in work request
Concepts
Difference between Flagged Prescription and Front Counter views
How work request affects movement of individual fills
Difference between different types of comments and where they appear
Reason Willow uses flags
Flags can block either fill or work request
Effects a flag has on fill and work request
Options for when flag blocks
How color of flag can indicate blocking behavior
How blocking behavior affects review and filling workflows
Different statuses a script goes through and what each means
Given work request, identify key information about each fill
Given in-progress work request, predict status after task completed
Given Med Profile, determine what happening with each prescription
Entering New Prescriptions
Introduction
Most prescriptions arrive electronically
Paper prescriptions still necessary
When other clinics not live on Epic
When patients arrive with outside provider prescription
Primary workspace: EMC Prescription North Pharmacy
POS turned OFF
Fills move from Verified directly to Dispensed
Skips Ready to Dispense status
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
Access
Front Counter window
Pharmacists default to Medication Profile
Rx Management tab for prescription entry
Work Requests section at bottom
Customer is waiting checkbox
Starts counting wait time
Example: Sherlock arrives with paper scripts
Entering a Simple Script
Location: Rx Management tab
New Rx field
Search for medication (full or partial name or synonym)
Example: metoprolol tartrate (Lopressor) tablets
Finding Medications on a Preference List
Two lists available
Preference list
Medications available in your pharmacy
All medications
Every medication in database
In US: All FDA approved medications
Example: Choose metoprolol tartrate (Lopressor) tablet 50 mg
Where Does the Medication Come From?
Source: Medications (ERX) master file
Master file in Epic database
Contains medication records
Simple ERX records
Specific combination of drug, strength, form
Example: metoprolol 25mg, 50mg, 100mg, extended release, combination drugs
Third-party vendors (import most ERX records)
Medi-Span (and Medi-Span GDD in Singapore)
FDB (First Databank)
Multilex (from FDB-Europe, UK)
G-Standaard (Netherlands)
ERX record information (from vendor)
Industry-standard clinical information
Pharmaceutical classes
Therapeutic classes
DEA schedule
Product index
Equates different but equivalent medication records
Example: ASPIRIN 325 MG PO TABS = ASPIRIN 500 MG PO TABS (different strength)
Links to medication warnings
Drug-drug interactions
Duplicate therapy warnings
Where Do the NDCs Come From?
Source: NDC master file in Epic
Record for every NDC available
Inactive NDCs
Marked by third-party vendors when manufacturer stops production
Epic maintains records for inactive NDCs
Purpose: In case pharmacy still has stock
Why is This NDC Selected?
Pharmacy configuration
Each pharmacy maintains list of stocked NDCs
Each pharmacy maintains preferred NDC for each ERX
Selection process
When medication selected for script
Willow fills in preferred NDC for that ERX in that pharmacy
Storage: Medication List (EFY) master file
Must be updated when pharmacy changes stocked NDCs
Entering a Script's Details
Navigation
Tab key to move between fields
Alt + underlined letter for field name
Example: Alt+E for Dispense field
Sig field: Alt+U
Example: Sherlock's metoprolol script
Medication: metoprolol tartrate tablets 50 mg
Route: oral
Frequency: 2 times daily (choose first option)
Dispense: 60 tablets
Refills: 11
Prescription date: today
Provider: Marty Seeger, MD
Origin: Written
Sig building
Automatically composed from dose, route, frequency
Adding to the Sig
Composed sig
Built automatically from structured fields
Free-text sig
Edit composed sig directly
Warning: If dose/route/frequency changed after free-text edit, sig turns yellow
Purpose: Warn that dose/route/frequency no longer matches sig
Adding text after composed sig
Does NOT activate yellow warning
System can update composed sig while keeping additional text
Revert option
Click composed sig icon to revert to original composed sig
Example: Add "Take with food" to metoprolol
Using Inline Prescription Entry
Purpose: Quickly enter prescriptions
Format
Medication name first
Additional instructions last
Order of other fields doesn't matter
Example: Sherlock's hydrocortisone cream
Inline entry: hydro 2.5 cream bid d30g r0 wt owrit [Apply to left arm
Interpretation
hydro 2.5 cream = hydrocortisone cream 2.5%
bid = 2 times daily
d30g = dispense 30 grams
r0 = 0 refills
wt = written today
owrit = origin written
[Apply to left arm = instructions
Prescription entry shortcuts
Common Latin abbreviations
PO: per os (oral route)
PRN: pro re nata (as needed)
Q4H: quaque 4 horam (every 4 hours)
Q6H: every 6 hours
Q12H: every 12 hours
BID: bis in die (twice per day)
TID: ter in die (three times per day)
QID: quater in die (four times daily)
Forbidden abbreviations
QD: every day
Q1D: every 1 day
QID: four times daily
Reason: Can be misread
ISMP recommendation: Spell out all frequencies
Epic behavior
Spells out frequencies in sig
Allows Latin abbreviations during entry
Standard frequency tip
Use period before frequency name for standard version
Example: .bid for scheduled 2 times daily
Shortcuts used in example
2 times daily: .bid
End after 10 days: x10days
Days supply of 10 days: ds10
Shortcut help
Click question mark button to far right of New Rx field
Entering a Free-Text Provider
When needed: Provider not in system
Method: Click Other
Enter free-text provider name
Note: Automatically uses first script's provider for subsequent scripts in same work request
Entering a Script That Will Not Be Filled Now
Method: Do NOT click Accept
Simply start entering next script in New Rx field
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