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Define Order Entry Clinical Screening system defaults

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This form defines how myAvatar Order Entry connects to our third-party clinical screening database, Micromedex. 

This form also allows you to set the filtering level for drug interaction screening as well as defining additional screening that may be available.  

Upon installation, the only screening that is turned on by default is Drug-Drug and Drug-Allergy.  Any additional checking such as ingredient or therapeutic duplication as well as dose range checking must be configured by the organization on a per root system code basis.

  • Screening rules set up in this form apply to the medication screening performed when creating a new order and when renewing, discontinuing, validating, holding, and resuming an order.
  • Regarding the drug interaction severity level:
    • The First Databank choices with the notation "(but also include Unknown severity)" will cause the severity filter value (Moderate, Severe, Contraindicated) to be applied, but any drug-to-drug interactions that are classified with an 'Unknown' severity will also be displayed.
    • With First Databank, if the filter chosen does not indicate "(but also include Unknown severity)", then the filter value (Moderate, Severe, Contraindicated) will be applied, but any drug-to-drug interactions that are classified with 'Unknown' severity will not be displayed.
  1. Go to Avatar Order Entry > Order Entry System Definitions > Order Entry Clinical Screening System Defaults.
  2. In the Clinical Screening Database Provider field, select the database provider (First DataBank or Micromedex).
  3. For the Netsmart Clinical Screening Middleware/Server IP Address or Server Name field, enter the IP address or server name for the selected third-party database.
  4. In the Netsmart Clinical Screening Middleware/Server Port Number field, enter the port number used to connect to the clinical screening database middleware/server.
  5. In the CKO Server IP Address Or Server Name field, enter the location of the CKO server that will be used for Patient Specific Dosing checking in the Order Entry Console.
  6. In the CKO Server Port Number field, enter the port number of the CKO server. If a value isn't defined here, a default value of "80" will be used.
  7. Click Check CKO Server Connection to verify that there is a connection to this CKO server.
  8. In the Severity Filter For Drug-Drug Interactions Alerts field, select the drug interaction severity level to use as a filter for issuing alerts for drug-to-drug interactions. The severity level is associated with an order status.
    The severity level choices correspond to the medication database being used. For Micromedex, the levels in order of increasing severity are: Minor, Moderate, Major, Contraindicated. For First DataBank,the levels in order of increasing severity are: Moderate, Severe, Contraindicated.
    • Minor = No filtering. This setting displays alerts for all drug-drug interaction alerts categorized as minor (potentially causing limited effects) or worse.
    • Moderate = Suppresses minor drug-drug interactions. This setting displays alerts for all interactions categorized as moderate (potentially worsening the condition) or worse.
    • Major = Suppresses minor and moderate interactions. This setting displays alerts for all interactions categorized as major (potentially life-threatening) or worse.
    • Contraindicated = Suppresses all drug-drug interaction alerts except for those categorized as contraindicated (ill-advised treatment).
  9. For the Severity Filter for Drug-Allergy Alerts field, select the severity level to use as a filter for issuing alerts for drug-allergy reactions. Choices range from 1 (least severe allergic reaction) to 9 (most severe allergic reaction). Setting this field to the lowest value (1) will result in no client allergies being excluded from screening based on an allergy's reaction severity. Using a higher setting may result in excluding client allergies with less severe reactions from clinical screening. If this field is left blank, no client allergies are excluded from screening based on the reaction severity.
  10. For Types of Screening Performed Via Direct CKO Server Connection choose the type of screening to perform:
    • Dose Range  Helps clinicians monitor the appropriateness of drug dosing for a given age, route.
    • Drug-Drug Interactions  Notifies the clinician of an interaction between medications when placing an order, in accordance with the severity filters set within the Order Entry Clinical Screening System Defaults form.
    • Drug-Allergy Interactions  Notifies the clinician of an interaction between medications and the patient’s documented allergens captured within the Allergies and Hypersensitivities form, in accordance with the severity filters set within the Order Entry Clinical Screening System Defaults form.
    • Ingredient Duplication  Notifies the clinician of a duplication of ingredients between medications when placing an order.
    • Therapeutic Duplication  Notifies the clinician of a duplication of therapies should medications typically used for the same therapeutic class be attempted to be prescribed at the same time.
  11. For Exclude the Following Screening When Performing Copy/Modify/Reorder choose the type of screening to exclude:
    • Drug-Drug Interactions  Notifies the clinician of an interaction between medications when placing an order, in accordance with the severity filters set within the Order Entry Clinical Screening System Defaults form.
    • Ingredient Duplication  Notifies the clinician of a duplication of ingredients between medications when placing an order.
    • Therapeutic Duplication  Notifies the clinician of a duplication of therapies should medications typically used for the same therapeutic class be attempted to be prescribed at the same time.
  12. For the Include Orders With The Following Order Status In Clinical Screening field, select the order statuses to be included when performing clinical screening on orders. Orders with the selected order statuses are available for clinical screening.
  13. Click Submit.
  14. Click Check Connection to verify there is a connection to the clinical screening middleware/server.
  15. Click Display Version Information to view version information for the clinical screening database being connected.
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