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Patient Specific Dosing

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Features

Patient Specific Dosing gives myAvatar Order Entry the capability to provide dosing guidelines based on patient-specific information. This is available from both the Client Profile and the Order Console. Patient Specific Dosing uses the following information when providing the dosing guidelines:

  • Height (Required)
  • Weight (Required)
  • DOB (Required)
  • Gender (Required)
  • Diagnosis (Diagnosis associated to individual Order)
  • Frequency
  • PRN Indicator
  • Medication
  • Dose
  • Dose Unit 
  • Duration

When enabled, Patient Specific Dosing will deliver a message regarding dosing guidelines based on the data above. If any of the required data is missing or out-of-date, Patient Specific Dosing will issue a warning and ask for valid information. The content used for this checking is provided by Truven Health. The Micromedex CKO Server is responsible for all patient specific dosing checking.

Warnings

Patient Specific Dosing is not supported when sending an order to an external pharmacy.

The server will not return even basic dose checking unless all the required fields above are provided. If the required information is not available, the system will return a message indicating that Patient Specific Dosing cannot be completed because the required information is not available.This message is returned to both the provider and the pharmacist to alert them that dosage range checking could not be performed. 

In regards to the weight requirement referenced above, certain time parameters are required to ensure the weight is up-to-date:

  • If over the age of 18 years old, height and weight vitals must be entered within one year of the date the order is being created.
  • If older than 12, but less than 18 years old, height and weight vitals must be entered within the past 6 months of the date the order is being created.
  • If older than 2, but less than 12 years old, height and weight vitals must be entered within the past 30 days of the date the order is being created.
  • If older than 1, but less than 2 years old, height and weight vitals must be entered within the past 7 days of the date the order is being created.
  • If less than 1 year old, height and weight vitals must be entered on the current date that the order is being created.

Finally, not all Micromedex items have patent-specific dosing records. We are working with Truven Health on providing a list of all medications that have a patient-specific dosing record available. In order to reduce alert fatigue,  the decision was made as part of the Order Entry implementation to not return an alert that patient specific checking was not performed as Netsmart believed that would result in nuisance alerts and potentially create a scenario where providers were not reviewing alerts where dosing warnings were returned. However, those alerts ARE available to the pharmacist if they are using RxConnect.

Setup

Perform the following to enable Patient Specific Dosing:

  1. Access the 'DictAccess the 'Dictionary Update' form under myAvatar CWS > RADplus Utilities > Dictionary and Table Maintenance.
  2. Search for and select "Dosage Check Override Reason Code" under 'Order Entry Client Information'.
  3. Enter code in the 'Dictionary Code' field. (ex. 1)
  4. Enter a value in the 'Dictionary Value' field. (ex. As per Doctor's orders)
  5. Select the 'Require Override Text With This Override Code' extended attribute and select "No" in the 'Extended Dictionary Value (Single Dictionary)' field.
  6. Submit the form.
  7. Access the 'Order Entry Clinical Screening System Defaults' form.
  8. Verify that the 'CKO Server IP Address Or Server Name' and 'CKO Server Port Number' fields are displayed.
  9. Populate both fields and click [Submit].