Electronic Medical Records. Centricity EMR Medication Monographs & Dosing Calculator

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Electronic Medical Records

Centricity EMR 9.2

---Medication Monographs

&

Dosing Calculator

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Michigan State University EMR Rev. Date: 6/25/2010

MEDICATION MONOGRAPHS & DOSING CALCULATOR

PURPOSE

The intent of this document is to inform and instruct HealthTeam staff and providers on the use of the medication Monograph and Dosing Calculator in Centricity EMR 9.2.

MEDICATION MONOGRAPHS AND DOSING CALCULATOR

The medication Monograph and Dosing Calculator in Centricity EMR 9.2 can facilitate safe and effective prescribing of medications to HealthTeam patients. These tools can be used independent of one-another, or together. Clinicians can benefit from familiarizing themselves with the menus, dropdown list options, and other features available in the various Monograph and Dosing Calculator screens.

MEDICATION MONOGRAPHS

What is a Medication Monograph?

A medication monograph is a detailed explanation of a medication and how it should be used, for what purpose, its possible side effects and contraindications, precautions, and more.

Accessing the Medication Monograph

The default Monograph site for the HealthTeam is Lexi-Comp (Lexi-Drugs Online), though Pediatricians and their staff may have their default set to its pediatric equivalent (Pediatric Lexi-Drugs Online).1 The Monograph button is located in the New Medication, Update Medication, and Change Medication windows of Centricity EMR 9.2. An individual wishing to utilize this feature first selects a medication, then clicks the Monograph button.

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Using the Medication Monograph

Once a medication has been selected from either the medication Reference List… or a Custom List and the Monograph button has been clicked, the Monograph window opens; its content pertains directly to the medication initially selected in the EMR. In the illustration below, Synthroid (Levothyroxine Sodium) had been selected in the New Medication window.

Main Monograph Tools

While the actual content of the Monograph window varies from one medication to the next, the built-in tools remain relatively constant.

 Navigation arrows help you move between screens associated with the featured medication that you’ve visited during the current look-up, forward and back.

 The Search button allows you to expand your research on the medication you already entered, or a different medication. Buttons to go to the Lexi-Comp Online home page, and to

access other Indexes, are in the mid-section of the Search window. Or, enter text in the Search for field, select from the options in the Within dropdown list, then click Search. The results will then be displayed directly below these Search fields.

NOTE: Avoid clicking the Interactions, Drug ID, Calculations, and Logout buttons in the Search window, as they require a login ID

and password independent of your HealthTeam Centricity EMR ID and password.  Click the Print button to print the content of the Search screen currently displayed.

 The Close button will close the Monograph window and return you to the Medication window in which you have been working in Centricity EMR 9.2.

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The Title, Home Button, and Print Button

Below the main navigation and function buttons in the Monograph window, you see the name of the medication you selected prior to accessing the Monograph tool. The medication name is displayed on the left, and on the right there are two additional buttons that you can use to move to the Lexi-Comp home page, or to print the current Monograph page.

The Monograph Toolbar

Between the name of the medication and the findings about that medication is another toolbar that provides a means by which you can perform multiple tasks.

Images

The Images button opens a window where you can view images of the medication as provided by various pharmaceutical companies, when available.

Click directly on one of the images to see a more detailed description of that medication.

Having viewed the medication image(s), use the arrow buttons to return to the Monograph pages that you previously viewed.

Or, click the Close button to close the Monograph window entirely and return to your EMR chart update.

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Interactions

Check interactions by clicking the Interactions button. Known interactions related to the medication are displayed in a table format, with the interacting drugs in the left column, and their Risk Rating in the right column. When you click directly on a particular drug in the left column, details about the interaction between that drug and the

medication you initially selected are provided.

A No Known Interaction

Data have not demonstrated either pharmacodynamic or pharmacokinetic interactions between the specified agents

B No Action Needed

Data demonstrate that the specified agents may interact with each other, but there is little to no evidence of clinical concern resulting from their concomitant use.

C Monitor Therapy Data demonstrate that the specified agents may interact with each other in a clinically significant manner. The benefits of concomitant use of these two medications usually outweigh the risks. An appropriate monitoring plan should be implemented to identify potential negative effects. Dosage adjustments of one or both agents may be needed in a minority of patients.

D Consider Therapy Modification

Data demonstrate that the two medications may interact with each other in a clinically significant manner. A patient-specific assessment must be conducted to determine whether the benefits of concomitant therapy outweigh the risks. Specific actions must be taken in order to realize the benefits and/or minimize the toxicity resulting from concomitant use of the agents. These actions may include aggressive monitoring, empiric dosage changes, choosing alternative agents.

X Avoid Combination

Data demonstrate that the specified agents may interact with each other in a clinically significant manner. The risks associated with concomitant use of these agents usually outweigh the benefits. These agents are generally considered contraindicated. * For more on the Risk Rating scale, click directly on the Risk Rating link of the Interactions window.

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Patient Education

Adult and Pediatric Patient Ed buttons are also available. Click to access Patient Education handouts written for adult and pediatric populations, respectively. These handouts can be displayed and printed in various languages.

NOTE: While the language options remain static in both the Adult Patient Ed and

Pediatric Patient Ed dropdown lists, whether a handout can actually be displayed and printed in a selected language is determined by the fonts installed on the computer you are using.

Print the patient education handout by clicking one of the Print buttons, in the upper left and upper right portion of the window.

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The Jump To Field

Back in the main Monograph window, there is also a Jump To Field dropdown list that you can use to go to a particular aspect of that medication’s reference information.

Closing the Monograph Window

When you’ve completed your research and wish to return to the Centricity EMR 9.2 Medication window, click the Close button, at the top of the Monograph window.

The Lexi-Comp Online Home Page

Access the Lexi-Comp Online homepage from the main Monograph window by clicking either the Search button or the Home link (the small icon of a house). In addition to the Search tools already discussed in this document, the Home page offers other valuable resources, as well. One such resource that is especially useful is the Training link, and the training materials accessible via that link.

Lexi-Comp Online provides valuable training materials for persons interested in learning more about the medication Monograph

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The Dosing Calculator is a tool designed to assist clinicians in performing mathematical calculations, and it displays computed dosage options. However, the clinician remains solely responsible for choosing the dosage correct for a given patient, under the circumstances of that current instance.

NOTE

THE DOSING CALCULATOR

Along with the Monograph utility, the Dosing Calculator is available for use in Centricity EMR 9.2. The Dosing Calculator is designed to assist a prescribing clinician in determining how much medication should be prescribed, how it should be taken, and when it should be administered. The clinician verifies that the formula and the components factored in are accurate, then selects the desired calculation and dosing interval. The value selected then becomes part of that prescription’s Instructions in the EMR.

The Dosing Calculator

Access the Dosing Calculator by first selecting a medication in the New Medication, Change Medication, or Update Medication window, then clicking the Dosing Calculator button.

Use the Monograph button to access this online medication resource.

Click Print to print the Dosing Calculator screen currently displayed. Patient identification is included in both the calculator display and its printed equivalent. Return to the medication window in your EMR chart update by clicking Close .

Dosing suggestions are displayed, some of which offer additional options in their dropdown lists. When applicable, the patient’s last documented weight, and when it was recorded, is displayed and factored into calculations. Values highlighted in pale yellow/peach change when a new selection is made from one or more of the dropdown lists.

Once the desired dose and instructions have been established, clicking directly on an instruction set in the lower portion of the Dosing Calculator pushes that information to the Instructions field of the medication window of the EMR chart update.

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If you change the weight in the Dosing Calculator, that change is not saved in the patient chart, and should also be updated in the Nurse Intake form, or another form component in the EMR.

NOTE

Using the Dosing Calculator

1. First select a medication in either the New Medication window, Change Medication window, or Update Medication window.

2. Click the Dosing Calculator button.

3. When applicable, the patient’s most recent, documented weight is included in the Dosing Calculator window, and when it was recorded. Verify that the

weight displayed is correct before continuing on with the calculation

process. Change the weight, if necessary.

4. Use the dropdown arrow of the Target Dose field to view additional doses; if necessary, change to one of those options provided. (The content of the list varies, depending upon the medication and pertinent patient attributes.) Changing the Target dose automatically changes the values in associated fields of the Dosing Calculator.

5. Choose from one of the intervals provided in the Dosing interval dropdown list.

6. When applicable, use the dropdown list for possible units of measure to be considered.

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7. Click to select the desired dosage (typically the one that most closely matches the target dose) in the lower portion of the Dosing Calculator window. The selection made here is automatically sent to the Instruction field of the prescribing Medication window in Centricity EMR 9.2.

8. When you select a specific instruction set in the Dosing Calculator, that window automatically closes, returning you to the chart update in the EMR. If, however, you do not select an instruction set in the Dosing Calculator window, click Close , near the top of that window, to return to the EMR.

9. If you selected a dosing option in the Dosing Calculator, verify that the instruction set entered in the patient’s EMR chart is correct, and complete the medication prescription process as normal.

Dosing Calculator Exception

Most medications in the Centricity EMR 9.2 full medication Reference list can be used with the Dosing Calculator. Medications that cannot be checked in the Dosing Calculator are those that do not specify a strength or unit of measure. Also, some units of measure, such as displayed in the illustration here, cannot be calculated. In such cases, Centricity EMR 9.2 alerts you to that system limitation.

Electronic Medical Records. Centricity EMR Medication Monographs & Dosing Calculator