RPMS Pharmacy
Best Practice
Recommendations
December 2014
Approved by: Pharmacy Professional Services
Group and National Pharmacy Council
Table of Contents
General Information
Pharmacy Visit Documentation
Drug File Maintenance
RPMS Reports
Verbal Orders
Transfer of Prescription
Medication Ordering
Medication Safety Communication
Return to Stock
Medications Administered in Clinic
Adverse Reaction Tracking
Extended Expiration Dates
Controlled Substances
Pharmacy Education
**If you are unable to access any of the links in
this document, please contact your Area Pharmacy
Consultant, Area PSG Representative**
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General Information
What is the Pharmacy Professional Services Group (PSG)?
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The IHS Pharmacy Branch Professional Specialty Group (PSG) serves as a liaison between
IHS computer systems analysts and pharmacy computer system users. This IHS-wide
committee was organized to develop short and long term goals and objectives for the
development and enhancement of pharmacy software. The PSG consists of
representatives from different Areas of the IHS and tribal programs. The PSG has
responsibility for recommending, reviewing, implementing, and evaluating appropriate
pharmacy software for use in all IHS facilities and those Tribal and Urban Health facilities
using the IHS RPMS system.
Sign up for the appropriate listservs:
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Pharmacy listserv http://www.ihs.gov/listserv/topics/signup/?list_id=31
Inpatient Pharmacy: http://www.ihs.gov/listserv/topics/signup/?list_id=149
Pharmacy Billing: http://www.ihs.gov/listserv/topics/signup/?list_id=150
Pharmacy Anticoagulation: http://www.ihs.gov/listserv/topics/signup/?list_id=277
Namespaces of RPMS Pharmacy and related Packages:
GMRA = Adverse Reaction Tracking
APSP = IHS Pharmacy MOD
PSN = National Drug File
APSS = Rx Outpatient Automation Interface
PSJ = Pharmacy Inpatient Suite
APSP = Average Wholesale Pricing
BPER = e-Prescribing Productions
BPDM = Controlled Drug Export System
PSO = Outpatient Pharmacy
BEX = Pharmacy Auto Refill System
BOP = Automated Dispensing Interface System
ABSP = Pharmacy Point of Sale
Pharmacy Visit Documentation
See Appendix A: Pharmacy Documentation Standards.pdf
AND
See Appendix O: NPC Recommendation on Pharmacy Visit Documentation.pdf
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Drug File Maintenance
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Clearly assign role of maintenance tasks to individual(s)
Consider who has access to modify drug file. It may not be appropriate for every pharmacist to
have this ability
Maintenance Tasks:
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National Drug File (NDF) Updates - critical for drug interaction and adverse reaction tracking to
work correctly
Benchmark Pricing and AAC Pricing – important for Point of Sale, billing, and many related
reports in RPMS
Drug File Optimization – critical to have and maintain an optimized drug file, the basis of a
functioning pharmacy package
Quick Orders and Quick Order Menu maintenance
NDF Updates
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Watch for Announcement via IHS Pharmacy Listserv
The NDF Updates are called PSN National Drug File patches
Develop internal communication method for appropriate individuals to be notified when
Pharmacy Patches are installed.
Once installed, follow directions in the email from the Pharmacy Listserv
Goal: complete update within a week of release.
See Appendix G NDF Patches and Appendix F CompletingNDF_PatchScriptfor power
point presentation and a step by step script on how to match drugs to the NDF
Benchmark Price and AAC Updates
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Watch for Benchmark Price update patch (APSA Consolidated Price Patch)
announcements via the Pharmacy Listserv.
These come approximately monthly. If you think you may be behind, check the
Pharmacy Patch Lister. Look for Benchmark Price Update – you want to see a date with
the last month, or you are likely behind.
Step 1 - Apply Benchmark Price Update Patch (APSA Patch) (this is done by the same
process that other RPMS Patches are loaded into your system, typically by IT
department). This places Benchmark price information in the AWP-Med transaction file
and then an automatic update pushes the information into the Drug File
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Step 2 – Apply Actual Acquisition Price Update – see Appendix B Acquisition Price
Updating using AAC.pdf as the “how to” document. This is typically done by pharmacy,
but you may need IT help to get it set up. This action places the acquisition price
information from McKesson in the AWP-Med Transaction File. This should always be
done immediately after APSA Patch is loaded.
Step 3 – Run the Manual Benchmark Price Update. This will push all the new
information from the AWP-Med Transaction file to the Drug File
 This will likely result in some Mailman messages that you can review and
manually update the individual drugs. Most examples are “missing 660 Node
NDC” and “Package size/Dispense Unit mismatch.” Example - might be due to a
billing need – 118g vs 120g or 473g vs 480g
 Do a manual update in drug file off of mailman messages.
POS Billing is based off of Benchmark Price. Recommend using a multiplier of 1.5 in the
POS parameters
Overall Drug File Maintenance
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Drug file should be optimized regarding doses, naming conventions, orderable items,
etc.
Recommend following the drug file optimization guidelines provided at this link:
ftp://ftp.ihs.gov/pubs/EHR/Training/Manuals/E%20Prescribing%20Drug%20File%20Trai
ning/
These were developed by the e-prescribing team, and are titled as e-RX drug file
optimization. However, all reports with the exception of the LONG NAME report are
considered best practice for optimizing the drug file for any use, regardless of if you plan
to do e-prescribing. The Long Name field is specific to e-Prescribing.
BCMA drug file recommendations – see guidelines provided at this link:
ftp://ftp.ihs.gov/pubs/EHR/Training/Manuals/BCMA%20Drug%20File%20Optimization/
Ongoing maintenance
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Recommend running the drug file optimization reports once a year after initial
optimization
Quick Order Maintenance
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Appropriate individual should fix quick orders as soon as issues are identified. Most
problems are caught through communication between providers and pharmacy staff
based on what they are seeing on a day to day basis.
Maintenance activities through NDF patches or other actions may cause some quick
orders to break
Assign the task of testing every quick order systematically twice a year to identify
broken orders. Pharmacy students could possibly assist with this task.
Use Appendix P Missing Dose Quick Order Fileman report
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Compounded Medications
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These can now be set up correctly in the drug file. This allows for more complete order
checking and adverse reaction checking.
Recommendation: All locally made compounds should be set up in the drug file as such. See Appendix N
eRx2_0ConfiguringCompoundsfor instructions on how to do this. RPMS Reports to run periodically
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Released/Unreleased Prescription Report – Run weekly at a minimum. Large sites may need to
run daily. This helps catch prescriptions that are caught in CMOP process and with Controlled
Substance reconciliation.
Auto Finish Failure Report – run monthly to watch for drugs that are consistently failing so that
they can be addressed.
Verbal Orders
Verbal orders are discouraged. They should be reserved for special circumstances.
Verbal orders from providers outside of your clinic:
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If your facility accepts verbal orders from outside sources, we recommend having a Policy and
Procedure about the topic.
Ensure outside provider is entered into your system so that you can accurately document the
prescribing provider on the prescription.
Use the notation VORB (this stands for Verbal Order Read Back) and the name of the person
taking the order with the name of the person giving the order in the note or prescription pad in
which you are documenting that the prescription was called in to you.
Example:
VORB J Johnson/S Smith
Lisinopril 10mg daily #30 3 RF
B Yost, MD
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Use Nature of Order = Telephone
Follow your practicing location State Board of Pharmacy guidance on prescription
documentation for verbal orders
The Telephone nature of order will create a “hanging” notification in your system because it will
be looking for the outside provider to sign the order. Just something to be aware of for now.
Request for new options for nature of order is approved by PSG and pending an available patch The request is that new natures of order won’t ask for signature from the ordering provider and
might be called something like Outside Telephone.
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Verbal orders from providers within your clinic:
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Have a Policy and Procedure about the topic.
Use the notation VORB (this stands for Verbal Order Read Back) and the name of the person
taking the order with the name of the person giving the order in the note or prescription pad in
which you are documenting that the prescription was called in to you.
Example:
VORB J Johnson/S Smith
Lisinopril 10mg daily #30 3 RF
B Yost, MD
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Use the Nature of Order = Verbal so that notification to sign the order will be generated and the
provider can enter their electronic signature to sign off on the order.
As a pharmacist entering the medication order in the pharmacy package, you may use the Remarks field
in backdoor order entry to note that the prescription was a verbal order.
Transfer of Prescription
Accepting the transfer in of a prescription
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EHR note is indicated. TIU Template use is encouraged to help ensure all needed data elements
are captured. See Appendix C Transfer in and out template examples for example templates
Ensure outside provider is entered into your system so that you can accurately document the
prescribing provider on the prescription.
Use the notation VORB (this stands for Verbal Order Read Back) and the name of the person
taking the order with the name of the person giving the order in the place in which you are
documenting that the prescription was called in to you.
Use Nature of Order = Telephone
Follow your practicing location State Board of Pharmacy guidance on prescription
documentation for verbal orders and transfers.
The Telephone nature of order will create a “hanging” notification in your system because it will
be looking for the outside provider to sign the order. Just something to be aware of for now.
Request for new options for nature of order is approved by PSG and pending an available patch The request is that new natures of order won’t ask for signature from the ordering provider and
might be called something like Outside Telephone.
Transferring a prescription out:
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See Appendix M Transferring a Prescription for more detailed instructions
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With the original provider as the “doc in the box”, use the “Change” function on the transferred
medication in EHR
Change the pick up location to “Outside pharmacy print”
Use “Notes to Pharmacist” field to note transfer details, following practicing State Board of
Pharmacy guidance on prescription documentation.
Choose “Policy” as nature of order.
TIU note is indicated as well to document transfer. See Appendix C Transfer in and out template
examples document for examples.
Medication Ordering
Medication ordering should be accomplished from the Medications Tab only. Remove medication order
menus from the Orders Tab.
Rule of Thumb:
Medications ordered by inhouse providers should be in the OutPATIENT medications section of
the Meds Tab.
Any medication filled by your inhouse RPMS pharmacy should be in the OutPATIENT
medications section.
Medications ordered by providers outside of your facility should be in the OutSIDE medications
section, unless they were filled by your inhouse pharmacy.
Autofinish and Prescription Print templates
These functions allow accurate documentation when configured correctly.
Medications written by your providers, but filled at an outside pharmacy:
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These belong in the outpatient medication section of the medication tab. During order
entry, the provider chooses either “Outside Pharmacy – Print” as a pick up location and,
if formats and printer defaults are set correctly, the provider can efficiently generate a
printed legal prescription to hand to the patient. If the site is live on e-Prescribing, then
they can choose “Outside Pharmacy – eRx” as the pickup location and the medication
will electronically transmit to the chosen outside pharmacy.
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Enabling Autofinish, setting up the format of the print templates through the EHR RX
Generator options, and assigning printer defaults makes it seamless for the ordering
provider to generate a legal printed prescription. Example: Controlled substances can
be defaulted to a secure printer that contains tamper evident paper if that is desired.
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Order Print Templates
In house CII Prescriptions
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Set up the print formats and defaults with the same tools in EHR mentioned above. For
inhouse CII prescriptions, they are considered Orders in this context if they are meant
for filling at your inhouse RPMS pharmacy. Set up the Order for Signature print format
and the provider will be able to efficiently print a hard copy of the CII order to be signed
and filled inhouse. Recommend against using the Orders tab to generate the hard copy
for signature as had been the practice in the past.
See Appendix D Autofinish Guide for information on both Autofinish and Print Template set up.
Medication Safety – Black Box Warnings and REMS communication and documentation
For ordering providers
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Several options exist for communicating to the ordering provider that a medication has
a Black Box Warning or is a REMS medication.
 Restrict particular medication so it can only be ordered through use of a quick
order. This allows you to use some features of the quick order and you won’t
have to worry that your quick order is being bypassed by the use of the “all
other medications”
list for ordering. Then, some options are:
 The Black Box Warning notation or REMS can be placed in the name of the quick
order
 A short hand notation could be placed in the mnemonic for that quick order on
the quick order menu
 Imbed a TIU template field in the quick order that will pop up when the
medication is ordered
 Use Drug Text field
 Use Drug Message field
For dispensing staff
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There is an existing prompt in RPMS Pharmacy Package
Utilize robotics – Ex: Scriptpro can be set to notify scanner/checker/dispenser of
need for Med Guide handout
Note: there is currently no way to automate the printing of an FDA Med Guide
from RPMS during prescription processing.
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Return to Stock
RTS has implications for Third Party Billing, insurance, and Accounts Receivable. Consistently waiting
longer than 7 days to return medications to stock can flag the site for an insurance audit. It is also
critical to keeping the EHR medication list as accurate as possible.
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Recommendation: Return medications to stock within 7 calendar days (5 business
days).
Example: Every Monday, return last Monday’s medications that are not picked up.
Develop local policy on when to notify providers that certain medications were returned
to stock and when to make additional attempts to contact patient. Examples: Seizure
meds or antibiotics for UTI in pregnancy.
Filling a Medication that was Returned to Stock
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Use the REISSUE function in RPMS.
Other methods may results in problems with the prescription file.
Medications Administered in Clinic
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When documenting medications administered in clinic, use the pickup location = clinic
Have a separate drug file entry for medications given in clinic and unique orderable item.
This avoids the problem of a one-time doses discontinuing chronic medications.
You can work with your robotics to assign a symbol or string of characters in the name or sig
that blocks it from being filled by the robotics. Example: [clinic]
Consider a specific Medications Given in Clinic quick order menu. Place the phrase: given in
clinic in the Notes to Pharmacist Field. Consider restricting these meds so they can only be
ordered via quick order to avoid the drug entry from inadvertently getting ordered as “take
home” medication.
Do NOT use the Status field set to DONE. The status of DONE has potential problems if a
correction to an order needs to be made.
The Inpatient Medications for Outpatient Package (IMO) is available now, but is essentially
just a bridge to when the VA and then IHS get a package called Clinic Meds. Clinic Meds
functions as BCMA for outpatients.
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Adverse Reaction Tracking
See Appendix H GMRA Script Configuration, Appendix I GMRA Optimization and Maintenance, Appendix
J Adverse Reaction Tracking, and Appendix K EHRv1.1p13_Allergies for supporting information.
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Allergy Clean Up utility – if this hasn’t been done, it needs to be done now.
The Free Text ingredient cleanup is a one-time task because you can no longer free text in a
reactant.
Ingredient and Drug class clean up reports need to be run quarterly
The generic term for vague or unknown reactions = HYPERSENSITIVITY
o Use this instead of UNKNOWN or OTHER
Verifying new reactions
 Technical verification, not clinical
 Clearly identify rolls and responsibilities at local site
o Some have every pharmacist verifying and they do it every day
o Some have one person assigned and it is done periodically
o Recommendation – verify new reactions weekly at a minimum
Auto-verification – GMRA files have been locked down, so it is now recommended for sites
without onsite pharmacy to use auto-verification. For sites with inhouse RPMS pharmacies, it is
recommended to do the manual verification.
Allergies on the Problem List
 Not necessary for all allergies to be removed from the problem list. Some belong there
in addition to being documented in the Adverse Reaction Package. Example: Peanut
Allergy and Bee Sting Allergy
 Run PLAL Allergies on Problem List report quarterly to monitor. You want to avoid
adverse reactions that are only listed on the problem list. If only on the problem list and
not in the ADR Package, they will not participate in order checks.
 Environmental Allergens – may be more appropriate for problem list than ADR package
Extended Expiration Dates
o Available in the drug file – field is named EXTENDED PRESCRIPTION DATE:
o Use for special drugs like Mirena or other IUD, bisphosphonate implants, DM supplies,
etc.
o The extended expiration date will prevent these from expiring in the pharmacy package
and on the EHR Medications Tab after 1 year.
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Controlled Substances
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See Appendix E CS Report Recommendations for Controlled Substance Report
Recommendations
Pharmacy Education
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If providing education to the patient, document it.
Use the Pharm Ed button in EHR
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