International Setup Document
Contents
1. Combivir zidovudine lamivudine 4507 60 0623 06 Efavirenz b00qd 30 04 01 06 Invoice Dispense e Under the Drug Strength Frequency field click the down arrow Any combinations that have been entered in the Medications module will be available here You can review or edit the prescribed entries by clicking the Medications button at the top e This client has been prescribed 3 medications Note that the entry for Zithromax azithromycin 100 mg ad one pill a day is indicated as Not in Formulary To track the dispensing of this medication and strength combination we would need to return to the Formulary and add it to the list with this specific strength 100 mg e After selecting the Drug Strength Frequency enter the Duration of the prescription in days and the number of Refills For the ARV Combivir zidovudine lamivudine 450 mg bid we ve entered 60 days and 3 refills e Based on the prescription Start Date duration and number of refills CAREWare will calculate the Stop Date the date when this prescription ends In the example above the prescription duration for Combivir is 60 days and there are 3 refills that would equal a total of 240 days or approximately 8 months starting on 11 1 05 that would make the Stop date 6 29 2006 e The total number of pills prescribed 480 is also automatically calculated and is the product of the number pills taken per day in this example it s two bid2. Robert Doe BBDEO 1 2711U Combivir zidavudinedamivudine 450 shid 04 01 2006 Robert Doe BRDEO21 27110 Efavirenz 600 qd 0407 2006 THOMAS BAIRD 123411 Combivir zidovudinesamivudine A 25 tid O01 31 2006 Now let s try an Expired Refills report Pharmacy Adherence Need Refills Expiration As Of Date 06 21 06 Hame Unique ID Medicatiore Expected Refill Date Days Expired Julius Cesar JLOS0912651U Combivir zidoyvudinesamivudine 450 hid 04 30 2006 52 Julius Cesar JLCS094 2651 Efavirenz 500iqd Ooo29 2005 Robert Doe BBDEO 1 27110 Agenerase Camprenavirl 25 9 03 03 2006 Robert Doe BRDEO 1 27110 Combivir zidovudinesamivudine 450 hid 03 03 2006 Robert Doe BBDEOS1 27110 Efavirenz 600 qd 04 01 2006 THOMAS BAIRD 125411 Combivir zidovudineJamivudine 1 25 tic 10032005 NOTE We can see for the client Doe that the prescription for Combivir expired on 4 1 2006 but the Refill lapsed on 3 3 2006 indicating that he had not filled that entire prescription similarly for the client Baird Pharmacy Aggregate Now let s return to the main Pharmacy reports menu and run an Aggregate report Here we can obtain a list of how many clients have received each medication in the designated time period the amount dispensed and the total cost International Version Setup 07 20 06 p 17 Pharmacy Aggregate From Date 0101 06 Through Date 06 21 06 Drug Unduplicated Client Dispense Quantiy Dispense Totat Agene rase famprenaviry 125 1036
3. 203 90 amoxicillin as trihydrate 200 1006 197 90 Combivir zidovudinesamivudine 450 1006 197 90 Sustiva efavirenz 600 265 13 40 Grand Total 3316 61 3 10 And the Pharmacy Activity Report shows the following entries for date range selected Pharmacy Activity From Date Through Date Active Only 01 01 06 06 2106 Summary Activity for all dates Stock OnOrder Dispense Received Orderect Agenerase anprenmmr 125 amoxicillin as trihydrate 200 Combai zidovudine Jannah 450 Crixivan indinavir 400 Epivir lamivudine 300 isoniazid 2700 Sustiva efavirenz 00 Sustiva efavirenz 600 trimethoprim sulfate 100 Triznar abacavir lamivudineretrov ir 750 Viramune nevirapine 200 0 fiagen abacavir 300 0 International Version Setup 07 20 06 p 18
4. Setup 07 20 06 p 3 To add a province click New The Item field will be activated Enter your first Province Name and set It to Active Here we have entered Northern Click Save and repeat these steps until you have entered all the geographic locations at this level List Marne For Country Add Edit ltem Norther Active Save da Cancel We ve added two Provinces in this example Now note that the button on the bottom right has now been relabeled Health D short for Health District which we had entered previously CAREWare is ready to create the next level of geographic locations under each Province Hortherr Yes Southern es si 2 Hew Edit Delete Health D Let s first create names for Health Districts within the Northern Province Highlight Northern then select the button labeled Health D Repeat the process above by selecting New item Enter any designations here To create Health Districts in the Southern Province we would need to highlight Southern and repeat the above steps There is one more level of related Geographic entities that we can add under the last level created Health Districts The process is exactly as we did for the others In the end we have created a set of geographic relations that will ensure that if Level 1 is entered only specific choices for Level 2 related to Level 1 will be available for entry and so on down to Level 4 Coun
5. available In the above screen Sustiva efavirenz is listed twice once as a 600 mg formulation and another as 200 mg The unit price column 4 will likely differ International Version Setup 07 20 06 p 6 e To add anew item to the formulary simply click New Formulary Item This will enable the fields above and your list of Active Medications will be available in the Medication dropdown list Add the strength unit price per pill and check the Active box Click Save and repeat as necessary e Inventory stock details can be entered here for each drug as well Highlight a medication and then click the Stock Details button You ll see a screen like this r Stock Details Lombrwvir zidovudine jlamimvucdine 450 biases In Shock On Order Dispensed Add Adjustment Date Amount Reason se OOO Negative Numbers Represent Lost Stack Adjustments Reason 1201 05 Hew shipment e Click Add on the right e Enter the date of the stock adjustment and the amount adjusted Note that stock levels for each medication can first be established through the Orders module accessed on the Pharmacy menu e Here we have added 10 000 units of Combivir to the stock on Dec 1 2005 and supplied the reason All 3 fields are required here to adjust the stock e Note as well that the user who made these changes is automatically recorded for your records and serves as an audit trail International V
6. the duration of the prescription 60 and the number of refills 8 that is 2 pills a day or 60 pills a month for 8 months International Version Setup 07 20 06 p 11 e Of course the total number prescribed will likely differ from the number actually dispensed to the patient at a given visit For example as shown here the client has been dispensed 114 out of 240 pills The remaining pills will be dispensed when the client returns for his her refills and perhaps after adherence has been evaluated in this individual after the first 30 days of taking a medication Details of dispensing and invoicing are outlined below e Click Save also click on the Report button on the top right to generate a formal report of this prescription as in this screen Prescription Client Blowfish Christina Date 11 01 08 Unique ID 49099 Number QOQUU01 Client ID 460 Clinician Ronald McDonald Drug Strength Frequency Duration Refills Stop Date Prescribe Dispensect Comment Combivir BO z OB292005 460 114 Take with lots of zidoyudinesamivudine 450hid food Efavirenz 600 qd 2 Ogidi 00E 90 90 The clinician is now done entering the initial prescription data The next steps are to be completed by Pharmacy personnel Dispensing and invoicing Note If the prescribing clinician has not entered the above information directly into CAREWare it is assumed that the patient will provide this information to the Pharmacist on a prescription paper fo
7. How to set uo CAREWare 4 for use in International Settings Plus Pharmacy Module June 2006 International Version Setup 07 20 06 Introduction International version of CAREWare To accommodate use in international HIV treatment settings specific screens have been modified and functions have been added to version 4i of CAREWare Changes have been made to the Demographic and Annual Review tabs a Pharmacy module and visit scheduler have also been added An ICD 10 diagnosis file replaces the ICD9 CM list Note Before you begin customizing you may need to check that the version of CAREWare is set to International in the Business Tier To begin using the international version customization of a few specific fields is recommended e To access the international custom field list press Ctrl E on your keyboard You ll see this screen Edit Lists Invoice Funding e For the Pharmacy module you ll need to set values for Invoice Funding and Pharmacy Supplier Employee e The Employee field is used in the Prescribing module Geographical Entities Sere cies e The fields Geographical __ Education Level Entities e g Country Province E District Village Education Level and meee Language are all found on the client fener nee Demographic screen e Appointment Purpose is used in the Scheduler Close Customizing lists in CAREWare is easy to do and the process is the same for most a
8. Medications Drug Strength Frequency Agenerase amprenavir 1 25y qd Combrvir zidovudine lamivudine 1 25tid Combivir zidovudine lamivudine 450 bid Efayirenz600 igd Select All Clear Run e Two Reports are available here Expired prescriptions or patients who based on their dispensing history need refills Either report is calculated relative to a specific Expiration date which is set in the top right Typically this would be set to today s date e Days Expired Indicate how long the prescription or refill has expired The default is 0 to 100 days Setting this range will limit any prescriptions that have lagged for a particularly long time e Sort order Reports can be sorted by Client Name Medication or Expiry days e Finally Select one All or any group of medications Hold down the control key if you want to select medications that are not next to one another on the list International Version Setup 07 20 06 p 16 Here s an example of a very short Adherence report listing Expired Prescriptions from 0 to 1000 days Pharmacy Adherence Expired Prescriptions Expiration As Of Date 06 21 06 Hame Unique ID Medication Expire Date Days Expired Christina Blow tish 39099 Eftavirenz 500 qd 0401 2006 ad Julius Cesar JLCS0912651U Combivir zidovudinedamivudine 450 id 04 30 2006 52 Julius Cesar JLOS0912651U Efavirenz 600 qd O9 29 2005 Robert Doe BRDEO 1 2711U Agen rase famprenavir a 25 0 04 01 2006
9. ddition the combination of a medication name and its strength typically in mg are required for a prescription entry in the medications module to match an entry in the Formulary If these don t match then a specific combination won t be listed in the Formulary International Version Setup 07 20 06 p 5 2 Formulary Setup Return to the main menu and select the Pharmacy button to obtain this menu Pharmacy Menu Formulary Orders Reports Close e Click Formulary A screen like the following will appear this example is already populated with some medications initially it would be blank Close Add Edit Formulary Details Medication Strength Custom Mame Gave Eancel albuterol say Combrvir zidovudineslam 450 Combivir zidovudine lamivudine 450 0 25 Yes Crisivan indinavir 400 Crisivan indinavir 400 0 12 jes Epivir lamivudine 300 Epivir lamivudine 300 0 10 Yeg Sustiva efavirenz 00 Sustiva efavirenz 200 0 05 es Sustiva efavirenz B00 Sustiva efavirenz 600 0 10 es Viramune nevirapine 200 Viramune nevirapine 200 0 10 Yes lagen abacavir 300 lagen abacavir 300 0 10 es Stock Details New Formulary ltem Edit ltem Delete ltem e Medication entries in the Formulary are defined by the medication name and the according strength It is very likely that your formulary will contain the same medication with different strengths
10. e Health District Village vietnam Morth Hunang E Quietville Fostal Code Phone Humber Includ _ s8642 aee On the pharmacy screen click Add Prescription e The Prescription will auto populate and increase by one e Enter the Date of the Prescription and the prescribing clinician this value is taken from the customizable Employee field see above e Click save Client Information BLOWEISH CHRISTINA Change Log Delete Client Encounters Referrals HI C amp T Pregnancy Relations Custom Tab 1 Custom Tab 2 Custom Tab 3 Custom Subform Pharmacy Scheduler Last Name First Mame BLOWFISH CHRISTINA me e Add Edit Prescription Prescription H Date Clinician Prescription Dae Cii o O aooaa 1171 72005 Ronald McDonald AZT 3TC EFW e Now click Prescription Details in the bottom left Click Edit to change a previous entry the following screen will appear International Version Setup 07 20 06 p 10 Prescription Client Blowfish Christina Medications Report Close Date Prescription H Clinician Prescription 11 01 05 ooo0001 AddEdit Drug Drug Strengths Frequency Duration Refills Stop Date T Save Combivir 2idovudinelarnivudine 450 bid Prescribed Dispensed mas daps per Efavirenz 600qd N Cancel ithromax 1 00d Mot In Formular fillig Drug Strength Frequency Duration Refills Prescribed Dispensed
11. ersion Setup 07 20 06 p 7 Orders Let s look at how the stock level of a specific medication could have first been set by accessing the pharmacy Orders module Find Add Order Close 1 New Order Record Add New Order 2 Find by Order Number Find Order 3 Find by Order Date From Through arar 2005 Edit Selected Order e On this screen we can either Add a New Order or retrieve an existing one Here we re going to pull up Order number 1 created on 8 8 2005 International Version Setup 07 20 06 p 8 Report Order Order Date Order Number Supplier Payment T pe 88 2005 The Global Fund Purchase Cove Order Invoice Humber Date Recernved Receiving User Delete Order 101 W Received g 30 2005 CwTEMAl Close Form Add Edit Order ltem Details Drug Quantity Price Total Batch Expiry re Quantity Sustiva efavire 25000 1 250 00 A500 or a0 200E Mew Order ltem Edit Order ltem Delete Order ltem e First select New Order Item on the bottom left of the screen this will enable the top half of the screen e Enter the Order Date Supplier and Payment Type The Order number is auto calculated and increments by one each time an order is added The field Payment Type has the following response categories Purchase Donation Cons Bonus NTLP Returns in Compensation e Values for the Supplier field must be added by the Administrator in
12. ll fields except for the Geographical Entities Here we ll demonstrate customization of the Geographical Entities which allows the user to create a set of relational fields from country down to village or any designation To begin e Select Geographical Entities e When the screen below appears click New on the bottom left The List Name field at the top defaults to Country We could change this to any name we want International Version Setup 07 20 06 p 2 but we ll leave it here as country and under the Item field will enter the country name in this example Uganda and check Active List Name Country AddE dit ltem Uganda i Active Save a Ey Cancel e Now click Save e Our new country Uganda will appear in the list box below e Now we want to create geographical locations within the country Note that the button on the bottom right is labeled Province Lets say there are 3 provinces in Uganda To create them first highlight Country or first level designation and then click Province Vietnam es kS iili gt Hew Edit Delete Province e The screen below will appear Now note that the List Name field is Province and to the right it indicates For Country Uganda showing that the provinces we are about to add are within this country Again we could change the designation Province to anything else International Version
13. nt clinical conditions develop multiple prescriptions will be necessary for each patient over the course of their therapy for their antiretrovirals and preventive medications such as cotrimoxazole Bactrim AddE dit Invoice Date Invoice H Funding Dispensing Employee Total PEPFAR Ronald McDonald Save Cancel Dispense Employee 05 30 06 OOOo003 PEPFAR Ronald McDonald 16 50 12 02 08 OOOO00S The Global Fund samuel Spade 1 50 17 07 405 ooono02 PEPFAR Ronald McDonald 16 50 EFW AZT 3TC EFV EFW AZT 3TC We ve added one more dispensing invoice on 5 30 06 and the resulting Prescription summary report for this client looks like this Prescription Summary Client Blowtish Christina Date 11 01 05 Unique ID 49099 Number 0000001 Client ID 460 Clinician Ronald MicDonald Prescribect Price Drug Strength Frequeny Combivir zidovudinedamivudine 450 hid Efavirenz 600 qd 40 a International Version Setup 07 20 06 Dispensect 120 a0 30 00 4 50 Pharmacy Reports Three major Pharmacy Reports are available Adherence Aggregate and Inventory To access them select Pharmacy on the main screen then Reports 1 Adherence Report screen Pharmacy Adherence Report Report Type Expiration 4s Of C Expired Prescriptions o l C Need Refills Days Expired Sort Order et From oo Through 100 Select Medications to Report Prescribed
14. rescription International Version Setup 07 20 06 p 13 Dispensing Details Delete All Report Close Chent BLOWFISH CHRISTINA Invoice H Prescription Running Total Invoice ono0002 o000001 16 50 Add E dit Drug Quantity Unit Price Total Save Combivir zidovudine lamivudine 60 Cancel Quantity Unit Price Total Combivir zidovudinelamimvud 60 Sustiva efavirenz 800 30 At any time press the Report button on the top right of this screen to obtain an easy to print Dispensing Invoice report For example from the above screen we get this report Pharmacy Invoice Client ID RISE Invoice OOOO Client Name BLOWFISH Invoice Date 11 1 2005 CHRISTINA URN CRBOUYZO F920 Funding PEPFAR Gender Female Prescrip 0000001 Drug Quantity Unit Price Combivir zidovudinetamiv udine BO 0 25 450 Sustiva efavirenz 600 30 0 05 Grand Total International Version Setup 07 20 06 p 14 Of course each time the patient comes in for a refill the pharmacist will return to this section updating the invoice with the date and number of medications dispensed Here we ve added another invoice on 12 2 and dispensed 30 more units of efavirenz Dispense Employee Drugs 12 2 2008 EFW EFW AZT T The Global Fund PEPF 4A 1 50 16 50 OOOO003 OOO0002 Samuel Spade 117172005 Ronald McDonald As medications are added or switched doses are changed and differe
15. rm e The pharmacist should retrieve the correct patient record and go to the client s pharmacy tab e Highlight the Prescription of interest and then Select Invoice dispense this screen will appear We have been taken to Prescription 1 International Version Setup 07 20 06 p 12 Invoicing Dispensing Client Blowfish Christina Report Close Date Prescription Clinician Frescription 701405 a000i Add Edit Invoice D ate Invoice H Funding Dispensing Employee Total 05 30 06 OOOO00S PEPFAR Ronald McDonald 16 50 EFV AZT 3TC 12 0205 OOOO00 The Global Fund samuel Spade 1 50 EFY 11701705 gogoo PEPFAR Ronald McDonald 16 50 EFW 447 3TC lt E Add Invoice Edit Delete Click ADD Invoice 1 Add the Invoice Date CAREWare will automatically add the Invoice 2 Add the funding source for this prescription and the Dispensing Employee 3 Click Save or cancel 4 With your mouse highlight the Invoice number just created and select Dispensing Details in the lower left 5 In the Dispensing Details screen below enter the Quantity of drug dispensed In the screen here we have dispensed 60 combivir pills and 30 efavirenz 6 Note that by selecting the Add all from Prescription button in the bottom left you can populate this section at once with all drugs that the client has been prescribed 7 Note that the number of pills dispensed cannot exceed the amount established in the p
16. the international custom field setup screen see above for customizing this field e Click Save Order in top right That will enable the Add Edit Order item Details in the lower half of this screen e Inthe order details section enter the drug name the pulldown list will taken directly from the formulary quantity ordered unit price the price from the Formulary entry will be used here but can be altered as well the Batch number and Expiry date Now that we ve setup the Formulary and Stock lets go to a specific client and use the pharmacy module to track prescriptions and dispensing International Version Setup 07 20 06 p 9 The Pharmacy tab is on the far right and may require clicking the right arrow to reveal the tab as in this screen Client Information BLOWFISH CHRISTINA Change Log Delete Client Encounters Referrals HI CRT Pregnancy Relations Custom Tab 1 Custom Tab 2 Custom Tab 3 Custom Subfora Pharmacy Scheduler First Hame Middle Hame Latest HIV Status Contirmed HI at HIY Care Entry Ft CHRISTINA HIV positive not AIDS Last Name Date of Birth ART BLOWFISH 9 20 1979 fap Eligible Ready Selected Started Stopped Gender Client URN Enoypted U URN cd ie x i reer s33 Female ICA z me ART Eligible By HIY Subtype CE4 WHO Stage Type Type ll Languages Education Level Case Notes Client ID Address City pieno ae o Country Provinc
17. try lt Province lt Health District lt Village International Version Setup 07 20 06 p 4 Pharmacy Module Background The pharmacy module in CAREWare allows users to track prescriptions and produce invoices for all medication dispensing Easy to generate reports include e Patient specific prescriptions and costs e Lists of clients who did not pick up a prescription on a designated date or those who are due to pick one up or whose prescriptions are overdue for renewal e Aggregate clinic summary reports that list the quantity of each drug that has been dispensed and the amount remaining in stock These figures can be used for important inventory tasks and determining when drug stocks might require refilling How to use the module 1 Setup for the Pharmacy Module and Formulary begins with Medications Setup You must first activate medications before they can be added to the Formulary and prescribed To activate medications Select Administrative Options on main screen Select Clinical Encounter Setup Select Medications Setup Click the Advanced options button to access the full medications database that will appear on the left of the screen e Within medications you can activate any drugs on the list and customize the generic name if desired See the main user manual for further details gt Note If you don t first activate a medication then that drug will not be available in the Formulary setup module In a
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