Adding a new prescription should almost always be done via the Plan section in an open encounter note. But a prescription may also be added outside of an encounter note (generally for administrative purposes) by clicking on the green plus icon at the upper right-hand corner of the Medications block. The + Add New Rx pop-up will appear with a smart search bar.
Search for Prescription
In the + Add New Rx pop-up, search in the field provided for the drug name, brand, ingredients, strength, delivery method, or form. Partial words or numbers are fine and the system will search as you type. By default, the search will return drugs from your preferred short list. If none match, or if you enter a "+" in the search bar, it will instead return all matching entries from the full VA National Formulary database. When you select "+ Add Rx to Pt Record," another pop-up will appear for you to enter prescription details and notes.
Add/Edit Prescription Details
Add or edit prescription details in the + Complete and Add Rx, Edit Rx, Renew Rx, or Replace Rx pop-up, making changes or accepting default values, as needed.
Profiles (dropdown) – apply, delete or create a saved dosing profile. Saved dosing profiles for a drug, if any are available, can be accessed via the Profiles dropdown menu. To save existing settings as a new dosing profile, complete desired changes, then click on the Profiles drop down and select "Save Current Settings as a New Profile." Enter a name, set the scope to be personal (available only to you) or global (available to everyone in the practice), and set the new profile as the default settings for whenever that dosing is used or as a secondary dosing profile. Once created, a dosing profile cannot be edited, but it can be replaced by deleting the original (select "Manage Profiles" in the drop down menu and delete profile(s) as needed) and then creating and saving a modified version.
Administrative Record (checkbox) – adds a medication to the patient's file without ordering a new prescription for that drug. This checkbox is used, for example, to add a drug that was prescribed by another practice so that it appears in the patient's medication history list and in drug-drug interaction checks.
Strength (free text field) – the dose strength being ordered. The database should contain practically every available dose-strength for each medication so that you will almost always select the correct dose-strength when you choose which prescription to add. So, you should only edit the Strength field if, after searching the database, you are certain that the correct dose-strength is not available for that drug.
Method (free text field) – drug delivery method. The VA provides a list of 85 officially-accepted drug delivery methods. Enter one of these, or type something else. Externally, some older electronic systems may recognize only methods from the VA's list, but newer systems generally do not have this limitation.
|QD||once a day||PRN||as needed (or other)|
|BID||twice a day||QHS||before bed|
|TID||three times a day||Qweek||once a week|
|QID||four times a day||Qmonth||once a month|
|PID||five times a day||QOD||once every other day|
Frequency (dropdown) - how often the patient should take the drug. Select from the options in the drop down menu or, to enter a frequency that does not appear, select PRN (as needed) and enter special instructions in the Physician's Notes field.
Amount (integer) - the number of units being ordered
Refills (integer) – the number of refills that will be available.
Dosing Expires (integer) – the number of days after the start date that this prescription expires. While this is initially calculated automatically based on the number of doses times the number of refills, it is not automatically recalculated if either of these inputs are manually changed. Click the calculator icon to recalculate.
Patient Instructions (notes field) – instructions for the patient. Enter instructions, or leave blank for the pharmacist to enter default instructions.
Physician's Notes (notes field) – instructions for the pharmacist. Enter notes about this prescription that will be visible to the pharmacist, such as the drug's DEA number, if applicable, or information about how a prescription for a highly controlled substance was conveyed to the patient.
Chronic Drug (checkbox) – indicates whether the drug is taken for a chronic condition.
Warn me when this Dosing Expires (checkbox) – creates a reminder that will appear on your task list when the prescription expires.
Start Date (calendar) – indicates the date the drug was prescribed (default is the date the prescription is created).
Generic OK (checkbox) – indicates that a generic version of the drug may be used in place of the specific name brand prescribed (checked by default).
Pharmacy (drop down) – indicates which pharmacy the prescription will be sent to. If the patient has a preferred pharmacy, it will automatically appear in the Pharmacy field. If the patient has multiple preferred pharmacies, the primary pharmacy will appear by default and other preferred pharmacies will appear in the drop-down menu below. Also in the Pharmacy drop-down menu are "None/Not in System," which leaves the pharmacy and fax information blank, and "Select Other", which pulls up a pharmacy smart search field. When this is used to select a pharmacy that is not already in the patient's file, you will have the option to add it to the patient's preferred facilities (where it would appear below any existing preferred pharmacy entries).
If the pharmacy that you select is faxable, you will have the option to complete the prescription and create a faxable form with one click. But note that you cannot fax directly from the Edit Rx pop-up. Instead, you must save edits and then create a faxable prescription form.
Warnings will appear at the bottom of the form if the patient has an allergy to the selected drug and/or drug class. Any warnings must be manually overridden before that drug can be added to the note.