Using MILT 4 - Advanced - Step 1: Choose/Edit Medication

Don Lawson -

Step 1: Choose/Edit Medication – Advanced

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The Medication tab is where you select, edit and save medications to your formulary.  The formulary should NOT be a list of everything you ever printed (that is the Log Report.) Instead, it should be a list of medications you are going to print on a regular basis.

The data you save here should be the constant information, like generic name and strength, which does not change often. Information that changes each time you package, like lot number or beyond use date, is unique each time you print, so the medication would not need to be saved again every time that information changes. MILT has several features (see Prompt and Date Calc below) that will help your staff provide that information when they choose a medication from your formulary.

Ideally, you would have one Aspirin 81 mg with constant data like the NDC number, Manufacturer’s Name and the Form. This makes it easy for your staff, who will select that medication and provide the unique information, like Beyond Use Date, when they package. 

At some facilities they have more than one supplier for that Aspirin 81 mg. A different brand, or even a different size bottle, will have a different NDC number. If it is a replacement, they would update the one record. If they carry both, they would have two Aspirin 81 mg entries and the staff would need to pick the correct entry (see the Sort and Find sections below for strategies to manage these situations.) When they stop buying a specific medication, often they delete that medication from the formulary.


Sort

You can group and sort your formulary by one, two or three fields.  This enables you to group medications together and makes it easier for your staff to find the right drug.

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With only one sort value selected we have an alphabetical list of Generic names. Note the two “Aspirin” items on the list. A user would have to select each one to identify the strength.

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With two sort values selected, like Generic and Strength shown above, all the “Aspirin” entries group together. When you click the plus sign (+) next to Aspirin you can select from the two different Strengths.

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If we change the third sort from “(None)” to a field name the list will be organized in three layers. 

Find

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If the medication you want to package is not in the formulary you can either manually enter the information in the fields, or click the Find button at the bottom of the formulary.

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On the Find menu, you can scan the bulk bottle’s bar code, or type in the NDC or a drug name in the Find field. Choose “All”, “Formulary” or “FDA NDC (HC DPD in Canada)” to select where to search, and then click the Search button.

Because you can search for anything, and may be storing any kind of information in your formulary, MILT uses several methods to search for drugs.

The search methods MILT uses, in order of reliability:

  1. GS1 (01) NDC
  2. NDC 11 Digit, NDC 10 Digit, DPD 8 Digit
  3. MPN (Manfacturer’s Packaging Number)
  4. Other Application Identifiers
  5. Text

It is important you understand that an NDC Number is just a number. It is possible that you could inadvertantly store a number that matches a real NDC number in one of your formulary items. MILT searches multiple ways, and notes the type of match, so you can use your knowledge and experience to select the correct medication. This information  is not provided as, or intended to be, a substitute for expert pharmacological knowledge.

The following examples demonstrate how MILT searches for matches, and some of the scenarios that may occur.

Find Example 1

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In the example above we search for a (fake) NDC number. MILT found the same drug twice in the formulary: once as a plain text search and once as an NDC-11 match.

They are both the same drug and the same item in the formulary, but because we know the text we entered was supposed to be an NDC number, the NDC-11 match would be a more reliable match, even though they are the same item in this case.

Remember, MILT searches multiple ways, and notes the type of match, so you can use your knowledge and experience to select the correct medication. This information  is not provided as, or intended to be, a substitute for expert pharmacological knowledge.


Find Example 2

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In the example above, we searched the FDA NDC database for a known NDC number in the GS1 format (01 + 000 + 11 Digit NDC) which is a common standard used by manufacturers in their bar codes.

MILT recognized the 01000 as a GS1 application identifier and it found a GS1 match (00054057521).

It also found an NDC-11 match (00054057521) because those 11 digits in the right order are contained in the data. MILT did this by taking the data in 11 digit groups (01000000540, 10000005405, 00000054057, 00000540575, 00005405752 and 00054057521) and searching for an exact match.

It also found an NDC-10 match because the 10 digit version of this NDC removes the first zero (^0054057521) which leaves all 10 digits in the right order to match. If this had been a drug where the zero in the second position (00054^57521) would be removed for the NDC-10, then it would not have matched for NDC-10.

It did NOT find a text match because the entire text (0100000054057521) did not exist in any field.

Remember, MILT searches multiple ways, and notes the type of match, so you can use your knowledge and experience to select the correct medication. This information  is not provided as, or intended to be, a substitute for expert pharmacological knowledge.


Find Example 3

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In this final example of the Find menu we searched for the text “aspirin” in all databases.  MILT found the characters “aspirin” well over 1,000 times. Had we only been searching our formulary this may have been a good strategy, but with a database as large as the FDA NDC, and text as generic as “aspirin,” we will not be able to find the right medication easily in these results.

That being said, we could still click on any of the column headers to sort the results, like by Brand Name, to make it easier to find the one “aspirin” we were looking to find. Also note there are more columns of information to the right.

Remember, MILT searches multiple ways, and notes the type of match, so you can use your knowledge and experience to select the correct medication. This information  is not provided as, or intended to be, a substitute for expert pharmacological knowledge.


Data Fields

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The Data Fields are your stored information about each item in your formulary. The colored fields in the image above have special features activated:

Pink = Locked – The “Brand” field in the image above is LOCKED (Settings - Fields, Type.) Users who do not have “Edit Locked Fields” in their assigned role (Settings-Roles) will never be allow to alter the text in this field.

Orange = Auto-Lot – The “Lot” field in the image above has been assigned to the Auto-Lot feature (Settings - Auto-Lot.) No users will be able to change the text in this field. When you print, MILT will change the text to the current Auto-Lot number, print, record the information in the log, increment the Auto-Lot to the next number, then change this text back to “Auto-Lot.”

Yellow = Prompt – The “Pkgd Exp” field in the image above has been set to PROMPT (Settings - Fields, Type.) When a user selects a medication from your formulary they will be prompted with the screen shown below to supply the information for this field.

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Data Fields – Context Menu (Right-Click Menu)

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If you right-click on any Data Field you will get a menu of functions you can perform on this field.

Auto-Text – Opens the Auto-Text Insert menu where you can select an Auto-Text item. Pressing the F12 key on your keyboard will also open that menu.  The list of Auto-Text items can be maintained from Settings - Auto-Text.

Swap – This feature enables you to swap the current text in two fields as shown on the following image.  This would be like copying and pasting the information from one field to second one, and then from the second to the first, in one easy step.

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Fields – Opens the Settings-Fields menu where you can adjust the names, types and links for each Data Field.

Cut, Copy and Paste – This buttons perform the same functions you would expect in any Windows based program on the currently highlighted text in this field. Ctrl+X, Ctrl+C and Ctrl+V will also perform these functions.


Data Fields - Dates

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The two date fields will not accept an invalid date, like the 31st of February, and have several features that can help you with your date information.

Manual Entry

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If you click on a part of the date, like the month shown above, you can manually type in a value, or use the up and down arrow keys on your keyboard to adjust the value.  The left and right arrow keys will move to the previous or next part of the date.


Select Entry

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If you click on the pull down next to the date field you will get a calendar, as shown above, where you can select the date.

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Clicking the left or right arrows will move you backward or forward by month.

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Clicking on the month will zoom you out to the Year View where you can select a month.

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Clicking on the year will zoom you out to the Decade View where you can select a year.

 

Date Calculation Entry

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Date Calculations format and calculate date information for you. When you save a medication to your formulary, the selected Date Calculation saves with it. Every time someone opens that medication, the Date Calculation format and calculation will be applied.

You can add, edit and delete Date Calculations from Settings-Dates.

You can disable or enable either Date Calculation, and set a default for each of the two date fields from Settings-General. If disabled, MILT always uses the “SAVED” Date Calculation formatting.


Data Fields – Controlled

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The Controlled field is used to label a medication as one of the five FDA Controlled types. Drugs imported from the FDA NDC have this value preassigned.

If the Data Field Controlled is included on your Template, this item will display the 1-5 in a capital C symbol. If (None) is selected, this item will not appear on the printed label.

As of update 4012, the symbols used by MILT were changed from Roman (I, II, III, IV or V) to standard (1, 2, 3, 4 or 5) numbers in response to an ISMP warning about the potential for the Roman Numeral IV to be confused as meaning an intravenous route of administration.  

So instead of:

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MILT now uses:

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Data Fields – Special Functions

As of Update 4013, MILT includes two new features that can assist you with your packaging process: Tall Man Lettering Recommendation and CDC NIOSH Warning.

Tall Man Lettering Recommendations

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If enabled in Settings-General, the Tall Man Lettering feature will recommend that text it recognizes when tested against the FDA and ISMP Tall Man listings should be formatted in that style (i.e. DOPamine instead of dopamine.) It will only test text when you leave a data field. You can also test your entire formulary from Settings-General.

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The example above demonstrates how the Tall Man Lettering Recommendation could be wrong. MILT found the word prednisolone inside the word methylprednisolone and is offering to fix the formatting, but MILT is wrong in this case.

This feature is provided for informational purposes only. It is not provided as, or intended to be, a substitute for expert pharmacological knowledge.

CDC NIOSH Warning

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If enabled in Settings-General, every time you select that medication in the formulary, and when you leave a Data Field, the CDC NIOSH Warning will test all text against the medications named in the CDC NIOSH List of Antineoplastic and Other Hazadous Drugs in Healthcare Settings, 2016. If a match is found, It SUGGESTS that you may want to take precautions when handling this medication.

This feature is provided for informational purposes only. It is not provided as, or intended to be, a substitute for expert pharmacological knowledge.

 


Save Formulary Item

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Remember, the idea of the formulary is that it is a list of medications you are going to print over and over again. If you are only updating information that changes every time you print, like a Lot Number, you would not need to save the item again. All information in the fields at print time will be saved to the Log when you print.

Ideally, you would save the constant information, like the Generic Name and NDC Number, to the formulary, and the user would provide that job specific information when they select the medication to print.  Features like Data Field Prompts and Date Calculations can be used to help them provide the correct information required when they select the item.

When you do save an item, you can overwrite the existing item (e.g. you start using a new brand of “Aspirin 81 mg” and you will no longer use the old one,) or you can save it as a new item (e.g. you are going to continue to use both brands of “Aspirin 81 mg.”)

This is also where you assign a Label and a Template to a formulary item. Each time someone picks this item from the formulary, MILT will load the assigned Label and Template.

With planning, you can make doing the “right thing” the easiest option for your staff. If I pick a medication, it prompts me for the lot number, calculates the expiration, and selects the label type and template for me, I only need to decide how many to print!

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