December 4, 2007
Editor: Jeff Johnston
Welcome to the first issue of the CPR+ Weekly Infusion. We’re going to try our hand at publishing a weekly newsletter that we hope will “infuse” your organization with useful and interesting knowledge and information. We’ve mapped out an “editorial schedule” for the next 12 weeks or so but we’d LOVE to hear any suggestions you have for upcoming articles. The content will be heavily oriented toward CPR+ training and we will also explore IT topics, profile employees and customers and highlight various CPR+ features. We will have a CPR+ Tip-of-the-Week, and we just might throw in a “Special Offer” from time to time. Thanks for being our customer - we hope you enjoy the Weekly Infusion.
Jeff & Stuart
In v8.0 we introduced a series of enhancements to help pharmacists process TPN prescriptions. These new enhancements provide the ability to enter TPN orders by individual ion, the ability to balance the amount of chloride and acetate, and the ability to enter multiple qualifiers per macro or micro nutrient. We’ve integrated these improvements with the standard TPN processing so that you can begin using them with minimal training.
There are a couple of things that must be set up prior to using the Nutritional Calculator for TPN’s. First, it is ESSENTIAL that the nutritional values for each TPN ingredient (located on the “TPN Info” tab) are correctly entered. Prior to v8.0, these values were used to display the total of each ion on the TPN Work Order but now these values are used to calculate the number of milliliters of each ingredient. We recommend that you double-check them for accuracy. Second, set up a TPN template that includes all of the ingredients that you would want to use when the salt forms of the ingredients are being calculated. As with any template, you can always make adjustments to the ingredients after they have been “pulled into” a prescription, but having a template will make things quick and easy.
Here’s How It Works:
Create an order and a prescription for the TPN just like you do now. When you get to the “TPN Order Entry” tab you’ll notice a new button called “Nutritional Calc. (F4)” located under the grid that contains the ingredients. Before you click on this new button, make sure that all of the ingredients that you want to use are listed in the grid (the template that you selected will populate the grid but this is your opportunity to make modifications specific to this prescription). Once complete, click the button and open the “Nutritional Calculator.”
The “Nutritional Calculator” screen contains three sections: Macro Nutrients, Micro Nutrients and Chloride / Acetate Balancing.
Macro Nutrients – The Macro Nutrients section consists of the three items that make up the base solutions. You have the ability to enter the amount of Protein and Dextrose by percentage or “Gm”. Lipids can be entered by “mL” or “Gm”. All three items allow you to enter an amount by weight or Body Surface Area per “Day”, “Liter” or “100ml”. Also included in the Macro Nutrients section is a “Do Not Inherit Nutritional Properties from Macro Nutrients” checkbox. If this box is checked, any nutritional values found in the base solutions will NOT be used as part of the calculations for the individual ions. For example, Aminosyn 10% contains a small amount of sodium and Acetate that will not be included if the box is checked.
Micro Nutrients – The Micro Nutrients section consists of Phosphate, Potassium, Sodium, Calcium and Magnesium. This is the same order in which the nutrients will be balanced (e.g. total phosphate will be calculated first followed by Potassium and Sodium). Just like the Macro Nutrients, all five items can be entered by weight or Body Surface Area per “Day”, “Liter” or “100ml”.
Chloride / Acetate Balancing – The percentage of Acetate can be entered into this section. During the ion balancing calculations, CPR+ will utilize the Chloride or Acetate form of each ingredient based on the percentage entered into this section.
Once all the information is entered, click the Calculate (F2) button. CPR+ will calculate the amount of each ingredient needed based on the nutritional information that was entered and populate the “Amount” column in the TPN Order Entry grid. At this point, you can continue to process the TPN the same way you did with previous versions of CPR+.
Here are a couple of final notes about the Nutritional Calculator for TPN’s. When refilling a TPN that was initially processed by the Nutritional Calculator, the “Nutritional Calc. (F4)” button will appear in RED. If any of the original calculations were based on the patient’s weight or BSA and those values have changed since the last fill, a message will appear in RED to the right of the grid explaining that the calculations must be performed again by going into the Nutritional Calculator. The “Calculate TPN (F2)” button will be disabled until this function is completed.
If you have questions about this or any other v8.0 enhancement, check out the free On-Demand training videos or give us a call to arrange one-on-one training.
Optimizing SQL Server System Performance – Maintenance Plans and Report Servers
By Scott Adkins & Tom Rooker (CPR+ Programmers)
SQL Server data can, over time, become cluttered and disorganized. This can lead to degradation in the performance of the SQL Server, and therefore CPR+. A SQL Server Database Maintenance Plan (not available with SQL Express or MSDE) can be configured that will de-clutter and re-organize your data and improve system performance by automatically rebuilding the indexes, shrinking the database to free up disk space, and updating statistics. In addition, a SQL Server Maintenance Plan can check the database for errors and provide an easy way to perform automatic backups of your data. We encourage every customer to have a robust backup solution to prevent data loss and minimize down time.
System performance can also be adversely affected by running frequent data intensive reports in CPR+ or other applications on the server. Implementing a “Report Server,” fully supported by CPR+, will improve system performance by off-loading resource intensive reporting to another box, allowing your primary data server to continue to function at peak performance. To learn more about creating a SQL Server Database Maintenance Plan or implementing a Report Server, contact your IT Professional or give us a call to arrange a SQL Server consultation.
Did you know that you can easily make a new Prescription Template out of a new or existing prescription? Yep, it’s true. If you’ve created a prescription from scratch and you’d like to save your work for future use as a template, make sure your cursor is at the bottom of the Compounding Record tab on the Pharmacy Work Order and press <Ctrl+F10>. Give the template a name and you’re good to go.
A lot of you made it out to Vegas for the 2007 CPR+ User Conference. Most of you even made it to all the User Conference Sessions . . . although we did notice a few people skipping out of the Report Writer session to hit the tables! Not to worry, we recorded all the sessions on DVD. Over 16 hours of up-to-date training on CPR+ core functionality and new v8.0 enhancements.
As an added bonus, between now and the end of the year, if you order one or more days of On-Site Training, you will receive a FREE copy of the 2007 User Conference DVD. And remember, at just $249, or $99 for conference attendees, it makes a great stocking stuffer too!
For more info on the DVD or this limited time offer, contact Kim Carlsen at the office today!
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