Medication Section
- Cathy Allison
Medication Section
This section on the patient record tracks any medication administered to the patient in the course of the episode.
This includes over the counter medications, vaccines, and prescriptions. You can complete Medication Administration Records (MARs) for prescriptions of controlled substances, and Vaccine Certificates for vaccines that require them.
You can also track Client Reported medications for things that were prescribed outside of your hospital, to ensure a patient's complete medication history.
Add Medication
If no medication section appears on the episode yet, you can Add Medication using the Add New Element menu that is found by right clicking on the Episode Header.
After at least one Medication has been added to the episode, the Medication section is visible, and you can add additional medications using the right click menu there.
The Episode Type can also be pre-set to display the Medication record as soon as the episode is created, if it is an episode type that will require the use of medications (e.g. a surgery.)
Medication Types
The main medication types are Prescriptions, Medications (OTC), and Client Reported. In addition, any prescriptions issued during the course of the episode will appear here even if they did not originate from the episode. This includes prescriptions routed through the pharmacy, and any medications issued from a Controlled Drug Machine.
Add Prescription
To add a prescription, right click on the Episode Header and choose Add New Element > Add prescription.
A new window will open for a Prescription Request. This is a dynamic form that will change based on the selections that your hospital has set up on a per pharmacy basis.
| Field | Description |
|---|---|
| Go Home (Client Labeling) | Prepares a prescription request to be issued with a client label and instructions on it. |
| In Hospital Use (Administration Record) | Prepares a prescription request to be issued for in-hospital use. If required, this will trigger a MAR on the patient record. |
| Pharmacy | Selects one of the custom in-hospital pharmacies to process this prescription through. |
| Drug | The specific product to be prescribed. Some products may be restricted to certain pharmacies - for example, a compounded product may need to go through the pharmacy that has a compounding facility. |
Prescription Types
After selecting Go Home Labeling and a pharmacy, the form will prompt you to select a prescription type.
| Field | Description |
|---|---|
| Regular Fill | A standard prescription that will be sent through the pharmacy, review by an in-house pharmacist, and issued from the Pharmacy inventory. |
| External Script | A prescription that will be printed and provided to the client to fill at an external pharmacy. It will be signed by the DVM, but not filled by the internal pharmacist. |
| CDM Fill | A prescription request that will be approved by a DVM but filled at a controlled drug machine, as opposed to by a human pharmacist. |
Prescription Options
In addition to the types, there are other prescription options that may become available based on the selections.
Hold Approved Script for Later Fill allows the DVM to pre-approve a prescription to be filled by the pharmacy at a later date. The prescription will not show up in the Fill Queue to be processed until the date entered.
Drug Not In List allows a DVM to issue a prescription to an external pharmacy without having the product in local inventory. This also can be used to request a specific compound from an internal pharmacy, if the pharmacy is set up to allow it.
Dispense as Written prints that text on the prescription label. This is required in some states.
Prescription Instructions
The instructions entered will be printed on the prescription. Quantity values provide the pharmacy with the information that they need to complete the fill.
| Field | Description |
|---|---|
| Instructions | The formal instructions to be printed on the prescription label. These can follow the traditional Draft Instructions (Verb, Quantity, Unit, Route, Frequency, Duration) or be more specific for the patient or owner. |
| Total Qty | The total quantity of the product to be dispensed. |
| Days Supply | How many days the dispensed quantity should last. Ideally this matches the value for the Duration in the instructions, if it will be given for a finite period of time. |
| Price | The price based on the total quantity. This is calculated based on Product Setup. |
| Refills | The total number of refills available for this prescription. It may be as many as 12 months depending on the pharmacy setup, based on state laws. PRN is available for unlimited refills until the expiration of the prescription, usually within six months or one year. |
Expirations and Withdrawals
| Field | Description |
|---|---|
| Label Expiration | The expiration date that will appear printed on the label. This may be different from the actual drug expiration. In most states and provinces, a prescription and the issued product is valid for only one year, but this can change based on the drug class. For certain products, such as a powered antibiotic that is mixed with water and must be refrigerated, you may want to consider an even shorter label expiration, such as 14 days. |
| Refill Expiration | How long this prescription is valid for refills, if any. If a product is intended to be giving daily for three months, but only one month supply is issued at a time, you may consider having the refill expiration be valid for the next four months. |
| Withdrawal | How long to withhold a patient from a specific usage. This usually applies to large animals or production animals, but Competition may also be valid for small animals who participate in shows as well. |
| Comments | Any additional comments regarding this prescription. Use this field for additional instructions for the pharmacy staff, or other information such as a client address for a prescription that will be mailed. |
| Patient Status | Indicates the current location of the patient, or the intended destination of the prescription. These statuses are custom for your hospital, but the most common would be "Inpatient" for a patient that was admitted to the hospital, or "Going Home" for an outpatient whose owner will be checking out shortly. These statuses are used by the pharmacy to prioritize the fill queue. |
| Patient Status Flag | A short word or phrase that can be used in addition to the patient status for the pharmacy to prioritize the fill queue. This flag's usage should be coordinated with the pharmacy. |
Dose Calculator
This tool is available on standard prescriptions to assist the clinical staff in figuring out the correct dosage. This tool can be hidden on a per pharmacy level to force a student to perform a manual calculation, e.g. for a Junior Surgery installation of VetView.
For this to work, both the species setup and the specific drug setup must be complete.
| Field | Descripiotn |
|---|---|
| Weight | The patient's weight. This may be required to request a prescription. If the weight is blank or has been flagged as approximate, a warning will appear next to the button. |
| M2 | The calculated meters squared volume of the patient. This is based on the K constant entered under species setup. If the species setup is not complete, this calculation cannot be performed. |
| Dosage | The recommended dosage of the product based on the product's packaging or a pharmacy reference book. For animal species, this may be given as a range. Check both the upper and lower bounds of the range to find the correct drug strength if necessary. |
| Diagnosis | This is an optional field that will add the diagnosis to the prescription. This may be required on the label in some states, and is also helpful to the pharmacist when reviewing the prescription to verify the product is being prescribed correctly |
| Total Dose | The value of the dosage in each unit as it is being prescribed to the patient, based on the patient's weight and volume. |
| Drug Strength | The value of the drug strength based on product setup. This is then used with the Total Dose to derive a value that shows how close the Total Dose is to the Drug Strength. In this example, each 100 mg table will contain 1.134 of the calculated dose for the patient. If the lower boundary of the recommended dosage is 15 MG/KG instead, then the value of the Drug Strength will drop to 0.851 per dose. Should a 100 mg tablet not fit within the boundaries of the upper and lower dosage, it may be better to prescribe a product with a smaller drug strength to allow for more precise dosing. |
Predefined Instructions
The Predefined Instructions are set at the Product Setup. Clinical staff should work with pharmacy to build out a list of the most common courses of a given product. These can be filtered or restricted based on species, or set as the default. Once selected, this will auto populate the Instructions, Quantity, and Refill values.
Draft Instructions
The Draft Instructions are a legacy teaching tool to help guide students in the correct pattern for writing a prescription. The key words available in each drop down menu can be defined at the Product Setup level. The Draft button will import the words into the Instructions field, and fill the Total Quantity and Daily Quantity fields.
Prescription Statuses
Prescriptions that are submitted as part of an episode will appear in the Medication section of the episode. The prescription status will display on the far right.
| Status | Description |
|---|---|
| Requested | A tech or student has filled out a prescription request and submitted it for approval from a DVM. The request will be sent through VetView mail, but will also appear on the widget on a users home screen. At this point, the prescription can still be modified by the clinical staff, as the pharmacy has not been given control yet. |
| Approved | The prescription was reviewed by a DVM and approved. The clinical staff cannot modify a prescription in Approved status. The pharmacy can make changes if contacted prior to the prescription being processed in the queue. |
| In Process | The prescription is actively being worked on by a pharmacy technician. |
| Submitted for Review | The prescription has been processed and is waiting for a pharmacist to review the prescription. |
| Ready for Pickup | The prescription has been reviewed by a pharmacist and is available at the pharmacy to pick up. Once it is marked as "picked up", the prescription will change to Issued. |
| Issued/Filled | The prescription has been reviewed by a pharmacist and issued. For schools that do not use the Ready for Pickup flag, this indicates the prescription is ready. |
| Cancelled | The prescription was cancelled prior to being filled. |
| Hold | The prescription is being held by the pharmacy and will not be filled until the Hold is lifted. Holds can be requested during the prescription creation process, to delay the fill until the patient is ready to go home. These will appear as "Approved Hold." |
| Rejected | The pharmacy will not fill this prescription as submitted. The drug requested may be the wrong strength for the patient, or is not safe for the species. Contact the pharmacy to discuss when a prescription is rejected. |
| Active | A Daily Fill prescription that is currently active and will be filled overnight for the patient. Clinical staff can Stop an active daily fill prescription at any time. |
| Stopped | A Daily Fill prescription that has been stopped, and will no longer be filled for the patient. |
Medication Administration Records
If a product is flagged as required a MAR on the Product Setup level, then after the prescription is issued, clinical staff will have to fill out a Medication Administration Record to account for the products.
A warning will appear at the top of the Medication group that the MAR is incomplete.
Click on the red X to open the MAR form.
Once the form has been filled out and all the medications have been accounted for, the X will change to a green check mark on the Medication section, and the background of the form will appear as green the next time it is opened.
For certain Dispensed types, the form will required a Witness. In addition, the logged in user must provide a password in order to Save the form. The witness cannot be the same as the Dispensed/Administered by user.
| Field | Description |
|---|---|
| Prescription Information | Details about the prescription will display as Read Only at the top of this form. This is the information that was entered on the prescription request, and confirmed during the prescription fill. |
| Date/Time | The date/time of the action being taken on the prescription. Click on the small green button to import the current date and time. |
| Type (of action) | The action being taken on the prescription. These include Administered, Returned (to pharmacy or CDM), Sent Home (with the patient), Variance (product incorrectly measured by manufacturer), Wasted (returned or destroyed), and Adjusted. |
| Dispensed By / Administered By | The user who performed the action. This does not have to be the user who is currently logged in, but cannot be the same user as a Witness to the action. |
| Quantity | The amount of product affected by the action. These should always be positive values to deduct against the initial Dispensed quantity. |
| Status/Comments | Automatic status information regarding an action, as well as any notes provided by the clinical staff during the action. |
| Wasted Method | If the action chosen is Wasted, the user will be asked to include the Wasted Method. These are custom defined by the pharmacy and may include being returned to the pharmacy, disposed of using Rx Destroyer, etc. |
| Witness | If the action chosen requires a witness, the user name should be added here. This person is legally liable for confirming the action taken by the Dispensed/Administered User occurred as described. |
| Adjustment Type | If the action chosen is Adjusted, the user will be asked to include the Adjustment method. This action is a custom list designed by the pharmacy. This may be reserved for administrative use, such as confirming an error in the prescription, or accounting for unusable product in a container. |
| Password | The logged in user will be asked to enter a password before Saving the form. The logged in user may either be a Witness or the Dispensed, or a third party (e.g. the supervising clinician.) |
MAR Automatic Pop Up Notifications
If he MAR Automatic Email job is turned on for your hospital, and you have overdue MARs, you may receive a pop up as soon as you log in to VetView.
This notice can be dismissed but will return as long as there are overdue MARs.
To make this pop up go away, click on Go To Administration Search to view your MARs on the Administration Search Screen and complete them.
Dispensary Prescriptions
If a product has been designated as being permitted from a Dispensary pharmacy, then the Pharmacy Queue workflow can be bypassed, allowing a DVM to Approve and Issue the prescription in a single step.
The Billing and Inventory section will appear when a qualified product has been selected from the Drug listing.
Use the scroll bar to go down past the Patient Status field to find this section.
| Field | Descriptions |
|---|---|
| Location | The physical inventory location for this product. This will deduct the product from the inventory counts at that location. Some fields may automatically import if the Inventory's product information was entered at the product level. |
| Lot | The product's lot number. Required for prescription labels in most states and provinces. |
| Serial No | The product's serial number. Required for prescription labels in most states and provinces. |
| Manufacturer | The product's manufacturer. Required for prescription labels. |
| Expiration | The product's expiration date. This is the actual expiration date of the drug itself based on the information on the manufacturer's packaging, as opposed to the Label Expiration that will apply to the dispensed product. |
| Used | The quantity of the product that will be dispensed and deducted from the inventory. |
| Bill | The patient orders that this prescription will be billed against. This is a hotlink, and you can open the patient orders via CTRL+Click to view it in a new tab. |
| RX# | The prescription number that will be printed on the label. If the number is not generated automatically, click on Get Rx to populate the fields. |
| Drug Label | The name of the drug as it will be printed on the label. This can be used to streamline the product name for clarity. |
| Lot and Manufacturer | The lot and manufacturer that will appear on the printed label. Click on the small green button next to the Used field to automatically populate these fields and not have to re-type them. |
| Drug Info Sheets | The drug Info sheet that will be printed alongside the prescription Data Card. In some states and provinces, this may be required for go-home labels. These can be added or removed based on relevance to the product. |
| Auxiliary Label | The recommended prescription stickers for the product. These will also be printed on the prescription label. |
| Print Label | Prints the prescription label that should be applied to the dispensed product. |
| Print Data Card | Prints the drug info sheets and prescription data card to be included with the dispensed product. |
Reset, Add Script, and Done/Close
Add Medication
Medication in VetView is broken down into sub types. Each sub type has its own fields, and will display on the medical record differently based on those fields.
To assign a pharmacy product to these categories, you should have a system administrator work with a pharmacist to have them associated to the categories on the Pharmacy Setup Screen or on the Product Setup Screen > Medical Record Tab.
Blank Lists
If the Product list for any of the medications is blank, it means that the medications have not been set up to appear in that part of the medical record. Note that in many states, antibiotics and euthanasia drugs require a prescription, so those products should be issued as a Dispensary Prescription instead of an in-office medication.
Type: Antibiotic
One common use case for antibiotic medications that do not require a prescription may be topical ointments. These products can be flagged as an Antibiotic under the Medical Record Setup, and become available from the non prescription Medication list.
In the example below, the product has been administered to the patient to treat an external wound.
The product will be added to the patient's bill, and pulled from Inventory based on the entered information.
Once saved, the product will appear in the Medication list.
Click on the Print Button to open a PDF for a prescription style label that can be applied to the product to comply with any state or province laws regarding antibiotics.
Type: Antiparasitic
The Parasite option in Medication can be used as a teaching tool in addition to a means of narrowing down recommended treatment options. The clinician must first choose the parasite, and then a list of associated products to treat that parasite appear. (These must be previously associated under the Pharmacy Setup screens.)
Like the Antibiotics, a prescription style label can be printed using the Print Button from the Medication section.
Type: Euthanasia
A product used for euthanasia can be added via the Medication section.
Adding this product will not automatically mark the patient as Deceased.
Instead, this should be done via the Discharge process, by selecting Euthanasia or another Discharge type set up to mark a patient deceased. The date of death will be the Discharge date from this window.
Type: Medication
Use this option for any other non specific medication that your office supplies to the client that may require an instruction label. For example, supplements and vitamins can be tracked under this, if they do not require a prescription.
Once added, Medication can have the label printed out and applied to a container, just like a prescription.
Type: Other
The Other category is intended for items that don't fall into any of the other categories, but may still need go-home label instructions for an owner. Bandages, e-collars, and other such products can be included in this section.
Once saved, the Other medication type can have its label printed like all other types in this category.
Type: Over the Counter
This Medication classification can be used for pharmaceutical products that do not require a prescription, but still require instructions for the client for usage or safe dosing. Standard OTC drugs like pet safe laxatives may be added to this category, or topical products like shampoos that will be used to treat a skin condition.
Once added, the OTC medication will appear in the Medication section, and the clinician can print a go-home label for the client.
Type: Vaccine
(Updated in Version 3.1 of VetView)
If a Vaccine is added, either directly through the Medication section or via the patient's orders, it will generate an entry on episode.
In addition, if the vaccine is set up to require a tag number, it may generate a Vaccine Certificate requirement on the episode as well.
After selection the Medication type for Vaccine, you will be prompted to choose a Vaccine Type from the list. (These types are custom created by your hospital.)
This selection will further restrict the available products to those that have been designated for that Vaccine type.
Client Report Flag
The Client Reported Flag for a vaccine will allow you to record the information provided by the client or another vaccine certificate provided by the referring DVM, but will not allow you to create a new Vaccine Certificate based on the information. This should only be used to add historical information for previous vaccines!
If the product has been flagged to Generate Vaccine Certificate, then the window will adjust to display the required vaccine fields.
Patient demographic information, owner information, and DVM information will automatically import to the vaccine certificate.
This form mimics how it will appear when printed.
| Field | Description |
|---|---|
| Type | The type of medication selected. In this instance, Vaccine has been selected, so the Vaccine type field will appear. |
| Vaccine | A menu to choose the type of vaccine that is being administered to the patient. |
| Client Reported | This flag will change the options on the window to match the fields for a previously administered vaccine provided by the owner or the referring DVM. Do not use this flag if the vaccine is being administered during the current episode. |
| Product | The specific product that is being given to the patient as a vaccination. The Vaccine Type from the drop down menu will limit the available products to only those associated with the vaccine type in product setup. |
| Sales Qty | The quantity of the product administered. For a single dose vaccine, this will be 1, and if this field is left blank, it will default to 1. If the vaccine is from a multi-use vial measured in milliliters, you may need to manually enter a larger quantity than 1. |
| Inventory | The inventory location of the product. This is where the product quantity will be deducted. |
| Lot | The lot number of the vaccine. This field is required for the vaccine certificate. |
| Serial No | The serial number of the vaccine. This field is required for the vaccine certificate. |
| Manufacturers | The manufacturer of the vaccine. This field is required for the vaccine certificate. |
| Expiration | The expiration of the vaccine product. This field is required for the vaccine certificate. |
| Date Given | The date that the vaccine is being given to the patient. Click on the small green button to input the current date into the field. The "approximate" flag is intended for use with Client Reported, but is made available on this field in case the patient is vaccinated during a multi-day visit, and the form was not filled out at the time of the vaccination. |
| Expires | The expiration date of the vaccination. This will default to 1 year out for a vaccine designated as "one year" and to three years out for a vaccine designated as "three year" on product setup. This field is required for the vaccine certificate. |
| Duration | Indicates whether this is a one year or three year vaccine. The default for this is set under Product Setup. |
| Owner Information | The owner's information as it will be printed on the vaccine certificate. If this information is incomplete, it should be updated on the Owner's client screen before printing the vaccine certificate. |
| Microchip | If the patient has been microchipped, this field may be required in your state or province. If the patient is being given a microchip during this visit, it should be added to the Patient Tags before printing the vaccine certificate. Patient Tags that have been flagged as type "Microchip" in ID/Tag Setup will automatically import into this record if they were already added to the patient record. |
| Tag Number | Confirms the type of Tag/ID that this number will be created under in the Patient ID/Tags section of Patient Details. The Tag Number should be manually entered by the clinical staff who are giving the vaccination. Once Saved, the rabies tag will automatically be added to the patient record. |
| Patient Information | The patient information that will be printed on the Vaccine Certificate. Any fields that have already been entered will be imported. Any fields that are left blank will not be printed. The clinical staff can enter in missing information, such as breed and color, to complete the demographics. This information will then be back filled to the Patient Details. |
| DVM Information | The DVM information that will be printed on the Vaccine Certificate. This is the DVM name and address as it is stored in the system (the Hospital address under Hospital Setup will be used.) The DVM license number is required for vaccine certificates in most states and provinces, and for international travel. This must be filled out under user setup. The DVM signature will display as the text signature on the form in VetView, but will also print as a blank line that can be physically signed by the DVM in the printed report. If a DVM has a digital signature stored, that will be printed instead. |
Print Vaccine Certificate
The Vaccine Certificate PDF is designed to comply with USDA requirements for international pet travel. Your hospital may adjust the layout of this form to include university branding, so the exact layout may be slightly different.
The DVM issuing the vaccination should physically sign this certificate, if no digital signature was automatically recorded.
Incomplete Vaccine Certificate
if a vaccine was added to the patient orders and the vaccine certificate was not completed by the tech adding the order item, it will appear on the patient record as a deficiency. (MAR incomplete in 3.2, Vaccine Certificate Incomplete in 3.3)
The clinical staff should click on the Edit button to complete the form.
If this form is incomplete, the Order cannot be closed on the cashier screen.
Delete Medication
A non-prescription medication can be deleted from the patient record at any time. Right click the Medication, and choose Delete.
Prescription medications cannot be deleted from the patient record after they have been Approved. Contact the Pharmacy you requested it from to cancel the prescription request.
If the deleted Medication was associated with a Vaccine Certificate, the corresponding tag will also be removed from the patient record.
Add Client Reported
Any medication list provided by an RDVM or given verbally by the client can be added as a Client Reported Medication. This includes prescription medications, over the counter medications, vaccines, etc.
| Field | Description |
|---|---|
| Type | The type of client reported medication being recorded. Each type should be recorded as a separate entry. |
| Vaccine | If the type of medication was a vaccine, you should add in the specific vaccine to ensure a complete vaccination history. |
| Drug Name | The name of the medication. Since this is not a product within VetView, this can be entered free hand. |
| Date Given | For vaccines, the date it was given. For other medications, this can be used as the approximate date it was prescribed. |
| Instructions | The client description of instructions for the medication if it was provided. Otherwise, this can be used for notes about the medication. |
| Comments | Any additional comments |
Client reported medications will appear in the appropriate subsection within the Medication category.
The Info Dot will display the Client Reported Medication flag.
CDM Medications, Daily Fills, and other external sources of medications
The Medication section on the episode will also display medications added via Controlled Drug Machines, via prescriptions outside of the episode but added to this episode's bill, and products added directly to the patient orders that have been flagged to display as a Medication.
This allows for streamlined workflows for nurses and technicians who will add the product via the Patient Orders, instead of adding them to the episode. For routine visits that do not include a teaching component or heavy documentation, this eliminates the need for double entry, but still allows for a complete capture of the medications administered during an episode.
Stopping Daily Fills
When a Daily Fill prescription is added, there is a set expiration date. The prescription is considered Active until the expiration has been reached, or the clinical staff clicks on the Stop button that is hidden next to the Daily Fill prescription on the patient record.
The clinician will receive a warning to verify they really want to stop the prescription.
Once Stopped, the prescription status will change. If no products were dispensed, the drug will appear with a strike through the name.
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To see commonly used terms in VetView Hospital, please visit our Hospital Glossary of Terms.