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UWHC,

Policies,Administrative,UWHC,Department Specific,Pharmacy,Administration

Directions - HL, Mobile Meds, and or Connect-Rx Downtime (1.27)

Directions - HL, Mobile Meds, and or Connect-Rx Downtime (1.27) - Policies, Administrative, UWHC, Department Specific, Pharmacy, Administration

1.27

POLICY & PROCEDURE




Revised Date:

March 2008
…Administrative Manual
… Nursing Manual
⌧ Other: Pharmacy

Policy #: 1.27

… Original
⌧ Revision 6/12
Page 1
of 11
Title: Directions for Health Link, Mobile
Meds, and/or Connect-Rx
Downtime

I. PURPOSE: To describe the downtime procedures for the pharmacy department applicable
to the following applications:
A. UWHC Hospital Network / Intranet
B. UWHC Novell Application Launcher (NAL)
C. Health Link
D. Health Link interfaces (ADT, Allergy)
E. Connect-Rx
F. Robot-Rx
G. Med Carousel
H. AcuDose
I. Mobile Meds

II. SCOPE: This policy and procedure is specific to Health Link downtime. It does not
address hardware issues. Sentinel Technologies maintenance of hardware information is
available in Appendix A. Please refer to the Pharmacy Operations manual for specific
details related to handling central pharmacy downtime.

III. POLICY: The following procedure will be implemented in the inpatient and other affected
pharmacy locations when there is planned or unplanned hospital network, Health Link,
and/or Connect-Rx downtime.

IV. PROCEDURE:
A. Communication
B. Scenario Overview
C. Network Downtime
D. Novell Application Launcher (NAL) Downtime
E. Health Link
F. Health Link-related Interfaces Downtime (See Connect-Rx Downtime)
1. Allergy
2. ADT
G. Connect-Rx Downtime
1. Robot-Rx
2. Med Carousel
3. AcuDose
V. FORMS/ATTACHMENTS:
Appendix A Sentinel Technologies Maintenance of Hardware Information
Appendix B Downtime IV Solution Ordering System

VI. DEFINITIONS:

POLICY & PROCEDURE




Revised Date:

March 2008
…Administrative Manual
… Nursing Manual
⌧ Other: Pharmacy

Policy #: 1.27

… Original
⌧ Revision 6/12
Page 2
of 11
Title: Directions for Health Link, Mobile
Meds, and/or Connect-Rx
Downtime

A. MPI = Manager, Pharmacy Informatics/Information Systems
B. SOC = Supervisor on-call (Pager 8771)
C. PIS = Pharmacy information system
D. NOTE: A supply of all forms mentioned in this policy and procedure will be available
in C6/106A (the “hot” room) and in each of the pharmacy locations.
VII. PROCEDURE:
A. COMMUNICATION
1. Network or Health Link downtime is categorized as planned or unplanned.
The activities to be performed vary depending on the specific applications
that are down and the extent to which details regarding the downtime are
known.
2. Planned downtime
i. If network or software downtime is planned, staff will be notified in
advance via e-mail notification and at staff meetings.
ii. Specific arrangements for planned downtime will be communicated in
these notifications.
iii. If the need for planned downtime is urgent, the length of notice may
be as short as the next day. Notification in these instances will be
made by sending urgent e-mails, InBasket messages, and using the
Message of the Day within Health Link.
iv. Refer to Administrative policy 6.37 for Health Link communication
plans.
3. Unplanned downtime
i. The first time an application does not work for a user, the user should
call the Information Systems Help Desk at 265-7777. The Help Desk
will use the on-call schedule to contact the appropriate server and
Health Link analysts to investigate the downtime.
ii. The Health Link Medication Management analyst on-call will be
notified about all downtime that effects the application, s/he should
call the appropriate pharmacy manager when a downtime occurs:
a. Contact the Pharmacy Supervisor On Call at Pager # 8777
iii. Notification of the current situation to the applicable pharmacy staff
should occur as soon as possible if any system downtime affecting
Health Link occurs. See Appendix B for locations, phone numbers,
and other applicable information.
a. Weekdays:
i. Phone: Notify via telephone the central pharmacy
(SPA) (263-1270)

POLICY & PROCEDURE




Revised Date:

March 2008
…Administrative Manual
… Nursing Manual
⌧ Other: Pharmacy

Policy #: 1.27

… Original
⌧ Revision 6/12
Page 3
of 11
Title: Directions for Health Link, Mobile
Meds, and/or Connect-Rx
Downtime

ii. Page: Pharmacists and PHAs should be notified of
issues using text pagers, when possible, and pager
groups 7888 (Decentral RPh’s), 7889 (Decentral
PHA’s) and 0535 (Managers).
iii. Message: If Health Link is up but another
application is down, a Health Link InBasket message
to the appropriate users should be sent with all
applicable information.
iv. E-mail: An appropriate e-mail should be sent to the
following e-mail groups:
1. Rx - Pharmacists, Rx - All Department Techs &
PHAs
2. Rx - Administrative Staff
b. Weekends:
i. Phone: The Supervisor On Call will communicate via
telephone with the central pharmacy.
ii. Page: Pharmacists and PHAs should be notified of
issues using text pagers, when possible, and pager
groups 7888 (Decentral RPh’s), 7889 (Decentral
PHA’s) and 0535 (Managers).
c. Nights:
i. Phone: Notify the Central night pharmacist by calling
3-1270.
ii. Page: Notify the Decentral night pharmacist by paging
#7057.
SCENARIO OVERVIEW

Policy
Section
Scenario Other
Applications
Affected
Areas
Affected
Planned Unplanned
4 Network/
Intranet
All All Depending on the length
of planned downtime,
manual system may or
may not be in place for
all systems.
Begin network downtime
procedure if expected to
last greater than 2 hour.
5 Novell
Application
Launcher (NAL)

Health Link All Health Link should be
locally installed at each
workstation.
Begin NAL downtime
procedure as soon as
identified.

POLICY & PROCEDURE




Revised Date:

March 2008
…Administrative Manual
… Nursing Manual
⌧ Other: Pharmacy

Policy #: 1.27

… Original
⌧ Revision 6/12
Page 4
of 11
Title: Directions for Health Link, Mobile
Meds, and/or Connect-Rx
Downtime

6 Health Link (all) All
interfaces,
Connect- Rx
All If downtime is planned to
be greater than 2 hour,
must have interfaces,
Connect-Rx, and
AcuDose, downtime
procedures in place.
If downtime is anticipated
to be greater than 2 hour,
must have interfaces,
Connect-Rx, AcuDose,
and Mobile Meds
downtime procedures in
place.
7 Health Link
Mobile Meds
Health Link Inpatient
only
If downtime is planned to
be greater than 2 hours,
units will print paper
MARs and assemble
downtime binders.
If downtime is expected to
be greater than 2 hours,
units will print paper
MARs and assemble
downtime binders.
7 Health Link
Interfaces
Varies on the
interface
Varies Inform other application
users of issues
Recovery methods need to
be communicated, if
necessary.
8 Connect – Rx AcuDose,
Med
Carousel,
Robot-Rx
Decentral
& Central
AcuDose local mode (see
also AcuDose Downtime
policy 14.1) Implement
central automation
downtime procedures;
applicable billing details
need to be addressed;
only take down outside
cartfill hours
AcuDose local mode (see
also AcuDose Downtime
policy 14.1) Implement
central automation
downtime procedures;
applicable billing details
need to be addressed.
Begin manual cartfill as
described in section 8.
B. Network Downtime
1. Planned
i. Manager and ITS should verify with the network team what
applications the downtime will affect.
ii. If downtime is determined to affect Health Link and Connect-Rx, refer
to planned downtime procedures.
2. Unplanned
i. The Manager or Supervisor on Call should contact the IT Help Desk to
identify extent of areas affected and estimated length of downtime.
ii. If downtime is expected to be greater than 2 hours and it affects Health
Link and/or Connect-Rx, refer to unplanned downtime procedures
titled Health Link Downtime.
C. NAL Downtime
1. Planned

POLICY & PROCEDURE




Revised Date:

March 2008
…Administrative Manual
… Nursing Manual
⌧ Other: Pharmacy

Policy #: 1.27

… Original
⌧ Revision 6/12
Page 5
of 11
Title: Directions for Health Link, Mobile
Meds, and/or Connect-Rx
Downtime

i. Manager and ITS should verify with the NAL team what applications
the downtime will affect.
ii. The Health Link application should be loaded onto the desktops of all
patient-care critical computers for local mode access.
2. Unplanned
i. The Manager or Supervisor on Call should contact the IS Help Desk to
identify extent of areas affected and estimated length of downtime.
ii. If downtime is expected to be greater than 2 hour, refer to unplanned
downtime procedures for Health Link as noted below.
D. Health Link Downtime
1. Refer to Administrative Policy 6.37 for non-pharmacy specific procedures.
2. Planned
i. The following steps should to be taken to prepare for Health Link
planned downtime:
a. Re-educate all staff about downtime procedures.
b. Inform and coordinate with McKesson IS and UWHC IS
regarding interface issues, particularly with Connect-Rx.
c. Print patient specific and blank MARs and create downtime
binders on each unit for charting medication administration.
d. Generate the cartfill list prior to the downtime, when
possible.
e. Print IV System reports, extemp lists, and special orders lists
when possible.
f. Verify all orders prior to taking system down
g. Distribute paper forms (MARs, yellow transcription order
forms, downtime IV order forms, patient activity rosters.
h. Provide medication chart and self-administration sheet access
to staff.
3. Unplanned
i. Determine expected length of downtime (contact ITS Help Desk,
and/or look at UConnect System Alerts)
ii. If expected length of downtime is expected to be greater than 2 hour or
significant, implement manual downtime procedures (refer to section
V. for communication guidelines).
iii. Distribute paper forms and refer to section 8, Mobile Meds downtime.
iv. Use blank medication charts and self-administration sheets.
v. Refer to decentral and central manual downtime procedures for
guidance in each of the affected areas (below).
E. Decentral Manual Downtime Procedures

POLICY & PROCEDURE




Revised Date:

March 2008
…Administrative Manual
… Nursing Manual
⌧ Other: Pharmacy

Policy #: 1.27

… Original
⌧ Revision 6/12
Page 6
of 11
Title: Directions for Health Link, Mobile
Meds, and/or Connect-Rx
Downtime

1. First 24 hours
i. Handwritten transcription will be done on Health Link generated
MARs. MARs should be separated by scheduled, PRNs, non-
continuous IV medications, and continuous IV medications. The
inpatient technician or PHA responsible for each unit will ensure that
these forms are obtained and are available on the unit.
ii. New orders should be transcribed using 3 yellow sheets.
a. Keep one copy of the orders separated and labeled by unit
and date for entry into Health Link upon recovery.
b. The second copy is used to communicate new med orders to
the carousel technician and to obtain all new medications
through the cartfill period.
c. Only STAT medications should be called down to triage to
avoid tying up the phone lines.
iii. Orders should also be transcribed by pharmacy and overnight nursing
staff onto the appropriate MAR for paper documentation of
administration to occur.
iv. To order new IV medications:
a. Ordering System.
i. IV solution orders should be transcribed as closely as
possible to the way the current order looks in Health
Link, but it is not necessary to include all the comments
and notes shown on the IV label, unless you need to
communicate specific information to the nurse, such as
refrigeration, etc.—i.e. information they would rely on
if they were viewing and charting the IV in Health
Link.
1. To do rate changes on an IV, yellow out the
order, add a note to “See Rate Change Below”,
and transcribe a new order with the new rate.
ii. Pharmacists should pass along the remaining yellow
order transcription forms and downtime IV order forms
to the next shift. Also pass along an updated patient
roster for the unit. The document is located in Rx Share
Directory, j:\rx\rxinfo\downtime roster form.

Diluent Name and Volume Dextrose 5% 100ML
Drug Additive(s) Dose and Dose Units Morphine 100MG
Notes/Comments Note: Concentration=1MG/ML

POLICY & PROCEDURE




Revised Date:

March 2008
…Administrative Manual
… Nursing Manual
⌧ Other: Pharmacy

Policy #: 1.27

… Original
⌧ Revision 6/12
Page 7
of 11
Title: Directions for Health Link, Mobile
Meds, and/or Connect-Rx
Downtime


2. Extended length of downtime (>2 hours)
i. MARs will be printed from the designated back up computer in each
of the medication rooms on each unit.
ii. Print only one page of MARs to a page in order to avoid orders from
two different patients displaying on the same page.
a. Pharmacists and pharmacist assistants should staple each
patient’s MAR individually and place in one of the four 3-ring
top loaded binders, organized by room number. Maintain
MAR binders in the team support area.
b. Nurses should write the time of administration in the field next
to the scheduled time due and initial beside the time. Circle
and initial any held doses.
c. Pharmacists will transcribe medications for all new orders
(orders originated during the downtime). Both nurses and
pharmacists should initial all new orders on the paper MAR
prior to administration of any medication. Note all parameters
including start and stop dates and times and compare them
against the original order sheet.
i. For new orders, pharmacists should transcribe the blank
MAR.
ii. A new blank MAR and Health Link MAR should be
generated every 24 hours starting at 0700.
iii. When new patients are admitted, a Health Link MAR
should be printed for that patient for the appropriate 24-
hour interval after admission orders are entered into
Health Link.
d. Both nurses and pharmacists should initial discontinued orders
on the original order sheet and on the MAR. (Pharmacists will
highlight discontinued orders in yellow on the MAR.)
e. Prior to the old MAR being filed in the patient chart it should
be examined for completeness. Any medications not given
(charted) should be given (charted against) before the MAR is
filed in the patient chart.
F. Central Manual Downtime Procedures
1. First doses:
i. New medication orders and first doses will be requested by the
decentral pharmacist using a paper order form (yellow slip) that
includes start date, time and the number of doses needed.

POLICY & PROCEDURE




Revised Date:

March 2008
…Administrative Manual
… Nursing Manual
⌧ Other: Pharmacy

Policy #: 1.27

… Original
⌧ Revision 6/12
Page 8
of 11
Title: Directions for Health Link, Mobile
Meds, and/or Connect-Rx
Downtime

ii. Medications are picked “On Demand” from the MedCarousel using
the CRX-Web application.
iii. Medications are tubed or delivered to the floor in the usual manner.
iv. As needed medications (PRN) that are not on the University of
Wisconsin Hospital and Clinics AcuDose-Rx Override List or
Controlled Substances that are not patient specific on override will be
treated as a first dose.
2. Cart Fill:
i. Carts are filled using a print off of the MAR and all medications will
be picked off the MAR
ii. MAR cartfill can be printed from the downtime computer in central
pharmacy.
iii. Before filling carts, a technician or pharmacist should determine the
number of doses needed per order so that the picking of medications
can be done quickly.
iv. Document the number of doses needed per order on the cartfill MAR.
v. Medications are picked from the MedCarousel using the “On
Demand” picking process.
3. AcuDose:
i. AcuDose restock requests and the restocking process is unaffected, as
these requests are generated through CRX.
4. SPA (Trigger Fill, Extemps, IV’s)
i. First doses will be processed as described in section F.1. Generic
labels will be generated using the manual label process.
ii. For subsequent doses: If another IV bag is needed, the pharmacist will
request using the trigger fill form to indicate the number of additional
bags needed and time requested. Generic labels will be generated
using the manual label process.
G. Inpatient Recovery Procedures:
1. Once the PIS is back online, the pharmacist will enter medication orders
into the system:
i. The start date/time of the order should match what was used on the
paper MAR.
ii. The pharmacist should click on “Do Not Dispense” when verifying the
order. By leaving it blank, this medication will not be dispensed until
the next cartfill.
iii. The pharmacist or technician then needs to go to the Medication Order
History and manually charge for each dose that was dispensed during
the downtime.

POLICY & PROCEDURE




Revised Date:

March 2008
…Administrative Manual
… Nursing Manual
⌧ Other: Pharmacy

Policy #: 1.27

… Original
⌧ Revision 6/12
Page 9
of 11
Title: Directions for Health Link, Mobile
Meds, and/or Connect-Rx
Downtime

H. Nights procedure during any downtime
1. For patients admitted during nights:
i. Only enough doses to last through the night will be sent to the unit by
the Night pharmacist, the quantity sent should be indicated by the
pharmacist on the order slip for the medication.
ii. The Night pharmacist will provide orders to be transcribed and
remaining doses to the A.M. pharmacy staff (technician/RPh) for
transcription onto the MAR.
2. Nurses should chart all first doses of medications given to existing patients
during Nights (2300 – 0700) by writing it on the one-time medication order
MAR.
VIII. REFERENCES:
Administrative Policy 6.37 - Health Link Downtime Procedure
Administrative Policy 14.1 - AcuDose Downtime policy
University of Wisconsin Hospital and Clinics AcuDose-Rx Override List
Inpatient Pharmacy Operations Manual: Using the Abacus software when network is
down
Inpatient Pharmacy Operations Manual: Central Pharmacy Downtime Operations

IX. COORDINATION:


Approved By: ____________________________
Director of Pharmacy Services

Date: _______________

XC: Ambulatory Pharmacist Master Training Folder
Supervisor On-Call Book
Ambulatory Pharmacy P&P Book


Appendix A. P&P 1.27

Sentinel Technologies Maintenance Of Hardware Information

Machine Type Machine Serial Model/Feature Description System
------------ -------------- ------------- ------------------------------- ---------------
7017 96067 S80 enterprise server RxTFC WARF
7017 96067 5318 6-way RS64 processor RxTFC WARF
7133 DK908 D40 serial disk system RxTFC WARF
7133 DK909 D40 serial disk system RxTFC WARF
7205 A3864 311 ext.digital. linear tape drive RxTFC WARF
3490 64565 A20 magnetic tape subsystem Mainframe DoIT
3490 70383 B40 magnetic tape Mainframe DoIT
3490 72874 B40 magnetic tape Mainframe DoIT
7043 10-3D33F 150 RS 6000 server Hemocare CSC C5/255
7025 43286 F50 RS 6000 server Delta WARF

ƒ To place a service call:
• Call Help Desk
• Give them the following information:
o Phone # (aka account number):
ƒ Company Name: UW Hospital and Clinics
ƒ Contact Person for the call: Most likely this will be
you.
ƒ Contact Person phone number: Most likely this will
be your number.
ƒ Equipment type and optional serial number: See
above equipment list.
ƒ A brief description of the problem.
o You will get a six digit call number to track the call.
o Within 30 minutes the assigned engineer will call back the
contact number to further troubleshoot the problem. If an
on-site visit is needed, an estimated time of arrival will be
given and arrangements to get access to the hardware will
be made.





Appendix B. P&P 1.27





















Downtime IV Solution Ordering System Order Labels Through
Batch Day Time
Patient:
Additive & Plain
IV's Monday 959
Unit: Narc IV's Monday 1559
Pharmacist: Onc IV's Monday 1359

Bag #
Time
Needed
Filled
By
Checked
By

Base Solution:
Volume
:

Additive 1
Additive 2
Additive 3
Additive 4
Circle: D/C New Rate Change
For Spa Use: HIGH ALERT MED? Yes No