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Initial Checking with all 820 MLMs

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Daniel Romischer
2020-02-02 00:54:01 -05:00
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maintenance:
title: Total Daily Dose Exceeded warning;;
mlmname: STD_TOTAL_DAILY_DOSE_EXCEEDED;;
arden: version 2.5;;
version: 18.4;;
institution: Allscripts, Standard MLM;;
author: Allscripts Healthcare Solutions, Inc.;;
specialist: ;;
date: 2018-10-26;;
validation: testing;;
/* P r o p r i e t a r y N o t i c e */
/* Unpublished (c) 2013 - 2018 Allscripts Healthcare, LLC. and/or its affiliates. All Rights Reserved.
P r o p r i e t a r y N o t i c e: This software has been provided pursuant to a License Agreement, with
Allscripts Healthcare, LLC. and/or its affiliates, containing restrictions on its use. This software contains
valuable trade secrets and proprietary information of Allscripts Healthcare, LLC. and/or its affiliates and is
protected by trade secret and copyright law. This software may not be copied or distributed in any form or medium,
disclosed to any third parties, or used in any manner not provided for in said License Agreement except with prior
written authorization from Allscripts Healthcare, LLC. and/or its affiliates. Notice to U.S. Government Users:
This software is {{{SINGLE-QUOTE}}}Commercial Computer Software{{{SINGLE-QUOTE}}}.
All product names are the trademarks or registered trademarks of Allscripts Healthcare, LLC. and/or its affiliates.
*/
/* P r o p r i e t a r y N o t i c e */
library:
purpose: Provides a warning if the current dose being scanned will exceed the daily total
allowed for this medication order item for this patient.
;;
explanation:
Total Daily Dose Limit Exceeded Warnings are based on Dosage Range Criteria defined
for the Order Item compared to the current dose to be administered summed with the
previous doses given in the past 24 hours. Based on settings this MLM will not alert
if the entering provider was issued a Dosage Alert at Order Entry and the order was
verified by Pharmacy. The MLM can also be set not to alert for patients with missing
physical characteristic data or for patients at particular locations.
REQUIRED FIELDS:
(When an appropriate criteria cannot be found, there will not be an alert.)
- The patient data must be present for:
* Age
* Height
* Weight
* Gender
- The task occurrence form fields must include:
* TaskDose
* TaskUOM
* TaskRoute
- The facility must map the following "Core UOM" to their "Dictionary Code"
in the Unit Of Measure Dictionary:
* BSA: M2
* Weight: kg, g, lb, oz
* Age: year, month, week, day
NOTE THE FOLLOWING ARE NOT INCLUDED IN MEDICATION DOSE RANGE CHECKING:
- This MLM is NOT currently using Base Solution, Base Solution UOM,
IV Rate, or IV Rate UOM fields to perform Dose Range checking on order entry
or modification.
- Generic item matches are NOT included.
The only TASKs that are checked include those tasks that orignate from matching
Catalog Order Items. That is they are the same medication in the Item Catalog.
At this release Tasks and Occurrences that orginate from the same
OrderCatalogMasterItem will have a matching CatalogItemTaskGUID and there is
a one to one relationship between OrderCatalogMasterItem and CatalogItemTask.
- Tasks with diffrernt uom are NOT included in the calculations.
Only Tasks with matching units of measure will be totaled since there is means of
converting units of measure. There is no Conversion table available in this
release.
- IV-ADDITIVES are NOT considered when doing dosage range checks; concentrations
and amounts are entered on flowsheets, not on IV tasks.
To calculate the {{{SINGLE-QUOTE}}}Total Dose Daily Dose Allowed{{{SINGLE-QUOTE}}}, the Dose Range Criteria for the parent
order of this task occurrence will be examined. The MLM will determine if a dose range
has been specified in the item catalog for one of the following {{{SINGLE-QUOTE}}}Total Daily" criteria
types:
- BSA - Total Daily
- Weight - Total Daily
- Age - Total Daily
If data are available for more than one criteria type, the priority will be in the order
listed above.
An alert will be generated for the first method encountered where the total dose is
outside of the recommended Total Daily dose.
If a matching criteria is found, the total daily dose determined. Calculations are
performed if a PER method is defined such as per kg or per M2.
The following patient characteristics will be used to determine if the specified total
daily dose is appropriate:
(1) patient body surface area (BSA),
(2) patient weight, and
(3) patient age
(4) gender, if listed on the Total Daily dose criteria
Absence of a patient characteristic required to perform the calculation will result in
an alert warning that the calculation cannot be determined due to missing data.
SPECIAL CONSIDERATIONS:
a. The SYS_CALC_BSA.mlm calculates the Body Surface Area (BSA) for
Dosage Range MLMs. SYS_CALC_BSA.mlm has two BSA formulas (standard or pediatric).
If patient is 18.0 years or younger, Pediatric BSA formula is used.
If age of patient cannot be determined due to missing birth year,
facility{{{SINGLE-QUOTE}}}s preference in the enterprise profile for BSAFormula.
Should facility{{{SINGLE-QUOTE}}}s preference be needed and BSAFormula has not been set, then
Standard BSA formula will be used. In addition, calculated BSA value
is rounded to two decimal places.
b. When patient has a partial birthday (missing birth month), then
dosage range check by AGE will not be done if patient is less than
3 years old (an age based on the birth year).
c. The MLM uses data from Unit of Measure dictionary and Dosage Range panel in
the Item-Catalog. The Unit of Measure dictionary maps facility-defined UOM called
"Dictionary Code" to System-defined UOM called "Core UOM." "Dictionary Codes" in
Dosage Range panel of item-catalog.
When calculating dose-ranges, only "Criteria Unit" and "Dosage Per-Wt-or-M2"
fields are converted from facility-defined UOM (Dictionary Code) to System-defined
"Core UOM";
d. "Dosage Unit" is not converted. For example if one tasks dosage is in grains and
one in umg, the doses are not converted to the same unit of measure.
f. The absence of an alert can mean one of the following:
* The all the doses were within the acceptable range.
* The appropriate criteria could not be found; so the Dosage could not be checked.
* No item matches were found for the item in this task.
;;
keywords: total daily dose, exceeded
;;
citations:
{{+B}}Development{{-B}}: Allscripts Healthcare Solutions, Inc. Clinical Information can be customized and configured by local facility.
{{+B}}Funding{{-B}}: None specific to the development of this alert
{{+B}}Release{{-B}}: None
{{+B}}Revision Date{{-B}}: 2012-11-07
{{+B}}Citations{{-B}}: None
;;
knowledge:
type: data-driven;;
data:
/*******************Make Changes To Spelling And Flags In This Section*******************/
/* Set to true if a decision.log is needed.*/
log_execution_info := false;
/* Set these flags to limit alerting.*/
no_alert_if_RxVerified := TRUE; // no alerts if Rx has verified all the orders
alert_if_patient_data_missing := TRUE; // issue alert if patient data is missing
alert_limited_locations := FALSE; // no alerts for particular patient locations
/* Insert the CV3Location.Code for each location that will not issue alerts in this list */
no_alert_locations := ("NGH |1C |","NGH |2A |");
/* The facility must map its Dictionary Codes to the Core UOM in the Units of Measure */
/* Dictionary. The MLM converts the facility-defined units of measure to the System- */
/* defined values in the Unit of Measure Dictionary called CoreUOM. */
lb_string:= "lb";
gm_string:= "g";
kg_string:= "kg";
M2_string:= "M2";
ounce_string:= "oz";
day_string:= "day";
month_string:= "month";
week_string:= "week";
year_string:= "year";
/* Change the message within the quotes if a different short-message is needed.*/
dose_exceeded_alert := destination { Alert: Warning, "Daily Dosage Exceeded", high,
chart, "Dosage Administration Alert", 5010,"DoNotSend",
"Must Acknowledge and Comment" };
/* Called on scanning event for Tasks */
medication_scan := event {OrderTaskOccurrenceIntendToAdmin User OrderTaskOccurrence :
WHERE OrderTask.TaskSeqNum = 0};
/***************************************************************************************/
/* DO NOT CHANGE the following System-defined values */
age_total_daily_dose_string:= "Age - Total Daily";
BSA_total_daily_dose_string:= "BSA - Total Daily";
weight_total_daily_dose_string:= "Weight - Total Daily";
continue_processing := TRUE;
found_range:= FALSE;
found_total_daily_dose:= FALSE;
more_than_one_task_in_sum := FALSE;
first_dose_given := FALSE;
mismatched_occ_uom_found := FALSE;
mismatched_med_uom_found := FALSE;
missing_data_error := FALSE;
missing_age := FALSE;
missing_weight := FALSE;
missing_height := FALSE;
past_administered_doses := 0;
pharmacy_verified_current := FALSE;
pharmacy_verified_all_past := FALSE;
err_msg := "";
missing_data_msg := "";
mismatched_past_occurrences_msg := "";
mismatched_occ_uom_msg := "";
mismatched_med_uom_msg := "";
alert_detail_text := "";
alert_msg := "none";
/* Execute only when this MLM is called by the editor */
if called_by_editor then
task_obj:= read last
{OrderTaskOccurrence: This,
WHERE TaskName = "Ampicillin Dosage:500"
and EXIST TaskDose
// AND SignificantDtm = 2004-11-17T15:00:00
AND TaskStatusCode = "Performed"
};
EvokingObject:= task_obj;
endif;
/* Declare MLMs which can be called */
find_daily_dose_range := MLM {{{SINGLE-QUOTE}}}std_func_total_daily_dose_cat{{{SINGLE-QUOTE}}} ;
calculate_BSA:= MLM {{{SINGLE-QUOTE}}}sys_calc_BSA{{{SINGLE-QUOTE}}};
/* Declare function for adding commas into numbers */
add_commas := MLM {{{SINGLE-QUOTE}}}SYS_FORMAT_NUMBER{{{SINGLE-QUOTE}}};
/**************************************************************************************/
/* Check Client location immediately if if client in "no alert" location, if so, exit */
/**************************************************************************************/
if alert_limited_locations
then
/* Get the patient{{{SINGLE-QUOTE}}}s current location, assigned or temporary */
if called_by_editor then
patient_loc_guid:= read last
{ClientVisit: BusinessRuleLocationGUID };
else
patient_loc_guid:= read last
{ClientVisit: BusinessRuleLocationGUID};
endif; /* if called by editor */
/* Get the Code for the GUID */
patient_loc_code:= read last
{"SELECT Code "
|| " FROM CV3Location "
|| " WHERE GUID = "|| SQL (patient_loc_guid)
, PrimaryTime = TouchedWhen };
endif; /* if alert_limited_locations */
if (patient_loc_code in no_alert_locations) AND alert_limited_locations
then
continue_processing := FALSE;
else
/*******************************************************(****************/
/* Get current task occurrence data - use to get Dose Range Criteria */
/************************************************************************/
/* Get information from the Current Evoking OrderTaskOccurrence */
(occurrence_name,
occurrence_guid,
occurrence_client_guid,
occurrence_summary_line,
occurrence_dose,
occurrence_uom,
occurrence_route,
occurrence_status_code,
occurrence_catalog_item_task_guid,
occurrence_order_guid,
occurrence_significant_dtm,
occurrence_performed_from_dtm,
order_obj,
order_task_obj,
back_up_obj ) := read last
{OrderTaskOccurrence: TaskName, GUID, ClientGUID, SummaryLine,
TaskDose, TaskUOM, TaskRouteCode, TaskStatusCode,
CatalogItemTaskGUID, OrderGUID, SignificantDtm,
PerformedFromDtm, Order, OrderTask, Backup
REFERENCING EvokingObject};
/* Get the reference to the current order{{{SINGLE-QUOTE}}}s Dosage Information */
(order_name,
order_med_uom,
order_med_route,
order_med_frequency,
order_med_significant_date,
chart_guid,
order_guid,
order_catalog_item_obj,
order_component_obj,
order_CMI_GUID,
order_GUID ) := read last
{ Order: Name, UOM, OrderRouteCode,
FrequencyCode, SignificantDtm, ChartGUID, GUID,
OrderCatalogMasterItem, OrderComponent,
OrderCatalogMasterItemGUID, GUID
REFERENCING order_obj};
/* Get the reference to the CatalogItemDosage object */
ordercatalog_item_dosage_obj:= read last
{OrderCatalogMasterItem: CatalogItemDosage REFERENCING order_catalog_item_obj };
/* Get the dosage range HIGH info from the item-catalog. */
/* Match to the order route and one of the Total Daily Dose Criteria Type Codes. */
(total_daily_range_high_codes,
total_daily_range_units,
total_daily_range_units_per,
total_daily_criteria_lows,
total_daily_criteria_highs,
total_daily_criteria_units,
total_daily_gender_code):= read { CatalogItemDosage:
RangeHigh,
RangeUom,
RangePerUom,
CriteriaTypeLow,
CriteriaTypeHigh,
CriteriaTypeUom,
GenderCode
REFERENCING ordercatalog_item_dosage_obj
WHERE RouteCode = order_med_route
AND CriteriaTypeCode is in (age_total_daily_dose_string,
BSA_total_daily_dose_string, weight_total_daily_dose_string ) };
/* Only retrieve other data if the medication has a Total Daily Dosage range */
If exist(total_daily_range_high_codes) and any (total_daily_range_high_codes > 0)
then
/* Get the patient{{{SINGLE-QUOTE}}}s birthday and other relevant data */
(client_guid,
client_birthdate,
client_birthMonthNum,
client_gender,
client_gender_internal,
client_info_obj ) := read last
{ ClientInfo: GUID, BirthDateTime, BirthMonthNum, GenderCode,
GenderTypeIntlCode, this, };
If NOT exists client_birthdate
then
missing_age:= TRUE;
missing_data_msg := missing_data_msg ||"\nPatient{{{SINGLE-QUOTE}}}s age must be entered "
||"to check Dose Range Limits. ";
endif;
/****************************************************/
/* Get Site Preferences for height, weight and BSA */
/****************************************************/
/* Get the BSA calculation preference */
/* This SQL statement will cause a table scan */
/* But the table only has 400 rows, so the impact is minimal */
BSA_formula_preference:= read last
{"SELECT Value "
|| " FROM HVCEnvProfile "
|| " WHERE Code = {{{SINGLE-QUOTE}}}BSAFormula{{{SINGLE-QUOTE}}} "
|| " AND HierarchyCode = {{{SINGLE-QUOTE}}}Client Info{{{SINGLE-QUOTE}}} " };
/* Retrieve the facility{{{SINGLE-QUOTE}}}s scope pref for HEIGHT */
general_scope_for_ht := read last
{"SELECT case when ScopeLevel = 3 then 1 else 0 end "
|| " FROM CV3PhysicalNoteType "
|| " WHERE Code = " || SQL("HEIGHT")};
/* Set the scope to retrieve the Height */
if general_scope_for_ht = 1
then ht_patient_chart_str:= "";
else ht_patient_chart_str:= " AND ChartGUID = " || SQL(chart_guid);
endif;
/* Retrieve the facility{{{SINGLE-QUOTE}}}s scope preference for WEIGHT */
general_scope_for_wt := read last
{"SELECT case when ScopeLevel = 3 then 1 else 0 end "
|| " FROM CV3PhysicalNoteType "
|| " WHERE Code = " || SQL("WEIGHT")};
/* Set the scope to retrieve the Weight */
if general_scope_for_wt = 1
then wt_patient_chart_str:= "";
else wt_patient_chart_str:= " AND ChartGUID = " || SQL(chart_guid);
endif;
/****************************************************/
/* Retrieve height and weight from the database */
/****************************************************/
/* Retrieve Height*/
/* Warning--keep this SQL in synch with business rules on patient height */
(ht_cm_str,
ht_date) := read last
{"SELECT Text, TouchedWhen "
|| " FROM CV3PhysicalNoteDeclaration"
|| " WHERE ClientGUID = " || SQL(client_guid)
|| ht_patient_chart_str
|| " AND Active = 1 "
|| " AND TypeCode = " || SQL("HEIGHT")
|| " AND Status = " || SQL("Active")
, PrimaryTime = TouchedWhen };
/* Convert height strings to numbers */
ht_cm:= ht_cm_str as number;
/* Retrieve patient{{{SINGLE-QUOTE}}}s actual current weight (expected in grams) */
/* Warning--keep this SQL in synch with
business rules on patient weight */
(wt_gm_str,
wt_date) := read last
{"SELECT Text, TouchedWhen "
|| " FROM CV3PhysicalNoteDeclaration"
|| " WHERE ClientGUID = "
|| SQL(client_guid)
|| wt_patient_chart_str
|| " AND Active = 1 "
|| " AND TypeCode = " || SQL("WEIGHT")
|| " AND Status = " || SQL("Active")
, PrimaryTime = TouchedWhen };
/* Convert weight string to number and convert grams to kilograms */
wt_kg := (wt_gm_str as number)/1000;
/*------------------------*/
/* CHECK FOR MISSING DATA */
/*------------------------*/
/* Check to see if height is present */
if ht_cm is number
and ht_cm > 0
then
missing_height := FALSE;
else
missing_height:= TRUE;
missing_data_msg := missing_data_msg || "\nPatient{{{SINGLE-QUOTE}}}s height must be "
||"entered to check Dose Range Limits. ";
endif;
/* Check to see if weight is present */
if wt_kg is number
and wt_kg > 0
then
missing_weight := FALSE;
else
missing_weight := TRUE;
missing_data_msg := missing_data_msg ||"\nPatient{{{SINGLE-QUOTE}}}s weight must be "
||"entered to check Dose Range Limits. ";
endif;
/* Check to see if gender is required for any dose critiera */
if any(total_daily_gender_code) <> NULL
then
if not exist client_gender
then
missing_gender := TRUE;
missing_data_msg := missing_data_msg ||"\nPatient{{{SINGLE-QUOTE}}}s gender must be "
||"entered to check Dose Range Limits. ";
endif;
endif; /* Check to see if gender is required */
/* No point in continuing if critial data is missing */
If missing_height and missing_weight and missing_age
then
missing_data_error := TRUE;
endif; /* If missing ht,wt, and age */
/*-------------------*/
/* Calculate the BSA */
/*-------------------*/
If NOT missing_height and NOT missing_weight
then
BSA_number_rounded:= Call calculate_BSA with
BSA_formula_preference,
ht_cm,
wt_kg,
client_info_obj;
endif; /* If NOT missing height or weight */
/* Get the Units of Measure info */
(uom_facility_code,
uom_sys_code):= read
{"SELECT Code, CoreUOM "
|| " FROM CV3UnitOfMeasure"
|| " WHERE Active = 1" };
/****************************************************************/
/* Get the first Total Daily range that applies to this patient */
/****************************************************************/
// This paramenter can be blank and return Total Daily criteria.
order_med_per_uom := "";
(found_total_daily_dose,
total_daily_dose_calc_method,
total_daily_lower_dose,
total_daily_upper_dose,
total_daily_units,
total_daily_per_uom,
total_daily_type_name ):= call find_daily_dose_range with
(age_total_daily_dose_string,
client_birthdate,
client_birthmonthnum,
BSA_number_rounded,
BSA_total_daily_dose_string,
order_catalog_item_obj,
day_string,
order_name,
gm_string,
kg_string,
lb_string,
m2_string,
month_string,
order_med_per_uom,
order_med_route,
order_med_significant_date,
order_med_uom,
ounce_string,
client_gender_internal,
uom_facility_code,
uom_sys_code,
week_string,
weight_total_daily_dose_string,
wt_kg,
year_string);
if found_total_daily_dose
then
// check if the order uom mataches the order task occurence uom
mismatched_med_uom_found := (order_med_uom <> occurrence_uom);
/********************************************************************/
/* Obtain the past administerations based on matching OrderGUID */
/********************************************************************/
/* Set interval to look back for administered doses */
past_start_time := occurrence_performed_from_dtm - 24 hours;
/* Get a list of past 24 hours administrations of this med */
(past_occurrences_dose_list,
past_occurrences_UOM_list,
past_occurrences_route_list,
past_occurrences_name_list,
past_occurrences_PerformedDtm_list,
past_occurrences_OrderGUID_list,
past_occurrences_order_RxStatusType ):= Read
{" SELECT oto.TaskDose, "
|| " oto.TaskUom, "
|| " oto.TaskRouteCode, "
|| " oto.TaskName, "
|| " ConvPerformedFromDtm.TimeValue as PerformedFromDtmOffset, "
|| " oto.OrderGUID, "
|| " me.RxStatusType "
|| " FROM CV3OrderTaskOccurrence oto JOIN CV3MedicationExtension me ON"
|| " oto.OrderGUID = me.GUID"
|| " JOIN CV3Order o ON"
|| " o.ClientGUID = oto.ClientGUID AND o.GUID = oto.OrderGUID"
|| " JOIN CV3ClientVisit cv ON"
|| " o.ClientGUID = cv.ClientGUID AND o.ClientVisitGUID = cv.GUID"
|| " CROSS APPLY dbo.SXADBConvertLocalToOffsetTblFn(cv.TimeZone, oto.PerformedFromDtm) AS ConvPerformedFromDtm "
|| " WHERE oto.ClientGUID = "
|| SQL(occurrence_client_guid)
|| " AND oto.CatalogItemTaskGUID = "
|| SQL(occurrence_catalog_item_task_guid)
|| " AND oto.PerformedFromDtm >= "
|| SQL(past_start_time)
|| " AND oto.PerformedFromDtm < "
|| SQL(occurrence_performed_from_dtm)
|| " order by oto.PerformedFromDtm"};
/************************************************************************/
/* Step through the list to add each to the total or to error message. */
/************************************************************************/
If exist past_occurrences_dose_list
then
first_dose_given := FALSE;
/* Check to see if all past orders were verified */
if ANY past_occurrences_order_RxStatusType <> 2
then
pharmacy_verified_all_past := FALSE;
endif; /* if any past type <>2 */
// step through the list and sum the past doses with matching uom
list_index := 1 seqto (count past_occurrences_dose_list);
for x in list_index do
temp_dose := first
(past_occurrences_dose_list where list_index = x);
temp_uom := first
(past_occurrences_uom_list where list_index = x);
temp_route := first
(past_occurrences_route_list where list_index = x);
temp_name := first
(past_occurrences_name_list where list_index = x);
temp_performed := first
(past_occurrences_PerformedDtm_list where list_index = x);
temp_order_GUID := first
(past_occurrences_OrderGUID_list where list_index = x);
if temp_order_GUID <> occurrence_order_guid
then
more_than_one_task_in_sum := TRUE;
endif;
if temp_uom = occurrence_uom
then
temp_dose := temp_dose as number;
past_administered_doses :=
past_administered_doses + temp_dose;
else
mismatched_occ_uom_found := TRUE;
temp_occurrence := "\n"||temp_name||" "
||temp_dose||" "||temp_uom||" "||temp_route
||" administered on " ||temp_performed;
mismatched_past_occurrences_msg :=
mismatched_past_occurrences_msg,temp_occurrence;
endif; /* if temp_uom = occurrence_uom */
enddo; // step through the list and sum
else
more_than_one_task_in_sum := FALSE;
first_dose_given := TRUE;
endif; /* If exist past_occurrences_dose_list */
/* For first dose or single order event, check for alert at order entry */
if first_dose_given and NOT more_than_one_task_in_sum
then
(alert_match_guid):= Read
{" SELECT CV3AlertDeclaration.GUID"
|| " FROM CV3AlertDeclaration "
|| " WHERE CV3AlertDeclaration.pObjectGUID = "
|| SQL(occurrence_order_guid)
|| " AND CV3AlertDeclaration.MLMName = {{{SINGLE-QUOTE}}}STD_DOSAGE{{{SINGLE-QUOTE}}}"
, PrimaryTime = SignificantDtm };
if exists alert_match_guid
then
alert_at_order := TRUE;
/* Check to see if phamacy verified this order */
(Rx_verify_type_2):= Read
{" SELECT CV3MedicationExtension.RxStatusType"
|| " FROM CV3MedicationExtension "
|| " WHERE CV3MedicationExtension.GUID = "
|| SQL(occurrence_order_guid)
|| " AND CV3MedicationExtension.RxStatusType = 2" };
if exists Rx_verify_type_2
then
pharmacy_verified_current := TRUE;
endif;
endif; /* if exists alert_match_guid */
endif; /* if first_dose */
/* Add the current dose being scanned to the past administered dose */
total_dose:= (occurrence_dose as number) + past_administered_doses;
/* Compose Alert Message now that the data has been obtained. */
If total_daily_type_name = "Age - Total Daily"
then
Alert_msg := "Based on this patient{{{SINGLE-QUOTE}}}s age, ";
elseIf total_daily_type_name = "Weight - Total Daily"
then
Alert_msg := "Based on this patient{{{SINGLE-QUOTE}}}s weight, ";
else
Alert_msg := "Based on this patient{{{SINGLE-QUOTE}}}s BSA, ";
endif; /* If total_daily_type_name */
/* Round to the nearest 0.001 */
total_daily_upper_dose_rounded:= ((((int((total_daily_upper_dose
+ 0.00051)*1000))/1000 )
formatted with "%.4f") AS NUMBER);
total_daily_upper_dose_rounded := call add_commas
with ( total_daily_upper_dose_rounded );
total_dose_rounded:= ((((int((total_dose
+ 0.00051)*1000))/1000)
formatted with "%.4f") AS NUMBER);
total_dose_rounded := call add_commas
with ( total_dose_rounded);
Alert_msg:= Alert_msg || "the Total Daily Dose"
|| " for a patient fitting this profile and route is: "
|| total_daily_upper_dose_rounded
|| " " || order_med_uom || "."
|| "\nWith this dose, in the past 24 hours this "
|| "patient will have received : "
|| "\n {{+B}}{{+C}}Dose Total{{-B}}{{-C}}(in 24 hours): {{+B}}{{+C}}"
|| total_dose_rounded
|| " " || occurrence_uom || " {{-B}}{{-C}}" ;
mismatched_occ_uom_msg := "\n{{+B}}The following tasks have a different "
|| "unit of measure. {{-B}}"
|| "\nTherefore, they have not been included in calculations. "
|| "Please manually verify if the current dosage will "
|| "exceed the Total Daily Dose Range limits."
|| mismatched_past_occurrences_msg;
If Alert_msg = "none"
then
Alert_msg := mismatched_occ_uom_msg;
endif; /*If Alert_msg := "none" */
If mismatched_med_uom_found
then
mismatched_med_uom_msg := "\n\n{{+B}}The administered dose for the current task has a different "
|| "unit of measure compared to the original medication{{{SINGLE-QUOTE}}}s unit of measure. {{-B}}\n"
|| "The current task dose unit of measure is {{+B}}{{+C}}" || occurrence_uom || "{{-B}}{{-C}}"
|| " whereas the medication was ordered in {{+B}}{{+C}}" || order_med_uom || "{{-B}}{{-C}}.\n\n"
|| "Please manually verify if the current dosage will "
|| "exceed the Total Daily Dose Range limits.";
Alert_msg := Alert_msg || mismatched_med_uom_msg;
endif;
If mismatched_occ_uom_found
then
Alert_msg := Alert_msg|| "\n"|| mismatched_occ_uom_msg;
endif; /* if mismatched_occ_uom_found */
else
if missing_height or missing_age or missing_weight or missing_gender
then
missing_data_error := TRUE;
endif;
endif; /* if found_total_daily_dose ... */
else
// if NO Total Daily Dose criteria then stop processing
continue_processing:= false;
endif; /* If exist(total_daily_range_high_codes) */
endif; /* if patient_loc_code in no_alert_locations */
;;
evoke:
medication_scan;
;;
logic:
/* Stop Processing MLM when continue_processing was false. */
if NOT continue_processing
OR (alert_at_order
AND
((pharmacy_verified_current AND pharmacy_verified_all_past AND no_alert_if_RxVerified)
OR(pharmacy_verified_current AND NOT more_than_one_task_in_sum)))
then
conclude false;
endif;
If exists total_dose
AND exists total_daily_upper_dose
AND (total_dose > (total_daily_upper_dose as number))
AND order_med_uom = occurrence_uom
then
alert_detail_text := "{{+B}}{{+C}}{{+U}}"
|| "Total Daily Dose Exceeded for " || order_name
|| "{{-U}}{{-B}}{{-C}}\n\n" || Alert_msg;
conclude true;
elseif missing_data_error AND alert_if_patient_data_missing
then
err_msg := "{{+B}}There are dose range limits set for this drug. However, "
|| "Total Daily Dose Limits could not be checked due to "
|| "missing patient data:{{-B}} " || missing_data_msg;
conclude true;
elseif mismatched_med_uom_found
then
alert_detail_text := "{{+B}}{{+C}}{{+U}}"
|| "Total Daily Dose Checking Not Performed{{-U}}{{-B}}{{-C}}\n\n"
|| Alert_msg;
conclude true;
elseif mismatched_occ_uom_found
then
alert_detail_text := "{{+B}}{{+C}} {{+U}}"
|| "Total Daily Dose could not be determined{{-U}}{{-B}}{{-C}}\n\n"
|| Alert_msg;
conclude true;
else
conclude false;
endif;
;;
action:
/* Create an alert message */
If missing_data_error then
write err_msg
at dose_exceeded_alert;
else
write alert_detail_text
at dose_exceeded_alert;
endif;
;;
Urgency: 60;;
end: