maintenance:

	title:  Dosing recommendations based on age, weight, or total dose;;
	mlmname:  SCH_Other_Dosing_Recommendations;;
	arden: version 2;;
	version: 5.50;;
	institution: St Clair;;
	author:  Teresa Spicuzza, Allscripts Corp;;
	specialist: Teresa Spicuzza;;
	date:  2012-08-20;;
	validation:  testing;;

library:
	purpose:  Dosing Recommendations and Warnings for select medications
	;;
	
	explanation: MLM will read table for drug and suggest dosing as stated in logic.
	
	Change history 
    		06.12.2013   TMS   Created CSR 31334
			06.09.2015	 TMS   Updated for allopurinol alert.  CSR 33467
			05.16.2018   TMS   Add "With Dialysis Treatment" to Frequency retrievals that contain As Ordered.  CSR 33940

	Drugs included in MLM:  Methotrexate; Allopurinol
		
	;;
	keywords:  Dosing
	
	;;
knowledge:
	type: data-driven;;
	
	data:

		// Specify which .NET assemblies need to be loaded for ObjectsPlus
        standard_libs := MLM {{{SINGLE-QUOTE}}}std_include_libs{{{SINGLE-QUOTE}}};
   	    include standard_libs;

		error_occurred := false;
		error_message := "";
		str_parse := mlm {{{SINGLE-QUOTE}}}UTIL_STRING_PARSE{{{SINGLE-QUOTE}}};
		
		log_execution_info := false;
		
		//Set the text for this variable to indicate whether to send the message or not
		send_alert := "DoNotSend";
	
		//--------------------------------------------------------------------
		if called_by_editor 
		then
			EvokingObject := read last {Order: THIS 
											where Name="Ketorolac Inj" };
		endif;

		doalert := false;
		order_enter_event := event { OrderEnter User Order: where TypeCode = "Medication"};

		(CatalogItemObj, FrequencyValue, UOMValue, DoseValue, OrderName, AdminIns, UserSchedType ,UserSchedDays, UserSchedDoses, OrderingProviderGuid) := read last
		 {Order: OrderCatalogMasterItem, FrequencyCode, UOM, DosageLow, Name, AdminInstructions, Interval, DaysInInterval, DoseMultiplier, CareProviderGuid 
		 					REFERENCING EvokingObject};


		CatalogClassTypeValueObj  := read last {OrderCatalogMasterItem: CatalogClassTypeValue,  
							REFERENCING CatalogItemObj};

		ClassTypeValue_code_list, ClassTypeValue_value_list  := read {CatalogClassTypeValue: Code, Value 
							REFERENCING CatalogClassTypeValueObj where code = "PRX_DosingAlerts"};

	/* Get the OrderAdditionalInfo object pointer */
		OrderAdditionalInfoObj := read last { Order: OrderAdditionalInfo
							REFERENCING EvokingObject };

	/* Get information from the OrderAdditionalInfo object */
	(SummaryLine, FreqfromTime,FreqUOM, StopAfterValue, StopAfterOption ) := read last { OrderAdditionalInfo: FreqSummaryLine, FreqFromTime, FreqUOM, StopAfterValue, StopAfterOption 
							REFERENCING OrderAdditionalInfoObj };
	
	
		
	dose_alert_dest := destination {alert} with
								[alert_type := "Warning",
								short_message := "Dosing Recommendation",
								priority := "Low",
								scope := "Chart",
								rule_group := "Dosing Recommendations",
								rule_number := 4081,
								send_with_order := send_alert,
								alert_dialog_settings := "",
								display_alert := true];
	
	for r  in (1 seqto 1) do	
		classvaluelist := call str_parse with ClassTypeValue_value_list  [r],",";	
		classvalue := classvaluelist[1];  
	enddo;
//		
	if EvokingEvent = order_enter_event then
		 if "PRX_DosingAlerts" in ClassTypeValue_code_list then  
				continue := "yes";
		else   		
				continue := "no";
		endif;
	endif;
		
	If continue = "yes" then	
		(schedtime, freqcode, timefrom, timeuom) := read last
		{" select fsd.ScheduledTime, cft.FrequencyCode, cft.TimeFromValue, cft.TimeUom from  CV3CodedFreqTranslation cft"			
		|| " join CV3FixedScheduleDefinition fsd on fsd.ParentGUID = cft.guid "
		|| " where cft.FrequencyCode = " || sql(frequencyvalue) || " and FrequencyClass = {{{SINGLE-QUOTE}}}<Default>{{{SINGLE-QUOTE}}} and cft.Active = 1"
		|| " order by fsd.ScheduledTime "
		};

	(TimesPerDay) := read last  {" select count (fsd.ScheduledTime) from  CV3CodedFreqTranslation cft"
		|| " join CV3FixedScheduleDefinition fsd on fsd.ParentGUID = cft.guid "
		|| " where cft.FrequencyCode = " || sql(frequencyvalue) || " and FrequencyClass = {{{SINGLE-QUOTE}}}<Default>{{{SINGLE-QUOTE}}} and cft.Active = 1"
		};	


		
	Oncegroup := ("Now", "STAT", "Once", "One Time", "Today,", "Load", "Pre-procedure", 
				  "Post-procedure","Pre-Transfusion", "Post-Transfusion","Between Blood",
				  "PRE OP,", "POST OP", "As Ordered", "As Directed", "Given in Infusion Center", 
				  "Given in Delivery Room","With Dialysis Treatment");
				
		

		If frequencyvalue in Oncegroup then 	
			frequencygroup := "OneTime"; 
		else frequencygroup := "Other";
		endif;

		If frequencyvalue <> "<User Schedule>" and frequencygroup <> "OneTime" then

			If timefrom = 1 and timeuom = "day" then
				If TimesPerDay =  1 then frequencygroup := "Q24H"; Freqfactor := 24;  Weeklydoses :=  7; endif;
				If TimesPerDay =  2 then frequencygroup := "Q12H"; Freqfactor := 12;  Weeklydoses := 14; endif;
				If TimesPerDay =  3 then frequencygroup := "Q8H";  Freqfactor :=  8;  Weeklydoses := 21; endif;
				If TimesPerDay =  4 then frequencygroup := "Q6H";  Freqfactor :=  6;  Weeklydoses := 28; endif;
				If TimesPerDay =  6 then frequencygroup := "Q4H";  Freqfactor :=  4;  Weeklydoses := 42; endif;
				If TimesPerDay =  8 then frequencygroup := "Q3H";  Freqfactor :=  3;  Weeklydoses := 56; endif;
				If TimesPerDay = 12 then frequencygroup := "Q2H";  Freqfactor :=  2;  Weeklydoses := 84; endif;
				If TimesPerDay = 24 then frequencygroup := "Q1H";  Freqfactor :=  1;  Weeklydoses := 168; endif;

			elseif timefrom = 2 and timeuom = "day" then
				If TimesPerDay =  1 then frequencygroup := "Q48H"; Weeklydoses := 4; endif;
		
			endif; 
		endif;

		If frequencyvalue = "<User Schedule>" then
			If UserSchedType = "Weekly" then 
				If UserSchedDays <= 2 and UserSchedDoses = 1 then 
					frequencygroup := "Q7D";
				elseif
					UserSchedDays >2 or UserSchedDoses > 1 then 
					Weeklydoses := ((UserSchedDays as number) - 1) * (UserSchedDoses as number);
					frequencygroup := "Other";
				endif;		

			elseif UserSchedType = "Daily" and UserSchedDays = 1  and FreqFromTime = 1 and FreqUom = "day" then
				If UserSchedDoses =  1 then frequencygroup := "Q24H"; Freqfactor := 24; Weeklydoses := 7; endif;
				If UserSchedDoses =  2 then frequencygroup := "Q12H"; Freqfactor := 12; Weeklydoses := 14; endif;
				If UserSchedDoses =  3 then frequencygroup := "Q8H";  Freqfactor :=  8; Weeklydoses := 21; endif;
				If UserSchedDoses =  4 then frequencygroup := "Q6H";  Freqfactor :=  6; Weeklydoses := 27; endif;
				If UserSchedDoses =  6 then frequencygroup := "Q4H";  Freqfactor :=  4; Weeklydoses := 42; endif;
				If UserSchedDoses =  8 then frequencygroup := "Q3H";  Freqfactor :=  3; Weeklydoses := 56; endif;
				If UserSchedDoses = 12 then frequencygroup := "Q2H";  Freqfactor :=  2; Weeklydoses := 84; endif;
				If UserSchedDoses = 24 then frequencygroup := "Q1H";  Freqfactor :=  1; Weeklydoses := 168; endif;
	
			elseif UserSchedType = "Daily" and UserSchedDays = 1  and  FreqFromTime = 2 and FreqUom = "day" then  
				If UserSchedDoses = 1 then frequencygroup := "Q48H"; Weeklydoses := 4; endif;
	
			endif;
		endif;		//If frequencyvalue = "<User Schedule>" 

		DurationFactor := StopAfterValue;
		If StopAfterOption = 2 then DurationType := "Hours"; OrderDuration := StopAfterValue || DurationType; endif;
		If StopAfterOption = 3 then DurationType := "Mins";  OrderDuration := StopAfterValue || DurationType; endif;
		If StopAfterOption = 4 then DurationType := "Times"; OrderDuration := StopAfterValue || DurationType; endif;
		If StopAfterOption = 1 then DurationType := "Days";  OrderDuration := StopAfterValue || DurationType; endif;
		If StopAfterOption = 0 then DurationFactor := 1; DurationType := "Days"; endif;

	
// Calculate the Total Daily Dose //

		If (DoseValue as number) > 0 then
  
			If (UserSchedDoses as number)  > 0 and UserSchedType = "Daily" and UserSchedDays = 1 then 
			
				If DurationType = "Days" and StopAfterOption = 0  then  
					TotalDailyDose := ((UserSchedDoses as number) * (DoseValue as number)); 
					TotalWeeklyDose := ((TotalDailyDose as number) * 7);
						
				elseif DurationType = "Days" and StopAfterOption = 1 then 
			//	TotalDailyDose := ((UserSchedDoses as number) * (DoseValue as number)); 
					If (DurationFactor as number) < 7 then
						TotalWeeklyDose := ((TotalDailyDose as number) * (DurationFactor as number));
					else
						TotalWeeklyDose := ((TotalDailyDose as number) * 7); 
					endif;
//			elseif DurationType = "Times" and (DurationFactor as number) < (UserSchedDoses as number) then 
					TotalDailyDose := ((DurationFactor as number) * (DoseValue as number));
					TotalWeeklyDose := TotalDailyDose;

				elseif DurationType = "Times" and (DurationFactor as number) > (UserSchedDoses as number) then 
					If (DurationFactor as number) > (WeeklyDoses as number) then
						TotalWeeklyDose := (DoseValue as number) * (WeeklyDoses as number);
					else
						TotalWeeklyDose := (DoseValue as number) * (DurationFactor as number);
					endif;    
//
				elseif DurationType = "Hours" and (DurationFactor as number) <= 24  then 
					TotalDailyDose := (Int((DurationFactor as number)/(FreqFactor as number))) * (DoseValue as number); 

				elseif DurationType = "Mins" and (DurationFactor as number) <= 999  then 
					TotalDailyDose := (Int((DurationFactor as number) / 60)/(FreqFactor as number)) * (DoseValue as number); 
				endif;

			elseif UserSchedType = "Weekly" and  frequencygroup = "Other" then
				TotalWeeklyDose := ((DoseValue as number) * WeeklyDoses);

			elseif  (TimesPerDay as number) > 0 then 
				If DurationType = "Days"  and StopAfterOption = 0 then
					TotalDailyDose := ((TimesPerDay as number) * (DoseValue as number)); 
					TotalWeeklyDose := ((TotalDailyDose as number) * 7);


				elseif DurationType = "Days" and StopAfterOption = 1 then
					TotalDailyDose := ((TimesPerDay as number) * (DoseValue as number)); 
					If (DurationFactor as number) < 7 then
						TotalWeeklyDose := ((TotalDailyDose as number) * (DurationFactor as number));
					else
						TotalWeeklyDose := ((TotalDailyDose as number) * 7); 
					endif;
	
				elseif DurationType = "Times" and (DurationFactor as number) < (TimesPerDay as number) then 
					TotalDailyDose := ((DurationFactor as number) * (DoseValue as number)); 
					TotalWeeklyDose := TotalDailyDose;

				elseif DurationType = "Times" and (DurationFactor as number) > (TimesPerDay as number) then 
					If (DurationFactor as number) > (WeeklyDoses as number) then
						TotalWeeklyDose := (DoseValue as number) * (WeeklyDoses as number);
					else
						TotalWeeklyDose := (DoseValue as number) * (DurationFactor as number);  
					endif;    


				elseif DurationType = "Hours" and (DurationFactor as number) <= 24  then 
					TotalDailyDose := (Int((DurationFactor as number)/(FreqFactor as number))) * (DoseValue as number); 

				elseif DurationType = "Mins" and (DurationFactor as number) <= 999  then 
					TotalDailyDose := (Int((DurationFactor as number) / 60)/(FreqFactor as number)) * (DoseValue as number); 
				endif;	
	
			else TotalDailyDose := "Unknown";

		endif; 
	endif;  //If (DoseValue as number) > 0


	(ClientVisitGuid, ChartGuid, ClientGuid, CurrentLocation, LocationGuid, VisitStatus) := read last {ClientVisit: GUID, ChartGUID, ClientGUID, CurrentLocation, CurrentLocationGUID, VisitStatus };
		(UserGUID ) := read last { UserInfo: GUID };

// Get the patient age
		(birthdate,dobM,dobD,birth_year, patientgender ) := read last { ClientInfo: BirthDate, BirthMonthNum, BirthDayNum, BirthYearNum, gendercode };
  		patientAge := (NOW - birthdate) / (1 year); 
		patientage:= (int (patientage));

// Get the patient weight
	wtgm := read last 
			  { " Select Text from CV3PhysicalNoteDeclaration  "
				|| 	" where ClientGUID = " || SQL(ClientGuid)
				||  " and ClientVisitGUID = " || SQL(ClientVisitGuid)
				||	" and TypeCode = {{{SINGLE-QUOTE}}}weight{{{SINGLE-QUOTE}}} "
				||	" order by Entered asc "
			  };
	
	patientwt := (wtgm as number) / 1000; 

	if continue = "yes" then 
	


// Compare ordering info with rule info and process when match found.
						If Classvalue = "Methotrexate"  then
						
							If ((TotalWeeklyDose as number) < 25) and UOMValue = "mg" then	
								
								If (Frequencygroup <> "Q7D") then
									if (Frequencygroup = "Q12H" and OrderDuration = "3Times")and TotalWeeklyDose <= 25 then
										doalert := false; 
									else
										Rulemsg := "For autoimmune indications, methotrexate is usually dosed weekly OR the weekly dose may be divided q12hr x 3 doses." 
										||"\n Please review frequency, dosing, and indication carefully.";	

										alert_message :=   "{{+B}} Ordered: "||OrderName || " " || DoseValue || UomValue|| ", "  || SummaryLine 
													|| "\n\n {{+R}}"   || Rulemsg || "{{-R}} {{-B}}";
										doalert := true;	
									endif; 
								endif;
							
							
							elseIf (((DoseValue as number)> 25)or ((TotalWeeklyDose as number) > 25))  and UOMValue = "mg"   then
								If  Frequencygroup = "Q7D" then
									Rulemsg := "Methotrexate doses greater than 25mg PO weekly for autoimmune conditions"
										|| " are not usually recommended due to increased risk of toxicity.";
								alert_message :=   "{{+B}} Ordered: "||OrderName || " " || DoseValue || UomValue|| ", "  || SummaryLine 
													|| " \n\n {{+R}}"   || Rulemsg || "{{-R}} {{-B}}";	
								doalert := true;
																				
								else 
									Rulemsg := "Methotrexate doses >25 mg (or Total Weekly Dose > 25mg) PO are associated with increased toxicity and"
										|| " should be reviewed or prescribed by Hematology/Oncology.";
									alert_message :=   "{{+B}} Ordered: "||OrderName || " " || DoseValue || UomValue|| ", "  || SummaryLine 
													|| " \n\n {{+R}}"   || Rulemsg || "{{-R}} {{-B}}";
									doalert := true;	
								endif;
							

							elseIf ((TotalWeeklyDose as number)> 25) and UOMValue = "mg"   then
								If  Frequencygroup <> "Q7D" then
							
									Rulemsg := "Methotrexate doses >25 mg (or Total Weekly Dose > 25mg) PO associated with increased toxicity and"
										|| " should be reviewed or prescribed by Hematology/Oncology.";
									alert_message :=   "{{+B}} Ordered: "||OrderName || " " || DoseValue || UomValue|| ", "  || SummaryLine 
													|| " \n\n {{+R}}"   || Rulemsg || "{{-R}} {{-B}}";
									doalert := true;
									
								endif;	
							endif;
											
						elseif Classvalue = "Allopurinol"  then

							if frequencygroup = "Q24H" and (DoseValue as number)> 300 then
								Rulemsg := "Doses greater than 300mg/day should be administered in divided doses.";
								alert_message :=   "{{+B}} Ordered: "||OrderName || " " || DoseValue || UomValue|| ", "  || SummaryLine 
													|| " \n\n {{+R}}"   || Rulemsg || "{{-R}} {{-B}}";
								doalert := true;
							endif;
 
												

						else
								doalert := false;
						endif;
				
			//	endif;		
			
			endif;			

	endif;


	;;
	priority: 50
	;;
	evoke:  order_enter_event;
		
	;;
	logic:
	
		if 	called_by_editor 
		then
			conclude false;
		endif;

		//----------------------------------------------------------------
		// If there is no evoking object then do nothing, this can
		// only be true for the MLM Editor
		//----------------------------------------------------------------
		if EvokingObject is null
		then
			conclude false;
		endif;
		if continue = "no"
			then
				conclude false;
			endif;
		

	conclude doalert;

	;;
	action:
			write alert_message at dose_alert_dest
	;;
Urgency: 50;;
end: