Medicine to Medicine Interaction Checking
NZF Dispensing Alerts
When selecting a medicine during script processing, the Interaction Check will warn of any interactions with medicines already dispensed to the patient, unless the interaction has displayed previously (depending on the interaction levels set in General options). Warnings will not display for supply orders and inter-stores, or when the script is not for a real person (e.g. a company or pet) and No interaction checking or Suppress all clinical warnings has been set against that "patient".
The Interaction Check will be colour coded, and have Action, Severity, and Evidence, as per the NZF:
Above example has the Actions to show level set to All.
Manual Interaction Checking
It is possible to do a manual interactions check during dispensing - if an alert was missed, for example. After medicine selection, use F10 Other > Interactions/intolerances - check to redisplay the NZF Interaction Check:
Note: This manual interactions check will also display any NZF Allergies/Adverse Reactions (ADR) the patient has to the selected medicine.
NZF Information Panel
After medicine selection, an NZF Information Panel will display the number of recommended actions for interactions with previously dispensed medications, according to the options set in General options and irrespective of whether an Interaction Check has displayed:
If there are no interactions to show then the display will be blank, and if there is no NZF information available it will display:
Customise Interaction Levels and Options
Alerts can be customised to pharmacy specific requirements, to avoid alert fatigue for example, on the third page of General options (from the main menu: 7. Administration > 1. Setup > 5. General options).
NZF Specific Options
Actions to show
Medicine Interactions can be filtered by level of seriousness using Actions to show. The default is to show All actions, but to change this setting, press the spacebar and choose from the following options:
Patient history look back days
How far back the program looks for medicine interactions can be customized by specifying the Patient history look back days:
The default lookback is the whole of a patients’ history, indicated by 0 in Patient history look back days. This may be changed, with the minimum lookback being 180 days.
Note: Patient history lookback days will not work beyond the limit set by Patient history load days and Script load days (page 1 of General options) as they control the amount of history accessible by the Toniq program.
Normally an interaction will not re-prompt if it has previously displayed for a patient, however the following settings change this behaviour:
- Re-show interactions if pharmacist changes
Note: Change of pharmacist is determined by staff logon. If the pharmacy does not use this level of security, the Re-show interactions if pharmacist changes option will not work.
- Re-show interactions if doctor changes
Other options available are:
- Check held Rxs for interactions (if unticked, interactions will alert at the time of dispensing), and
- Suppress topical vs. systemic intolerances.
Note: The greyed-out options under Medicine Interactions are not applicable to NZF functionality.
Interaction Check Forms and Labels
As the name suggests, check forms and labels can be enabled to help medicine checkers by alerting them to interactions, allergies/adverse reactions, and other changes to scripts compared to previous dispensings.
Check Label Options
Depending on the Check Label Options set in 7. Administration > 1. Setup > 3. Printer setup > 2. Label print options, then F11 Next Page, either an A5 check form or a check label may print. Interactions to the level detected during script processing will be printed.
The options pertinent to NZF Interactions are:
- Print at 'End Visit' - Turns on (or off) the printing of check labels or forms.
- Interactions – NZF Interactions will print on the check form or label if ticked.
- Use CRC printer – Prints the check form to the A5 (CRC) printer if ticked, otherwise the label printer will be used, limiting the amount of information displayed.
- Maximum number of interaction detail lines – When set to a figure between 1 and 20, the check form will print NZF Explanation and Action lines of text to the limit of that value:
However, if Maximum number of interaction detail lines is 0 then only the interaction medicines, Action and Severity are listed:
Note: the level of Actions to show for two examples above was set to Monitor, Adjust, Avoid.
Reprint Check Form / Label
Check forms or labels can be re-printed from the patient history grid, if required. With a patient selected, press F5 Use History then F8 Re-Print, and select 3 Check items:
The program will then allow the user to select the medicine, or medicines, to check interactions against. Use F8 Check Items to select individual medicines, or F9 Select Day to choose all dispensings for that day, then press F11 Auto Accept:
Dispensary will query how far back to check for interactions before printing the check form or label: