AC Outpatient Label System Designed to use DYMO s LabelWriter Printers

Transcription

1 AC Outpatient Label System Designed to use DYMO s LabelWriter Printers Dave Andersen, RPh, MPA andersen-computing.com 3/15/2017

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3 Table of Contents Overview-Program Origins... 1 Outpatient Labels... 2 Runtime Module... 2 DYMO Label Software... 4 Installation Instructions... 5 Choosing the Full or Light Versions of the Backup System... 5 Using the Prescription Number Program (Rx_No.exe)... 6 Opening the Program... 7 Edit Hospital Data... 7 Manage Pharmacy Users... 9 Change User Passwords Program Buttons and Functions Label Printer Options Selecting the Printer DYMO Printer Settings Zebra Printer Settings Label Options Patient Database Locate Function Edit the Warning Label Database Edit the Drug Database Prescription Order Entry Prescription Numbers Reports Use as a Backup System with the Hospital computer software is down License Report Samples Warning Label Images Notes: Competency Assessment Form:... 38

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5 Overview-Program Origins In the late 1980 s, I was a Captain in charge of the Pharmacy at Noble Army Community Hospital in Ft. McClellan, AL. There I was introduced to dbase III (Wikipedia link). The DoD decided to change our supply system from punch-cards to a dataset with this new-fangled program that would work on an IBM based PC. We had to convert all that data into a database that could be accessed at will (almost). While entering our pharmacy s formulary into the system (the first dbase program I d ever seen), I began to imagine other possibilities. My first foray into dbase programing was to make a crash cart program to track the carts ingredients, their expiration dates, and the cart locations. Thanks to a professor at Jacksonville State University (I was getting a Master s in Public Administration at the time), I was given the basics in dbase programming and someone to help me get through some of the more difficult tasks. I progressed to Clipper in the 90 s, creating my first stand-alone Windows 3.1 program, a poker game. With Clipper, not could I now create a database program, but distribute it without the expense of a user buying their own copy. The outpatient label program I eventually developed was MS-DOS based and used dot matrix printers. The label program found its way into military field medical units, replacing some electric and manual typewriters. Ashton-Tate sold the program to Borland, who also eventually developed a product to make stand-alone programs using a Runtime Module (Visual dbase). I used this version to improve my crash cart programs, created a program to track pharmacy supplies, pharmacy interventions, and a new and improved label program using this new label printer from DYMO, the LabelWriter 330. Next, I used the same program to port the program to laser and ink jet printers, for the days our hospital system (CH CS) would go down. Later, in 2005, just after I had left the Army for the civilian world, I was introduced to another company, dbase, Inc. They improved the database, though, much of the world was moving to Microsoft Access and others. Their product was far superior to the earlier versions, the runtime modules kept getting easier to use and install. I used the program to design a business card software program, an IV Label program, Unit dose system, two different methods to track Crash Carts and Emergency Kits, a program to keep compounding formulas and data, and, yes, another label program. In 2007, I left a community hospital in South Carolina, to work with CVS. They kept me busy enough, that I had to give up the programing sideline. I left CVS and went back to work at that same community hospital 6 years later. This time I tried my hand at MS-Excel programming, producing label programs and a Pharmacy Compounding program to help us comply with USP Now, as I near complete retirement from the practice of Pharmacy, I have a new version of dbase (10) and I m keeping the mind sharp by more programming. Each of the programs will be designed as tools for use by pharmacists and technicians (civilian and military). These programs are free of charge and require only minimal registration. These programs will be available from my website, Andersen-Computing.com as they are updated. 1

6 Outpatient Labels This Rx label system can be used in many ways: humanitarian missions, label backup options when the hospital system goes down, military field deployments, and even in some academic settings. Once the program has been downloaded (see link above), the zipped file will have a password required for installation. That password will be sent after minimal information is left at the registration site. These programs were developed with various versions of dbase. This program is a 32 bit version for Windows 2000, XP, and 7. It should also function properly in Windows 8.X or Windows 10. I am currently working on a 64 bit version, available soon. Runtime Module The first step is to install the Runtime Module. This is an earlier runtime and must be installed before the Outpatient Label program is installed. Other of my database programs will be available in the near future. They will require the same Runtime, but it only needs installation one time. This program allows dbase programs to be run on a PC without buying the full dbase software package. Best of all it is FREE!! Download the zipped Runtime, unzip and run Setup.exe. Please install the files to a folder named (this will probably be the default location) C:\Program Files (x86)\dbase\runtime. If you install to a different folder, please note the exact location. The following images depict each step: Step 1: From the Outpatient Label Website, click on the link to the dbase Runtime zipped file. Save the file to a folder easily found, such as the default Downloads folder. You will eventually copy this zipped file to a USB thumb drive to transport to other PC s. FIGURE 1-STEP 1: DOWNLOAD RUNTIME ZIPPED FILE 2

7 FIGURE 2-STEP2: UNZIP THE RUNTIME DOWNLOAD Step 2: Use your Web browser software to unzip the file to a temporary folder, preferably in the Download folder. Name this temporary folder Runtime. Alternatively, you can just open the file from the Download folder without unzipping the file. Step 3: Double click the file Setup.exe to start the Runtime Installation. (the image above depicts an earlier Runtime module, It has been since changed to ). The process remains the same. Step 4: The first file installed is the Runtime Module. Install it to the default folder mentioned above: C:\Program Files (x86)\dbase\runtime Step 5: Next, the routine installs the Borland Database Engine. Again, choose the default folder. FIGURE 3-STEP 3: RUN THE SETUP.EXE FILE TO START INSTALLATION OF THE RUNTIME MODULE FIGURE 4-STEP 4: INSTALLING THE RUNTIME MODULE INTO A DEFAULT FOLDER FIGURE 5- STEP 5: INSTALLING THE BORLAND DATABASE ENGINE Microsoft 10 doesn t like software that isn t registered with them when it comes to installing programs into Windows. This is a good thing, usually. Below are the steps to override its reluctance. FIGURE 6-SELECT THE DOWNLOADED FILE AND DOUBLE CLICK 3

8 FIGURE 7-RUN SETUP ROUTINE FIGURE 8- WINDOWS 10 DOES NOT RECOGNIZE THE APP AND REFUSES TO INSTALL. CLICK THE MORE INFO TEXT FIGURE 9 - CLICK THE RUN ANYWAY BUTTON TO INSTALL DYMO Label Software If you are to use the DYMO printer option, you must also install the complete DYMO Label software, not just the printer drivers. The Outpatient Label program uses the DYMO label software to format the label and control the printer. Though the DYMO 330 is no longer available, it too is an option for use. More than likely, either the DYMO 400 or 450 will be used, though the Twin and Duo (400) printers are also options. You must name the printer in Windows exactly as in the program. DYMO LabelWriter Printers are found at most office supply stores and on Amazon. (See Selecting Printers later in the manual). 4

9 FIGURE 10- TITLE SCREEN Installation Instructions To get the latest version, visit the Andersen- Computing.com website. Simple registration is required, a form from the site asks only for your name and a valid address. Support will only be provided to those with valid addresses on file. Two download files are required: Setup_OPD.zip (This file includes four programs, a few pdf report samples and a readme.txt with basic instructions.). AC_OP_DYMO_Complete.pdf (this manual is available for download from site individually (it s also a great way to get more information about the program s function and requirements before it is installed). FIGURE 11-OPEN SETUP-OPD ZIP FILE Unzip the first file to a location of your choice. This zip file contains an installation routine (Setup.exe). This routine requires a password that is provided upon registration on the Andersen-Computing.com website (Registration Form for Unlock Code ). Unzip or Open the Zip file and run the Setup Routine. This installs the program to C:\AC Pharmacy Tools\ AC Outpatient Backup System- DYMO. Please do not move!!!! Choosing the Full or Light Versions of the Backup System There are two options to printing labels with the Backup System: Complete or Light. The Complete version allows the use of encrypted data for the provider, patient and prescription data. Prescription data is saved for future use and data retrieval. User passwords are necessary to access the program. The Light version does not use data encryption, as prescription data are not saved. Prescriber and patient data (each encrypted in other versions) are also not used. User names (also encrypted) are neither used nor saved. Only the user s initials are required for label printing. 5

10 Using the Prescription Number Program (Rx_No.exe) Installed and located within the program folder, is the Prescription Number program. This program should be run before beginning the Outpatient Backup Label program. This program not only establishes the prescription numbers used in both the Full and Backup versions, but also determines if the Light version will be used. Use this function to determine whether the user will have access to the drug and warning label data for modification or be blocked from use through the menu (Light Version only). FIGURE 12-PROGRAM AND PRESCRIPTION NUMBER OPTIONS To open this option, you will be prompted for the Unlock Key: 71!Cubs (my old high school mascot). Enter the desired Rx # prefix, with a maximum of 3 characters. The numbers for the three classifications may be changed but they must have 7 digits and the numbers must have the same starting numbers (4,5, or 6 for non-controlled Rx, 3 for CIII-CV, and 2 for CII). If running this program on multiple machines during a downtime of the hospital system, you can use these numbers to establish which computer station printed the prescription label. Choose whether the Full Program (complete with a Refill system) or the Backup system is to be used. The Backup System has two versions: (Complete or Light). If the Light Backup System is selected, choose whether or not each user will have Administrative rights to access the drug and warning label data (not recommended). Select the checkbox if the label program is to be used on only one computer. Users with Admin rights may add and delete medications, set default directions and quantities, select warning labels, and even determine the Controlled status of medications (for local control options, such as with Viagra). Some menu options discussed below are not available on the Complete Backup version and even using the Light version. 6

11 Opening the Program Installation of the program should place an icon on the Windows background screen. Click the Icon (blue mortar and pestle), and the following image (Figure 14) should appear. Click the AC button on the Splash Screen. FIGURE 13- In all but the Light version, the PROGRAM ICON user will be required to enter a username and password. The first time you open the program, use the fictional user Clark Kent (username: kentc, password: 19@!FordPU). Passwords are required because the major databases (patient, provider, prescription, username data, and some temporary databases used for reports are encrypted). Other files such as the drug database, AHFS Classification, and clinic data are not encrypted. FIGURE 14-SPASH/WELCOME SCREEN FIGURE 15-REQUEST FOR INITIAL PASSWORD From the Title screen (Figure 10), click the Accept button to enter the user s initials and the Rx label number prefix. This also notes whether the user has Administrator Privileges. Some of the functions below require an Administer to access the module. In the Light version, users must enter their initials first. The Accept button then locks the user s initials until the program closes. Edit Hospital Data The next step is to enter hospital data and two images (a photo of your facility and a crest or hospital seal image). Click File; Change Hospital Data from the menu at the top of the opening screen. 7

12 From this screen, Figure 16, enter your facility s name, address, outpatient or office phone, and a phone number for patients to call for refills. This screen also creates the label and report headers. After entering the data, you must decide it his program is to display only the refill phone number or add the office phone. If this program is to be used as a downtime backup to the usual outpatient software, click the checkbox to use the Backup System Warning Label. This label will instruct the patient to call a specific number to receive a new prescription number to be used for refills (discussed later under Warning Labels, page 19). This final label will replace one of the (maximum of) three warning labels that are associated with each drug record. FIGURE 16-EDIT HOSPITAL INFORMATION Click the Facility Image button to enter an image of your facility. Size is not too important, but for adequate printing it should be at least 400X400 pixels in size. Upon clicking the button, FIGURE 17-CREST IMAGE EXAMPLE USED IN REPORTS AND LABELS you must locate a folder or external drive with the image and left click the image file (see Figure 7) and Open. This loads the FIGURE 18-SELECT AN IMAGE FROM FILE image into the database (used for some reports). Repeat the process for the facility seal or crest. The crest image should be at least 200X200 pixels in size, as it prints on the prescription label (see below). Click the image viewers to see the images in their actual size. Save the data, then Close the screen. Note the Title screen now displays the hospital/facility crest and the updated header file. Greyscale crest images will print best with label printers, since color printing is not an option. 8

13 Manage Pharmacy Users. From the same menu, this time choose Manage Users (not available in the Light version). The next screen displays an unlock screen (see Figure 19). The data entered here is a little different, there is an Unlock Key (71!Cubs) required and the username and password of an administrator. If this is the first time opening the program, enter the username : kentc and Clark s password: 19@!FordPU. The first user record displayed is blank and must be left blank. Use the VCR buttons at the top right of the window to move to the next record (button functions will be discussed in greater detail later). Since the current user, Clark Kent, has administrative privileges, he can change the settings from all users. FIGURE 19-UNLOCK KEY FOR THE (Don t worry. If you forget the password of your PASSWORD MANAGER administrator, I have an emergency password.) You will now take the identity of good old Clark and set up your users (Figure 20). Except for those with Administrator status, users should be issued a temporary password that they can change once the program is opened. All passwords will only be valid for 90 days (once Saved ). Don t wait for an emergency, keep at least one administrator password current. Click Add to add another user, assign a password and username (probably the same user name on the facility s label software). Close once completed. Again, keep up with new users and make this program part of their orientation. Also, at the end of this menu (and as a MS Word document available for download that can be edited) you will find a Competency Assessment form. FIGURE 20-PASSWORD MANAGER 9

14 Change User Passwords Each user, either after getting a temporary Password, or after 90 days since the last change, will require a new password. The user will be prompted upon opening the program or the user can change the password using the program s menu. Click File; Change Password from the menu. The following screen appears with the current User name., which can only be edited by an Administrator. The Username s password is changed by entering the current password, the new password and a repeat to make sure it is correct. If the new passwords match, click OK. Passwords for this program must be 10 characters in length, have at least two capital letters, two lowercase letters, 2 numbers, and 2 special characters # ^ /? are accepted). Click OK to accept the changes, giving the Password a 90- day expiration. Now, either delete Clark Kent or change his record to a current user, ensuring an unauthorized FIGURE 21-USER UPDATING PASSWORD This option is not available in the Backup Light version, as no user data is stored. individual does not get access to the protected information. 10

15 Program Buttons and Functions The following are images used by the program for various functions. Not all buttons will be shown, but many will be covered. Colors of buttons and text may vary from program to program. These are the primary program functions. Each is selfexplanatory. The "Add" button adds one blank record, the "Save" button saves the current screen's data, and the "Delete" button will delete the current record and move to the next. "VCR" buttons are used to move from one record to the other. The buttons on the far left and far right move to the first and last record respectively. The middle two buttons move to either the previous or next record. Drop-down menus are available throughout. This data is taken from variables placed within the program. Click on the drop-down button and the variable data will be displayed. Left click on the data to select. These "radio" buttons are used to set the index (or sort order). Selecting "Drug" in this instance will set the sort (index) order to the drug name. After setting the index order, use the "VCR" buttons to move to the next record. Usually, silver buttons with text are used to view information relating to a topic. The "Report " function takes the data from the program and prints to to the screen Closes the program screen. Blue and silver buttons usually bring up a "Help" function screen. The "Locate" buttons are explained in greater detail on the "Locate" page. Three buttons are in place to print Rx labels. One for the label only, one for the label and to add a prescription for the same patient, and another to print the label and add a new patient/rx. Labels are sent directly to the printer. These are image add/edit/view buttons. Double clicking will bring up an image dialog box. From there you can add a new image or change to another. Data entry boxes (fields) are used to enter data (free text). They are not associated with predetermined variables in the program (such as the drug or provider databases). TABEL1-BUTTON AND FUNCTION EXAMPLES AND DESCRIPTION 11

16 Label Printer Options Two brands of label printers are supported. DYMO LabelWriters (Figure 22, the preferred label printer) and the Zebra 400/500 Series Label printer (Figure 23). DYMO printers are available in most office supply stores, from multiple sources on Amazon, and even in some of the big box stores. The advantage to the DYMO is the availability of the labels (off brand labels are found on Amazon at a great discount, compared to the DYMO brand labels, online or at Staples/Office Depot). DYMO labels are superior in print quality and the labels are larger than the Zebra labels. Zebra printers, however, use standard 4X 2 inch direct thermal labels that many pharmacies and healthcare FIGURE 22-DYMO LABELWRITER 450 facilities already have in stock. They have larger rolls (730/roll) and are even cheaper than the off-brand labels used by the DYMO. The printer is much more durable, though more expensive. Used printers are available at HIPPO Deals for ~ 200$. Get a direct thermal printer and thermal labels, rather than dealing with ribbons. Each printer has its own quirks and printer settings challenges. Direct thermal labels are available from U-Line in bulk and at OnlineLabels.com in smaller quantities. Like the DYMO, printer drivers must be installed for the Zebra, but only the settings, not any specific label printing software. The Zebra uses standard Windows print options for reports and labels. Selecting the Printer FIGURE 24-PRINTER SELECTION FIGURE 23-ZEBRA 420 THERMAL LABEL PRINTER From the Menu, select File; Select Label Printer. Choose the printer by selecting one of the radio buttons. The name of the printer selected is displayed under the printer image. Once the printer has been installed, use Windows (from the Control Panel) to change the name of the label printer to match the name displayed (exactly). Once OK is clicked, the program will recognize that printer for all labels (report printers are selected manually). If the Zebra Printer is selected, the standard 4X2 inch label is automatically selected. The Default label for the DYMO (all models) is the label (see below). Once the printer has been selected, choose the correct label to match the printer. Currently the DYMO Duo is not supported Regardless of the printer selected, there are a few setup options that must be performed before the printers can be successfully used. 12

17 DYMO Printer Settings Install the current DYMO printer drivers (available at the DYMO Website Downloads: Software, Drivers & User Guides page or with the installation files that came with the printer) before attaching the DYMO LabelWriter. Before the DYMO drivers can be installed, the software will determine if Windows requires the.net Framework 3.5 installation. This must be installed prior to the DYMO software and may have to be downloaded from Microsoft. Attach the printer via a USP cable (I have heard of issues with using USB3 ports, but I have not found this to be the case). Open the Control Panel to printers, and set the printer preferences. Labels are printed on 4X2 + inch labels, either the DYMO Shipping label or the 30323/ Set the printer settings to landscape printing, select the correct label# (and if using the LabelWriter Twin, select the correct roll location, left or right). From the Windows Control Panel, rename your DYMO printer to match the name used in the label program. Naming options are: DYMO LabelWriter 330 DYMO LabelWriter 400 (regardless of Turbo option) DYMO LabelWriter Twin Turbo DYMO LabelWriter 450 Turbo DYMO LabelWriter 450 Twin Turbo Zebra Printer Settings Zebra printing setup can be accomplished by installing the latest Zebra drivers (available on the Zebra Website: Support and Downloads page). Enter the model of your printer and download the printer driver. This file is an executable zipped file. In other words, opening the file unzips the contents of the file to a specific location without the need for specific software. I suggest unzipping to a specific location you can find. I made a folder called Zebra on C:\ and extract the files to that location. Run the Setup.exe application from the folder to install your printer into Windows. (Windows may ask you if you re sure you want to run the software. Select Run.) Select Install New printer. Scroll down to your printer model and select Next. This should install the printer for Windows. Attach to a USP cable and turn on the printer. Next open your Control Panel [Open File Explorer, Select This PC, and at the top of the screen. Choose Open Control Panel. Choose Devices and Printers, select the Printer (Double Click)]. 13

18 FIGURE 25-OPENING THE CONTROL PANEL Rename the printer to match that used in this Label Program: Zebra Label Printer (4X2 in) Choose Printing Preferences. Set the label Width to 4.0 inches and Height to 2.0 inches. Select Portrait printing and Rotate Click Apply and OK. Print a test page. If the green light is blinking, press the button on the front of the printer. Make sure the label starts as shown to the right, with the perforation just at the upper lip of the label opening. You can advance to the next label by pressing the button next to the green light. FIGURE 27-STARTING LABEL POSITION AND COMPLETED FIGURE 26-PRINTING PREFERENCES 14

19 Occasionally, when a Zebra ZP series printer is moved to another computer, or during initial installation, the printer may require calibration. An example would be printing multiple labels and the print starts at different areas of the label, usually moving down from the top of the label. The following instructions come from the Zebra Website: CALIBRATION: Ensures correct and consistent positioning of print on the label and the label in the printer. Applies To ZP Series Shipping Printers ZP450 ZP500 Details Symptoms addressed by this solution include: o o o o Prints, then skips a label or is skipping labels Print position is drifting up and down on the labels Labels stopping in random locations Feed Button (Status Light) is flashing red and the printhead is closed Calibration is recommended whenever you experience one of the above symptom. Calibrating the printer 1. Load the printer with the labels for your application Read More>> 2. Power on the printer. 3. Press and hold the Feed Button until it flashes two times then release it. Read More>> 4. Allow the printer to complete feeding labels and printing a sensor profile. 5. The printer should now be calibrated. Press the feed key and one label should be issued each time. Label Options Installation of the DYMO software and using that software to control the use and printing of the label has solved some of the issues I ve experienced in the past (namely, the annoying habit of Windows changing the default label from the shipping label to one of the address labels only one inch in height, thus printing only the top one inch of the label image on the bottom one inch of the shipping label). FIGURE 28-DYMO RX LABEL USING DYMO SHIPPING LABEL To the left is an image of a DYMO label printed with the program. The Zebra version is slightly smaller and the backup label instructions are printed across the bottom of the label. Note the heading that was created from Change Hospital feature. Depending on the option chosen, it will print the 15

20 Office and Refill phone numbers or just the Refill number. The Crest/Seal added to the program is printed on the top left (if you chose not to add your own image, I have included a few pharmacy related images you can use, see the Images folder from the website). Keep in mind the label printers do not print in color. Seals/crests that are in black/white format will print more clearly. If the program is used strictly as a backup system, the first two warning labels from the drug database will print (one of the 420 X 150 images in the Warning_Labels folder). The third label is not an image, but text instructing the patient to call a phone number to get the actual system Rx number to use for refills. If the system is used as a complete stand-alone label printer, complete with a refill module, this would be the third warning label assigned to the drug in the database. If the medication is a Controlled Substance, the second warning label will be the Federal Caution Label required for all Controlled Rx. The text of the sig may change depending on the number of characters used. The drug database allows the user to input default directions. These should fit within the box containing the default sig and be no longer than 4 lines of text, with a maximum of 254 characters. The more text you enter, the smaller the directions on the label. The only other difference from a normal Rx label is that I have designated each label with the associated printer (top right hand corner). FIGURE 29-SELECT LABEL SIZE Two DYMO shipping label sizes are used. One is 4 X 2 5/16 (30256) and a slightly smaller label, the label (4X 2 1/8 ). From the menu select, File, Select Label Size. See Figure 29. The third label option shown is the 4 X 2 label used in the Zebra brand label printers. Ensure the label selected is compatible with the label printer used. Select the desired size by clicking the respective radio button, then click Accept. Warning Label images used by the Zebra have been rotated 90 o to the left, while images used by the DYMO are rotated by the DYMO Label software. 16

21 Patient Database From the menu, choose Data; Edit Patient Database (this Option is not available in the Light version) If a patient has been entered incorrectly, use this screen to change the data. Note that only the patient s first and last name, sex, at least one allergy field, and last four of the patient s ID are FIGURE 30-EDIT PATIENT RECORDS required. Fields with ** are highly recommended (other allergy information and complete patient ID), but not required to print a label. There is a Sort Order option to the right of the window. You should set the sort order first then use the Locate function (see section below) to locate by any of the fields. There are two modules of this function, one to edit the fields as discussed above and one to enter a new patient from the order entry module. The edit function will only be available to administrators. The edit patient module also has a function to print this patient s profile, either in a condensed or more expanded version. You will need to enter a date range for the report. Save the file to complete changes or Save and Close to do precisely that. 17

22 Locate Function An example of the Locate function is shown with image below (Figure 31). Many other data entry screens have a locate function. Once you click the Locate button, all the fields are blanked. Enter the field you wish to search (you can only search one field at a time, so set the sort order first) and click the Locate button a second time. This will Locate the first record base on the sort criteria. Use the VCR buttons to move from record to record. Sort order may be changed at any time. The Locate Help button, explains the process while in the FIGURE 31- LOCATE FUNCTION program. Edit the Warning Label Database From the menu, choose Data; Edit Warning Label Database. This function requires an Administrator s credentials. Since the Drug data is linked to the warning label data, it makes sense to make sure this is acceptable before entering/editing any medication data. FIGURE 32-EDITING WARNING LABELS 18

23 As seen from the screen above, this is a very busy module. However, the process is not that difficult. HTML code is used to create text based labels and any graphic may be created using one of the blank labels templates (aux_blank.jpg for almost any graphic program and aux_blank.psp for Corel s PaintShop Pro). The current version uses.jpg graphic images for the almost all warning labels, but the next release will allow for the HTML labels as an option. Keep in mind that these label printers do not print in Color, so do not waste your time with elaborate color text and images. Two sets of graphic images in.jpg format are used. One set used by the Zebra are labels rotated 90 o to the left from the original version. The only images this version of dbase recognizes are of gif, jpg, or bmp varieties. Only fifty warning label images of each orientation are available. To edit the HTML based text, use the Report button to print examples of all warning labels available. This module does not have a Locate function, so use the report to locate the label you wish to edit. Use the VCR buttons to move to desired label. The text based warning label has two sections, a header and body of text. Each can be given different attributes. The best way to learn this function is to edit a label. Select the first label, Drowsiness (car and equipment warnings). Click the Header checkbox and change the text to Upper and Lower case (May Cause Drowsiness). At the bottom of the screen, change the font size to 16 point, select the attributes to Bold, Italicized, and Underlined. Change the alignment to Center. Click the Save button to attach the attributes to the header text. Notice the change to the HTML Warning label example. If you make the header text too large, the text in the body will be pushed out of the label and will not print. Change the font size to 12 point and Save. Deselect the Header checkbox, and select the Body checkbox. Change some of the attributes and Save to see the results. The HTML code of the warning label is displayed. Fifty HTML based labels found on this function are not used with this version. There is one HTML based label used in this version, if the system is to be used as a backup system. This label (number 99) used to explain to the patient that the label s Rx number he/she has is not a valid Rx number for refills, but produced with a backup system. Use this to edit your phone number used on the label. See the last label in the warning label database, 99. Note the check box under the label image to the right, make sure this checkbox is not selected. Edit the text phone number in the body of the warning label, select both the header and the body checkboxes, make it 10 point, bold and centered and it will fit the DYMO Rx label. Save the data. Move to label # 20. This is the Controlled Caution label. Make sure the Caution checkbox is selected. All other labels should have the Image selection checkbox selected. Save the data. 19

24 To change the image, click the Label button at the upper right of the screen. This button allows the user to do a couple of things; first you can locate the image used on the warning label, second it updates the path to the image file (required to make the image print on the DYMO label). Clicking the button should take you directly to the Warning_Labels folder, where all the warning label images are stored. Select the image associated with the warning label number. If you are still on 20, select aux20.jpg and click Open (if the program does not take you to the correct folder, use the Windows file system (Look In) drop down menu to locate the correct folder. Save the record. This will not only update the current image path, but also the image path for each of the other warning label images (just in case you installed the program to a different path). You can tell if the path is incorrectly set when you print a label and a Poison and a Do NOT Chew warning label are printed, regardless of any drug selected. (see Figure 33 below). FIGURE 33- EXAMPLE OF A LABEL WITH WARNING LABEL PATHS IN ERROR Edit the Drug Database From the menu, choose Data; Edit Drug Database. All versions of the label program contain the outpatient TriCare Basic Core Formulary. This list of drugs (generic name only) is a good starting point for most outpatient settings. FIGURE 34-EDIT DRUG MODULE 20

25 The initial Sort Order is by drug. New drugs may be entered manually or by converting a text report from your hospital system (discussed in another program). Some fields are required, while others are optional. The first required field is the drug name (used on the label), next Formulary status, the AHFS Category for the drug, and the DEA category (2,3,4,5 for controlled substances, 6 for other legend drugs, and 9 for OTC s). Finally, determine whether this is to be an outpatient or inpatient drug (or both). Inpatient drugs will not be available for use in the outpatient drug Pick List. The Pick List option will be discussed later. Optional Fields include just about everything else on the screen. There are several buttons to assist you, the DEA button displays a screen to remind you of the categories. Use the Warning Label Report printed above or use the report located at the end of the manual before making wholesale changes or additions. As you change the Warning label number the path to the warning label image and description of the warning label are changed. The first warning label should always be the most important to the patient, and the other two in order of importance. Remember to use the second warning label as the Federal Warning label for controlled substances (number 20). Again, only 50 options are available for warning labels, use 0 to delete the warning label image for this drug. For the backup version of this program, the third warning label will be the backup label with the phone number included. Compounded products should also be noted and use the AHS Classification for the most important drug on the compound. Select the Default Label Values tab. From this screen, you can enter a default sig, default quantity and unit of measurement (tablets, capsules, ml, grams, etc.). Save any changes. FIGURE 35-DEFAULT SIG, UNIT OF MEASUREMENT AND QUANTITY On the first screen (Drug Data) of the module is a field for formulary comments, administration/storage requirements and restriction comments. 21

26 From the first screen of this module, you may notice a red OOPS!! Button. Many of the fields may be returned to their original values if the data has not been saved, or moved to the next record. Click the button if you have changed fields inadvertently. Medication Pick List Note there are five fields where a drug name may be entered: the label drug line, the generic name, and up to three synonyms (different brands or a short code used in your hospital system). These five fields are used to create a drug pick list used in Rx order entry. Any time a change is made to any of these 5 fields on any medication, select the Pick List check box (lower right portion of the window). When the screen is Closed, the old drug pick list is deleted and a new one is created. The actual use of the Pick List is detailed in the Order Entry Section. Update Warning Labels Once any warning labels have been modified, you must then update the drug database. Choose Data; Update Warning Labels from the menu. Click on the Update button. Previous prescriptions filled are not changed, but the warning labels associated with the medications will be updated for future prescriptions. This function may take a few minutes, depending on the size of the drug database and speed of your computer. Once the procedure is complete, the dialog box closes Clinic Data Choose Data; Edit Clinic Data from the menu. The program comes loaded with some clinic and MEPRS code data (TriCare and the DoD uses these codes to classify workload and costs). The clinic data should be loaded before the provider database, as these are linked to the primary FIGURE 36 EDITING CLINIC DATA 22

27 location for prescribers. Same Locate and VCR functions as well as the primary, Delete, Add, Save, Help and Close buttons found in most data modules and windows of the program. Clinic Data is not available in the Light Backup version. Provider Data From the Menu, choose Data; Edit Provider Database (See Figure 37) Included in the program are four fictitious providers to give you a general ideal of the database fields used. The taxonomy field is used by DoD facilities to identify the Class of the provider. The required fields are the Provider s Name, a Clinic Name from the module above, and the provider s DEA if controlled prescriptions are written by this provider. Use of the Provider s SSN may be necessary if the provider is using the facility s DEA number and the prescriber does not currently have a DEA number. Again, the Sort Order options and VCR Controls work just as in the other modules screens. Provider data is not available in the Light Version. FIGURE 37-EDITING PROVIDER DATA 23

28 Prescription Order Entry FIGURE 38- ORDER ENTRY-FULL BACKUP VERSION Now to the heart of the program. From the menu, choose Labels, Rx Order Entry-New. Click on the OK button in the next dialog box to continue. A blank record is opened (scrips.dbf) with the username s initials, date filled, and RX number Prefix automatically entered. There are three patient entry options: FIGURE 39- ORDER ENTRY-LIGHT BACKUP VERSION 24

29 Option One. An existing patient is found. Select a patient from the drop-down menu. A dialog box with allergies and notes about the patient is displayed. Click OK. The patient s first and last name are entered along with the family member prefix (a DoD/TriCare thing) and the patient s age (just in case the drug you select is restricted to/from the age classification of your patient). Select the fictional character Allen, Barry (aka The Flash). Option Two. An existing patient requires entry and patient data entered (new allergies, spelling corrections, etc.) Click the Add/Edit Patient. If the patient name has been entered on the patient dropdown field and is found, the Patient Edit module displays. You can edit any field from this field, regardless of user status, but only for this patient. Closing the form updates the order entry field. Option Three. A new patient requires addition to the patient database. You have checked the dropdown menu and the name does not exist. Leave the patient field blank and click the Add/Edit Patient button. At a minimum, enter the patient s name (Iast and first), patient s date of birth, sex, (M/F), a patient identifier, last 4 of ssn, fmp/ssn for a military patient, and at least one phone #. Allergies and any notes are also suggested. Click to save the patient. If you have another patient in the same family receiving a prescription through this system, click Add and enter the other family member s data. Save and Close when complete. Once this record is closed, the patient information is added to the new prescription record. Select the drug using the next drop-down menu. The sort order is by drug name from the drug pick list. Enter the name Ibuprofen. The drop-down menu moves to the first mention of the name. You will also see 10 more items, sorted by alphabetical order. Left click the text IBUPOROFEN, and the following screen appears. Left click IBUPROFEN PO 800 MG TAB (unless you renamed it during the drug editing process). Note a formulary comment and status are displayed, default QTY (90) is entered, Refills set at 0, the default Sig (TAKE 1 TABLET FIGURE 40- DRUG SELECTION THREE TIMES DAILY WITH FOOD) and default units of measurement (TABLETS) are entered. Everything but the formulary comment and status may be edited. Up to three warning labels are entered. To edit the Warning Labels for the drug selected, click on the text [Click to change Auxiliary (Warning) Labels]. This will unlock the options to change or deselect the labels. Once the user moves to the next prescription, these options are re-locked. If you do not wish the label to be displayed, deselect the Keep checkbox. 25

30 Just like with the patients above, you may run into a situation where the prescriber is not in the current database. You now have two options: Option One. An existing provider is in the database. Type in the first three or four letters of the provider s last name. The first record to match the search is displayed and the next nine records (in alphabetical index) are also displayed. Choose from one of these or move the slider bar to find your record. Left click on the provider s name, his clinic code and DEA (if in the system will be displayed). Option Two. Your provider is not in the database. Leave the field blank and click on the New Doc button. From the next screen enter the provider s name (Last, First) format, clinic name from the drop-down menu, and a DEA if required. Save and Close and the new data are entered into the prescription database. Again, there are three options to print a label. Print one label for one patient only, print the label and add a new record for the same patient, or print the label and add a blank record for a new patient. Option One. Printing one label and leaving the screen on this patient s prescription data. This might be useful for that one patient who shows up for a prescription and no others are in line. Print the label and when the patient counseling is complete and the medication dispensed, Close the screen Option Two. Your patient shows up with two or more prescriptions. Enter the prescription data and click the New Rx Same Patient Label. The label prints and a new record is added with the same typist s initials, fill date, Rx number prefix and the provider remains the same. Either repeat the process for a new RX or click Label Print only for the last label, closing the screen when complete Option Three. You have a line of patients waiting on prescriptions to be filled. After you ve completed the prior patient s prescription(s), click New Rx New Patient button. A new blank record is added and you start the process again with a new prescription. The Light Backup version requires the user to enter the patient information and prescriber, while retaining the use of the drug drop-down menu. If a drug name is not found within the formulary, a second screen displays an option to add a new drug with minimal required data. Once the OK button is closed that drug will be added to the formulary with the drug name, DEA schedule and strength used for labeling. FIGURE 41-NF DRUG ENTRY FIGURE 42-NF DRUG ADDITION 26

31 New drug additions will require data clean-up. Later, open the Drug Database as shown above. Set the sort order to Category. Use the VCR button to move to the first record and edit the record, to include warning labels, AHFS Category, NDC Number, and synonyms (for drug look-up). Save the data and move to the first record in the sort order again. Continue until all new drugs added have been updated. Prescription Numbers As you might expect, there are three sets of prescription numbers generated, each 7 digits in length. CII prescriptions start with the number (numeric prefix is always a 2), CIII CV prescriptions start with (numeric prefix always is a 3), and other prescription medications and OTC s by Rx, start with 4,5 or 6. Each of these numeric sequences are determined by the DEA category of the medication. See page 6 for prescription number reset options. Reports At present, there are only a few reports available: 1. Warning Label Report, accessed via the Warning Label Editing module or the Drug database (see PDF Report at the end of the manual). 2. Patient Profile, accessed from the Patient Editing module or the Reports Menu option, see below. The reports are either condensed or expanded (not found in the Light version). From the menu, choose Reports, and Print Patient Profile. Enter the date range. The To date cannot be > today and the From date must be < the To date. If you know the FMP/SSN, enter now. If unknown, enter the patient s Last (and First, if known) Name Click the Locate button and the following screen appears (very similar as to how patients, drugs and providers are located). FIGURE 43-LOCATE PATIENT FOR PROFILE REPORT FIGURE 44-SELECT PATIENT FROM LIST 27

32 Left click on the desired name, this closes the dialog box and enters the patient information onto the Outpatient Reports-Patient Profile. Select either the condensed report or the expanded version and click the Report function, click Report to print the record. The following screen appears: (the report is attached to a Report Viewer). Select a report printer (you do not want to print a report to the DYMO). Even a Network printer may be selected for printing. Close the form and change the format to Expanded and print again. The Clear button allows the user to start over. FIGURE 45-EXPANDED PATIENT PROFILE 3. End of Day Reports or Rx Logs. From the menu choose Reports, Choose Outpatient Reports and the following (figure 41) appears. Select a date range, choose the desired report using the checkboxes and click the Select button. Again, choose a Report printer, and print the report. If you select all reports, they are automatically sent to the selected printer. 28

33 FIGURE 46-END OF DAY REPORTS Use as a Backup System with the Hospital computer software is down This system as discussed earlier is not a multiuser database. As such, a copy must be installed at each prescribing station. This may leave to duplicate numbers but this is not a real problem. The next version will allow an administrator to set the start Rx number at each station. Bates stamp each Rx blank for a unique number. In the meantime, print the prescription log when the hospital system goes back up. Take the prescriptions from each of the backup stations and enter them into the hospital system with real RX numbers. From the Rx Log, enter the new prescription numbers. Use this report to assist patients in requesting refills. It might also be useful to print a second label for each prescription and attach to the back of the Rx blank. 29

34 License February 2017 Software License Agreement The following Software License Agreement is between Andersen Computing (herein after known as "Licensor") and you, the user (herein after known as "Licensee") for the use of Licensor's program(s): AC Outpatient Label Program (all versions). By installing the enclosed programs, you indicate that you accept all the terms and conditions of this agreement as written without modification. If you do NOT so agree, DO NOT INSTALL the program but, instead, immediately remove it from your computer. BY INSTALLING THE PROGRAM, LICENSEE AGREES THAT THIS LICENSE IS THE COMPLETE AND EXCLUSIVE STATEMENT OF THE AGREEMENT BETWEEN LICENSOR AND LICENSEE. GRANT OF MULTIPLE MACHINE USE LICENSE: All Andersen Computing Programs are free to health care organizations for unlimited use, provided the organizations register the software (at Andersen-Computing.com). Otherwise, all terms apply to the Licensee. RESTRICTIONS ON USE, TRANSFER, AND COPYING: AC Outpatient Label Program and the accompanying manuals are copyrighted by Licensor and are protected under the Copyright Act of the United States. Under this Act, LICENSEE MAY NOT, OR ALLOW ANOTHER TO: USE, COPY, MODIFY, SUBLICENSE, RENT, LEASE, CONVEY, TRANSLATE, OR TRANSFER THE PROGRAMS OR DOCUMENTATION, OR ANY COPY EXCEPT AS EXPRESSLY PROVIDED IN THIS AGREEMENT. LICENSEE MAY NOT, OR ALLOW ANOTHER TO: CONVERT THE SOFTWARE TO ANY PROGRAMMING LANGUAGE OR FORMAT, DECOMPILE OR DISASSEMBLE THE SOFTWARE, OR ANY COPY, MODIFICATION, OR MERGED PORTION, IN WHOLE OR IN PART. The above shall prevail in whole except as permitted by Title 17, United States Code and subparagraph (c)(i)(ii) of the Rights in Technical Data and Computer Software clause of DFARS or subparagraphs (c)(1) and (2) of the Commercial Computer Software - Restricted Rights at 48 CRF , as applicable. If this program was acquired in the United States, this Agreement is governed by the laws of the State of South Carolina. If this program was acquired outside the United States, then local law may apply. LIMITED WARRANTY AND DISCLAIMER Technical Support will be provided via to Licensee at no charge for a period of 360 days from date of download, provided the Licensee registered the product. Licensor shall bear no responsibility for telephone or other charges incurred by Licensee in obtaining Technical Support. Licensor shall bear no responsibility to provide Technical Support to non-registered users. 30

35 Report Samples FIGURE 47-SAMPLE REPORT -CONDENSED PROFILE 31