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VA Code In Flight Submission - EPIP 2.0 Patch OR*3.0*444
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Submitted by OIT EPMO Open Source Coordination Office on 06-26-2018.
OR*3.0*444 enables a clinician to view existing inpatient and outpatient medication orders from the local site on a single page when preparing to discharge a patient. This order information is displayed on a new Unified Action Profile (UAP) form available from the View menu on the Computerized Patient Record System (CPRS) Orders tab.

Duplicate orders can occur because outpatient orders remain in the system after a patient is admitted, and new inpatient orders are created after admission. When discharging a patient, a clinician must review all orders to avoid duplication, while ensuring the correct medication orders are continued for patient safety and care. The clinician must take the appropriate action for each medication order, deciding whether to continue, change, renew, or discontinue the order prior to discharge.

Previously, when preparing to discharge a patient, a clinician had to switch between forms in order to review all medication orders. OR*3.0*444 enables the clinician to review all medication orders at one time from the new UAP form. This change both simplifies order reconciliation and reduces the time and effort required from the clinician when making decisions on each active inpatient and outpatient order. The UAP sorts orders by drug name so that inpatient and outpatient medications are grouped together. Sorting drugs by medication name ensures that the clinician sees all existing orders for each drug when making decisions during reconciliation.

The UAP includes a Reviewed column that displays the decision made by the clinician during review. A new “UAP Reviewed?” (#.61) field is added to the order record in the ORDER (#100) file. This field denotes whether an order was reviewed (“1”) or not reviewed (“0”). Two additional fields store information about previous reviews: the “UAP Last Reviewed” (#.62) field stores the date an order was last reviewed using the UAP form; the “UAP Last Reviewed By” (#.63) field stores identification information for the last person to perform a review of the order using the UAP view.

This enhancement also adds a Discharge Meds Review form, which provides a summary of all medications being continued for the patient upon discharge. This form is accessed by selecting the Discharge Meds view from the Orders tab. The Discharge Meds Review form enables a clinician to see the full list of medications prescribed for a discharged patient after the UAP review is completed.

A new parameter (OR UNIFIED ACTION PROFILE OFF) in VistA enables sites to turn the UAP functionality On/Off. This parameter is set at the facility level and is located in the PARAMETER DEFINITION (#8989.51) file. Initially, this parameter is set to OFF (“0”). When the parameter is set to OFF, the two options used to access the Unified Action Profile functionality (Unified Action Profile (UAP) and Discharge Meds) are not displayed on the CPRS View menu. To enable this functionality, set the parameter to ON (“1”) using the Edit Parameter Values function accessible from the XPAR MENU TOOLS option in VistA.

**Note: In addition to turning this new parameter ON, enabling UAP requires changing two settings for the Discharge Release Event using the CPRS Configuration (Clin Coord) menu in VistA. Both settings are accessible from the Event Delayed Orders option. First, activate the DISCHARGE Release Event by changing the Activate/Inactivate [AI] setting to ACTIVATE. Second, disable Copy Active Orders by changing the Copy Active Orders setting to NO. The medication reconciliation performed by UAP will not function as intended until the parameter is turned ON and these settings are configured.

BLOOD BANK Clearance:
EFFECT ON BLOOD BANK FUNCTIONAL REQUIREMENTS: Patch OR*3.0*444 contains changes to a package referenced in ProPath standard titled: BBM Team Review of VistA Patches. This patch does not alter or modify any VistA Blood Bank software design safeguards or safety critical elements functions.
RISK ANALYSIS: Changes made by patch OR*3.0*444 have no effect on Blood Bank software functionality, therefore RISK is none.

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