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[Gnumed-devel] Workaround for prescriptions

From: Busser, Jim
Subject: [Gnumed-devel] Workaround for prescriptions
Date: Thu, 6 Sep 2012 06:33:30 +0000

I am playing with a lateral solution for keeping a record of (and printing) prescriptions.

(1) in the Notes plugin, create a 'new problem' to become the fake-problem of 'Prescriptions', and input into this new problem's 'Plan' the drug intended to be prescribed, for example

        diltiazem hydrochloride 180mg CD / long-acting \\
        S: one daily \\
        M: 2 months

where the \\ is for the purpose of tidier LaTex output. Note that the above could have optionally been entered on a single line.

(2) 'Save' this notelet and input, for this Unattributed problem, the name 'Prescriptions'

 --> see Screenshot 1.

This will dismiss (close) the Prescription tab. Presently, it seems necessary to click into a different plugin (like EMR tree) and then click back into the Notes plugin. Can the creation and saving of a new problem henceforth cause an auto-refresh of the Notes left-sided problem listing?

(3) Double-click on the 'Prescriptions' problem to open a new notelet and input each drug to be prescribed in the Plan field, and click Save, e.g.

--> see Screenshot 2

        hydrochlorothiazide 25mg \\
        S: take one half tablet (0.5 x 25mg = 12.5 mg) once daily \\
        M: two months

(4) After any drug has been prescribed for the first time, it can be visualized and copied to the clipboard from the EMR tree 'Prescriptions' Journal and in this way cut down on keystrokes and keyboard errors.

--> see Screenshot 3


(1) While it does remain possible, via Correspondence > Write letter, to re-include in print output a previously-used prescription, I would not normally do this except in the case where I wanted to generate a replacement prescription to include something that was not placed on the original. It will be less confusing to the clinicians (and everyone else) in a praxis if a new item will have been created to correspond to each new prescription.

(2) 'Prescriptions' will appear, and be counted as, a Problem in the patient's statistic, and also in lists of problems in any medical documents created from the EMR tree.  I don't see any easy way around this. I did notice that to rename it


causes it to sort at the top among the items in the top left of the Notes plugin and perhaps that has a dual value. (??)


Advantages within the Notes plugin to this approach:

1. By keeping this 'fake problem' of Prescriptions active, it remains always available in the Notes plugin, and will even auto-open if so configured in the user's preferences, and by selecting it in the left-sided list you can easily see the previous prescriptions, no matter that they may have related to various of the patient's clinical problems, and also opening a new Prescriptions notelet is sufficient to refresh the bottom left area

--> see Screenshot 4

        (note the successive prescription rows within the
        (same encounter, with incremental timestamps.
        (In the 'glyburide' row, please ignore my mistaken // which should have been \\

Advantages when outputting a prescription e.g. to a LaTex template:

1. By limiting the interactive portion of the LaTex template to

        $<progress_notes::p//   {\item %s} \\>$

the clinician is then prompted:

        which Health Issues to select (select only Unattributed episodes)
        which episodes to select (select only Prescriptions)
        which narrative (type P) entries to include (select all desired)

See attached PDF (lacking my signature and reference number), in which it seems the Allergy detail is very nice but consumes space, and limits to 3 the prescriptions that will fit on this page, but that placeholder could easily be removed and replaced by -- say -- a text prompt, for example "Special instructions to Pharmacist".

I might play around more with the spacing. I am not sure whether the list can be split, or wrap, across two columns.

-- Jim

Attachment: Prescription.pdf
Description: Prescription.pdf

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