2.2.4 Writing Prescriptions with Rx3

Rx3 has to be installed and activated in oscar.properties at installation; can be chosen in users preferences

STEP 1- SEARCH FOR DRUG

1. In the box beside ‘Drug Name’ type in the name of the drug you want to prescribe.  After a few letters the appropriate choices appear in a drop down list TIP you can narrow your search by picking the unique part of the drug name and the dose.  For example "thiazide 25" will quickly find you HYDROCHLORTHIAZIDE 25MG TAB . Shown below is the use of "sitag" to narrow quickly to the METFORMIN / SITAGLIPTIN product desired.
   
   
2. Click on the SEARCH button if you want selections of brand and trade names as well as drug classes to choose from.
   
   
3. For prescription recommendations for certain diagnoses, click the ‘Drug of Choice’ link to the right of the box.
4. The Note function lets you write free text on the prescription without quantity and repeats such as "Tennis Elbow Brace"
5. For compounding drugs and mixtures such as 2% Hydrocortisone and 1/4% Menthol in Glaxal base use the custom drug function (detailed below)
6. The "Drugref Info" link gives you the date the Drugref Database was last updated

STEP 2- WRITE THE PRESCRIPTION

1. The writing area will expand to give you a space to fill in the instructions quantity and repeats for the medication
2. Forget your usual instructions? click on the red * and you will be given a pick list of your instructions to choose from.
   
3. Click off the Long Term Med check box as appropriate. If Long Term Med is checked off, the drug in question will appear every time you create a prescription for the patient.
4. Much natural language will be recognized and the Quantity, and Duration will be filled out for you according to the list that shows up when you click the ?.
   
5. If the quantity and the duration fields are filled improperly you can type them in manually.  To activate the duration field click on it as shown above and the focus will switch to where you can enter numbers.  Click on the Unit label to change or enter the duration unit.  The one character duration unit is either (D)ays (W)eeks or (M)onths.
   
6. To add additional drugs to the same prescription, simply start typing the drug name into the "Drug Name:" field. If no additional drugs need to be added, proceed to printing or saving the prescription by click the appropriate button ("Save and Print" or "Save").
   

STEP 3- PRINT THE PRESCRIPTION

1. The final screen brings up selections to actually print  the prescription.
   
   
2. If you or your patient forgot something you can click on Create New Prescription to return to the previous screen.
3. Use Additional Notes to add comments, ie Deliver to home! Click Add to Rx and this message will be added to Rx above signature.
4. The Drug Information link gives you the ability to consult a monograph or patient information on the drug(s) listed
5. OPTIONAL Mouse Signing (depending on what you have configured: )
   
1. First ensure that the patient has a pharmacy with a fax number recorded
2. Use your mouse or trackpad to sign in the signature box
3. Click 'Accept' to enable the Fax and Print 
   
4. Click on 'Fax & Paste into EMR' and the Rx will be sent to the patients preferred pharmacy
   
5. Add Pharmacy Info will add (alongside the Rx) the patients preferred Pharmacy information for printing or faxing
   
6. OPTIONAL Topaz Tablet Signing (depending on what you have configured: )
   
1. First ensure that the patient has a pharmacy with a fax number recorded
2. Clicking the 'Sign' button will open a window to receive your original signature from your signature tablet for this prescription.
   
3. Click 'Accept Signature' to enable the Fax and Print
   
4. Click on 'Fax & Paste into EMR' and the Rx will be sent to the patients preferred pharmacy
   
5. Add Pharmacy Info will add (alongside the Rx) the patients preferred Pharmacy information for printing or faxing
7. Click ‘Print’. If you wish for a record of the prescription to appear in you Encounter notes, click ‘Print & Paste into EMR’ or ‘Fax & Paste into EMR’

Custom Drugs 

If you can’t find the drug you are looking for, you can create a custom drug prescription. This can be done by clicking on the custom drug button.

Warning: Only use this feature if absolutely necessary, as you will lost the following functionality:

• known dosage forms/ routes
• drug allergy information
• drug-drug interaction information
• drug information

Fill out the drug, dosage and instructions as you would for a normal prescription.

Allergies

 If you write an Rx for something that the patient has a listed allergy, you will be informed at the drug selection stage.  For example if you wanted to write Clavulin(R) for someone who is listed as being allergic to Penicillins then the flag will come up in Red.  This is not a substitute for one's professional obligation to independently review allergies, nor will the program prevent you from printing the prescription if that is what you feel is the clinically most appropriate course.

Add Special Instruction

After you searched and selected a drug, when you click on "Instruction" in the prescription box , a text box for typing special instruction will blind down. If you click on "Instruction" again, the text box will blind up. A quicker way to invoke special instruction text box is to press the "Enter " key when you finished typing in the "Instruction" text box.While you are typing, a list of known special instructions are displayed for user to choose.

Re prescribe all long term drugs at once

Click on "Represcribe Long Term Meds" on the search page, all long term drugs will appear.

Discontinue a drug

Click on "Discon" on the right of a drug name.

Select the reason for discontinuing the drug and add any comment if needed.

Difference between an empty note and a written note to a prescription

By clicking on  ,a user can write and save a note to a prescription. When the page is loaded next time, shows up to help user remember which prescription has been noted.

Information on different profile views

Adding  a favorite drug

Search and select a drug.

Click on "more" after a prescription box appears.

Click on "Add to Favorite" and type a short name for your favorite drug.

Adding an allergy

Click on "+" sign beside "Allergies" in the left side bar.

Add an allergy in the same way as the old prescription module.

Generating multiple-page PDF prescription document in different page sizes

After a prescription is made by clicking the "Save & Prescribe" button, a preview window will appear.

You can choose to generate either A4 or A6 size pdf for your prescription. 

Click on "Print PDF" to download the generated prescription pdf file.

Setting personal preferences

This is managed through the patient appointment screen "Pref" tab link

• Set default quantity of prescription.
1. Click on "Set Default Quantity" link at top of the page. A small window pops up which allows you to modify default quantity.
   
2. Enter your desired quantity and click "Save" button and close the window. Next time when you make a new prescription of a drug which was not used by the patient before, the default quantity will appear in the "Quantity" text box in the prescription table.
   
• Set default size of prescription PDF document.
1. In patient appointment screen, click "Pref" link which is in the top bar. A small window pops up which allows you to set preferences for several things.
2. Click on "Set Rx Script Page Size" link and a window with a drop-down list will pop up.
3. Select the size you desire and click "Save" button and close the window. This size will be chosen automatically before you generate the PDF document next time.
   
• Set different drug profile for viewing
1. In the search drug page, click on "Change View " link, a window with multiple check boxes will pop up.
2. Check the display options which you want to view for drug profile and click "Save".
• Set to use Rx3 by an individual provider
1. In patient appointment screen, click "Pref" link which is in the top bar. A small window pops up which allows you to set preferences for several things.
2. Click on "Set to use RX3" link
3. Select checkbox if you want to use RX3, unselect if you don't