Ascend-I.P. Formulary Setup

The Ascend-I.P. Formulary module allows you to maintain a database of medications, IV solutions, IV additives, supplies, tubing, and similar pharmacy inventory items. The module lets you assign common settings to these items such as hospital charge codes, NDC numbers, and order entry defaults.

How to Reach the Formulary Module

Select the "Utilities" menu from the main program screen. Then select "Formulary" from the drop down list. Alternatively, select the formulary icon/shortcut from the main screen (the one that looks like a set of old-fashioned scales)

Formulary Records

Each inventory item occupies one record. When you first enter the formulary screen, you will be viewing the first record. The record that is currently selected always appears at the top of the screen.

To select another item:

  1. Click on the "Formulary Search" tab so that it is "on top" of the other tabs.
  2. Type 2 or more characters of the item name (e.g., "CEFAZ") in the "Description" box then press <Enter>
  3. A list of items matching your entry will appear. Click on the desired item as shown below.
  4. The record for the selected item will immediately be displayed in the upper portion of the screen.

In addition to the record detail at the top, the tabbed sections (e.g., "Defaults", "Inventory Control" and etc.) also apply to the selected record on the screen. These tabbed sections are briefly summarized below:

Getting Started with a New Formulary

In many cases, the initial formulary is imported from the hospital charge master. The resulting file usually contains at least one item description, the charge code and the patient price per unit. Other data, such as the NDC number, may be imported also. To help save start-up time, this documentation will focus on the more useful, "high payoff" settings that you should make right away. You should also concentrate on your fast moving top 200 items as these probably constitute 80% of your order entry workload. If you need to add formulary records, refer to the section "Adding, Modifying, and Deleting Formulary Records" near the end of this document.

The "high payoff" fields you should enter or modify first are listed below in bold print.

Formulary Record Main Fields (Top of Screen)

The fields at the top of the screen for this record can be edited by clicking on them and modifying them directly. 

  1. Description #1
    1. Edit the description to be "clinically" relevant. This is a required field and may be the primary description that will appear on labels, profiles, MARs, and etc. This description is NOT, however, the one that appears on the patient’s bill (the hospital’s database item description controls this). Therefore, you are free to edit the description to a more "clinically" relevant and meaningful one, as long as it is the same chargeable item. 
    2. Include "dosage form" in the description. e.g., "GENTAMICIN INJ"
    3. Don't include route, strength or volume in the description if they will appear elsewhere in the record. Each of these items has their own dedicated field which are separate from the description. If the item can have several dosage forms, routes and strengths ensure that the description clearly differentiates them. For example, change "DEMEROL 50MG" TO "DEMEROL TABLETS" or "DEMEROL INJ". The "dosage" fields (described below) may be used to save time during order entry, make dosage calculations, and transmit dosage information to other systems (such as Pyxis, etc.) via interfaces.  For example, the inventory item, "AMPICILLIN 250MG/5ML SUSP" should have a "description" field of "AMPICILLIN SUSP" while the "dose" fields could be "250" "MG" and the "per" fields could be "5" "ML".  For "TYLENOL 325MG TAB" the description could be "TYLENOL TAB" while the "dose" fields could be "325" "MG".
    4. Be consistent with generic and brand names. Most users will use Description #1 for a generic and Description #2 for a brand or "generic equivalent" name. The program doesn't care either way, but consistency on your part will make the formulary, MARs, reports and labels easier to manage.
    5. IV solution descriptions should be simple/consistent. Make them easy to find by using common terminology. For example, change "IV SOD CL .9% 500ML H2O" to "NS" with "per" fields of "500" "ML". Other common examples include "D5W" with  "per" fields of  "50" "ML"; "D5/0.45NS" with "500" "ML"; and "LACTATED RINGERS" with "1000" "ML". Edit the frequently used default IV solutions (D5W 50-100-250-500-1000 and NS 50-100-250-500-1000) so that they may be easily assigned as IV additive defaults elsewhere.
  2. Description #2
    1. This is an optional, alternate description for the item. Most users will use Description #1 for a generic and Description #2 for a brand name or "generic equivalent" name. The program doesn’t care which is which although it is less confusion if you are consistent. The program can be configured to always use drug description #2, or #1, (or whichever one you select at order entry time time) for new orders, regardless of which one you selected from the formulary item list at order entry time.
    2. In general, the format rules for drug descripton #2 are the same as for #1
    3. If a generic equivalent* message is to be used here, be sure the drug name appears first. For example, "DIAZEPAM TAB EQUIV".
  3. Mnemonic
    1. This is a short code that can be used to select an item from the formulary at order entry time. It could also be used for a third drug description if necessary.
    2. Example: "CFZ1" could be used to represent "CEFAZOLIN 1GM INJ". Or you might put "KEFZOL INJ" here as a third description option, assuming "CEFAZOLIN INJ" is #1, and "ANCEF INJ" is #2.
    3. Mnemonic codes don't appear on orders, labels, MARs etc.
  4. Dosage fields
    1. Several "dosage" fields must contain data for certain program features to work properly. These features may include billing, some interfaces (e.g., Pyxis, Omnicell, and Suremed "profiling"), electronic MARs, and medication safety features. Dosage fields include the "Dose" amount and unit of measure (typically a drug strength, e.g., 50MG), and the "Per" amount and unit of measure (typically a solution volume, e.g., 1000ML). The "Qty/dose" is a required dosage field that represents the number of units (e.g., tablets, vials, etc) that is represented by each dose. 
    2. Dosage field values are intended to equal the amount of the drug represented by the entire amount of the inventory item.  The dosage field values will also usually represent the billing amount represented by the billable unit "charge-code" and/or billable unit "patient price". 
    3. The "Qty/dose" field is required, and order ingredients will always contain a "Qty/dose" number. The default "Qty/dose" value is "1" unless otherwise specified in the formulary record or in the order.
    4. The "Dose" and "Per" values are optional. However, most formulary drug/solution records should have a "Dose" or a "Per" value, but usually not both. For multi-dose or bulk dispensed items, don't use the Dose/Per fields to represent concentrations; instead, place the entire content of the bulk amount in one of these fields (For example, for "AMPICILLIN 250MG/5ML 100ML", the Description should be "AMPICILLIN 250MG/5ML", the "Per" should be "100" "ML" and the "Dose" should remain blank.)
    5. For common IV additives, we recommend that you don't use the Dose/Per fields to represent concentrations. Instead, just use the "Dose" field. For example, for "KCL INJ 20MEQ/10ML" the description would be "KCL INJ" and the "Dose" would be "20" "MEQ". The "Per" field would be left blank.
    6. At order entry time, dosage fields are carried forward from the formulary into the order. These can then be edited to the exact dose the patient is receiving. The program will automatically recalculate the "Dose" (strength), "Per" (volume), and "Qty/Dose" (quantity per dose) values if you edit any one of these order ingredient fields.
    7. Be sure you set up the dosage fields in the formulary BEFORE creating common orders for these items.
    8. Hann's On Software provides a utility that attempts to extract dosage data from your drug description on a batch basis. It can also automatically strip duplicate dosage information from your drug descriptions. After using it, you must review each formulary record to be sure the results are correct.

        Examples of dosage fields: 

        1) Drug description: CARDIZEM CD TAB

            (Note: this is a 300MG tablet)

                Dose: [ 300 ] [ MG ] 

                Per:   [       ] [      ]   ( another option:  Per: [ 1    ] [ EA  ] )

        2) Drug description: D5W 

                (Note: this is a 1000ML IV solution)

                Dose: [       ] [      ]

                Per:   [1000 ] [ ML ]

        3) Drug description: GORILLACILLIN SUSP  

                    (Note: This is a 10ML unit dose container with a concentration of 250MG/5ML. The charge code for this item reflects the full 10ML amount )

                Dose: [ 500 ] [ MG ]  

                  Per: [ 10   ] [ ML  ]

    Method 3 above is not recommended for bulk (demand fill) items or multi-dose containers. Instead, the dosage field should reflect the entire amount of the container since the assigned charge code typically represents the entire container, not the dose amount.  Concentrations (if any) should be imbedded in the description field, or included in a comment line for bulk/demand fill or multi-dose items. At order time, the user typically leaves the "Quantity per dose" field at "1" to enable 1 bottle to be billed, and would not edit any "dosage" fields. See Example 4 below:

        4) Drug description: TYLENOL ELIXER 80MG/5ML 

            (Note: this is a 120ML bottle intended for multi-dose use. The charge code reflects the entire 120ML bottle)

                    Dose: [       ] [      ]  

                     Per: [ 120 ] [ ML  ]

  5. NDC number
    1. This number allows our program to keep your database updated with AWP prices, "clinical checking" tables (e.g., allergies, interactions, etc.), patient education monographs, formulary defaults, and etc.
    2. Use a 5-4-2 pattern. NDC’s are formatted in a 5-4-2 number pattern; i.e., three sections separated by 2 hyphens. The first section is for a manufacturer code, the second is a product identifier, and the last is a dosage form/strength identifier. If the bottle, or other reference, shows fewer than the prescribed number of digits in any section, use leading zeroes to pad them. For example, if the bottle shows "3546-234-2", you must enter the NDC as "03546-0234-02" (NOT as "00035-4623-42 !)
    3. Although NDCs are important, you can go "live" without them in place as long as you perform any necessary clinical checks yourself.
  6. AHFS
    1. This is the American Hospital Formulary Service code.
    2. This field will be automatically updated after the NDC number is in place.
  7. Entry date: enter the date the item was added to the formulary, or when it was updated, or leave it blank.
  8. Route: 
    1. Choose a route from the drop-down list. 
    2. If the route is present in the formulary record, it saves one order entry step each time you do a new order! 
    3. If the item can be administered by more than one route, you can leave it blank and select the route at order entry time. 
    4. How to add routes to IP's current list
  9. Generic code
    1. This is a First Databank code, used for clinical checks. You do not have to enter this data.
    2. This field will be automatically updated after the NDC number is in place.
  10. DEA code
    1. This is the DEA schedule code 2-5 for the item (if any).
    2. This field will be automatically updated after the NDC number is in place.
  11. Charge code
    1. Most facilities use a charge code (or CDM number) for each chargeable item. For your start-up formulary, these were probably imported from your hospital database.
    2. Be sure to include any leading zeroes and trailing "check digits" if your hospital system uses them.
    3. If your charge codes include hyphens, letters or punctuation, check with your hospital vendor AND Hann’s On Software to be sure they should/must be included. In most cases, they will not be included.
  12. Patient charge #1
    1. This is the patient charge, per unit of use, for the formulary item.
    2. The hospital financial system usually dictates this price.
    3. This field can be used by certain revenue/cost reports generated by the pharmacy software.
  13. AWP cost
    1. This is the average wholesale cost per unit of use.
    2. This field will be automatically updated after the NDC number is in place.
    3. This field can be used by certain revenue/cost reports.
  14. Cost
    1. This is the actual acquisition cost per unit of use.
    2. This field can be maintained manually, or via an optional interface with your wholesaler, or left blank.
    3. This field can be used by certain revenue/cost reports.
  15. Patient charge #2, Retail #1, Retail #2: These fields are not currently in use but may be used in future applications.

Defaults tab

    The next "high payoff" fields are found under the "Defaults" tab. Click on the "Defaults" tab to display them for the selected record (i.e., the one displayed at the top of the screen). The "high payoff" defaults fields are in bold lettering below.

  1. Formulary Type: This optional field could be used as a formulary report filter but can often be left blank.  This field may be removed in future versions.
  2. Order type
    1. Set IVPB and Large volume IV order types. For your IV piggyback "fast movers" (e.g., IV antibiotics, etc.) and large volume IV solutions, be sure to set this value to save several IV order entry steps.
    2. You can leave this field blank for typical "unit dose" medications because the program will prompt you for this information the first time you select the item from the formulary (i.e., you can set the formulary item’s "order type" from order entry "on-the-fly"). After a few weeks, most of your "fast movers" will have their formulary "order type" pre-set automatically via this one time on-the-fly process.
    3. If an item will only be dispensed as "floor stock" unit dose or IV, you can set the order type ahead of time. Otherwise, set it when you enter the order.
  3. Therapeutic code
    1. This field is present for upward compatibility with the previous program version. It can be left blank.
    2. In the previous version, this field was used as a report filter. In this version, the formulary "User defined" fields have greater flexibility and benefits as report criteria/filters.
  4. Renal warning
    1. If the drug’s dose and/or interval should be modified according to renal function, change this to "Yes".
    2. If set to "Yes", the program will check the patient’s creatinine clearance and display/record an appropriate reminder/warning at order entry time.
    3. Examples: GENTAMYCIN, VANCOMYCIN, etc.
  5. Expiration days
    1. You do NOT have to enter this value in the formulary unless it differs from the system level value.
    2. The program allows you to set the expiration time for IV orders (typically 24, 48 or 72 hours) at a system wide level (see Utilities/Options/Order Entry tab).
  6. MAR flag
    1. Leave this blank unless you want to force this item to be on a "Scheduled" MAR page, a "PRN" page, or set to "DON’T LIST" on the MAR.
    2. If this is left blank, the program will determine the proper MAR placement for the order from the SIG.
  7. Fill method
    1. Leave this blank unless you want to force this item to be an "Auto fill" versus a "Demand fill" item.
    2. If this is left blank, the program will determine the proper "fill method" for the order from the SIG.
  8. Billing Multiplier Learn More...
  9. Auto stop days 1
    1. The number of days after which the order containing this item should be renewed or discontinued.
    2. If present, this value is preferentially used to automatically generate the order stop date at order entry time.
    3. If it is absent, the default system level value is used (e.g, 30 days) ("Utilities"à "Options"à "Order entry").
    4. You do NOT have to enter a stop day value for all drugs in the formulary, unless it differs from the system level value.
    5. Enter a stop day value (e.g., 3-7 days) for drugs that are in specific categories (e.g., antibiotics, controlled drugs, steroids, anticoagulants, etc.) if they differ from the system level value.
  10. Auto stop days 2
    1. This works exactly like Auto stop days #1 but it is reserved for non-inpatient beds (e.g., SNF, Psych, etc.)
    2. This allows you to have different stop days for a drug for patients in different areas of the facility.
    3. The Room update program ("Utilities") allows you to specify which code (1 or 2) is used for each room/bed.
  11. IV rate
    1. You do NOT have to enter a rate value in the formulary, unless it differs from the system level value.
    2. The program allows you to set the default IV rate for small volume IVs (typically 100 or 200 ml/hr) at a system wide level (see Utilities/Options/Order Entry tab).
    3. For large volume IV orders, the rate is calculated from the volume and interval, or specified by the user. Therefore, formulary rates are rarely entered for large volume IVs.
  12. SIG default
    1. If standard directions for use (SIG) apply to the drug, you can preset a SIG in the formulary record.
    2. Typical examples: "QD", "BID", "2 TABS Q4H PRN PAIN", "Q8H", "50ML/HR" and similar entries.
  13. Comments default
    1. If the same comment is to appear on each order for the item, you can preset it in the formulary record.
    2. Typically, comments are coded to appear on pharmacy profiles and nursing MARs but not on labels.
    3. For example, "CHECK B/P BEFORE EACH DOSE"
  14. Label default
    1. If the same information is to appear on each label for the item, you can preset it in the formulary record.
    2. Typically, label information is coded to appear on IV and/or unit dose labels but not on nursing MARs.
    3. For example, "REFRIGERATE", "INFUSE OVER 30 MIN"
  15. Associated Items
    1. Click the Add Item button to set default solutions for IVPB drugs. The "Associated Item" is typically a default solution intended for an IV piggyback additive (e.g., you can add "D5W 50ML" from the drop down list for the IV piggyback "CEFAZOLIN 1GM INJ"). This is a big time saver for IVPB orders.
    2. Any inventory item (even non-IVs) can be assigned a second, third, associated inventory item that will be added to the order ingredient list automatically (with pre-set defaults intact) upon selection of the first item.
  16. Hide
    1. This checkbox controls whether the ingredient/item is visible to non-pharmacy staff on labels and MARs.
    2. This should only be "checked" for special fees such as "IV ADDITIVE FEE" which might appear as a chargeable ingredient in the order but should not visibly appear on labels/MARs. Otherwise, it is usually unchecked.
  17. No charge
    1. This checkbox controls whether the ingredient/item is chargeable or not. It is usually unchecked.
    2. This should only be "checked" for items/ingredients that are provided at no charge to the patient such as ACETAMINOPHEN TABS but which should otherwise appear on labels/MARs.
  18. Default dosing (administration) times
    1. If the daily administration time(s) for an item differ from the standard settings, you can enter them here.
    2. For example, "QD" might normally be set at "0800" as a system wide option (Utilities/Options/Administration times tab) but for "DIGOXIN 0.25MG PO QD" might want to always give it at "0700" each day. If so, enter "0700" in the "Dose 1" field for the "DIGOXIN 0.25MG TAB" formulary record.
    3. The 2nd dose of the day (if any) would be entered in the "Dose 2" field; the 3rd dose of the day in the "Dose 3" field and so on. For the vast majority of your formulary records, these fields will be blank.
  19. Order Entry Message
    1. Place a message in this free text field if you would like the message to appear on the screen when selecting the formulary item during order entry.
  20. Ignore duplicates
    1. Check this if you want duplicate drug/class checking turned off for this item.
    2. Most users prefer to ignore duplicates for IV solutions, saving time at order entry.
  21. Add drug description #2 to labels/MARs
    1. If this is checked, the order entry process will automatically add drug description #2 to the ingredient list as a no charge item (i.e., for information only).
    2. This is often used for IVPB drugs (e.g., antibiotics) so nurses can see both generic and brand names.
  22. AWP Divider
    1. This field helps calculate the AWP cost if the size of the formulary item does not match the size in First Databank's (FDB) database. For example, your formulary record for BACTRIM SUSP 5ML may use an NDC number which points to BACTRIM SUSP 355ML in the FDB tables. You want the AWP price in the formulary to be for 5ML not 355ML. To determine the proper multiplier value to use, divide the size of the FDB item by the size of the item in your formulary. Following our BACTRIM example: the multiplier value = 355/5 = 71.  Subsequent database updates will divide the FDB AWP for 355MLs by 71 to obtain the AWP for the 5ML formulary item.  
    2. See also "How AWP prices are updated and calculated" for more information.

Inventory Control tab

If you click on the "Inventory Control" tab, the screen below (example) will appear.

This screen is used to adjust/view inventory values, or view usage statistics for the selected formulary item. On the right side of the screen, the program will display calculated values for order counts, inventory and usage for this item. Most of the values are calculated from your orders and are not edited by the user. Inventory maximum and minimum values, however, can be edited directly.

If you must use inventory tracking, you can increase the inventory count by using the "Add" inventory button, then edit the resulting new record on the list. If inventory is transferred to another department, etc., you can use the "Utilities" à "Department Cost Transfers" menu option. These "department cost" transfers will also appear in the above list as an adjustment to your inventory, if you elect to do so.

First Databank Search tab

This tab provides access to the First Databank database. The FDB database contains approximately 100,000 items whereas most users’ inventory tables average around 1500-2500 items. You can update information in your formulary record with FDB data. This includes AWP, DEA codes (e.g., Schedule 2-5), AHFS codes, generic codes (used for allergy, drug interaction, duplicate checks, patient monographs, etc.), and NDCs.

Update method #1: record-by-record updates with the "Import" button

  1. Select the target inventory record (as we have done above).
  2. Select the First Databank Search tab
  3. Select the appropriate drug record from the FDB database.
    1. You can search by drug name or NDC code.
    2. Type 1 or more characters then press <Enter> to view a list of matching FDB drugs.
    3. Be sure to use the "Clear search" button to initiate the next search.
  4. Use the "Import" button to move the data from the FDB record into your inventory record. 

Update method #2: batch updates with the "Synchronize" button

  1. Be sure your target inventory records have valid NDC entries. (e.g., use manual entry or import the NDCs from another database)
  2. Select the First Databank Search tab
  3. Select the "Synchronize" button to import data from the FDB file into each of your inventory records containing a matching NDC.

Update method #3: monthly database updates

  1. Be sure your target inventory records have valid NDC entries. (e.g., use manual entry or import the NDCs from another database)
  2. Download a database update from the Hann’s On Software web site
  3. The update imports data from the FDB file into each of your inventory records containing a matching NDC.

How AWP prices are updated and calculated:

When using the "Synchronize" feature, or when doing a monthly database update, the program updates the user's formulary with new AWP data.  FDB provides AWP prices on a per "ML", "GM" or "EACH" basis.  If this data is missing, the program can also use the formulary field "Measurement Unit".  For drugs priced using the per "ML" or per "GM" method, the program multiplies FDB's "AWP" value by their "PackageSize" value and divides the result by our formulary "Multiplier" field value. If the Multiplier field is blank, the program will assume it is 1.   Summary:

For ML or GM: (AWP x PackageSize) / Multiplier =  AWP in formulary

     Examples: $0.020/ML x 500ML / 1 = $10.00 for the 500ML solution

     $0.020/ML x 500ML / 5 = $2.00 for the 100ML of the same solution

For EACH, and everything else: AWP / Multiplier = AWP in formulary

     Example: $0.450 EACH / 1 = $0.45 for each tablet

Floor Stock Lists tab

This tab allows you to add/delete the currently selected formulary/inventory item to/from any floor stock list listed on the right side of the screen.

This tab also allows you to see the various floor stock list(s) which include this inventory item. In the example, our selected CEFAZOLIN 1GM INJ formulary item is found only on the "Anesthesia Cart #1" floor stock list.

You should also be aware of the separate "Floor stock list" maintenance program found under the "Utilities" menu. This separate maintenance program shows/maintains all the drugs contained on each floor stock list and is suited for day-to-day floor stock maintenance duties.

User-Defined tab

The "User Defined" tab allows you to assign custom "fields" or "tags" to inventory items. For example, if the standard Ascend-I.P. data fields do not include a category that you want to track, you could create the desired field and assign it to the formulary item.

Another common use for user-defined fields is to "tag" various records in the inventory for reporting purposes. For example, you could create a user defined "tag" called "NON-FORMULARY DRUG" and then assign this to each formulary/inventory item that is not approved (i.e., by the P&T Committee) for use at your facility.

Although user defined fields are assigned to inventory records here, they are created elsewhere. To create them, go to "Utilities" à "Options" à "User Defined" tab (see the document "AIP Option Settings" for more information) 

Adding, Modifying and Deleting Formulary Records

To add a new item to the formulary:

  1. Select the "Formulary Search" tab
  2. Ideally, you should search the current records to be sure the item doesn’t already exist.
    1. You can search by drug name.
    2. You can search by charge code (ideal).
    3. You can search by NDC.
    4. Use the "Clear" button in between searches.
  3. If not found, select the "Add Formulary Item" button at the bottom of the screen
  4. The program will present you with a new, empty record with blank fields (at the top of the screen)
  5. Enter the item name (e.g., CEFAZOLIN 1.5GM INJ in our example)
  1. Enter the other required/optional data for the new record as discussed at the beginning of this documentation.
  2. Your work is automatically saved as you enter data. (i.e., there is no need to do anything special to "save" the record when you exit the program or select another drug via the "Formulary search" tab)

To modify a formulary record:

  1. Follow steps 1 and 2 in the "Add a formulary record" section above.
  2. After selecting the item, edit any field that requires changing at the top of the screen.
  3. Select the tabs for this item (e.g., Defaults) and modify any of the data under the tab screen as needed.

To delete a formulary record:

  1. Follow steps 1 and 2 in the "Add a formulary record" section above.
  2. After selecting the item, select the "Delete Formulary Item" button at the bottom of the screen.
  3. Confirm the deletion if you are sure the selected record showing at the top of the screen is, in fact, the one you want to delete.

Summary

In general, use the first tab to select the inventory/formulary record that you want to view or edit. The selected record will appear at the top of the screen. Select any of the remaining tabs to set additional options for the selected item. By the time you select a new item, or exit the formulary maintenance program, any changes to the previous record have already been saved.