This rule will summarize the total amount of acetaminophen administered to a patient in the last 24 hours. If the total is less than 4000 mg, a pop-up will display the total. If the current administration will cause the total to exceed 4000 mg, a pop-up will appear allowing the user to erase or override. If the total is already over 4000 mg, the current administration must be erased. The rule utilizes a custom keyword to calculate the running total and generates appropriate messages and responses based on the total and whether it will exceed 4000 mg with the current administration.

1. What the Rule Will Accomplish: This rule will attempt to total the amount of a drug
ingredient which has been administered to a patient in the last 24 hours. If the total
administered amount is less than 4000 MG, then a pop-up will appear on the eMAR
stating the total amount which has been administered in the last 24 hours (not
including the current administration). The user will be able to click close and continue
on with the current administration. If the total administered amount will exceed 4000
MG by the inclusion of the current administration, then a pop-up will appear on
the eMAR stating that the current administration will cause the total to exceed 4000
MG. The user will be able to erase the current administration or override it. If the total
administered amount is greater than 4000 MG prior to the current administration, then
a pop-up will appear on the eMAR stating that fact. The user will be forced to erase
the current administration.

2. KB ARTICLE: 42533 - EMAR RULE: WARN FOR MAXIMUM AMOUNT OF DRUG
INGREDIENT (ACETAMINOPHEN) BEING ADMINISTERED IN LAST 24 HOURS
Required Steps to See Rule in Action:
1. Attach the designated ingredient ("ACETAMIN") to all applicable drugs in PHA Drug
Dictionary
(Ingredients tab)
2. Designate an ingredient amount for each applicable drug in the PHA Drug Dictionary
(Amount
prompt on Ingredients tab)
3. Designate a unit (Ex: MG) for the ingredient in question
(Unit prompt in the Drug Ingredient Dictionary)
4. Create the keyword in the PHA Keyword Dictionary
5. Create MIS Override Comment(s) for use within the PHA rule (see linked KB 41528)
6. Create the rule in the PHA Rule Dictionary
7. Update keyword code to remove "XXX" and swap in a designated iv containing
acetaminophen
drug (if applicable)
8. If changing keyword code, make sure to re-file rule after keyword edits
9. Attach rule in CDP (Rules tab)
10. Select a patient for testing
11. Enter several Rxs on the profile for drugs containing the designated ingredient
12. Access the eMAR
13. Acknowledge and administer the Rxs in question
14. Ensure the rule pop-up appears under the appropriate conditions as described in the first
paragraph of this article.

5. Keyword Dictionary: There is 1 keyword required for the rule logic to work. As with any rule with custom keywords, the custom keyword(s) must be created prior to the creation of the rule.
Keyword 1:
Function: RX
Name: RX
Mnemonic: z.total.acet.doses
Active: Y
Name: Total Acet Admin Doses in Last 24 hrs
Assign to Group: Z
Number of Arguments:
Execute at Translation: N
Special Flag:
Value:
Code:
""^TOTT^ADM.PAT.mri.urn^INGR^RULEFLAG,
@PHA.OT.type[@order.type]^TOTT,
@ADM.PAT.mri.urn^ADM.PAT.mri.urn,
"ACETAMIN"^INGR,
@PHA.DRUG.ingredients[,INGR]^RULEFLAG,
""^ADM.PAT.urn^urn^OTT^admin.q^/ZTOTALINGRAMT^TOTALINGRAMT,
^$(T)^z,^?(T)^y,
DO{@Next(ADM.PAT.urn,ADM.PAT.mri.urn.x)&(RULEFLAG) 1,
DO{@Next(urn,PHA.RX.pat.tr.x) IF{"CAN"=@status;
@PHA.OT.type[@order.type]^OTT,
%PHA.RX.compile.med.array(urn,^/ZD),
""^DRUG^INCL,
DO{+/ZD[DRUG]^DRUG IF{@PHA.DRUG.ingredients[DRUG,INGR] 1^INCL}},
IF{INCL_.=.;
DO{@Next(admin.q) IF{(@.sd-(@admin.seconds))>86400;
IF{("Y"'=@admin.given)!(@admin.undone);
""^DRUG^DRUGINGRAMT^CV^DOS^DISPINGRAMT,
DO{+/ZD[DRUG]^DRUG IF{@PHA.DRUG.ingredients[DRUG,INGR]_.=.;
@PHA.DRUG.ingr.amount[DRUG,INGR]^DRUGINGRAMT,
IF{("IV"=OTT)&(DRUG="XXX") @carrier.volume[,1]^CV,
@PHA.DRUG.dispense.size[DRUG];@PHA.DRUG.order.size[DRUG]}^DOS,
((IF{CV;@admin.dose?0D}:6D)/DOS)^DISPINGRAMT,
(DRUGINGRAMT*DISPINGRAMT):0D+/ZTOTALINGRAMT^/ZTOTALINGRAMT}}}}}}}}},
;
@t.urn^urn,@t.PHA.DRUG.mnemonic^PHA.DRUG.mnemonic,
;
""^ADRUGINGRAMT^CVA^ADOS^ADISPINGRAMT^ATOTALINGRAMT,
@PHA.DRUG.ingr.amount[,INGR]^ADRUGINGRAMT,
IF{("IV"=TOTT)&(med="XXX") @carrier.volume[,1]^CVA,
@PHA.DRUG.dispense.size;@PHA.DRUG.order.size}^ADOS,
((IF{CVA;/MAR.ADMIN.DOSE?0D}:6D)/ADOS)^ADISPINGRAMT,
(ADRUGINGRAMT*ADISPINGRAMT):0D^ATOTALINGRAMT,
;
/ZTOTALINGRAMT
From KB Article: 42533

6. RULE LOGIC:
Rules Dictionary (Entry Screen):
Mnemonic: ACET.TOTAL
Active: Y
Name: TOTAL ACET ADMIN DOSES
Data Fields From: RX
Enabled For: PCS
Ignore Renew Stop:
Evaluate at: PCS MAR
Rules Dictionary (Shortcut):
Shortcut Type Shortcut Definition
TOTALINGRAMT VARIABLE [f z.total.acet.doses]
FINALINGRAMT VARIABLE (TOTALINGRAMT+ATOTALINGRAMT)
Rules Dictionary (Editor):
At the Table field, type LINE, and hit Enter. Create the following lines:
LINE(1)
If Value: TOTALINGRAMT
Associated Data:
Comparison: Does Not Exist
Value:
Associated Data:
Outcome: rx ok
Associated Data:
Link: Else
Button:
Message:
LINE(2)
If Value: TOTALINGRAMT
Associated Data:
Comparison: Greater Than
Value: 4000
Associated Data:
Outcome:
Associated Data:
Link: Else
Button: Erase
Message: Prior admins have exceeded 4000 MG of acetaminophen in last 24 hrs.
LINE(3)
If Value: FINALINGRAMT
Associated Data:
Comparison: Greater Than
Value: 4000
Associated Data:
Outcome:
Associated Data:
Link: Else
Button: Erase
Override
Message: Current admin will exceed 4000 MG of acetaminophen in last 24 hrs.
Total Acetaminophen Administration in last 24 hrs: [f TOTALINGRAMT] MG
If overriding, please select override reason from down arrow.
LINE(4)
If Value: FINALINGRAMT
Associated Data:
Comparison: Less Than or Equal To
Value: 4000
Associated Data:
Outcome:
Associated Data:
Link: Else
Button: Close
Message: Total Acetaminophen Administration in last 24 hrs: [f TOTALINGRAMT] MG
END
If Value:
Associated Data:
Comparison:
Value:
Associated Data:
Outcome: OK
Associated Data:
Link:
Button:
Message:
If you do not have access to KB Article: 42533 - Copy Rule into Word to make
bigger.