“Spring Cleaning”— some of us love it, some of us hate it, but we all know that periodically taking the time to clean will benefit you and those around you in the future. The same applies to your MEDITECH dictionaries; performing routine cleanups will lead to less maintenance (and stress) in the future. More than that, making sure your dictionaries are up-to-date helps clinicians document more efficiently and accurately.
Where can you start? Here are some tips from a MEDITECH Pharmacy Expert. Think: Clean, concise, and clear.
Clean: What mnemonics are you using?
Inactivate what you don’t use. Start with a dictionary (try to start small) that has not been reviewed or updated in years. Be sure to collaborate within your facility, with MEDITECH specialists, and expert CereCore consultants through the process, because while some dictionaries house mnemonics your facility does not use often or at all, they may be required and remain active for other applications and interfaces to function properly.
- Get a list of active mnemonics within that dictionary. NPR dictionaries can provide this from the List routine, M-AT dictionaries can provide this from the Report routine within each dictionary. To create a more accessible list, you may want to use a custom report that you can download and manipulate in Excel. We have many already created and can help with these.
- Determine if any active mnemonics are no longer being used. This is a little tougher to uncover depending on the dictionary, but you can review usage statistics on many mnemonics using MEDITECH’s Activity Logs. In NPR, MEDITECH will also provide a list of dictionaries that a particular entry is referenced in by setting N in the Active field. For those with a status you can’t quite determine, check with other departments and applications to insure no one throughout the facility uses it.
- Add entries no longer being used to the Inactive pile. (Be sure you have collaborated, first.)
Now you know what you are currently using.
Concise: What mnemonics do you need?
Remove duplicates. We all know you cannot have two of the exact same mnemonics in MEDITECH, but we have all seen two different mnemonics that share the exact same Name or the same meaning.
- Insure there is only one Mnemonic per purposeful and necessary entry. This will help keep your dictionaries uniform, and remove confusion to technicians, nurses, and even ordering providers.
For example, let’s look at “TAB – Tablet” and “TABLET – Tablet” from the Medication Form dictionary. Both refer to a medication that is in the form of a tablet, both have their own unique mnemonic, and both may even be associated to various medications within the Drug dictionary. However, you only need to use one. Collaborate with your facility and CereCore Consultant to choose which one is most appropriate for you.
- Compare similar mnemonic entries and determine the necessity of each. Not only are there duplicates in Names and Mnemonics, but in some cases, there are duplicates in use.
Another good example of this is the Charge Formula and Charge Type dictionaries in Pharmacy. Though you can create as many Charge Types as you have medications (each with their own specific mnemonic), you may find you only need a handful to cover all charging scenarios. Many “different” Charge Types use the same Charge Formula as well as the same workload entries. If the only difference between several Charge Types is their Name, decide which one to use going forward.
- Determine if your facility requires any differentiations by asking questions like: What are they attached to? Do they need to be separated into different categories and is this dictionary the appropriate place to do that? Are there any other fields within the two entries that are purposefully different from each other? Asking these questions will enable you to slim down your dictionary mnemonics to only the entries you need and actually use in your facility, alleviating future confusion.
Now you are using only what you need.
Clear: What do the mnemonics describe, if anything?
Clarify each entry. Are the Mnemonic, Name and descriptions still appropriate and relevant today? The healthcare world is ever-changing. What was considered critically necessary one month is obsolete the next, locations are adjusted, staff protocols updated, machines moved or entirely replaced. Your nurses may see PRESURG as a medication’s Dispensing Machine location, and just have to “know” that PRESURG is actually the Machine that was moved out of PreOp five years ago and is now housed in the 3rd floor ICU wing.
- Use clear descriptions (and when possible, mnemonics) for each entry. The clearer your descriptions, the clearer the entire process becomes for clinical staff. Plus, IT staff can maintain dictionaries and troubleshoot errors more efficiently, no longer having to guess what a decade old Pharmacy Rule simply labeled “MEDS” is supposed to do.
Caveat: Renaming or editing within certain dictionaries is not always recommended. Instead, it may require a copy of the entry to be created or a complete rebuild for a particular item. Be sure to reference MEDITECH’s P&R page as well as seek guidance from your MEDITECH Specialist and CereCore consultant when working through this process.
- Determine if any existing mnemonics have become an umbrella for multiple uses and functions. Some entries may need to be parsed out to help maintain a clear purpose or to prevent clinicians from being too vague in their documentation.
For example, you might need to clarify a particular entry used by nurses within the Override Comment dictionary. When attempting to document an administration of a medication order, you might find that, regardless of what type of conflict there is, the Override Comment every nurse uses is “MO - Med Override”. This is a perfect example of an entry that is too vague, and even though it is being used constantly, it is not creating a clear documentation trail to help others understand why an override was necessary. Instead, you could collaborate with the various nursing, provider, and pharmacy teams to determine multiple — but specific— entries that could replace this one.
- Establish a set of Naming Conventions within your facility. Start to standardize the formatting within each application and each dictionary. Do you want all mnemonics to always be in ALL CAPS, but all names to be in Mixed Case? In some cases, you can use the same Naming Conventions across all dictionaries within an application or department. In others, because of the unique function of a particular dictionary, you may have to decide on specific Naming Conventions per dictionary.
For example, in PHA many of the supporting dictionaries (Charge Formula, Charge Type, Medication Form, etc.) could easily follow the “MNEMONIC - Name” type of Naming Convention. However, the Generic Name and Drug dictionary often should not follow this convention, as look-alike and sound-alike drugs generally use taLL MAn lettering to clarify the specific drug entry.
Now what you are using is appropriately defined.
By following the 3 Cs of organization, you can have a dictionary that is efficient and effective for your facility. Lastly, one final C:
Continue this process on to the next dictionary, and eventually next application, until all have been reviewed within a year or set period of time. Establish a routine or ongoing project so that gradually more dictionaries are cleaned up. The more you follow this process, the smaller and faster the clean-up job becomes. Your clinical staff will reap the benefits of your labor, and that’s why we do what we do — to help make a difference in their jobs of delivering patient care.
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