USER GUIDE

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TABLE OF CONTENTS V7..2 TABLE OF CONTENTS V7 2

ContentsPage No. Table of Contents v7.2 ................................................................. 2 1.0 STARTING UP ......................................................................... 4
1.1 Switching on and Starting NexPhase 1.2 Initial screen 1.3 Pop-Up Menu 1.4 Workflow 4 4 4 5

2.0 PATIENT Details...................................................................... 6

2.1 Patient search 2.2 Adding a new patient 2.3 Last patient 2.4 Patient history 2.5 Patient Notes 2.6 Merging duplicate patients 2.7 Deleting a patient (Patient Status 6 6 7 7 8 9 10

3.0 DISPENSING .......................................................................... 10

3.1 Dispensing a repeat 3.2 Dispensing a new item 3.3 Endorsing 3.4 Adding dosage 3.5 Labelling 3.6 Finishing the prescription 10 11 11 12 13 16

4.0 INTERVENTIONS................................................................... 17
4.1 How to Intervene 4.2 Reviewing an Intervention 17 18

5.0 Prescriber search ................................................................. 18

5.1 Prescriber Maintenance 18

6.0 Prescription types ................................................................ 19

6.1 NHS Scripts 6.2 Private Prescriptions 6.3 Veterinary Prescriptions 6.4 Emergency supply 6.5 Counter Sales 6.6 Parked Prescriptions 19 20 20 21 22 23

7.0 collection & delivery ............................................................. 24 Page - 2

7.1 Configuring C&D settings 7.2 Registering a Delivery Patient 7.3 Managing Collections & Deliveries

24 24 25

8.0 Owings ................................................................................... 26

8.1 Creating an owing 8.2 Redeeming an Owing 26 26

9.0 Extemporaneous dispensing .............................................. 27

9.1 Extemps. 9.2 Specials & Alternative Medicines 27 28

10.0 Instalment dispensing ........................................................ 29

10.1 Dispensing in Instalments 10.2 Managing Instalments 29 29

11.0 REPRINTING ........................................................................ 31

11.1 Reprinting a label 11.2 Reprinting Endorsements 31 32

12.0 Drug information................................................................. 32

12.1 Drug Info Menu 12.2 Drug Interactions 12.3 Drug Details 12.4 Attaching Drug Notes 32 33 34 35

13.0 Medicines Use review ........................................................ 37

13.1 Processing an MUR script 13.2 Printing the MUR Form 37 39

14.0 Batch repeat prescribing ................................................... 40

14.1 Processing RA Scripts 14.2 Dispensing an RD Script 40 42

INDEX ........................................................................................... 45

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1..0 STARTING UP 1 0 STARTING UP

1.1 Switching on and Starting NexPhase
Switch on printers, base unit and monitor. Double click on the NexPhase icon on the screen, and enter your User name and Password, this is set to ______ and ______, now press OK and wait for it to load.

1.2 Initial screen

The initial screen will display an On Screen Graphical Representation of the Prescription (named OSCAR) on the left hand side. This is where the whole dispensing process takes place, i.e. Patient search, Item search, Endorsing, Labelling and Prescriber search. All of this is done in the appropriate fields. The Workflow screen, on the right hand side, shows you: Script Items (a history of dispensing); Parked Prescriptions (i.e. put on hold while you deal with something else); Scriptserve (the repeat management service); the Owings register; the Emergency supply register (a record of Prescriptions waiting to come in), a Reminders list; the Instalments Tab; a useful Help section and an ETP(Electronic Prescriptions) Tab.

1.3 Pop-Up Menu

As you work through NexPhase, there are different things you can do at each step. You can see what functions are available by pressing the CTRL key on your keyboard. This displays the Popup Menu, which shows only those commands that are valid for where you are at the moment, i.e. it is screen specific. All commands have keyboard shortcuts associated with them just hold the CTRL key down and type the letter. Hence, CTRL+N = New Prescription. With practice, you will not need to wait for the popup menu window to appear - you will automatically use for New Prescription. Page - 4

N.B. pressing the Ctrl Key on the right hand side of the keyboard will bring the Popup menu immediately, whereas the one on the left hand side has a few seconds delay, thus use the left Ctrl Key when short cuts are known. You can also right-click the mouse to instantly display the menu. Pressing Escape removes the Pop-up menu.

1.4 Workflow
The Workflow is your Pharmacy Management screen. It shows you the status of all the scripts you have ever worked on, divided into these categories: Script Items, Parked Scripts, Scriptserve, Owings, Emergency Supply, and Instalments. It also enables you to create memos on the Reminders tab, has the facility for an ETP service and also displays a Help section. The Workflow normally shows up to a maximum of 500 lines of information on each tab. The tab most likely to reach this limit is the Script Items tab (scripts that have been completed). This can make it difficult to find particular information, such as finding a particular script for a particular patient. Nexphase includes a filter that allows you to make particular selections and display only certain information Press F4 to display the Filter screen. Printing directly from the Workflow: To print Bag Labels from the Workflow highlight the relevant prescription on the Script Items Tab and press Ctrl+B. To reprint a label, highlight the prescription on the Script Items Tab and press Ctrl+R (note that this will print all labels for that prescription). If you require a reprint for one particular item on a multiple item script you will need to highlight that item in the bottom half of the Script Item tab and press Ctrl+R.

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2..0 PATIENT DETAILS 2 0 PATIENT DETAILS

2.1 Patient search
Start typing the patient name in the Patient search box on the FP10. . You can search for a patient using any information. For e.g. First name, Surname, DOB and the First line of address. As you start typing the Patient search screen will appear. This list will become narrower with the more you type. If the patient you are searching for is at the top of the list, simply press ENTER on your keyboard and that patient will be selected. If the patient appears somewhere between the list, use your down arrow key, , to highlight the patients name and press ENTER. This will now take you straight into the Patients history. (Note: you can also select the patient by clicking on the patients name using the mouse.)

2.2 Adding a new patient

If the patient you are searching for does not appear to be on the list, use your arrow keys, as above, to highlight the New Patient line in the Patient search screen, then press ENTER. As you do this, the Patient details screen will appear and the name you had entered will be populated in the patients name field. If you search for the patients name by entering first name [space] surname the correct fields in the Patient details screen will be populated. If however, you wish to enter the patients name by entering the surname first, you must add a comma between the surname and first name. I.e. Surname, first name this will then also populate the correct fields. The Patient Detail screen has the patients name field highlighted in pink, this indicates that this is a mandatory field, therefore must be populated before saving. Pressing TAB or ENTER will take you through all the fields and pressing [Space] will tick any check boxes. You can Page - 6

add as much or as little detail for the patient before pressing CTRL+S to save. Adding Family Members If you have several members of the same family to register onto Nexphase you can use the F9 New Family Member Option to speed up the process. Simply locate the existing patient, press CTRL+E to access their details screen and press F9. The screen will already be populated with the last name, address, telephone number and GP. Update accordingly and press CTRL+S to save. Other Information You can also use the Patient detail screen to record the patients Exemption status, register the patient with different services, i.e. Scriptserve, Delivery, Oxygen or Visually Impaired Labels; record the patients Medical condition, add them to a Nursing Home and add any Other information that may be relevant.

2.3 Last patient

To bring back the last patient viewed press F9.

2.4 Patient history

Once a patient has been brought up, the focus is on the Patient History screen. The most recently dispensed item will be at the top of the list. If you use the down arrow key to move down the list, each individual dispensing of that item will become visible. Each line tells you the prescription type, date of dispensing, quantity prescribed, dosage and prescriber. The post-it note (which appears when the line is highlighted) tells you the quantity dispensed, brand dispensed and the pack size dispensed out of. On the right hand side of the Patient History page is a Compliance Time Line. Each space on the line is equivalent to a month (therefore six months can be viewed at one time and clicking on the highlighted black triangle will move the line forwards or backwards). The green line indicates each individual dispensing for that item. Page - 7

2.5 Patient Notes

Attaching standard notes Patient notes appear under patient history when a patient is selected To access this press Ctrl+T or click on the patient notes area to add. Use Ctrl+N from the patient details screen to add patient notes as well. Once the note has been added exit the screen and the information will automatically be saved. Attaching Categorised Patient Notes The categorised patient note facility enables the user to keep a record of any advice given to the patient, as well as any referrals and interventions concerning the patient's well-being that are made by the Pharmacist. These notes can be recorded on the system under specific categories so that details of the essential services that you provide can be accurately logged. It also means that detailed reports can be generated for specific categories if and when required. Patient notes will be displayed once a patients records are accessed. If you feel that more attention needs to be brought to the information you can set the notes to 'flash up' when the patient is selected. Enter the patients name and select them from the search window Press Ctrl+T to activate the notes window Press Ctrl+D to bring up the Note Details & Categories screen Tick the boxes of all categories that apply to the notes Enter the details of the notes into the Note Text box. If you require the notes to be flashed up on the screen every time the patient is selected you will need to tick the Flash Note when patient selected check box. Press Ctrl+S to save the note

NB: For patients that have had notes attached that have been set to 'flash up' the system will display an Important Notes information box once they have been selected. Press the Escape key to continue dispensing

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Patient Note Reporting From the Main Menu click on the Utilities Menu and select Reports Set the required parameters and press Ctrl+W to preview the report.

2.6 Merging duplicate patients

Before attempting to merge patients it is important to know the following: To merge successfully, patients cannot be: MDS patients, Scriptserve patients and cannot have different genders. From the OSCAR select the patient record you wish to keep i.e. Patient (1). Select Merge Patient from the Patient menu. Locate the patient that you wish to merge i.e. Patient (2) The system will display a confirmation box click on Yes. A screen will now appear showing both patients details side by side. This also contains a warning that if you continue from this point this cannot be undone. Select YES to merge. A prompt will confirm that the merge has been successful. Click on OK and escape back to the main screen.

Patient Merge Details The following information will be kept or disregarded

Patient (1) PMR Patient Conditions Owings Prescriber Exemptions Emergency Supply Parked Scripts Patient Addresses Patient Contacts Patient Notes Patient (2)

(If none for patient 1) (If none for patient 1)

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2.7 Deleting a patient (Patient Status

The system allows the user to make a patient inactive. This means that the patient will no longer be found on any searches or in any reports. Inactivate Patient Select Patient Status from the Patient menu. Start on the Active Patients tab. Find the patient by typing the first few letters of the surname. Press F5 or click Search. The list appears, filtered by what you have typed. Find the name you want. If all is OK, click to tick the check box(es) as above, for each patient you want to remove. Press F6 or click Inactivate. This removes the name from the list. Reactivate Patient Repeat the process as above but start from the Inactive Patients tab. Then press F7or click Activate. This removes the name from the Inactive list the patient will now appear in the search

3..0 DISPENSING 3 0 DISPENSING

3.1 Dispensing a repeat
If the prescription is for an item that appears in the patients history then this item can be dispensed again by simply selecting the number that appears along side the item. The information from the last dispense will then be populated on the on-screen prescription. Any of this information can be amended i.e. labels. Finally, press F8 to print endorsement and finish prescription. CTRL+S will finish the prescription without printing the endorsement. If the focus is on the FP10 and you wish to repeat an item from the Patients History simply press r in the quantity field and the focus will go back to the Patient history, then continue by selecting the number of the item.

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3.2 Dispensing a new item

If the patient has not had the prescribed item before, press 0 (for new item) and the cursor will appear in the quantity field. Insert the quantity and press ENTER to move the cursor to the Prescribed item field. Now as you start typing the name of the item the Drug Search window opens on the right showing you a list of items. As you type, the list shortens until you can see the one you want. The most frequently used item will be at the top of the list with a blue arrow, , next to it. Select item from the list as before for patient search. Drug Search Key points to note on drug search. Blacklisted items or items which are not prescribable by script type or Prescriber type are shown in Red. No more then 30 items can be shown on the search at any one time. If a drug you wish to dispense is not shown within the first 30 items on the search narrow down the search by entering part of the drug name and the strength ie Isosorbi 20mg instead of Isosorbide

3.3 Endorsing
Once item is selected, the Dispense screen will automatically appear. This will show dispensable options with the top one highlighted on the right hand side of the screen. Use the arrow key to select the item to be dispensed and press ENTER. The selected line will now appear on top of the screen, this now indicates that the item is dispensed and thus endorsed. If any additional item is to be endorsed for a particular drug or item, i.e. Water for Injection, this will automatically pop up and can be selected as normal. If a pop up does not appear, you can select items from the search field to add to the endorsement. Page - 11

On the left hand side of the screen is an information screen. This shows any Contraindications, counselling points, warnings and any extra information relating to the item being dispensed. To Exit the screen, press ENTER and you will move onto the dosage directions field. The symbol on the right hand side of the item is now ticked to indicate that this item has been dispensed. Optional endorsement: To add additional endorsements such as PC, PNC, PA, OPE, MF and Urgent, simply click onto the endorsement field or move the cursor onto it and press [Space]. The Optional endorsement screen will now appear and the appropriate endorsement can be selected. Once selected, press OK to exit. Essential endorsement: This is the correct way of endorsing as recommended by the PPA. The endorsement in Nexphase endorses the prescription in the most efficient way, thus it does not over endorse. The endorsement you will see on screen will be in Blue and Grey Italics. The blue part of the endorsements indicates what will print out on the form. This is the Essential endorsement required by the PPA. The grey part is for your reference only, and will allow you to see, at any point, what was dispensed. In the case of a Handwritten Prescription, where the item(s) may not be easily read by the PPA you will be required to endorse the whole prescription completely. This can be done by pressing [F2].

3.4 Adding dosage

As you exit the Dispense screen the dosage field will be highlighted .You can free type over the default dosage of As Directed or select a dosage from the list that appears on the right hand side in the same way as drug search. If dosage code is Page - 12

known (e.g. 1T take one three times a day) you can just press ENTER to select the code. To create your own dosages, go to Drug Info. In the Menu bar at the top then select Dosages. A screen will appear where you can create a dosage and give it a code. When you save this dosage (CTRL+S to save) it will appear in the Dosage search screen.

3.5 Labelling
There are two Label printing modes; Manual and Auto, this can be set up by going to Utilities menu> System Configuration> labels> Label printing mode Manual When on this mode each label for each item will have to be viewed, amended if needed, and printed. Once the item has been selected, dispensed/endorsed and the dosage is added press CTRL+L. The Dispensing label screen will now appear. Pressing CTRL+O here will bring up the Label option screen, which will allow you to edit the way the label is printed. I.e. One label only, One per pack, split over a certain quantity or labels with different Allocated quantities. You can even print Copies if required. If the item being dispensed has a warning that is not relevant to the particular patient, i.e. Warning. May cause drowsiness. If affected do not drive or operate machinery and the patient is a child, the warning can be removed. To do this press CTRL+W and a list with the warning(s) for that item will appear. Use arrow key to highlight the warning and press [Space]. The warning will then disappear from the label (pressing [Space] again will bring the warning back) then click on the at the top right hand corner of the warning screen to exit it.

Once you are satisfied with the label press CTRL+P to print the label, or click on the picture of the printer on the bottom right hand corner. The Dispensing label screen will now automatically close.

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The symbol on the right hand side of the item is now ticked to indicate that this item has been labelled. Auto If you are on Auto label mode simply select the item, dispense/endorse, add dosage and press , or to move to the next line on the FP10 and the label will automatically be printed. You can still edit the label if you need to by accessing the Dispensing label screen as described in Manual labelling mode. Auto Label Preview Alternatively you can configure the system to display a preview of the labels after each item is dispensed. This would then disappear when you press to move onto the next item. You can set this configuration by accessing Utilities menu > System Configuration > Group option > Labels. When doing a repeat item from the Patient History enter the number of the first item to be repeated; the label will not print immediately as you may wish to edit it. When you enter the number of the second item to be repeated, the label for the first item will be printed, and so on. The label for the last item on the form will print on pressing Bag Labels In system configuration bag labels can be set to the following: None - No Bag labels printed Single - One per script All - One per dispensed item One - One per prescribed line If printing is set to auto the bag label will print out at the appropriate time. However labelling is set to manual a preview of the bag label will appear once you have finished dispensing Press to print. Alternatively a bag label can be produced at any time by pressing form the FP10 Page - 14 .

To print Bag Labels directly from the Workflow highlight the relevant prescription on the Script Items tab and press Ctrl+B. Free format labels This can be accessed by going to Utilities menu > Free Format Label. Once the Free format label screen appears, press on the label and start typing. Holding down the options. Press to print or just click key will show you

Batch Labels To create Batch Labels click on the Utilities Menu and select Batch Labels. Search for the drug in the usual way and select a dispensable option. Enter the quantity that you want printed on the labels. Enter a Batch Number and a Product Licence number if required. Enter a Packing Date and an Expiry Date if necessary. Type in the number of labels required Press to print the labels.

N.B. If the labels are being printed for MDS purposes tick the MDS Batch check box. This will automatically enter a Pre-Pack Expiry Date, which will be set as 8 weeks from the date of packing. To save the batch label settings for a product complete the screen and press . The next time that you select the item for Batch Labelling, the details will automatically be entered onto the screen, allowing you to proceed straight to the print process. Visually Impaired Labels For patients who have difficulty reading the print on a standard medication label, Nexphase has the facility to produce label information (in a larger font size) on a sheet of A4. Each dispensed item will produce a standard label along with a reference label. The reference label will give the item number, which in turn refers to the corresponding item number on the sheet of A4 that is printed when the prescription is saved. Page - 15

Setting up a patient for Visually Impaired Labels: Click on the Services Tab in the Patient Details screen Tick the Visually Impaired Labelling check box and press Ctrl+S to save the changes

Producing Visually Impaired Labels: The Visually Impaired Labels will be produced at the same time as your normal labels so that will of course depend on your label configuration. When the labels are printed two will be produced for each dispensed item, a standard label and a reference label:

Example of a reference label

On completion of the prescription a sheet of A4 will be printed from the Report Printer. This will list all dispensed items, their reference number (corresponding to the number on the label) and the dosage instructions for those items.

3.6 Finishing the prescription

Load the printer with the form and press to print the endorsement and finish the script, if you wish to finish the script without printing endorsement just press . You will not be able to finish the script unless a valid Prescriber has been entered in the Prescriber field on the FP10. On pressing a flash will appear asking you to check if this is the correct prescriber, if it

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is then press the form press

on YES. If the Prescriber is different to the one on on NO. See Prescriber search.

4..0 INTERVENTIONS 4 0 INTERVENTIONS

An intervention is anything that requires you to interrupt your routine dispensing activities to resolve an issue. You may sometimes need to intervene before the dispensing of a prescribed item, if you are not happy in some way with what has been prescribed.

4.1 How to Intervene

To intervene for anything on the prescription form: If you are intervening on the whole form click anywhere on the form If you are intervening on an item on the form click on that item

Press A prompt will appear asking you to select A, B or C Press Press to record an intervention against the whole script to record an intervention against the script line

Press to return to the script without recording an intervention If A or B are selected the Interventions Screen will be displayed this is made up of three tabs, each containing questions about the intervention. The check boxes for the available options will either be round or square . Round check boxes mean that only one out of the list of options can be ticked. With square check boxes however, you can tick as many as necessary to provide all the information. The Interventions screen is made up of the following tabs that should be completed as comprehensively as possible: Page - 17

o The Intervention Details Tab o The Intervention Reasons Tab o The Intervention Outcome Tab Once all the information has been recorded press CTRL+S to save. You can also print out the Intervention details by pressing CTRL+P.

4.2 Reviewing an Intervention

A script which has had an intervention recorded against it will be shown on the Finished Scripts tab with the icon. To review the intervention retrieve the script by double-clicking it and then press CTRL+I. Select A or B and the previously selected intervention details will be displayed. NB: To quickly locate the script you are looking for use the filter option CTRL+F4 from the Script Items tab to show all Intervened scripts.

5..0 PRESCRIBER SEARCH 5 0 PRESCRIBER SEARCH

The Prescriber can be searched in the Prescriber search field on the FP10 in the same way as the Patient search. As you start typing the Prescriber search will appear, this contains a complete list of all General Practitioners in the UK. Use the arrow key to select the required Prescriber.

5.1 Prescriber Maintenance

If the patients prescriber cannot be found when searching for existing Prescribers a new Prescriber can be added to the system. Various types of prescribers can be added: Dentist; Veterinary; Nurse; Extended Formulary Nurse; GP

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Adding a prescriber Add a new prescriber by selecting 'New Prescriber' from the list of prescribers from which you are unable to find a match. Alternatively you may access the prescriber list from the Main Menu selecting Prescriber > Prescriber Details. Pink fields are mandatory and must be filled in before you can save a record. . Save and exit you can now search for and allocate that prescriber to different patients. Duplicate Prescribers If the prescriber you have entered already exists in the prescriber search the system will notify you that either the PPA number or a matching first name, last name has been found. The option is then to abandon entering a new prescriber or merging the details with the exiting prescriber. Be aware this will overwrite the existing prescriber details.

6..0 PRESCRIPTION TYPES 6 0 PRESCRIPTION TYPES

6.1 NHS Scripts
Various NHS scripts are available for dispensing: FP10 (MDA) Change the prescription type to FP10 (MDA) from the main menu by selecting Dispensing > FP10 (MDA) Prescription. The FP10 (MDA) form is Blue . Dispense as normal but once the item has been selected from the Dispense as screen you will be given the option to complete an Instalment Dispensing schedule. Dental Change the Prescription type to Dental from the main menu by selecting Dispensing > Dental Prescription. The Dental form is Yellow . You may then dispense as normal. Only items prescribable by Dental Practitioners can be dispensed on the Dental Prescription type. Page - 19

Nurse Change the Prescription type to Nurse from the Main menu by selecting Dispensing > Nurse Prescription. The Nurses form is Purple . You may then dispense as normal. The Nurse Formulary automatically changes according to the Nurse Prescriber Type allocated i.e. Nurse, Extended Formulary Nurse. Hospital Doctor Change the Prescription Type to Hospital Doctor from the Main menu by selecting Dispensing > Hospital Doctor Prescription. The Hospital Doctor form is Gold. You may then dispense as normal.

6.2 Private Prescriptions

Change the Prescription type to Private from the Main menu by selecting Dispensing > Private Prescription. The Private form is White Pricing A summary of Fees and Charges will automatically appear at the base of the Oscar when any item incurring a charge added to the prescription. Click on bottom of Oscar to get detailed breakdown of the fees and charges, such as Container Allowances & Professional Fees. A report is available to view all Fees & Charges over a specific period of time in the Reports section called the Summary of Payments Amounts (FP34) . You may then dispense as normal.

6.3 Veterinary Prescriptions

Change the Prescription type to Veterinary from the Main menu by selecting Dispensing > Veterinary Prescription. The Veterinary form is Dusky Pink . The Veterinary script is in effect a private prescription and therefore has no limitations as to what can be prescribed. Page - 20

Adding an animal Animals are added to the system from the Veterinary Prescription type. Only animal patients are shown when searching for a patient name on this Prescription type. Note the search is on the owners name not the animals although the animal name will be shown when a match is found. New, animal specific, patient details may be added as, normal, if New Patient is selected from the search list.

6.4 Emergency supply

Creating an emergency supply To dispense an emergency supply, you need to select the "Emergency Supply" script type from the Dispensing Menu. Once selected the script will immediately flip to the reverse side were you can specify who requested the emergency supply and the reason for them doing so. Tick either Supply at request of patient or Supply at request of prescriber. Paid To ensure the patient will be charged for the items leave the Script to be supplied option unticked. Unpaid If the patient is not to be charged for the items tick the Script to be supplied option. If this option is ticked the emergency supply item will be saved on the Pending Scripts tab once the script has been completed. Use to flip to the front of the form, and finish the script as normal.

Redeeming an Emergency supply Go to the Pending Scripts tab in the Workflow. Double-click on the item you want. This retrieves it to the prescription form. Select the item from the Emergency Supply patient history and change the Quantity on the OSCAR to the prescribed quantity and then finish the script as normal.

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Alternatively search for the patient. If you look in the Patient Drug History screen you will see an item marked with the emergency supply icon . Dispense the item as normal on the OSCAR and the system will automatically take off the quantity already supplied in the Emergency supply. Once this has been redeemed the Patient history will now show the icon by it. An Emergency Supply script is denoted on the Workflow screen as a red form .

6.5 Counter Sales

Nexphase incorporates a Counter Sale prescription type, as occasionally it may be necessary to dispense an item as an Over the Counter (OTC) product. This will mean that the item can be added to the patient's PMR and in turn ensures that drug interaction checking for that patient can be more thorough. It also means that if you are using Automatic Stock Control the items will be included in the usage figures. Processing a Counter Sale From the Dispensing Menu select Counter Sales Locate the patient and select them from the search list Either select the item from their PMR or select New Item Add the item and dispense in the usual way Press or to save

The Counter Sale prescription will now be added to the patients PMR and will be shown with the Counter Sale icon Counter Sales Configuration Options In order to make the Counter Sales functionality work more effectively for your dispensary there are some configurable options that you may wish to set within System Configuration.

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For Counter Sale Label configurations see: Utilities Menu > System Configuration > Labels For Counter Sale Ordering configurations see: Utilities Menu > System Configuration > Ordering

6.6 Parked Prescriptions

Parking a Prescription At any stage whilst you are working on a prescription, rather than cancel the work you have done so far, you can park it. There are no criteria for parking a prescription - you may park a blank script or one for which only partial information has been entered. To park the script, make sure the focus is on the prescription form, and then use . This transfers the incomplete prescription and all its details to the Parked Scripts tab of Workflow. No transactions are written to the database until you finish a prescription. Retrieving a Parked Prescription Once a script has been parked for a patient each time you access the patients details a prompt will appear advising the user that there is a parked prescription for this patient and suggesting this be processed. If YES is selected the parked prescription is then transferred back onto the FP10. If NO is selected the prescription will remain parked. Alternatively clicking on the Parked Scripts tab from the workflow or pressing can retrieve a parked script. Look though the list for the patient you need, and then double click on that patient's script, or highlight and press . This transfers the details back to the or to finish

prescription form. Once complete press the script as normal.

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7..0 COLLECTION & DELIVERY 7 0 COLLECTION & DELIVERY

The Collection & Delivery management tool within Nexphase enables you to effectively manage prescriptions that are processed and dispensed without the patient actually being present.

7.1 Configuring C&D settings

The Default Collection Status By default a prescription will be identified as being for collection. However, if a patient has the delivery required box ticked in their patient details the prescription will be identified for delivery. To change the default collection status: Select System configuration from the Utilities Menu Select System Options from the group option drop-down menu Highlight Default Collection Status Click on the arrow at the end of the Value field and select one of the following options: Pending Collection - All prescriptions will be added to the Finished Scripts tab with a status of pending collection by patient (this is the system default) Prompt - When a script is completed the system will display a prompt asking whether the item has been collected. Collected - Defaults all completed prescriptions to a collected status. Choose this option if you do not wish to manage collections & deliveries within Nexphase.

7.2 Registering a Delivery Patient

Add the patient in the usual way or access their details screen by double-clicking the name on the OSCAR Select the Delivery Tab Tick the Delivery Required check box and add any other relevant information Press Ctrl+S to save the changes Page - 24

7.3 Managing Collections & Deliveries

The Script Items Tab As all completed prescriptions are added to the Script Items tab on the workflow screen, Nexphase uses this tab to facilitate the management of Collection & Delivery items. For patients that have been registered as Delivery patients Nexphase will automatically add the Pending Delivery icon next to the script icon on the Finished Scripts Tab. Once delivery has taken place you can then update the status to show that the prescription has either been Delivered or Not Delivered . All other prescriptions will revert to the default collection status as set up in System Configuration. Workflow Options - Mark item as collected by patient - Mark item as not collected by patient - Mark item as pending delivery instead - View Delivery Management Console The Delivery Management Console The Delivery Management Console has three main functions: Batch Updating - Access the Delivery Console by pressing Ctrl+M from the Finished Scripts Tab. Select the relevant Delivery run (it will default to todays run) and press the key to view the options.

Assigning items to other delivery runs - Select the items that are to be moved by ticking their check boxes and press either: Ctrl+M to Move the selected items to the next run or Ctrl+R to Move the selected items to a specified run (allows you to select a run number) Printing Delivery reports - The delivery report is a list of all the prescriptions that need to be delivered along with their delivery Page - 25

instructions. This will assist the delivery person to efficiently deliver the items. Access the Delivery Management Console and select the relevant run. Press Ctrl+P to print a Delivery report and mark the run as closed.

8..0 OWINGS 8 0 OWINGS

8.1 Creating an owing
Follow the normal dispensing procedure through Find Patient, Find Item, until you come to the Dispense Drug screen. Select the products from the list in the normal way but before pressing enter to move on overwrite the prescribed quantity with the actual quantity you are dispensing. When you press a prompt will appear asking if you would like to raise owings against this line items. Select yes, the owing will be created and you will move onto the dosage directions for the item. Use to Label and/or to Finish as usual.

Nexphase prints two labels for the Owings item: one for the packaging, showing the quantity dispensed, and one for the Owing. Nexphase keeps a copy of the Owing on the Owings Register. Click on the Owings Reg tab to see all patients for whom you have created an owing.

8.2 Redeeming an Owing

Redeeming an owing can be done in either from the patients history, the owings register or directly from the Workflow. From patient history When a patient with an outstanding owing is selected a prompt will appear asking whether you would like to redeem the owed item now or later. Select YES to process the item. The Owings History window will appear which is similar to the Patient Drug History screen. Select the Page - 26

item from the Owings history window and print labels in the usual way using and/or to finish. If you are still not able to give the full amount owed access the dispense screen by clicking on the dispensed icon and amend the quantity accordingly. An owed item will remain on the Owings Register until the full amount has been redeemed. From the Workflow (Owings Register) Highlight the Owing on the Owings Register Tab and press Ctrl+O to process the owing. The owing will be removed from the Owings Register, a label will be printed for the owed quantity and the item will now show on the Workflow as a redeemed owing.

9..0 EXTEMPORANEOUS DISPENSING 9 0 EXTEMPORANEOUS DISPENSING

To create a drug that is not in the current drug list i.e. an Extemporaneous item, a Special or an Alternative medicine select Dispensing menu > Extemps Press CTRL+N to add a new item or alternatively CTRL+L to view a list of any existing Extemps that may have already been created.

9.1 Extemps.
When an extemporaneously dispensed item is created only the General and Ingredients tabs are available for editing. Press to add a new Extemp. Enter all necessary details on the first tab. It is at this point fee types and warning information can be entered for the item. Press &[2] to add ingredients. Ingredients can be added using either the quantity for which Nexphase will calculate the percentage automatically or you can choose to enter the percentage of each ingredient to begin with. Page - 27

After an ingredient has been entered a dispensable option for this item must be selected this is the ingredient that will be reordered upon the dispensing of the Extemps. This also allows for broken bulk claims to be made when appropriate. Once all ingredients have been added, press exit to the prescription. to save and

N.B. Once an Extemp item has been dispensed some of the fields can no longer be amended.

9.2 Specials & Alternative Medicines

The tabs available for editing when creating a special item are General and Spls. & Alternative Med. Press and then select Specials or Alternative medicines from the dropdown list at the top of the screen. You can now add a new Special or Alternative medicine in the General tab. The Spls. & Alternative Med. Tab, &[3], allows you to put the manufacturers details, pack size and price for the special in no ingredients can be added at this point. Note: All extemporaneous preparations are saved in the drugs list, with the word EXTEMP added to the name. Therefore, dispensing follows the same basic procedure as dispensing anything else. This is also true of Specials or Alternative Medications that have been added only the word EXTEMP is then followed by the type of item it is i.e. EXTEMP (Specials) etc.

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10..0 INSTALMENT DISPENSING 10 0 INSTALMENT DISPENSING

Instalment Dispensing involves more than one dispensing from a single prescription. It is a process more commonly used for the dispensing of a controlled drug on an FP10 (MDA) (or Addicts) script although may also be used for dispensing items of Limited Stability.

10.1 Dispensing in Instalments

If processing an FP10 (MDA) script you will need to select the FP10 (MDA) script from the Dispensing Menu an Instalment Schedule will then automatically appear once the item has been dispensed. If not, dispense as normal and after selecting the item press to display the schedule. The Instalment Dispensing Schedule Use the options in the top half of the screen to build your schedule. For example, select whether you wish to dispense in days or instalments and whether or not you will be dispensing Sundays instalment on Saturday. Once you have chosen your options click on the Rebuild Schedule button. Press to save the schedule and return to the dispensing process. N.B. If the item dispensed was considered to be of Limited Stability Nexphase will endorse the instalments on the script. Any item dispensed in instalments will now be shown with the instalments icon

10.2 Managing Instalments

The Instalments Tab located on the Workflow screen will list all patients who are either scheduled to collect their instalment that day or Page - 29

who have uncollected past instalments. Not only does it enable you to view the status of their instalments but it also allows you to efficiently manage those instalments without having to go into the patient's details. For example, you will need to show when an item has been administered to the patient and whether or not it was supervised. You may have prepared the medication for all your instalments due that day and now at the end of the day wish to globally mark them as having been collected all these functions can easily be carried out from the Instalments Tab using the filtering options and batch marking facilities. Filtering the Instalments Tab To filter out the Instalments Tab press the filtering options. To view instalments due today To view all controlled drug instalment To view all controlled drug instalments due today Displays the Advanced Filter screen Marking an item as collected Once an instalment has been administered it will need to be marked as collected against the patient name. This can easily be done from the Instalments Tab. Tick the patients who have collected their instalment and press CTRL+K The instalment will then be marked as collected and will display the collected icon key to view the

Marking items as not collected Tick the patients for whom items have not been collected and press CTRL+L Page - 30

Instalments status icons Instalment has been dispensed Instalment has not been dispensed Instalment has been labelled Instalment has been collected Instalment has not been collected Instalment requires supervision A controlled drug item

11..0 REPRINTING 11 0 REPRINTING

11.1 Reprinting a label
All scripts are stored on the Workflow screen after they have been processed so in order to amend a script and reprint a label for an item: Locate the script you wish to edit and double-click the required line to retrieve the details to the prescription form. Retype the information as required. When the information is correct, highlight the line that needs reprinting and use and then to print the Label(s). to save.

Once label(s) is/are printed, press

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11.2 Reprinting Endorsements

Locate the prescription on the Script Items tab, highlight it and press to endorse.

12..0 DRUG INFORMATION 12 0 DRUG INFORMATION

12.1 Drug Info Menu
To view comprehensive details on Prescription items select Drug Info > Drug Information. You may filter information by any of the following categories. Type the name of the drug to start a Drug Search and the select the item from the list. Interactions Warnings Flashes (Offer additional information to the pharmacist, such as Reimbursement guidelines, Patient charges and additional product information (discontinued, use by period, strength etc). Counselling Contra Indications Interactions between drugs To determine interactions without dispensing to an individual patient, between any two drugs select Drug Info > Interactions between Drugs. Type the name of the drug to start a Drug Search and the select the item from the list.

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12.2 Drug Interactions

A warning screen will appear either when newly dispensed items interact with each other or when an item interacts with another on the patients PMR. The interaction screen will appear once, listing all the interactions for items on that script when you press F8 or Ctrl+S at the end of dispensing. If you repeat an item and then go into the dispense screen the interaction screen will be displayed for that item only at that point. When you finish the prescription you will see the interaction screen with interactions for all the other items on the script but not for the item you have already seen. You will see the interaction only once per item.

Click the <Less button if you do not wish to see the information box on the right of the window. Interactions are also colour coded: = Minor Interaction Interaction = Medium Interaction = Severe

Tick the interaction alerts (by clicking in the check boxes) that you require labels for and then click on Print or Print All. Alternatively,

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press the Escape key to continue dispensing without printing warning labels. Suppressing Interactions You can only suppress a Minor interaction alert. To do this, tick the items check box on the warning screen and click on the tab. If you have suppressed an item and this item is subsequently dispensed you will not see the interaction on the screen, although you can press Ctrl+U to show suppressed interactions. You could then unsuppress this interaction if you wish. You will not be able to see interactions that have been suppressed if that item is not on the prescription. NB: All interactions that have been suppressed are patient specific and a note reminding you of this will be displayed in the patients notes screen.

12.3 Drug Details

The Drug Details screen for a product consists of six different tabs and allows the user to record item specific information as well as details relating to stock and suppliers. It is also where notes can be tagged to the item and where usage information is displayed. Access the Drug Details screen for an item via: Main Menu > Product details > Item Details > Search for item > Drug Details screen > Item Details Tab Once the appropriate tab has been selected complete the information and press to save.

N.B. the Usage Details Tab displays information that has been calculated by the system and cannot be adjusted by the user.

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Item Details Tab The item Details Tab is where you can record all descriptive information about a product and is especially useful if you do MDS Dispensing. Stock Info Tab Stock Information for a product is particularly important if you are using Automatic Stock Ordering. Use this tab to record how much of the item you would like to always have in your dispensary. Supplier Details Tab Use this tab to assign first and second choice suppliers and to assign a different ordering mode to the item other than the system default. Barcodes Tab This is where you can record Barcode information for a particular product.

12.4 Attaching Drug Notes

Notes can be attached to an item either locally or on a group level (if the pharmacy is part of Head Office Group). They may also be system based i.e. Enigma Health may provide the user with extra information. Notes will be displayed when the product is selected at the Dispense screen. Pressing Esc will clear the notes screen in order for you to continue dispensing. N.B. On the Dispense screen you will see the following icon next to a drug that has notes attached. The drug note itself will be also be defined by an icon: - A Local Note i.e. a note that has been added by one of the users in the Pharmacy.

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- A Group Note i.e. a note that has been added to the item at the Head Office. - A System Note i.e. a note that has been added to the item by an Enigma Health administrator. Attaching Drug Notes From the Main Menu select Product details > Item Details Type in the name of the item and press Enter Select from the list and the Drug Details screen will be shown Click on the Drug Notes Tab Press to attach a New Drug Note

Enter the information into the Drug Note box and press to save

Deleting Drug Notes Access the Drug Notes Tab for the item and highlight the note in the Drug Note box Press Ctrl+Del to delete the note

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13..0 MEDICINES USE REVIEW 13 0 MEDICINES USE REVIEW

Nexphases Service Script facility allows the Pharmacist to maintain records of Medicines Use Reviews or Prescription Interventions that they are carried out.

13.1 Processing an MUR script

From the Main Menu select the Service Script type Type in the patient name and select from the search window. If the patient has a drug history the cursor will be located on the New Item option at the top of their records. Simply press enter to move onto the Service script form. Type in the name of the Pharmacist conducting the review, (this field is linked to a prescriber search, showing pharmacist prescribers only).

N.B Type either MUR or Review to enter an MUR service onto the prescription form. If entering a Prescription Intervention Service type in Prescription, Service, or Intervention. Highlight the service type from the available list of options and press enter

At this stage the MUR form will be displayed with the following five tabs of information for you to complete.

Removing Medicines from the MUR The Medicine Tab is where you will be able to maintain the medicines that are to be included in the MUR. Initially, the tab will bring across

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items from the patients PMR. However, you may wish to remove certain medicines from the list: Whilst in the Medicine Tab press Ctrl+M to Maintain Medicines:

Remove the tick from the item that is not to be included in the MUR by clicking the box with the mouse. Then press Ctrl+S to save the changes and return to the MUR. Adding items to the MUR Additional items that do not show in a patients history, such as OTC medication, for example, can also be included in the MUR: From the Medicine Tab press Ctrl+Insert to insert a medicine

Type in the name of the product and complete the remaining fields as required.

Once all relevant information has been recorded on the MUR form you will be able to print copies of the review/intervention form if required.

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13.2 Printing the MUR Form

Copies of the MUR form can be printed for your records, for the patient and for the GP if required. If the form is incomplete or contains invalid entries the system will warn you and will give you the option of returning to the form to complete it or to print it out as it is. Whilst in the MUR form screen press to print If the form is incomplete the system will warn you, and list the problem areas Press Enter to continue. The system will then give you the option of printing the review as it is or, of returning to the form to complete the information. Select Y or N.

N.B: If you have amended the form you will need to press once more to display the Print Options box At the Print Options box enter the number of copies that you require

Click the Print button and a Print Preview of the form will be displayed

N.B: Previews for all requested copies of the report will be displayed. So, if you have asked for copies for the patient, GP and Pharmacy, three previews will be shown.

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Click on the green arrow at the top of the screen to view the other pages of the MUR Form

You can then choose to print the whole form by clicking on the Print button in the top left-hand corner or, if you prefer, you can click on the Print Page option to simply print the page that you are viewing.

14..0 BATCH REPEAT PRESCRIBING 14 0 BATCH REPEAT PRESCRIBING

Batch Prescribing is when a prescriber writes a batch of prescriptions in one go rather than writing repeat prescriptions on a re-occurring basis. The Pharmacist will hold the patient's repeat prescription in the Pharmacy and dispense according to the directions given. By enabling the user to record the interventions that are made with for repeatable prescriptions in the patient's history, Nexphase effectively maintains the details of batch repeats so that there is a valid audit trail. An RA script or Repeat Authorisation script is the initial repeat dispensing prescription that validates the batch repeat process for a particular patient. An RD script or Repeat Dispensing script is the prescription subsequently issued for dispensing the repeats.

14.1 Processing RA Scripts

From the Main Menu click on the Dispensing Menu Select the FP10 RD Prescription Type and enter the patients name into the surname field

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Press Enter to select the Create/Review RA option from the patients PMR

At the following prompt select Create a new RA

The system will then flip the FP10 form over and allow you to complete the necessary details required for an RA script.

Once complete click on the bottom right-hand corner to flip the form over again

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You can then enter the Qty and prescribed item(s) that are to be dispensed.

N.B: As no medicine will be dispensed as a result of the RA Script it will not be possible to select a product from the dispense list or to produce labels. Press F8 or Ctrl+S to save the script and confirm whether or not the Prescriber has signed the script at the following prompt:

At the end of processing the RA script the system will ask you if you wish to dispense the first RD prescription now or later. If you choose to dispense now, the system will pass you into the dispense screen for the items on the prescription and you can dispense, endorse and save the RD as normal. Once all RDs associated with the RA have been dispensed you will be prompted to endorse the RA with the dispensing dates for the RD.

14.2 Dispensing an RD Script

From the Main menu click on the Dispensing menu and select the FP10 RD script type Type in the patient's name and select from the search list The patient's history will be shown on the right of the screen as normal but will also list all items that have been added to an RA script. These items will be shown with the icon, as in the example below:

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Select the item to be added to the RD script by pressing its number or clicking it with the mouse.

N.B: If there is more than one item on the RA then all of these items will appear with the same number on the patients history. Pressing this number once will automatically select all the items on the RA Select a product from the Dispense list in the usual way. You will only need to do this for the first RD that you dispense. From here onwards the system will automatically select the physical item you selected last time and will therefore not display the dispense list. If you have restrictions it will take you back to the dispense list for reselection as per normal. Once the item has been dispensed the cursor will be located in the RD Number box where you can enter the number of the Repeat Dispensing script that you are processing.

Press F8 or Ctrl+S to save and finish the prescription.

NB: the RD prescription will be endorsed as a normal FP10.

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TIP: If you highlight either the line of the RA or the RD on the Workflow and press Ctrl+7 you will see the RA Status. This will show you the items on that RA, the number of repeat scripts (RDs) for that RA, the dates they were dispensed and the repeat dispensing number that has been dispensed.

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INDEX INDEX
Adding adding a dosage .................................................................................13 adding a new patient ............................................................................ 7 adding a prescriber ............................................................................20 adding family members ........................................................................ 8 Attaching Drug Notes .............................................................................36 Automatic automatic label preview......................................................................15 automatic labelling .............................................................................15 Bag Labels printing bag labels ..............................................................................15 Barcodes Tab ........................................................................................36 Batch Labels printing batch labels ...........................................................................16 Batch Repeat Dispensing RA icon ...............................................................................................43 Batch Repeat Prescribing ...................................................................41 Collection & Delivery C&D configurations ............................................................................25 C&D workflow options ........................................................................26 default collection status ......................................................................25 Delivery Management Console ..........................................................26 managing collections & deliveries ......................................................26 registering a C&D patient ...................................................................25 Counter Sales counter sale configurations ................................................................23 processing a counter sale ..................................................................23 Deleting deleting a patient ................................................................................11 deleting drug notes .............................................................................37 Dental prescriptions ...............................................................................20 Dispensing dispensing a new item........................................................................12 dispensing a repeat ............................................................................11 Dosage creating a dose code ..........................................................................14 Page - 45

Drug Details ...........................................................................................35 Drug information ....................................................................................33 Drug Notes .............................................................................................36 Drug Search ...........................................................................................12 Emergency Supply creating an emergency supply ...........................................................22 redeeming an emergency supply .......................................................22 Endorsing ...............................................................................................12 essential endorsement .......................................................................13 optional endorsements .......................................................................13 Exemptions patient exemption details ..................................................................... 8 Extemps dispensing extemps ...........................................................................28 Finished Scripts Tab ..............................................................................26 Finishing the prescription .......................................................................17 FP10 (MDA) prescriptions .....................................................................20 Free format labels printing free format labels...................................................................16 Hospital Doctor prescriptions .................................................................21 Instalments collected items ...................................................................................31 dispensing in instalments ...................................................................30 filtering the instalments tab ................................................................31 Instalment Dispensing Schedule ........................................................30 instalment status icons .......................................................................32 managing instalments ........................................................................30 not collected items .............................................................................31 Interactions interactions between two drugs .........................................................33 Interventions how to intervene .................................................................................18 Intervention Outcome Tab .................................................................19 Intervention Reasons Tab ..................................................................19 reviewing an intervention ...................................................................19 Item Details Tab .....................................................................................36 Labelling manual labelling .................................................................................14

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Last Patient F9 key .................................................................................. 8 Merging patients ....................................................................................10 MUR adding items to the MUR....................................................................39 entering an MUR ................................................................................38 maintaining medicines........................................................................39 print options ........................................................................................40 printing the MUR Form .......................................................................40 removing medicines from the MUR ....................................................38 MUR Medicine Tab ...............................................................................38 MUR script .............................................................................................38 Nurse prescriptions ................................................................................21 Oscar ....................................................................................................... 5 Owings creating an owing ...............................................................................27 owings register ...................................................................................28 redeeming an owing ...........................................................................27 Parked Prescriptions parking a prescription .........................................................................24 retrieving a parked prescription ..........................................................24 Patient patient history ....................................................................................... 8 patient notes ......................................................................................... 9 patient search ....................................................................................... 7 Pop-Up Menu ........................................................................................... 5 Prescriber duplicate prescribers ..........................................................................20 prescriber maintenance......................................................................19 prescriber search ...............................................................................19 Prescription types ..................................................................................20 Printing printing labels .....................................................................................14 Private Prescriptions ..............................................................................21 Repeat Authorisation scripts RA Status ...........................................................................................45 Repeat Autorisation scripts processing RA scripts ........................................................................41 Repeat Dispensing scripts..................................................................41

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dispensing an RD script .....................................................................43 Reprinting a label ...................................................................................32 Reprinting Endorsements ......................................................................33 Service Script .......................................................................................38 Specials & Alternative Medicines ..........................................................29 Stock Info Tab........................................................................................36 Supplier Details Tab ..............................................................................36 Switching on ............................................................................................ 5 Veterinary Prescriptions.........................................................................21 Visually Impaired Labels ........................................................................16 Workflow .................................................................................................. 6 filtering the workflow............................................................................. 6 printing the workflow ............................................................................ 6

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