**Note: Delivery of this patch is required to meet VA VistA
Standardization requirements. The functionality in this patch is not
dependent on the OR*3.0*405 VistA build (CPRS V32 COMBINED BUILD 1.0);
however, the GUI code needed to run the new functionality created by this
patch will not be available until the CPRS V32 cprschart.exe is released.

OR*3.0*435 enables clinicians working in the Computerized Patient Record
System (CPRS) to order a new medication for an inpatient where the first
dose is to be administered immediately and ongoing doses are scheduled for
administration on a regular schedule.

Before implementation of this patch, when clinicians checked the "Give
additional dose now" checkbox in the Inpatient Medications dialog box, two
orders were created and both were given the same priority. If the assigned
priority was ROUTINE, then the dose prescribed for immediate
administration was processed during routine background processing and
consequently not administered immediately as the clinician intended.
Similarly, if the assigned priority was set to ASAP, then both orders were
processed immediately when only the first dose required immediate
processing.

OR*3.0*435 implements enhancements to the CPRS Graphical User Interface
(GUI) and VistA routines so that the first dose is automatically set to
the priority ASAP and the ongoing order is set to the priority ROUTINE
when "Give additional dose now" is selected. Sites that do not use the
priority ASAP can select a site-specific alternative during patch
installation. A Warning message notifies users that two orders are created
and the dosing schedule and priority (ASAP and ROUTINE) are set
automatically for each.

Although the priority of the first dose defaults to ASAP, the clinician
may select any available alternative from the Priority field before
accepting the order. If "Give additional dose now" is selected and the
Priority field is blank when the order is accepted, then the first dose
will default to ASAP when the order is signed. If a value for the Priority
field is selected before the "Give additional dose now" checkbox is
enabled, a message notifies the user that the priority will be changed to
default values (ASAP and ROUTINE).

When the "Give additional dose now" checkbox is left unchecked, only one
new medication order is created. The dosing priority and schedule are
based on the priority and schedule specified by the clinician who creates
and signs the order.

A new parameter [ORDER URGENCY ASAP ALTERNATIVE] in VistA enables sites
that do not have the priority ASAP in the Order Urgency file (#101.42) to
use this enhancement. If the priority ASAP is not found during
installation, then the installation program prompts the user to select an
alternative urgency from the Order Urgency file. This alternative
selection is stored in the PARAMETER DEFINITION file (# 8989.51) in the
ORDER URGENCY ASAP ALTERNATIVE parameter. If an alternative priority is
defined at installation, then CPRS displays the alternative to ASAP when a
new inpatient medication order is placed and "Give additional dose now" is
selected.

BLOOD BANK Clearance:
--------------------

EFFECT ON BLOOD BANK FUNCTIONAL REQUIREMENTS: Patch OR*3.0*435 contains
changes to a package referenced in ProPath standard titled: BBM Team
Review of VistA Patches. This patch does not alter or modify any VistA
Blood Bank software design safeguards or safety critical elements
functions.

RISK ANALYSIS: Changes made by patch OR*3.0*435 have no effect on Blood
Bank software functionality, therefore RISK is none.