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When writing a schedule, the end-user can taper the dosing to either increase or decrease the amount of medication that is to be dispensed over time. Also, the end-user can indicate for what duration of time and the amount of days between dosages the tapering will occur. Once again, it is important that the end-user stipulate the treatment instructions when writing the order. When writing the order, the Dose Amount MUST be the max amount of medication that will be dispensed. Follow the steps below to properly write the medication order and schedule to taper up.
The steps below are the same for the TGI Medication Order Form v2 AND TGI Medication Order Form v3.
Writing a Tapered-Up Order
- Open the patient’s Chart Details and select TGI Medication Order Form v2 from Available Forms list.
- Order Date – Defaults to the date the form was first opened/created.
- Start Date – Select the date of which the patient is to start receiving medication (This is the first date of which the patient will appear in the Medication Dispensing Screen).
- Discontinue Date – If known, select the date of which the patient’s medication is to discontinue (at midnight of the day selected). If left blank, the order will be continuous and NEVER expire.
- Medication- Select the medication to be dispensed.
- Dose Amount- Enter the maximum amount of methadone to be dispensed during the tapering.
- Guest Dosing- Flag Yes if patient is receiving dosing at a clinic other than their own, otherwise flag No.
- Treatment Instructions (Optional)- Enter the dosing/tapering instructions for the dispensing nurse.
- Admin Instructions (Optional)- Enter any desired Admin Instructions. This would be used for administrative purposes such as if the order should be discontinued at some point.
- Sign- A Nurse’s signature is required to sign/lock the form, unless marked N/A which would require a Doctor’s signature to sign/lock the form.
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Save- Click Save to create the Order Form (You can now write the accompanying schedule).
Writing a Tapered-Up Schedule
- Click on TGI Medication Order Form v2 from the Available Forms list to open it.
- Order Information- If you have previously signed/locked an order the information will populate here once you open the form. A patient can have multiple orders written so ensure you are writing a schedule for the correct order. You can change the order by selecting it from the Order ID drop-down. If the order was written properly the treatment instructions should be described and from that the end-user will write the schedule.
- Recurring- Select if the schedule will recur weekly, bi-weekly, or monthly.
- Clinic/Take Home- Select which days the patient will receive their medication at the clinic or at home.
- Dose 1/Dose 2- Indicate if the dosing is split into two doses or not. If the dose is not split leave the dosing in Dose 1. If the dose is split enter the amount for Dose 1 and the amount for Dose 2, the total should equal the amount indicated in the Order Information.
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Comments (Optional) – Enter comments associated with this schedule. (Only seen on this form).
- Open the Overrides Tab once you have completed the “General Schedule / Order Information Tab”.
- Dispensing Type- Select Clinic, Take Home or “Use Schedule to Fill” (Selecting “Use Schedule to Fill” will use what has already been selected on the “General Schedule / Order Information” tab).
- Backfill Schedule / Fill Schedule with Ending Doses- When selected, indicates that the final dosage will be the continued dosage once the tapering protocol has ended until this order is discontinued.
- Starting Dose 1- Enter the first dose amount to be dispensed.
- Ending Dose 1- Enter the maximum dose amount to be dispensed.
- Incrementing Dose 1- Enter the amount to increase each dosage by (amount in mg).
- Starting Dose 2- Used for split dosing (if not using split dosing, must enter 0).
- Ending Dose 2- Used for split dosing (if not using split dosing, must enter 0).
- Incrementing Dose 2- Used for split dosing (if not using split dosing, must enter 0).
- Start Date- Select the date of which the patient is to start receiving medication (This is the first date of which the patient will appear in the Medication Dispensing Screen).
- Days between dose change – Enter the number of days between dosages before the dose changes based on what is indicated in Increment Dose 1 and/or Increment Dose 2 (Dose changes every X days).
- Reason Code- Select a reason code from the drop-down (Options created from Lookup Manager 🡪 Methadone Adjusted Dose Reason Codes table).
- Reason Text- Enter a reason for the “override” (EX: Tapering Up).
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Fill Overrides- Click to generate the medication schedule based on the tapering protocol.
- The table below will now populate if the information was entered correctly. It will display the schedule of the tapering protocol entered, including the dosing per day. If you flagged Fill Schedule with Ending Doses the schedule will continue to dispense the ending amount until the order is discontinued.
- NOTE: If you don’t like the results in the table, select the “Clear Overrides” button to clear the values in the table, adjust your values and select the “Fill Overrides” button again.