Medication Dispensing - Tapering Down (Detox) (TenEleven)

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Tapering down works almost identically to tapering up. The only difference being, the initial dose would start at the max amount that can be dispensed and go down. If the tapering down is being set up as a detox, meaning the ending dose will ultimately be 0 mg, there is an additional step that must be followed. The ending dose will be set to 5mg and a discontinue date must be set as the last day the patient will receive 5 mg of medication. Follow the steps below to properly write the medication order and schedule to taper down, then select a discontinue date to complete the detox.

The steps below are the same for the TGI Medication Order Form v2 AND TGI Medication Order Form v3.

Writing a Tapered-Down Order

1. Open the patient’s Chart Details and select TGI Medication Order Form v2 from Available Forms list.
   
   
2. Order Date – Defaults to the date the form was first opened/created.
3. 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).
4. 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.
5. Medication- Select the medication to be dispensed.
6. Dose Amount- Enter the maximum amount of methadone to be dispensed during the tapering.
7. Guest Dosing- Flag Yes if patient is receiving dosing at a clinic other than their own, otherwise flag No.
8. Treatment Instructions (Optional)- Enter the dosing/tapering instructions for the dispensing nurse.
9. 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.
10. 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.
11. Save- Click Save to create the Order Form (You can now write the accompanying schedule).
    

Writing a Tapered-Down Schedule

1. Select TGI Medication Order Form v2 from the Available Forms list.
   
   
2. 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.
3. Recurring- Select if the schedule will recur weekly, bi-weekly, or monthly.
4. Clinic/Take Home- Select which days the patient will receive their medication at the clinic or at home.
5. 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.
6. Comments (Optional) – Enter comments associated with this schedule.  (Only seen on this form).
   
7. Open the Overrides Tab once you have completed the “General Schedule / Order Information Tab”.
8. 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).
9. 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.
10. Starting Dose 1- Enter the first dose amount to be dispensed (this will be the maximum).
11. Ending Dose 1- Enter the minimum dose amount to be dispensed.
12. Incrementing Dose 1- Enter the amount to decrease each dosage by (amount in mg).
13. Starting Dose 2- Used for split dosing (if not using split dosing, must enter 0).
14. Ending Dose 2- Used for split dosing (if not using split dosing, must enter 0).
15. Incrementing Dose 2- Used for split dosing (if not using split dosing, must enter 0).
16. 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).
17. 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).
18. Reason Code- Select a reason code from the drop-down (Options created from Lookup Manager 🡪 Methadone Adjusted Dose Reason Codes table).
19. Reason Text- Enter a reason for the “override” (EX: Tapering Down).
20. Fill Overrides- Click to generate the medication schedule based on the tapering protocol.
    
21. 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.

Scroll down to the bottom of the medication schedule to see the last day medication will be dispensed.

• This will be selected as the Discontinue Date on the order.
  

Open the Signature Tab once you have completed the General Schedule / Order Information Tab and Overrides Tab.

Sign- Once signed, the patient will appear in the Medication Dispensing Screen based on their schedule and starting date.

Save- Click save to sign/lock the schedule.

Selecting the Discontinue Date

1. Click on the Locked Order from the Selected Chart list to open it.
   
2. Select the Discontinue Tab.
3. Discontinued Date – Select the Discontinue Date that appeared at the end of the medication schedule generated on the Overrides Tab of the Medication Schedule (For our example it is 9/7/2019).
4. Sign/Route To.
5. Save- The order will now expire at midnight on 9/7/2019.