Skilled Nursing Facilities

Therapeutic Interchange

Therapeutic Interchange occurs in Integrated Medication Management scenarios when the facility enters an order for one drug, but the pharmacy substitutes the ordered medication with a different, but equivalent medication. To maintain consistency between the pharmacy system and PointClickCare, when the pharmacy sends a Therapeutic Interchange (TI) dispense message, PointClickCare translates the single dispense message into three separate pharmacy initiated messages:

  1. The original order is Discontinued Pending Confirmation with a discontinue reason =Therapeutic Interchange.

  2. A New Order is created as Pending Confirmation.

  3. A Supply Message (dispense) - This updates the supply in PointClickCare to match what was sent by pharmacy and to match the new order.

During confirmation of the new order, you see a Therapeutic Interchange Reconciliation Screen to compare the new order to the original order and to opt to transfer the original sliding scale and pass times into the new order when confirming it.

  1. When the Therapeutic interchange supply is scanned, the system matches the supply to the original order that is pending discontinuation and also matches to the new order created to accommodate the therapeutically interchanged.

  2. Confirm the pending discontinue of the original order, and confirm the new order by clicking the red links. If the medication is insulin with sliding scale coverage, you see a message indicating so.

  3. Click the Therapeutic Message in the row under the schedule you want to review to open the Therapeutic Interchange Review window.

  4. Review the order details.

  5. Select the option to the left of any pass times and/or sliding scales you want to bring forward to the new order.

  6. Click Select Values to apply the pass times and/or sliding scale information to the new order, and return to the order confirmation screen.

  7. If there are multiple schedules associated with the order, repeat this for each schedule.

  8. After all missing fields are complete, click Confirm.

  9. After confirmed, select the new order to link to the supply.

  • Orders pending confirmation can also be accessed from the order listing (under the orders tab) in the resident's individual chart. The workflow remains the same.

  • New orders created as a result of Therapeutic Interchange are supplied with the Order ID from the original order. It is the inclusion of the order ID in the Rhapsody Messaging that tells the system the order is a result of a therapeutic interchange and therefore triggers the appropriate workflow.

  • If there is no Order ID returned by the Pharmacy, then the system cannot auto-create the Discontinue administrative order. In this case, an alert is generated on the Alerts Dashboard.

  • The Therapeutic Message link only appears if a valid order ID from the original order is present with the new order.

  • To determine that the order ID is valid, the system matches the order ID to verify it is for the same resident within the same facility, and that the original order has not been struck out. This validation occurs on initial scheduler processing and on each page load.

  • If there are less pass times than the frequency supports, the additional pass time slots are left blank. Enter the values before saving. If you try to save with blank values, a message appears.

  • If there are more pass times than the frequency supports, the additional pass times are shortened.

  • If the order is not an applicable sliding scale order, you can only move the Pass Time information from the Original Order to the New Order. The applicable Sliding scale check boxes are removed and the text reads 'N/A'.

  • The time code must contain a value to bring forward the original order pass times. If a time code has not yet been set on the new order, only the Schedule, if selected, is loaded into the New Order.

  • You can only move information forward from the original order to the new order. The system does not create additional schedules for the new order. The system updates the Routine from the Routine that the link was selected on. If there are multiple routines, the link is visible on each routine.