DOCUMENT TITLE: C&W Pharmacy Downtime Procedure

DOCUMENT TYPE: PROCEDURE

Site Applicability
• C&W Pharmacy

Practice Level/Competencies
• Pharmacists
• Pharmacy Technicians

Equipment & Supplies

The pharmacy is responsible for creating and maintaining at least 1 grey binder called the CST Downtime
Toolkit, which will contain:
• 724 Application
➢ Quick Reference Guide – see CST Cerner Help 724 Downtime Quick Reference Guide
➢ 724 Data Check Procedure – See CST Cerner Help 724 Data Check Procedure

• Appendix B: Add new patient to an OMNICELL (print off separately)

• Appendix C: How to print a Restock Report Manually at the ADC (print off separately)
• Appendix D: Turning on Critical Override from a Cabinet (print off separately)
• Downtime Forms:
o Caution Sheet
o IV Room Downtime Dispensing Log
o Prescribers Order
o Medication Reconciliation Orders
o Chemotherapy Log

Note

• The CST Downtime Toolkit must be kept up to date.

• Pharmacies may want to create more than 1 downtime toolkit.

Procedure/Protocol/Algorithm

This is a procedure document which:

• Recommends a checklist of activities to prepare for downtime in the pharmacy.

• Provides instructions for assembling and maintaining the CST Downtime Toolkit.
• Provides a checklist of activities for ensuring the 724Access® Downtime Viewer and 724 Computers are
functional during downtime.

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Procedure Steps & Rationale:

NOTE:
If CST Cerner is down but the network is still functioning, users can access different systems
such as iClinic, CareConnect, iSite, PharmaNet, Medinet, and Excelleris.

Preparing for Downtime

• Please refer to the checklist below to ensure pharmacy is prepared for a planned downtime.
Incorporate this checklist for downtime as appropriate to your HO.
• Complete it when a 7-day IMITS Broadcast notification is issued for planned downtimes.

 Know where the 724 computer(s) are located.

 Know where the CST Downtime Toolkit is located.

Purpose
• Document downtime instructions for the Pharmacy when Cerner and / or OMNICELL is down.

Scope and Responsibilities

# Scope Responsibilities
1. Pharmacy procedures Pharmacist, Providers
2. Recovery Pharmacist, Providers

Pharmacy Procedures
All highlighted documents should be available in the CST Downtime Toolkit.
Pharmacy areas are to follow the below steps during downtime events.

# Workflow Role Downtime Action

Step Responsible
1. Allergy Provider • For new patients without reviewed allergies on this encounter
Intolerance (Nurse or (hence no allergy information in 724), the Caution Sheet will be
Status Physician) required with orders sent to pharmacy. One form needs to be
completed for each inpatient. Multiple copies corresponding to
the number of beds in each unit should be readily available in
preparation for a scheduled or unscheduled downtime.

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DOCUMENT TYPE: PROCEDURE

2. Medication Pharmacist PLANNED DOWNTIME PREPARATION:
Orders • If possible, determine the duration of downtime by observing
printed messages from information services or from advance
notification. DO NOT PHONE INFORMATION SERVICES.
• Non-urgent orders may be delayed for up to 60 minutes if
downtime is expected to be 60 minutes or less.
• The 724Access Viewer workstation will have a view only
snapshot of medication order profile including Allergies (refer to
724Access Viewer Quick Reference Guide for instructions).
• All patient medication profiles must be reviewed retrospectively
after the downtime when catch-up orders are entered.
UNPLANNED DOWNTIME:
• The 724 computer provides a snapshot of inpatients’ medication
order profile including allergies.
• For new patients without reviewed allergies on this encounter
(hence no allergy information in the 724Access Viewer), the
Caution Sheet will be required with orders sent to pharmacy.
• All patient medication profiles must be reviewed retrospectively
after the downtime when catch-up orders are entered into the
computer.
• Pharmacy will use pharmacy designated labels during
downtime.
3. Refill Lists Pharmacist PLANNED DOWNTIME PREPARATION:
• Daily refill and IV refill lists should be manually run ahead of
downtime forward and rotation shift. If refills are scheduled to
run near the end of downtime, refill lists can be run after end
of downtime.
• AUD/RUD batch refills will be captured at VPPC.
Contingency extracts for Acute Care run every 3 hours and
capture fills for the future 72 hours. Contingency extracts for
Residential Care run every 24 hours and capture refills for the
future 72 hours.
UNPLANNED DOWNTIME:
• During downtime, daily refill and IV refill lists may or may not
run. If unable to run, use the 724 refill list and manually
reconcile the meds with the printed MAR.
• If the system is not available for the scheduled IV fill list, the
IV Room Downtime Dispensing Log and printed MAR will
be used to create manual labels and prepare medications for
the run.
• In the event of an anticipated extended downtime, the
decision may be made by the Pharmacy Management to
begin double filling all medication doses to provide
medications for the next cart fill.

4. Order Entry Nurses – Regardless of length of service interruption, paper orders will be
verbal faxed to Pharmacy (generic order form: Prescribers Order (blank).
orders; or
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the For Medication Reconciliation, Medication Reconciliation Orders
prescriber may be used.

All paper orders must include the following patient information:

• PHN or Encounter number
• Patient’s name
• Patient Room Number and Bed Number
• Allergy information

All paper orders must include the following information from the
Prescriber:
• Date and time orders written
• Prescriber’s name and person taking verbal order (if applicable)
• Prescriber’s signature or signature of person taking verbal order
(if applicable)

Upon receipt of the downtime paper order form, all medication

orders will be reviewed for allergies, drug interactions, and
appropriateness of therapy (including therapeutic interchange) by
the pharmacist.
The 724 Medication view is available for pharmacist review. Allergies
entered prior to downtime will be captured by 724 and can be viewed.
New patients without allergies entered in the system must have a
completed allergy form accompany new orders.
Drug interactions may only be done for orders that have been
entered in the system and captured by 724 before downtime.
Depending on the duration of the downtime, other orders may or may
not have drug interaction checking.
All order sheets that have been processed but require computer entry
when the system is operational must be set aside in the dispensary
ready for catch-up procedures.

Level 1 Downtime
(LESS THAN 2 hours)
For medications that are dispensed, record the following information
on the copy of the Physician’s order:
• Quantity of medication dispensed (enough to get to the next
refill or IV batch
• Initials of the Pharmacist or designee filling and/or checking the
order
• For IV orders, the start time of the order should be documented

Sterile Products (IV room)

The sterile products preparation area (IV room) will prepare doses
of the desire product and label the product with backup (downtime)
labels

The IV Technician must document the following on any products

dispensed for a patient on the IV Room Downtime Dispensing
Log:
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• Patient Name and Room Number
• Drug/Dosage Ordered
• Diluent/Volume
• Administration Rate
• Expiration Date
• Number of doses dispensed
• File paper orders in chronological order (oldest on top) by unit in
downtime folders

NOTE: The 724 computer will be available for Medication Profiles

and MAR viewing if needed.

Level 2 Downtime
(GREATER THAN 2 hours)
• Unit Dose Dispensing Areas: The pMARs (paper
Medication Administration Record) should immediately be
separated by room number, stapled, and placed in the
appropriate location per site specific procedures.
• For existing admissions, the Physician’s original order, faxed
or delivered to the pharmacy, will be used for filling orders.
• For new admissions, all new medication orders should be
kept together as they are received and filled. The number of
doses to be sent will be the number needed, to supply the
patient until the next refill list.

Sterile Products (IV) Preparation Area:

• The Sterile Products Preparation Area will maintain an IV Room
Downtime Dispensing Log. The log will contain the following
information:
• Patient Name and Room Number
• Drug/Dosage Ordered
• Diluent/Volume
• Expiration Date
• Number of doses dispensed

• The dispensing log should remain updated using a yellow

highlighter to indicate the discontinued medications. Use
Pharmacy-generated labels.
• The number of doses to be sent will be the number needed to
supply the patient until the next IV batch fill is run.
• If the system is not available for the next IV fill batch, the run will
be filled using the:
• IV Room Downtime Dispensing Log
• 724Access Viewer MAR
• Chemotherapy Log

Unit Dose Refill & Scheduled IV Refill lists:

• Use the 724 refill list and manually reconcile the meds with the
printed MAR.
• If the system is not available for the scheduled IV fill list, the IV
Room Downtime Dispensing Log and printed MAR will be
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used to create manual labels and prepare medications for the
run.
• In the event of an anticipated extended downtime, the decision
may be made by the Pharmacy Management to begin double
filling all medication doses to provide medications for the next
cart fill.

• The Pharmacy Distribution Coordinator will designate one staff member to maintain the downtime Code
Grey Box.
• If applicable, the Pharmacy Distribution Coordinator will provide the Pharmacy Manager with a brief
report of downtime events including an evaluation of the downtime procedures and any problems
encountered. This is specific to local site communication for any issues related to downtime.

Recovery
# Workflow Role Recovery
Step Responsible
1. Medication Pharmacist • Medication orders that have been faxed (or delivered) to
Orders pharmacy during downtime will be back-entered into the patient
medication profile.

o Medication orders for inpatients will be back-entered

based upon facility practice and verified by a
pharmacist.

o One time doses, stats, or medication orders that were

completed prior to system recovery will not be entered
and verified.

o Orders for Emergency Department patients not being

admitted will remain on paper and these orders will not
be back-entered.

o Orders for discharged patients will not be back entered.

**Reports routinely scheduled to run during a downtime will

print once the system recovers.
2. Refill Lists Pharmacist PLANNED DOWNTIME:
• After manual run of refill lists and after downtime has passed,
refill batch clock needs to be reset.
UNPLANNED DOWNTIME:
• After downtime, local pharmacy must determine which high
priority refills are to be manually generated first. The scheduled
runs of these refills must be skipped by the system engineer.
o After manual run of all refill lists, the refill batch clock
needs to be reset.

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• After downtime, daily refill and IV refill lists for the last
successful run coverage/capture must be checked manually
and reset.
• After downtime, the scheduled ops job runtime for each refill list
must be checked and corrected as necessary.

Pharmacy Supply Chain

# Workflow Step Downtime Action
1. Purchasing Recovery • Review log and complete Standard Operating Procedure for the
process used in downtime
• Create a Purchase Order
• Complete a requisition for goods from a Cerner site
2. Receiving Recovery • Review documents received during downtime, complete the
Standard Operating Procedure for the process used in
downtime.
• Receiving a vendor PO shipment in Cerner application
• In transit review for internal fill shipments
3. Inventory Recovery • Review log and complete the Standard Operating Procedure for
the process used during downtime.
• Distribution
• Adjustment
• Requisition
4. Cerner Recovery • No recovery process required, as the ADT, ZPM & DFT files
queue and backflush inventory upon recovery

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724Access® Downtime Viewer and 724 Computers

To ensure that the 724 computer is fully functional and usable during a downtime, complete the checklist of
activities below before a planned downtime:

 Ensure the 724 downtime computer is always powered on and is connected to the network.

 Do not hold down the power button to shut down the computer unless instructed by IMITS or Service
Desk for troubleshooting purposes. Pressing the power button to turn off the computer prevents it from
shutting down properly, and could potentially corrupt the patient downtime data that is locally installed
on it.

 Check that the 724 computer is connected to the Universal Power Source (UPS). The UPS is
connected to a red plug that allows the computer to run on emergency power during a power outage.
See the diagram below for reference.

 If a printer is connected to the 724 computer, check that the printer is also plugged into the Emergency
Power Outlet.

724 Data Check

• All 724 computers should have regular data checks to ensure the 724 data is current in the event of a
downtime.

• The 724 data check can be found at: The 724 data check procedure can be found here.

• The data check should be done weekly, to ensure current data is loaded on the 724 computers in case of
UNPLANNED downtimes.

• For PLANNED downtimes, a data check should be done 2-3 days before the downtime.

• If the data is not current, call Service Desk who will triage to CST Integrated Technologies.

References

None

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Definitions

Planned Downtime
• Occurs at a scheduled time to minimize impact to patient care.
• Scheduled to complete system maintenance or upgrades.

Unplanned Downtime
• Occurs unexpectedly.
• Length is unknown and dependent on the time required to identify and remediate the cause.
• Results from hardware failure, power outage, or network outage.

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Appendix A: Related Documents and Training

Related Documents
• 724 Downtime Quick Reference Guide
• 724 Data Check Procedure

Training Available
• 724Access Downtime Viewer Course id: 23890

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Appendix B: Add new patient to an OMNICELL

Adding a patient to the system should be a rare occurrence. It is very important that you enter the
information correctly so that the patient information can be reconciled for proper billing.
Note: Contact your system administrator if patient names are not regularly displaying on the patient
lists as expected.

1. From the Main Menu, press Patient Care.

2. Press Add New Patient.
3. On the New Patient Information screen, enter all required information.

4. Enter the patient’s assigned account number if you know it. If you do not, enter as much information about
the patient as possible, such as date of birth, OR number, etc.
• MRN input: blanks entered between, leading, or trailing will be stripped off.
• PID input: leading or trailing blanks will be stripped off. Spaces in between are included in count.

5. Press Add New Patient.

The patient screen for the temporary patient is displayed. The temporary patient’s name is displayed on the
patient list as a TMP type (temporary).

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Appendix C: How to print a Restock Manually at the ADC

These downtime procedures apply when the ADC is not communicating with the Server
The Omnicenter (Server) will not have the correct Quantity On Hand (QOH) at the cabinet level (i.e. what you
see in Omnicenter will not match the actual QOH at the cabinet level)

1. Log in at the cabinet with credentials.

2. Choose Reports (bottom of screen), the select Inventory Reports.

3. Select Restock List

4. Select Control Level 2 (Narcotics) for first report.

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5. Select Print all pages

6. Select All Medications for second report.

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7. Select Print all Pages.

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Appendix D: Turning on Critical Override from a Cabinet

This downtime procedure is for accessing medication when an Omnicabinet is not connected to the
Omniserver due to local network issues or due to issues with the Omniserver.

Login to the affected Omnicell cabinet with the user: CWCODEGREY (password needs to be set up
and reset after each downtime) – CW generic user name [contingency] is in place and the only
function that can be performed is the override function. The password in physical form is stored in the
narcotic safe in an envelope titled: Critical Override Password. Direct patient care 24/7 units would
need the password in the event they have to apply the override function. They are to call the main
pharmacy for the password. This scenario occurs when pharmacy cannot log in remotely to the
OMNICELL cabinets (network outage).

1. Override not permitted

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2. Admin Menus >Omni Config

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3. Critical Override

4. Allow Cabinet Critical Override

5. Change Control by Site to Enable at Cabinet > Update

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6. Override permitted

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7. Once uptime resumes, Pharmacy would reverse the overrides to regular functioning.

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