xLab Pain Management
Overview
The xLab Pain Management module provides a mechanism for reporting Conformation testing. Understanding the relationships with Medications, Classes, and Metabolites is essential to understanding the configuration of the Pain Management module.
Definitions:
Drug Class - The user defined Class of drug such as "Barbiturates", "Illicit Drugs" or "Opiates" which consists of one or more Medications.
Medication - The prescribed medication(s) for a particular patient. For example: 'Vicodin'. A Medication can have one or more Metabolotes associated with it. (see Procedures)
Metabolite - The actual item being measured that comes from your instrument (or manually entered). For example 'Hydromorphone'. Note that each Metabolite references an xLab Result which, in turn is member of a Test defined in xLab.
Active From To - Each Metabolite may have an active range (Time it takes to the Metabolite to metabolize out).
NOTE: Cut-Off and Upper Limit are set from the Procedures menu.
Cut-Off - A numeric value that is used to determine if a Metabolite is 'Positive' or 'Not Detected'. If a Metabolite result is below the Cut-Off it is considered 'Not Detected', if a Metabolite results is equal to or greater than the Cut-Off it is considered 'Positive'.
Upper Limit - A numeric value that is used to determine is a Metabolite result is greater than a viable measured value.
Initial Configuration;
Proper configuration of the Pain Management Module is essential for your Pain Managment Reports to be accurate and appear as you would expect. xLab comes pre-configured with common Classes, Medications and Metabolites and, if you have provided the information to your Deployment Associate, Relationships have been set up.
Configuration is composed of 6 steps. Following these steps in the order shown will ensure that your Pain Managment Module will properly function as you would expect.
Step 1 - Metabolites
As previously stated a Metabolite is a measureable item and references an xLab Result. Metabolites also have 4 Parameters that may be used to enhance the reporting of Pain Managment.
Special Note: When defining Tests in xLab (see Procedures) specifically a Conformation test, you create a group of Results members for that test. What the user Orders for a particular patient sample is a Test and, by definition, all of the Results associated with that Test. Having a Metabolite that is not part of any Test can be done but serves no usfull purpose as it will never show up on any Report.
Select Utilities-Pain Management Setup then the Metabolite Tab
Functions:
Add New Drug: When you have added a New Conformation Test or added additional Results for a Conformation Test, you must add it to the available Metabolites. To do this Click on "Add New Drug" and in the 'Code' field press Function Key 3 (F3) to get a list of all Results.
Select the desired Result. Then proceed to complete any required Parameters.
Remove Metabolite: You may remove metabolites that are not used. Note that if any patient sample used the Metabolite (Result) you will get a Warning Pop-Up.
Parameters: See Business Rules to understand the impact of Parameters
NOTE: All Parameters are Optional.
Active From: You may specify a range of times (in Hours, Days. Months or Years) after which that this Metabolite MAY have metabolized out of the patients system.
Active To: You may specify a range of times (in Hours, Days. Months or Years) after which that this Metabolite WILL have metabolized out of the patients system.
Detection Window: Text that will be output in some Summary Reports.
No Analyte Detected, Reported Rx: Text that will be output on some Summary Reports when an Analyte is Negative for a Medication taken
Analyte Detected, No Rx: Text that will be output on some Summary Reports when an Analyte is Positive and not Medication was taken.
Step 2 - Medications
Medications are the Brand Name or Generic Name medications that a patient may be prescribed.
Functions:
Add New Medication: Allows you to add a new Medication to your Pain Managment System
Remove Medication: Allows you to remove an unused Medication from your Pain Managment System
Parameters: See Business Rules to understand the impact of Parameters
Class: Defines the Class this Medication belongs to. (Note your may also assign a Medication to a Class under the Class Tab.
Consisten When: You have two choices, 'Any Metabolite' and 'All Metabolites'.
Select Anticipated Positives: Select the Metabolites that may be Positive for this Medication.
Step-3 Class
Classes are a logical grouping of Medications
Functions:
Add New Class: To add a new Class to your Pain Managment Module
Remove Class: To remove a Class from your Pain Managment Module
Properties:
Order: Specifies the Order of Classes on the Detail Report
Medications for Class: Allows you to select which Medications are a member of this Class
Step-4 Specimen Validity
Functions:
Add New: Allows adding a New Result to Pain Management Spceimen Validity
Remove Result: Allows removal of the Results
Add New Comment: Allows the entry of specific Pain Managment Comments based upon a range. As may comments as needed may be entered.
Parameters:
There are not Parameters for Specimen Validity
Step-5 Defaults:
Defaults are Text that is used on some Pain Managment Reports. In some cases they replace the Metabolite Text in others they are used under specifc conditions.
Key Words: Key words are used at Report Generation time to susbstitute a Value in place of the Key Word. There are 6 Key Words.
[ANALYTE] - The actual Analyte (Metabolite) name is output
[ACTIVELOW] - The value of the Active From for the Metabolite
[ACTIVEHIGH] - The value of the Active To for the Metabolite
[INTERPRETATION] - The Positive or Negative interpertaion of the Metabolite
[MEDICATION] - The name of the Medication
[ALLANALYTES] - a comma separated list of Metabolite Name and Metabolite Interpretation (Positive or Negative)
Detection Window: If the Detection Window Text for a Metabolite is blank, this Text is output.
No Analyte Detected, Reported RX: if the No Analyte Detected, Reported RX Text is blank for the Metabolite, this Text is output
Analyte Detected, No Rx: If the Analyte Detected, No Rx Text for the Metabolite is blank, this Text is output.
All Metabolites Not Detected: If a given medication's Consistent Property is set to All Metabolites and all Metabolites for the Medication were not Positive, this Text is output.
Analyte Detected Outside Active High: If a Metabolite has a Active To value and the Metabolite is Positive but the last taken for the Patient Sample is greater then the Active To value, this text is output.
No Analyte Detected, Below Active Low: If a Metabgolite has an Active From value and the Metabolite is Negative but the last taken for the Patient Sample is Less Than the Active From value, this text is output.
Step-6 Detail Report:
The Detail Report Tab allows you to set the order each Metabolite is reported on the Detail Report for a given Class
On the Pain Managment Detail Reports, the order of Classes is set under the Class Tab. The order that Metaboites are output for a particular Class is set here. Lower numbers are output first.
Business Rules
Business Rules apply to the generation of the Pain Management Summary Report. The Pain Management Summary Report consists of 5 sections: (Note the actual Text header for each Section is user definable)
Reported Clinical History: Lists the Prescribed Medications
Consistent: The Medications that are consistent.
Not Consistent: Medications are are Inconsistent
Present: Metabolites that are present but no prescribed Medication was found.
Not Reported: Medications that prescribed but no Metabolites were tested
To illustrate the Business Rules an Example is best used.
Example:
A patient is prescribed Gabapentin,Methodone and Opana.
Gabapentin
Taken 1 day ago, Consistent with Any Metabolite.
Metabolites:
Gabapentin - Active from 2 day to 10 days, Interpretation is Positive
Gabapentin is CONSISTENTMethodone
Taken 1 day ago, Consistent with All Metabolites
Metabolites
EDDP Active from 1 day to 5 days, Interprestation Positive
Methodone Active from 1 day to 3 days, Interpretation Negative
Methodone is INCONSISTENT - Both Metabolites were not PositiveOpana
Taken 12 Days ago, Consistent with Any Metabolite
Metabolites
Oxymorphone Active from 1 day to 5 days, Interpretation Positive
Opana is INCONSISTENT - Metabolite was Positive but medication should have metabolized out in 5 daysDemerol
Taken Today, Consistent with Any Metabolite
Metabolites
Meperidine Active from 2 days to 5 Days, Interpertation Positive
Noreperidine, Active from 1 day to 5 days, Interpretation was Negative
Demerol is INCONSISTENT - Noreperidine shoule have been PositiveContin was Positive
Contin is INCONSISTENT because there is no Medication prescribed that has Contin as a Metabolite







