RPMS Adverse Reaction Tracking (GMRA)

June 2011

Course ObjectivesAt the end of this session, participants should be able to:

• Enter, edit, and verify adverse reactions• Run basic reports to assist in documenting adverse

reactions• Set up package for efficient use• Recognize the importance of a comprehensive

Adverse Reaction review system• Run Adverse Reaction Tracking Package

management reports• Compare and contrast roles and assignment of “verify

key”• Learn about and get motivated to attend specific

allergy training

Adverse Reaction Tracking at WorkRPMS

CHOOSE 1-2: 1 PENICILLIN VK 250MG TAB AM110 -112926 000 93-5194-10 TEST PHARMACYNow doing order checks. Please wait...

A Drug-Allergy Reaction exists for this medication and/or class!

Drug: PENICILLIN VK 250MG TAB Ingredients: PENICILLIN,

Do you want to Intervene? Y//

EHR

How does it work?

• Each drug matched to the National Drug file has a VA Drug Class and Ingredients– If drug cannot be matched to the National Drug File, a

VA Drug Class can be manually assigned

• Adverse reactions are linked to VA Drug classes and ingredients

• RPMS checks for patient reactions upon prescription processing

• RPMS also checks for Drug-Drug and Drug-Food interactions

• Interventions can be tracked and trended using the Adverse Reaction Tracking (ART) Program

Adverse Reaction Tracking Package Setup

• The key to successful Adverse Reaction screening in EHR

• Impacts all disciplines

• Providers

• Nurses

• Pharmacy

• etc.

Adverse Reaction Tracking (ART)

• Different menus for different types of users, less important with EHR, but need well defined workflow

• Site parameters make package easier to use with workflow at site

• Drug interactions will be interactive based on VA drug class and/or ingredients

• Add users to mail groups so automatic bulletins will be sent appropriately

Set Up Users• Clinical users

– the doctors, nurses, other clinicians and clerks entering the data into ART

• Verifiers – designated users by the site who verify the correctness of

the data in ART

• Pharmacy and Therapeutics (P&T) Committee users– members of the hospital's P&T Committee or other

committee that reviews ADRs in the facility

Security KeysGMRA-USER• Needed to be able to enter reactions in EHR

or RPMS, allows access to RPMS ART “User” menu

GMRA-CLINIC• Allows access to the RPMS ART “Clinician”

menu, not needed for EHRGMRA-PT• Allows access to the RPMS ART “P&T” menu

Security KeysGMRA-ALLERGY VERIFY

• Needed to verify allergy/adverse reactions in RPMS or EHR

GMRA-SUPERVISOR

• Allows access to the RPMS ART full menu, and the authority to override the software’s security in order to edit data

GMRA-VERIFIER

• An obsolete key from a previous software version

Mailman GroupsA Site Manager can enter users into different

mail groups that will receive a bulletin when:– A reaction needs verification (can separate out by

drug, food, or other)– A reactions is marked as entered in error– P&T type data (FDA report) is entered– A chart/patient band needs to be marked for a

reaction– The signs/symptoms of a particular reaction have

been updated– A user has requested the addition of a new

reactant

Mailman GroupsThe mail groups are:• GMRA VERIFY DRUG ALLERGY - A list of all verifiers

who will need to be sent drug reaction information.• GMRA VERIFY FOOD ALLERGY - A list of all verifiers

who will need to be sent food reaction information.• GMRA VERIFY OTHER ALLERGY - A list of all verifiers

who will need to be sent other types of reaction information (i.e., not drug or food).

• GMRA P&T COMMITTEE FDA - A list of the members of the Pharmacy and Therapeutic (P&T) Committee.

• GMRA MARK CHART - A list of users who will need to mark a patient’s chart to record an allergy/adverse reaction.

• GMRA REQUEST NEW REACTANT - A list of users who will be notified of a new reactant request

Mailman Bulletins• GMRA ENTERED IN ERROR

– This bulletin is to be sent to both the verifiers and the chart marking groups so that the reaction can be corrected on the patient record.

• GMRA MARK CHART– This bulletin will alert the appropriate users to mark the patient

chart for the patient and allergy/adverse reaction specified in the bulletin.

• GMRA P&T COMMITTEE FDA– This bulletin will be issued when an agent is both observed and

a drug and has been signed off.• GMRA SIGNS/SYMPTOMS UPDATE

– This bulletin is to be set to the P&T committee if a reaction has had the Signs/Symptoms changed at anytime.

• GMRA VERIFY ALLERGY– This bulletin will indicate that an allergy/adverse reaction needs

to be verified.

Sample Mailman MessageSubj: ALLERGY/ADVERSE REACTION TO BE VERIFIED [#275013]

02/09/10@16:2610 linesFrom: NIESEN,MARY ANN In 'ALLERGIES' basket. Page 1 Priority!------------------------------------------------------------------The following allergy/adverse reaction needs to be verified for thefollowing patient: Patient: DEMO, PATIENT LIZA SSN: 00-29-45 Reaction: INFLUENZA VIRUS (SPLIT) VACCINE OBS/HIS: Historical Location: OUT PATIENTSigns/Symptoms Date Observed------------------------------------------------------------ANAPHYLAXIS Feb 09, 2010@16:21:08

Enter message action (in ALLERGIES basket): Ignore//

Sample Mailman MessageSubj: REACTION ENTERED IN ERROR [#20942] 30 Sep 03 17 LinesFrom: POSTMASTER (DSD-RPMS) (Sender: STARR,JANICE) Page 1---------------------------------------------------------------The following reaction has been ENTERED IN ERROR. Please ensure that the patient's Chart/ID Band are updated to reflect this change. Patient: LOPEZ,BYRON SCOTT SSN: 10-95-68 Reaction: CAPTOPRIL Location: 3EAST Originator: STARR,JANICE Entered in Error by: STARR,JANICE Entered in Error on: Sep 30, 2003@14:47:28Comments: ENTERED IN ERRORDate: Sep 30, 2003@14:47:28 User: STARR,JANICE Title: Patient denies reaction, is taking Captopril with no problems.Select MESSAGE Action: IGNORE//

Sample Mailman MessageSubj: Request to add new reactant [#4895] 05/04/11@08:25 18 lines

From: ALLERGY PACKAGE In 'IN' basket. Page 1

---------------------------------------------------------------------------

A request to add SEABASS as a new reactant was entered

User's contact information:

Title : PHARMACIST

Office Phone :

Digital Pager:

The user added the following comment:

This patient has throat swelling from seabass.

Please verify with the user the intended reactant and then take theappropriate action. Be sure to try alternate spellings, etc beforerequesting new reactants. If this reactant does require review foraddition, please submit through the IHS RPMS Feedback page athttp://www.ihs.gov/RPMS using the RPMS Application ‘Pharmacy-New

Reactant/Symptom Request (PRSR)’

Please note, an allergy to SEABASS was NOT entered for this patient!

Enter message action (in IN basket): Delete//

Setting up Mailman Groups

• May require Site Manager assistance

• Done via “Manage MailMan” menu which is usually part of the menus that only Site Mangers see.

• Bulletins and Groups are installed with the package– Need to assign people to the groups– Need to assign groups to the bulletins

ART Menu Options • This is the main menu that has all

options of the Adverse Reaction (ART) package

Adverse Reaction Tracking (ART)1. Enter/Edit Site Configurable Files ...2. Adverse Reaction Tracking User Menu ...3. Adverse Reaction Tracking Clinician Menu ...4. Adverse Reaction Tracking Verifier Menu ...5. P&T Committee Menu ...

Enter/Edit Site Configurable Files

1. Edit Allergy File

2. Enter/Edit Signs/Symptoms Data

3. Enter/Edit Site Parameters

4. Sign/Symptoms List

5. Allergies File List

6. Allergy clean up utility

Enter/Edit Site ParametersAllows site configuration across multiple divisionsThe site can configure the following:

– The list of the ten most common signs/symptoms

– The autoverification of data– Whether originator of the data should provide

comments– Marking of a patient’s ID band or chart to

indicate the presence of an allergy/adverse reaction

– FDA reporting data– Allows comments to be added to the reaction

data that is entered in error

Autoverification issues

• Can set autoverify ON for FOOD and OTHER reactions*

• Can set Autoverify for Historical reactions

• Recommended that all DRUG reactions be manually verified

• Recommended that all OBSERVED reactions be manually verified*Autoverify can cause odd results for some drug

allergies!

Associating Drugs with Correct VA Drug Class

• Ensure entries in the drug file are matched to the National Drug File– should do this before starting or as soon as

possible after

• Automatically assigns– once you have linked a reaction to the drug

ingredients and VA class, all previous and future reactions will have the same information

– order checks in EHR and RPMS are dependant on having a VA Drug Class and/or ingredients

Edit Allergy File• Software is distributed with a list of entries categorized

as NATIONAL allergies– Approximately 785 entries delivered with EHR patch 8

– Additional 16,000+ entries will be delivered with the next GMRA patch

• Due to data standardization and interoperability concerns, the allergy file can no longer be edited at the local site

• Users may request new reactants be added through the RPMS Feedback page– Accessed through http:www.ihs.gov/RPMS

– Click on “Feedback” on the left hand side

– Use the RPMS Application “Pharmacy-New Reactant/Symptom Request (PRSR)

Enter/Edit Signs/Symptoms Data• Due to data standardization and

interoperability concerns, this file is no longer editable at the local site

• Users may request new Signs/Symptoms be

added through the RPMS Feedback page

– Accessed through http:www.ihs.gov/RPMS

– Click on “Feedback” on the left hand side

– Use the RPMS Application “Pharmacy-New

Reactant/Symptom Request (PRSR)

Sign/Symptom List• Prints a list of entries in the Sign/Symptoms file

Select Enter/Edit Site Configurable Files Option: Sign/Symptoms ListSTART WITH NAME: FIRST// <enter>DEVICE: HOME <enter> RIGHT MARGIN: 80// <enter>

SIGN/SYMPTOMS LIST FEB 2,1996 08:21 PAGE 1

NAME Nat'l/Local SYNONYM--------------------------------------------------------------------------- AGITATION National AGRANULOCYTOSIS National ALOPECIA National ANAPHYLAXIS National

Allergies File List• Prints a captioned list of all entries in the

GMR Allergies fileSTART WITH NAME: FIRST// <enter>DEVICE: HOME <enter> RIGHT MARGIN: 80// <enter>

GMR ALLERGIES LIST FEB 2,1996 08:21 PAGE 1---------------------------------------------------------------------------NAME: ADHESIVE TAPE ALLERGY TYPE: OTHERNATIONAL ALLERGY: NATIONAL ALLERGY

NAME: ALCOHOL ALLERGY TYPE: DRUG, FOODNATIONAL ALLERGY: NATIONAL ALLERGYDRUG INGREDIENT: ALCOHOL

NAME: ANIMAL HAIR ALLERGY TYPE: OTHERNATIONAL ALLERGY: NATIONAL ALLERGY

ART Verifier Menu• This menu should be given to the verifiers of the

Adverse Reaction Tracking package as designated by the site. The options on this menu will allow the user to edit/verify/print allergy/adverse reaction data.

– Adverse Reaction Tracking Verifier Menu 1. Enter/Edit Patient Reaction Data2. Verify Patient Reaction Data3. Reports Menu ...4. Edit Chart and ID Band5. FDA Enter/Edit Menu ...6. Online Reference Card7. Reactivate Reaction/Allergy8. Unable to assess allergies

• This menu should be assigned to all users of the Adverse Reaction Tracking package who are not verifiers or ART coordinators. The options on this menu will allow the user to edit/display allergy/adverse reaction data.

– Adverse Reaction Tracking User Menu1. Enter/Edit Patient Reaction Data

2. Active Listing of Patient Reactions

3. Edit Chart and ID Band

4. List by Location of Unmarked ID Bands/Charts

5. Patient Allergies Not Signed Off

6. List by Location of Undocumented Allergies

7. Print Patient Reaction Data

8. Online Reference Card

ART User Menu

Patient Prescription Processing

• EA Enter/Edit Allergy/ADR Data– Enter/Edit or Remove a reaction from a

patient

• Same option can be accessed when processing prescriptions via the “Complete Orders from OE/RR” option in the Outpatient Pharmacy package

Adverse Reaction Trackingin EHR

• Providers can enter ADRs in the EHR using the right click menu on the Adverse Reaction component– Enter a new reaction– Edit an existing reaction– Delete their own unsigned reaction– Mark a reaction “entered-in-error”– Mark a reaction as inactive, or reactivate a

reaction– Document the inability to assess reactions– Document chart review functions (reviewed or no

active allergies)

Entry and Verification of reactions• Reactions are entered by a variety of

people: Coders, Providers, Nurses• Pharmacists verify reactions

– Verifying does not imply you have interviewed the patient and are convinced the allergy or reaction is real.

– It means you have checked the entry in the patient’s profile and it contains all required information

– If the allergy does not contain the correct information, the order checking will not work

Allergy Entry - EHR

Enter a few characters of the causative agent (watch for misspellings). For medications, choose from the National Drug File entries. For foods or other non-drug substances, choose from the VA Allergies file. The local drug file will not be selectable; drug ingredients and VA Drug class should only be used as a last resort.

Right click in a blank part of the adverse reaction component and select New Adverse Reaction

EHR Allergy Dialog BoxEnter the required information. Nature of Reaction will be set by the causative agent chosen, and cannot be changed. Event Code, Source of Information, and Signs/Symptoms are required (use “Possible Reaction” if symptoms are not known). Date and time and source of the signs/symptoms are optional. Comments may be added as needed to provide additional information.

“Roll & Scroll” Allergy EntryEnter Causative Agent: IBUPROFEN

Checking existing PATIENT ALLERGIES (#120.8) file for matches...

Now checking GMR ALLERGIES (#120.82) file for matches...

IBUPROFEN OK? Yes// N (No)

Now checking the National Drug File - Generic Names (#50.6)

1 IBUPROFEN

2 IBUPROFEN/PSEUDOEPHEDRINE

CHOOSE 1-2: 1 IBUPROFEN

IBUPROFEN OK? Yes// (Yes)

SOURCE: ?

Only allow items designates as a source of information

Answer with BEH ALLERGY VALUES NAME

Do you want the entire BEH ALLERGY VALUES List? Y (Yes)

Choose from:

CHART REVIEW

EXTERNAL SOURCE

FAMILY

FRIEND

MEDICAL PROVIDER

OTHER SOURCE

PATIENT

SPOUSE

“Roll & Scroll” Allergy EntryNo signs/symptoms have been specified. Please add some now.

The following are the top ten most common signs/symptoms:

1. ANXIETY 7. HIVES

2. ITCHING 8. DYSPEPSIA

3. SWELLING (NON-SPECIFIC) 9. ANAPHYLAXIS

4. DROWSINESS 10. RASH

5. NAUSEA,VOMITING 11. OTHER SIGN/SYMPTOM

6. DIARRHEA

Enter from the list above : 11

Select SIGN/SYMPTOMS NAME: GI REACTION NATIONAL SIGN/SYMPTOM

Select SIGN/SYMPTOMS NAME:

Date(Time Optional) of appearance of Sign/Symptom(s): 4-4-1973 (APR 04, 1973)

Select source: ?

Answer with BEH ALLERGY VALUES NAME

Do you want the entire BEH ALLERGY VALUES List? Y (Yes)

Choose from:

CHART REVIEW

EXTERNAL SOURCE

FAMILY

FRIEND

MEDICAL PROVIDER

OTHER SOURCE

PATIENT

SPOUSE

“Roll & Scroll” Allergy EntryThe following is the list of reported signs/symptoms for this reaction: Signs/Symptoms Date Observed-------------------------------------------------------------------- 1 GI REACTION Apr 04, 1973Select Action (A)DD, (D)ELETE OR <RET>:SNOMED EVENT: ?? Choose from: ALLERGY TO SUBSTANCE DRUG ALLERGY DRUG INTOLERANCE FOOD ALLERGY FOOD INTOLERANCE PROPENSITY TO ADVERSE REACTIONS PROPENSITY TO ADVERSE REACTIONS TO DRUG PROPENSITY TO ADVERSE REACTIONS TO FOOD PROPENSITY TO ADVERSE REACTIONS TO SUBSTANCECOMMENTS: No existing textCurrently you have verifier access.Would you like to verify this Causative Agent now? Yes// N (No) OBS/REACTANT SOURCE VER. MECH. HIST TYPE-------- ------ ---- ------- ---- ----BEN-GAY YES UNKNOWN HIST DRUGIBUPROFEN SPOUSE NO PHARM HIST DRUG Reactions: GI REACTION(Source: SPOUSE)

Reactions Needing Verification• Reactions entered by users without the

GMRA-ALLERGY VERIFY key

• May be found in Rx Processing, the Verification menu option, or using the ART reports

• Users may receive notifications in RPMS and EHR if:– They hold the GMRA-ALLERGY VERIFY key,

AND– They are members of the GMRA VERIFY

DRUG ALLERGY mailman group

Unverified reactions found in Rx processing

• Allergies and adverse reactions are displayed at the bottom of the patient information screen; non-verified reactions are listed separately from verified reactions

Adverse Reaction Tracking Verifier Reports Menu

1 Active Listing of Patient Reactions 2 Print Patient Reaction Data 3 Print an FDA Report for a Patient 4 Print All FDA Events within D/T Range 5 Print Patient FDA Exception Data 6 Print All FDA Exceptions within a D/T Range 7 List by Location of Unmarked ID Bands/Charts 8 Patient Allergies Not Signed Off 9 List by Location of Undocumented Allergies 10 List Autoverified Reaction Data 11 List by Location Not Verified Reactions 12 List by Location and Date All Signed Reactions 13 List FDA Data by Report Date

Patient Allergies Not Signed Off• Adverse Reaction Tracking Verifier Menu

Reports MenuPatient Allergies Not Signed Off– Procedure for completion depends on business

processes:• Get originator to sign off then verify• Users with GMRA-SUPERVISOR key may simply verify

ALLERGY/ADVERSE REACTIONS TO BE SIGNED OFF Run Date/Time: 5/19/10 10:53:15 am ORIGINATOR PATIENT ALLERGY ORIGINATION DATE/TIME -------------------------------------------------------------------------------- FEICHTER,GRACIE JUMPER,SHAWNA (10-70-47) NEOSPORIN AUG 29, 2005@10:57 KINSEY,SALLY WAKEFIELD,RICH(14-38-85) COMPAZINE SEP 15, 2005@08:45 KUNZ,ELIZABETH WOOTEN,MARILYN(11-43-61) SULFAMETHOXAZOLE MAY 18, 2004@10:16 KUNZ,ELIZABETH SMITH,DIANE(10-34-04) CODEINE MAY 25, 2004@16:16 LAB,JESSICA LOU WATTY,SHUSHANA(11-16-13) GABAPENTIN JUN 04, 2004@13:35

Unverified Allergies Search• Unverified reactions may be found through the

verification option, through the ART reports, or through notifications

• The “Verify Patient Reaction Data” is interactive– Can choose to look at a single patient or all patients

– Can choose to see Drug, Non-drug, or Both

– Can actually verify and edit from this menu option

• ART Reports “List by Location Not Verified Reactions” is a static report – Lists reactions entered and signed (either RPMS or EHR) but

not verified• Reactions entered in EHR by users with the GMRA-ALLERGY VERIFY key

will be verified when signed

• Notifications can be processed in EHR to verify these reactions

List by Location Not Verified Reactions

List of Unverified Reactions by Ward Location

Ward Location: OUTPATIENT Origination Date/Time Originator Reaction

-----------------------------------------------------------------

DEMO,RAY MITCHELL (14-42-39)

May 01, 2007@14:35 USER,BSTUDENT METFORMIN

May 01, 2007@14:37 USER,BSTUDENT METFORMIN

DEMO,CHASIDY SHA (14-54-90)

Jun 27, 2007@14:10 USER,CSTUDENT PENICILLIN

DEMO,MICHAEL (14-56-87)

Jan 10, 2007@11:16 USER,ASTUDENT PENICILLIN

DEMO,MUHAMMAD SHAHZAD (14-25-07)

May 19, 2010@10:45:20 USER,YSTUDENT MOTRIN

Verification

• Access option through multiple paths:– Rx processing– ART verifier menu– EHR via Notifications

Verification Via Rx Processing DEMO,PATIENT ALLEN <A> PID: 183-17-3440 (HRN: 142507) Ht(cm): _______ (______) DOB: MAY 16,1983 (27) Wt(kg): _______ (______) SEX: MALE

Eligibility: DIRECT ONLY Insurance Information:

Disabilities:

1333 WRIGHTS CREEK RD CARIBOU PHONE: 555-555-8591 MAINE 04736 Prescription Mail Delivery: Regular Mail

Allergies Verified: PENICILLIN V POTASSIUM, Non-Verified: RITALIN, + Enter ?? for more actions EA Enter/Edit Allergy/ADR Data PU Patient Record Update DD Detailed Allergy/ADR List EX Exit Patient List Select Action: Next Screen// EA

Verification VIA RX Processing REACTANT VER. MECH. HIST

TYPE -------- ---- ------- ---- MOTRIN YES PHARM HIST

DRUG (IBUPROFEN) Reactions: PENICILLIN V POTASSIUM YES ALLERGY HIST

DRUG (PENICILLIN) Reactions: APNEA, SWELLING-THROAT RITALIN NO ALLERGY HIST

DRUG (METHYLPHENIDATE) Reactions: TACHYCARDIA

Enter Causative Agent: RITALIN RITALIN OK? Yes// (Yes) PATIENT: DEMO,PATIENT ALLEN CAUSATIVE AGENT: RITALIN INGREDIENTS: METHYLPHENIDATE VA DRUG CLASSES: OPIOID ANALGESICS AMPHETAMINE LIKE STIM ORIGINATOR: USER,YSTUDENT ORIGINATED: MAY 19, 2010@13:39:13 SIGN OFF: YES OBS/HIST: HISTORICALID BAND MARKED: CHART MARKED: SIGNS/SYMPTOMS: TACHYCARDIA (May 19, 2010@13:39:13)

MECHANISM: ALLERGYIs the reaction information correct? Yes// <enter> (Yes)

Verification VIA RX ProcessingCurrently you have verifier access.Would you like to verify this Causative Agent now? Yes// <enter> (Yes)CAUSATIVE AGENT: RITALIN TYPE: DRUG INGREDIENTS: METHYLPHENIDATEVA DRUG CLASSES: CN101 - OPIOID ANALGESICS CN802 - AMPHETAMINE LIKE STIMULANTS OBS/HIST: HISTORICAL SIGNS/SYMPTOMS: TACHYCARDIA (May 19, 2010@13:39:13) MECHANISM: ALLERGY

Would you like to edit any of this data? N (No) PATIENT: DEMO,PATIENT ALLEN CAUSATIVE AGENT: RITALIN INGREDIENTS: METHYLPHENIDATE VA DRUG CLASSES: OPIOID ANALGESICS AMPHETAMINE LIKE STIM ORIGINATOR: USER,YSTUDENT ORIGINATED: MAY 19, 2010@13:39:13 SIGN OFF: YES OBS/HIST: HISTORICAL

ID BAND MARKED: CHART MARKED:

SIGNS/SYMPTOMS: TACHYCARDIA (May 19, 2010@13:39:13)Change status of this allergy/adverse reaction to verified? Y (Yes)Enter another Causative Agent? YES// NOThis session you have CHOSEN: RITALINHave the Chart(s) been marked for this CAUSATIVE AGENT? Y (Yes)

Verification Using ART MenuSelect Adverse Reaction Tracking Verifier Menu Option:

Verify Patient Reaction DataWould you like to verify a single patient's data? NO// YESSelect PATIENT NAME: DEMO,PATIENT ALLEN <A> M 05-16-1983 XXX-XX-3440 CI 142507 D Drug N Non-drug B BothSelect type of AGENT to verify:(D/N/B): BOTH OBS/ PATIENT ALLERGY HIST ADR TYPE ------- ------- ---- --- ----

1. DEMO,PATIENT ALLEN (142507) MOTRIN HIST YES DRUGSelect a number between 1-1: 1 PATIENT: DEMO,PATIENT ALLEN CAUSATIVE AGENT: MOTRIN INGREDIENTS: IBUPROFEN VA DRUG CLASSES: NONSALICYLATE NSAIs,A

ORIGINATOR: USER,YSTUDENT ORIGINATED: MAY 19, 2010@10:45:20 SIGN OFF: YES OBS/HIST: HISTORICAL

ID BAND MARKED: CHART MARKED:

SIGNS/SYMPTOMS: (May 19, 2010@10:45:20)

MECHANISM: PHARMACOLOGICIs the reaction information correct? Yes// <enter> (Yes)

Verification Using ART MenuCAUSATIVE AGENT: MOTRIN TYPE: DRUG INGREDIENTS: IBUPROFENVA DRUG CLASSES: MS102 - NONSALICYLATE NSAIs,ANTIRHEUMATIC OBS/HIST: HISTORICAL

SIGNS/SYMPTOMS: (May 19, 2010@10:45:20) MECHANISM: PHARMACOLOGIC

Would you like to edit any of this data? N (No)

COMMENTS: 1> PATIENT: ALLEN,MUHAMMAD SHAHZAD CAUSATIVE AGENT: MOTRIN INGREDIENTS: IBUPROFEN VA DRUG CLASSES: NONSALICYLATE NSAIs,A

ORIGINATOR: USER,YSTUDENT ORIGINATED: MAY 19, 2010@10:45:20 SIGN OFF: YES OBS/HIST: HISTORICAL

ID BAND MARKED: CHART MARKED:

SIGNS/SYMPTOMS: (May 19, 2010@10:45:20)

MECHANISM: PHARMACOLOGICChange status of this allergy/adverse reaction to verified? Y (Yes)

Verification in EHR

• Double click on a notification to process

• Select a set of notifications to process and click on the “Process selected” button– Can select several notification that are

grouped together by clicking on the first in the list, then HOLDING the shift key and clicking on the last in the list

– Can select several notification not grouped together by HOLDING the control key and clicking on each notification to process

Once the verification dialogue opens, you may click on the button to the right of the causative agent (labeled with the primary VA Class Code) to see the details on the VA Class Codes and Drug Ingredients tied to that causative agent. Note that these cannot be edited in EHR. You may also click on the “Current” button to see a list of the patient’s current active reactions, to ensure the new entry is not a duplicate.

Reactions Entered In Error• Entered in Error may be used when the reaction

was a mistake (wrong patient, wrong causative agent)– Wrong causative agent may require a new entry for the

correct agent

• Entering comments is strongly recommended to allow auditors, surveyors, and other providers to know what was done with the reaction and why

• NOT for reactions that the patient no longer has (e.g. Ibuprofen caused stomach upset once but is now taken regularly, or patient has undergone de-sensitization therapy)

REACTANT VER. MECH. HIST TYPE-------- ---- ------- ---- ----MOTRIN YES PHARM HIST DRUG (IBUPROFEN) Reactions: PENICILLIN V POTASSIUM YES ALLERGY HIST DRUG (PENICILLIN) Reactions: APNEA, SWELLING-THROATRITALIN YES ALLERGY HIST DRUG (METHYLPHENIDATE) Reactions: TACHYCARDIAEnter Causative Agent: MOTRIN <A> M 05-16-1983 XXX-XX-3440 CI

142507 MOTRIN OK? Yes// <enter> (Yes) PATIENT: DEMO,PATIENT ALLEN CAUSATIVE AGENT: MOTRIN INGREDIENTS: IBUPROFEN VA DRUG CLASSES: NONSALICYLATE NSAIs,A ORIGINATOR: USER,YSTUDENT ORIGINATED: MAY 19, 2010@10:45:20 SIGN OFF: YES OBS/HIST: HISTORICALID BAND MARKED: CHART MARKED: SIGNS/SYMPTOMS: (May 19, 2010@10:45:20) MECHANISM: PHARMACOLOGIC VERIFIER: USER,YSTUDENT VERIFIED: MAY 19, 2010@13:37:26Is the reaction information correct? Yes// N (No)Mark this reaction as 'Entered-in-Error'? YESCOMMENTS: 1>WRONG PATIENT 2>EDIT Option: Enter another Causative Agent? YES// NO

Inactivating reactions

• Used for situations where the patient has previously reported a reaction but is now able to tolerate the causative agent or is no longer allergic– Retains a record of the reaction that is visible

in EHR but clearly marked as “inactive”– Can be reactivated as needed– Retains record of when and who inactivated

and reactivated the reaction

Inactivating reactions

Inactivating reactions OBS/

REACTANT SOURCE VER. MECH. HIST TYPE

-------- ------ ---- ------- ---- ----

WALNUTS PATIENT NO UNKNOWN HIST FOOD

Reactions: HIVES(Source: PATIENT)

Enter Causative Agent: WALN

Checking existing PATIENT ALLERGIES (#120.8) file for matches...

<A> F 10-24-1933 XXX-XX-4127 WW 110211

WALNUTS

WALNUTS OK? Yes// <enter> (Yes)

PATIENT: DEMO,ALLERGY CONNIE CAUSATIVE AGENT: WALNUTS

SOURCE OF INFORMATION: PATIENT

ORIGINATOR: NIESEN,MARY ANN ORIGINATED: Apr 27, 2011@09:58

SIGN OFF: YES OBS/HIST: HISTORICAL

EVENT: FOOD INTOLERANCE CODE: 235719002 

ID BAND MARKED: CHART MARKED: Apr 27, 2011@09:59:49

SIGNS/SYMPTOMS: HIVES (Jan 29, 2010) SOURCE: PATIENT

MECHANISM: UNKNOWN

Is the reaction information correct? Yes// N (No)

Mark this reaction as 'Entered-in-Error'? NO

Inactivate this reaction? YES

Select reason: ??

Choose from:

NO LONGER ALLERGIC

REACTION IS TOLERABLE

Select reason: NO LONGER ALLERGIC

Enter another Causative Agent? YES// NO