Transcript 10 Appendix I GMRA May 2014 (Optimization and Maintenance)

Adverse Reaction Tracking Package
(GMRA)
Optimization and Maintenance
May 2014
Summary of Tasks
• Initial
– Review GMRA Package Parameters
– Perform Free Text clean up using utility
– Review PLAL reports
– Ensure local drug file entries are matched to NDF
– Verify Reactions
– Review patients with no assessment done
– Perform Drug Class and Ingredient clean up using
utility
Adverse Reaction Tracking (GMRA) Package
OPTIMIZATION
• Review Site Parameters
– Ability to configure the following:
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•
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The list of the ten most common signs/symptoms
The auto-verification of data
Force the originator of the data to provide comments
Marking of a patient’s ID band or chart to indicate the
presence of an allergy/adverse reaction
• Force entry of FDA reporting data
• Allow comments to be added to the reaction data that is
entered in error
– For details on every field please see included script,
“Adverse Reaction Tracking (GMRA) Site Parameters”
Adverse Reaction Tracking (GMRA) Package
OPTIMIZATION
• Free Text Clean-Up
– THREE clean up utilities are available as of GMRA
Patch 1001
• Free Text Clean Up: PRIORITY
• Ingredient
• Drug Class
– Patient Safety Concern: Reactions that have been
entered as free text may or may not have had drug
class code(s) or ingredient(s) attached and have the
potential for NOT participating in order checking
Adverse Reaction Tracking (GMRA) Package
OPTIMIZATION
• Free Text Clean-up
– This utility does NOT automatically match any
entry to a “better” entry, nor does it suggest
better entries
– It is simply a tool for identifying allergies that are
problematic and allows the user to take action on
them
– The goal of free text clean up is an empty list, or
as close to an empty list as is practical
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2
3
4
5
6
Edit Allergy File
Enter/Edit Signs/Symptoms Data
Enter/Edit Site Parameters
Sign/Symptoms List
Allergies File List
Allergy clean up utility
Select Enter/Edit Site Configurable Files Option: 6
Allergy clean up utility
Select one of the following:
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2
3
Free Text
Ingredient
Drug Class
Select the list you wish to work with: 1 Free Text
Building list of free text allergies...this may take a
few minutes
Allergy Tracking Update
Apr 6, 2013 10:33:16 Page: 1
Allergy Tracking Free Text Entries
Reactant
# Active Entries
1
AC I/ARB
1
2
ACEI
3
3
ACTIFED
1
4
ADVERSE DRUG REACTION H202
1
5
AKE: ACI
1
6
ALBUTEROL
22
7
ALENDRONATE
7
8
ALL ANTIBIOTIC UNKNOWN
1
9
ALL DYES
1
10 ALL EYE DROPS
1
11 ALL NSAIDS
1
12 ALL TAPES
1
13 ALLERGIC TO DYE
1
14 AMITRIPTYLINE
24
15 AMLODIPINE
30
16 AMOXICILLIN
700
17 AMPICILLIN
110
+
Select one or more entries
AE Add/Edit Allergy File EE Mark entered in error
DD Detailed Display
UR Update to new reactant
Select Item(s): Next Screen//
of
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Adverse Reaction Tracking (GMRA) Package
OPTIMIZATION
• Problem List entries to GMRA
– Long standing “issue” ever since the launch of EHR
– Transition of adverse reaction data from the
Problem List TO the GMRA Package
– Patient safety concern: Items entered on the
Problem List but NOT present in the GMRA
package will NOT participate in order checks
– Data removed from the Problem List?
• It depends!
Cleaning up the PLAL List
• Look at the problem list entry for the patient.
• Review the note for the date the problem was
entered.
• Look for other notes or data that provide
information on the reaction.
• Review the adverse reactions package to see if
it was already documented there:
– Ensure all information is included.
Cleaning up the PLAL List
If needed, enter or edit the reaction in the ART
package or adverse reaction module in EHR:
• Ensure all available data is included.
• Although sign/symptom data can be added in
EHR, deleting can only be done on non-verified
reactions.
• Include comments to show:
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–
–
–
Original date documented
Who documented
That it was moved from Problem List to ART
Any other information that may be useful in
determining who did what and why
Cleaning up the PLAL List
Remove the reaction information from the Problem
List, if appropriate
• Inactivated entries will still show on PLAL
• Consider waiting until the reaction has been verified
– In this instance, it may be useful to have the verifier
perform this step
• Remember that problems are now “logically” deleted
– This means that the information is still discoverable for
legal and other purposes
– Will not show in EHR, Health Summaries, etc for normal
users
Adverse Reaction Tracking (GMRA) Package
OPTIMIZATION
• Drug File Maintenance/National Drug File
(NDF) Matching
– Order checking depends on accurate information
in the GMRA package AND a well maintained drug
file
– Local drug file needs to be up to date, complete,
and accurate
• All items matched to the NDF
• If not possible to match then manually populate the VA
Class in the local drug file entry
Adverse Reaction Tracking (GMRA) Package
OPTIMIZATION
• Verify Reactions
– Auto verification is ONLY recommended for FOOD
reactions
– ALL medication reactions should be manually
verified
• Verifying in this context means
– Drug class code is present
– Ingredients are present (where appropriate)
– Not a duplicate entry
Adverse Reaction Tracking (GMRA) Package
OPTIMIZATION
• Verify Reactions (continued)
– “List by Location Not Verified Reactions” Report
– “Verify Reactions” option in RPMS
• In the case of “Unsigned” reactions
– May be seen with “old” data as software changes
have made it impossible for a user to leave a
reaction in an unsigned state
– Verify these unsigned reactions as well
• Must hold the GMRA-SUPERVISOR key
Adverse Reaction Tracking (GMRA) Package
OPTIMIZATION
• “Undocumented Reactions” or No Assessment
Done
– “List by Location of Undocumented Allergies”
Report
Adverse Reaction Tracking (GMRA)
Package OPTIMIZATION
• Drug Class and Ingredient Clean-Up
– THREE clean up utilities are available as of GMRA
Patch 1001
• Free Text Clean Up: PRIORITY
• Other two categories:
– Drug Class
– Ingredient
• Drug Class and Ingredient categories work the same as
the free text utility
• Most likely these two lists will never be completely
empty, but can most likely be reduced
Summary of Tasks
• Daily/Weekly
– Review RPMS Mailman messages
• New Reactant Requests
– Assist providers in finding appropriate reactant
– If no appropriate reactant can be found then submit request
through RPMS Feedback page
– Verify Reactions
Summary of Tasks
• Monthly
– Review NDF Patch notes and RPMS Mailman
messages and perform needed steps
– Review Auto-verification reports (if applicable)
– Review PLAL reports for new Problem list reaction
entries since it was last run
– Perform Drug class and ingredient clean up using
utility
Summary of Tasks
• Periodic
– Perform Automatic match of unmatched drugs
• THREE steps: Match, Verify, then Merge
– Review GMRA Site Parameters
Adverse Reaction Tracking (GMRA) Package
MAINTENANCE
• NDF Patch Updates
– Monthly updates
– Several RPMS Mailman Messages are generated
– Review the messages and take appropriate actions
Adverse Reaction Tracking (GMRA) Package
MAINTENANCE
• Auto-Verification Report (if applicable)
– If any “Auto-verify” is set to YES then run the “List
Autoverified Reaction” report
– Allows for spot checking and ensuring that auto
verification settings are functioning as desired
Adverse Reaction Tracking (GMRA) Package
MAINTENANCE
• Drug Class and Ingredient Clean-Up
– Goal is NOT to have an empty list
Adverse Reaction Tracking (GMRA) Package
MAINTENANCE
• Automatic Match of unmatched drugs
– Found in the National Drug File package
– Attempts to automatically match any currently
unmatched drugs to the local drug file
– MUST follow the following steps
• MATCH
• VERIFY
• MERGE
Questions?