Transcript 11 Appendix J AdverseReactionTracking_MAY 2014

Resource and Patient Management Systems (RPMS)
Adverse Reaction Tracking
(GMRA)
Overview
May 2014
Session Objectives
At the end of this session, participants should be able to:
• Understand the purpose of the Adverse Reaction Tracking
package and its role in patient safety.
• Define common terms associated with the GMRA package
• Demonstrate understanding of functionality of GMRA package
• Demonstrate working knowledge of drug file clean-up utility
• Demonstrate working knowledge of package maintenance
• Demonstrate working knowledge on patient ADR entry
What is an Adverse Reaction?
What is an adverse drug reaction (ADR)?
An adverse drug reaction is a “response to a drug which is noxious
and unintended and which occurs at doses normally used in man for
prophylaxis, diagnosis, or therapy of disease, or for the modification
of physiologic function.” Note that there is a causal link between a
drug and an adverse drug reaction. In sum, an adverse drug
reaction is harm directly caused by the drug at normal doses,
during normal use.
How does an ADR differ from a side effect or allergy?
An allergy is an adverse drug reaction mediated by an immune
response (e.g., rash, hives). A side effect is an expected and known
effect of a drug that is not the intended therapeutic outcome. The
term “side effect” tends to normalize the concept of injury from
drugs. It has been recommended that this term should generally be
avoided in favor of adverse drug reaction.
All Allergies are Adverse Reactions, but not all Adverse Reactions
are Allergies!
Why use Adverse Reaction
Tracking?
• Order checking in EHR and RPMS
• Tracking and trending adverse reactions and
outcomes
• Reporting Adverse Reactions to manufacturers
and the Food and Drug Administration (FDA)
• Information data exchange (interoperability)
• Meaningful Use/Certification requirements
Allergy Tracking at Work--RPMS
CHOOSE 1-2: 1 COTRIMOXAZOLE DS 800MG/160MG TAB
AM650
-78707
$ TAB
00093-0089-05
TEST PHARMACY
Now doing drug interaction and allergy checks. Please wait...
A Drug-Allergy Reaction exists for this medication and/or class!
Drug: COTRIMOXAZOLE DS 800MG/160MG TAB
Ingredients: SULFAMETHOXAZOLE (LOCAL),
Reactions:
RASH (8/22/11) Src: PATIENT,
Do you want to Intervene? Y//
Allergy Tracking at Work--EHR
How does it work?
• Each drug file entry has a VA Drug Class
and ingredient(s) assigned through the
matching process
• Allergies are linked to VA Drug classes and
ingredients where applicable
• EHR performs order checks on both order
entry and signature of orders
• RPMS checks for patient reactions upon
prescription processing
• Interventions can be tracked and trended
using the Adverse Reaction Tracking
(GMRA) Package
National Drug File: VA Class Code
• National Drug File (NDF) is developed by the
VA
• New drugs and changes are put in a master
VA databank and changes are transmitted
through periodic patches
• There is some lag time for new drugs, and
typically only contains items the VA uses or
used to use
• VA Drug Class Code is one element of NDF
• Example: CV100 Cardiovascular Agents
• VA Drug Class Code is one of several basic
links for drugs throughout the RPMS system
PACKAGE SETUP
Overview
Parameters and Set Up
• GMRA Package and EHR Parameter Setup
• The key to successful Adverse Reaction
Tracking in RPMS and 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 ingredients in Outpatient
Pharmacy v7.0 and Inpatient v5.0, and EHR
• Add users to mail groups so automatic bulletins
will be sent appropriately
Set Up Users
• Clinical users
– are the doctors, nurses, other clinicians and clerks
entering the data into GMRA or EHR.
• Verifiers
– designated users by the site who verify the
correctness of the data in GMRA or EHR.
• Pharmacy and Therapeutics (P&T)
Committee users
– members of the facility's P&T Committee or other
group who review adverse reactions in the facility.
Security Keys
GMRA-USER
• Needed to be able to enter allergies in
EHR or RPMS, allows access to RPMS
GMRA “User” menu
GMRA-CLINIC
• Allows access to the RPMS GMRA
“Clinician” menu, not needed for EHR
GMRA-PT
• Allows access to the RPMS GMRA “P&T”
menu
Security Keys
GMRA-ALLERGY VERIFY
• Needed to verify allergy/adverse reactions in
RPMS or EHR
GMRA-SUPERVISOR
• Allows access to the RPMS GMRA 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
Mail Groups
A Site Manager can enter users into
different mail groups that will receive a
bulletin/notification when:
– A reaction needs verification (can separate
out by drug, food, or other)
– A reaction 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
Mailman Groups
The 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 REQUEST NEW REACTANT – a list of persons
designated by the site to review local requests for new
reactant or sign/symptoms, and forward needed entries on to
the National team. By default, this will be set up to use the
GMRA VERIFY DRUG ALLERGY group but this can be
changed if needed.
• 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.
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.
• GMRA REQUEST NEW REACTANT
– This is NOT visible in the Bulletin edit menu
Sample Mailman Message
Subj: REACTION ENTERED IN ERROR [#20942] 30 Sep 03
17
Lines
From: 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@14:47:28
Comments:
ENTERED IN ERROR
Date: Sep 30, 2003@14:47:28
User: STARR,JANICE
Title:
Patient denies reaction, is taking Captopril
with no problems.
Select MESSAGE Action: IGNORE (in WASTE basket)//
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
Menu Options
•
This is the main menu that has all
options of the Adverse Reaction (GMRA)
package:
Adverse Reaction Tracking (GMRA)
1.
2.
3.
4.
5.
Enter/Edit Site Configurable Files ...
Adverse Reaction Tracking User Menu ...
Adverse Reaction Tracking Clinician Menu ...
Adverse Reaction Tracking Verifier Menu ...
P&T Committee Menu ...
Enter/Edit Site Configurable Files
1.
2.
3.
4.
5.
Edit Allergy File
Enter/Edit Signs/Symptoms Data
Enter/Edit Site Parameters
Sign/Symptoms List
Allergies File List
Enter/Edit Site Parameters
Allows site configuration across multiple divisions
The site can configure the following:
– 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
Associating Drugs with Correct VA
Drug Class
• Should be taken care of by the matching process in
the drug file
– Extensive localizations within the GMRA package have
been problematic and are no longer allowed
• GMRA automatically assigns the allergy entry VA Drug
Class(es), Ingredient(s), or both (in most cases)
– Most entries for drugs should be marked from one of the
National Drug files (generic name or VA Product)
– Other entries may have none (e.g. for some non-drug
items), one, or both
– If the VA Class and/or ingredients have not been
populated, then order checks in EHR and RPMS may fail.
Edit Allergy File
• NO LONGER ALLOWED
• Local entries should have been inactivated
with recent GMRA patches, if loaded at your
site
– Current patch is GMRA 1005
Software is distributed with a list of entries that
is categorized as NATIONAL allergies
Enter/Edit Sign/Symptoms Data
• NO LONGER ALLOWED
• New entries have synonyms to allow
providers to more easily find what they
need, but will not be visible in EHR until
EHR patch 11.
Sign/Symptom List
• Prints a list of entries in the Sign/Symptoms file
Select Enter/Edit Site Configurable Files Option: 4 Sign/Symptoms
List
START WITH NAME: FIRST//
DEVICE:
VIRTUAL TERMINAL
Right Margin: 80//
SIGN/SYMPTOMS LIST
APR 5,2013 14:14
PAGE 1
NAME
Nat'l/Local SYNONYM
---------------------------------------------------------------ABDOMINAL BLOATING
National
ABDOMINAL CRAMPS
National
ABDOMINAL DISCOMFORT
National
ABDOMINAL PAIN
National
GI PAIN
GASTROINTESTINAL PAIN
ABNORMAL ECG
National
ABNORMAL SEXUAL FUNCTION
National
SEXUAL DYSFUNCTION
ABNORMAL VISION
National
Allergies File List
• Prints a captioned list of all entries in the GMR Allergies
file
START WITH NAME: FIRST//
DEVICE:
VIRTUAL TERMINAL
Right Margin: 80//
GMR ALLERGIES LIST
APR 5,2013 14:16
PAGE 1
-------------------------------------------------------------------------------NAME: ABALONE
ALLERGY TYPE: DRUG, FOOD
NATIONAL ALLERGY: NATIONAL ALLERGY
DRUG INGREDIENT: OMEGA-3 POLYUNSATURATED FATTY ACIDS
EFFECTIVE DATE/TIME: AUG 09, 2006@10:44:52
STATUS: ACTIVE
EFFECTIVE DATE/TIME: AUG 09, 2006@11:03:34
STATUS: ACTIVE
EFFECTIVE DATE/TIME: JUL 26, 2006@16:21:58
STATUS: ACTIVE
EFFECTIVE DATE/TIME: JUL 26, 2006@16:46:11
STATUS: ACTIVE
VUID: 4691092
MASTER ENTRY FOR VUID: YES
GMRA Verifier Menu
• This menu should be given to the verifiers of the
Adverse Reaction Tracking package as
designated by the site. This is controlled by the
GMRA ALLERGY VERIFY key.
– Adverse Reaction Tracking Verifier Menu
1.
2.
3.
4.
5.
6.
Enter/Edit Patient Reaction Data
Verify Patient Reaction Data
Reports Menu ...
Edit Chart and ID Band
FDA Enter/Edit Menu ...
Online Reference Card
GMRA User Menu
• This menu should be assigned to all users of the
Adverse Reaction Tracking package who are not
verifiers or ADP coordinators. This is controlled by
the GMRA-USER key.
– Adverse Reaction Tracking User Menu
1.
2.
3.
4.
5.
6.
7.
Enter/Edit Patient Reaction Data
Active Listing of Patient Reactions
Edit Chart and ID Band
List by Location of Unmarked ID Bands/Charts
Patient Allergies Not Signed Off
List by Location of Undocumented Allergies
Print Patient Reaction Data
Adverse Reaction Tracking in EHR
• Providers can enter and edit reactions in
the EHR
– Users can only edit certain parts of reactions
– Reaction reverts to “non-verified” if edited
• Exception is if the documenting user is a verifier
– Can also mark a reaction as entered in error
or inactive, reactivate an inactive reaction, or
mark a patient as “unassessible”
– Can delete their own unsigned reactions
• This is rare, as reactions are now automatically
signed in most cases
EHR Parameters for GMRA
• In BEHART
AUT Automatic Signature of Adverse Reaction Data
ENT Enable Adverse Reaction Data Entry
VER Allow Adverse Reaction Verification
EHR Parameters for GMRA, cont.
• AUT controls whether user has to manually
enter signature or applied automatically
when clicking on the signature button
– Strongly recommended to set to “Yes”
• ENT controls whether ANYONE can enter
reactions in EHR
– Usually only set to “no” when there are problems
that are being fixed, i.e. rarely
• VER allows the GMRA-Allergy Verify key to
be assigned to users
EHR Order Checks
• BEHORDOCXPARENA and
BEHORDOCXPAREDT and
BEHORDOCXPARDAN
– ENA turns order checks on and off
– EDT sets whether the order check can be
turned off by the user
– DAN sets the danger level and whether the
provider has to enter an override reason
ENTERING A
NEW ADVERSE REACTION
Where can Reactions be
Entered?
• In RPMS
– Through the Adverse Reaction Tracking package
– Through prescription processing functions of the
Pharmacy package (or through the inpatient
pharmacy functions)
– Through Patient Care Component (PCC) data entry
(ALG mnemonic)
• In EHR
– Through the adverse reaction component
ART Allergy Entry
Enter Causative Agent: IBUPROFEN
Checking existing PATIENT ALLERGIES (#120.8) file for matches...
Now checking GMR ALLERGIES (#120.82) file for matches...
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
ART Allergy Entry
No 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
ART Allergy Entry
The following is the list of reported signs/symptoms for this reaction:
Signs/Symptoms
Date Observed
-------------------------------------------------------------------1 GI REACTION
Apr 04, 1973
Select 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 SUBSTANCE
COMMENTS:
No existing text
Currently 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 DRUG
IBUPROFEN
SPOUSE
NO
PHARM
HIST DRUG
Reactions: GI REACTION(Source: SPOUSE)
Prescription Processing
• Option is available from the patient
information screen when processing
prescriptions:
– EA Enter/Edit Allergy/ADR Data:
• Enter/Edit or Remove a reaction from a patient
• Can be accessed anywhere prescriptions
can be processed
• Once selected, displays the same entry
interface as when using the ART Package
PCC Data Entry
• Using the ALG mnemonic
– User must have GMRA-USER key
– Mnemonic must be allowed
• Once the ALG mnemonic is invoked,
displays the same entry interface as when
using the ART package
Adverse Reaction Tracking
in EHR
Providers can enter Adverse Reactions (ADR)
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)
Allergy Entry - EHR
Right click in a blank part of
the adverse reaction
component and select New
Adverse Reaction.
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.
EHR Allergy Dialog Box
Enter Required Information.
Nature of Reaction
•Set by causative agent chosen
•Cannot be changed.
Required Fields
•Event Code
•Source of Information
•Signs/Symptoms
Hypersensitivity- Used if symptoms
are not known
“Top 10” Sign/Symptoms visible in EHR
Sites MUST review the “top 10” list in the GMRA site parameters and
update where necessary. May need to review historical data or with
providers to determine which ones really need to be in the list.
Date and time and source of the
signs/symptoms are optional.
Comments may be added as
needed to provide additional
information.
REQUESTING A NEW
REACTANT
What if the reactant is not
available?
• IHS added more than 700 entries to the
allergy file with GMRA patches 1001 and
1002.
• Additional will be added as needed to
keep current with the VA (GMRA Patch
1008 to be released this summer).
• However, IHS has created a feedback
mechanism to request additional reactants
beyond these.
Requesting a New Reactant
• In both RPMS and EHR, if the desired reactant
is not found, the user will be offered the option to
send a message to request the new reactant.
• Although the text states this is an email, it is
really a mailman bulletin:
– Therefore, it cannot be directed outside the facility.
– A package coordinator will need to check these
messages routinely and send information to the
feedback mechanism.
RPMS
Could not find SPONGEBOB in any files.
Before sending an email requesting the addition of a new reactant, please
try entering the first 3 or 4 letters of the reactant to search for
the desired entry.
Would you like to send an email requesting SPONGEBOB
be added as a causative agent?
Send email? NO// YES
You may now add any comments you may have to the message that
is going to be sent with the request to add this reactant.
You may want to add things like sign/symptoms, observed or historical, etc
that may be useful to the reviewer.
Enter RETURN to continue or '^' to exit:
==[ WRAP ]==[ INSERT ]============< >===========[ <PF1>H=Help ]====
THIS PATIENT REPORTS A VIOLENT REACTION TO WATCING SPONGEBOB.
<=====T=====T======T======T======T======T======T======T======T>=====
Message sent - NOTE: This reactant was NOT added for this patient.
Enter another Causative Agent? YES// NO
EHR
Click Yes to open the Enter Optional
Comments dialog.
Entering Feedback
• Go to:
http://www.ihs.gov/RPMS/index.cfm?module=feedback&
option=add&newquery=1
– Optionally, go to http://www.ihs.gov/RPMS and click
Feedback in the left-hand menu
• Fill out the available form, using the RPMS
Application “Pharmacy – New
Reactant/Symptom Request (PRSR)”
• These will be reviewed promptly, and will be
added through patch updates on a regular basis
as needed
ENTERED IN ERROR &
INACTIVATING/REACTIVATING
Reactions Entered In Error
• Entered in Error may be used when the reaction
entry was a mistake (wrong patient, wrong
causative agent):
– Wrong causative agent will 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 desensitization therapy).
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
YES
ALLERGY HIST DRUG
(METHYLPHENIDATE)
Reactions: TACHYCARDIA
Enter 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: HISTORICAL
ID BAND MARKED:
CHART MARKED:
SIGNS/SYMPTOMS:
(May 19, 2010@10:45:20)
MECHANISM: PHARMACOLOGIC
VERIFIER: USER,YSTUDENT
VERIFIED: MAY 19, 2010@13:37:26
Is the reaction information correct? Yes// N (No)
Mark this reaction as 'Entered-in-Error'? YES
COMMENTS:
1>WRONG PATIENT
2>
EDIT Option:
Enter another Causative Agent? YES// NO
Select Entered in
Error from the right
click menu to display
the Confirm dialog
Click Yes to remove
the adverse reaction
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
OBS/
HIST
---HIST
REACTANT
SOURCE
VER.
MECH.
TYPE
---------------- ---------WALNUTS
PATIENT
NO
UNKNOWN
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
Inactivating reactions
Select Inactivate Adverse
Reaction on the right-click
menu to open the Confirm
dialog.
Click Yes to open the Reason
Prompt dialog.
UNABLE TO ASSESS
Unable to Assess
• Sometimes, the patient or proxy may not
be able to relate their adverse reaction
history.
• There is now a way to document that the
attempt was made but could not be
completed.
• It does NOT mean that NO reaction history
is available, just that the user is unable to
determine if the listed information is
current and correct.
Unable to Assess
• This information will remain until some
other action is performed on the adverse
reactions:
– Review
– Add/Edit
– Inactivate/Mark “entered-in-error”
• This information is retained for auditing
purposes.
• This may be marked several times:
– For example, once each nursing shift or when
handing off care in an emergency room.
Select Adverse Reaction Tracking Clinician Menu Option: 7
allergies
Unable to assess
Select PATIENT NAME: DEMO,ALLERGY CHARLES
REACTANT
-------ASPIRIN
Reactions:
SOURCE
-----FAMILY
VER.
---YES
MECH.
------UNKNOWN
OBS/
HIST
---HIST
TYPE
---DRUG
ANAPHYLAXIS(Source: EXTERNAL SOURCE)
BEE STINGS
CHART REVIEW AUTO UNKNOWN HIST OTHER
Reactions: HIVES(Source: CHART REVIEW)
Do you want to mark this patient as being unable to assess for allergies?? NO//Y
ES
Select reason: ??
Choose from:
ALTERED MENTAL STATUS
CAREGIVER DOES NOT KNOW
LANGUAGE BARRIER
OTHER
PATIENT DOES NOT KNOW
UNCONSCIOUS
Select reason: UNCONSCIOUS
Patient has been marked unasessable
Press RETURN to continue
Select Inability to
Assess from the rightclick menu to open the
Reason Prompt dialog.
Select a reason, type a
comment, and click OK
to complete the action.
or
VERIFYING A REACTION
Verification of Reactions
• In this instance, “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 (VA Class code,
Ingredients, sign/symptom info, source,
SNOMED Event code, etc.)
• If the allergy does not contain the correct
information, the order checking will not
work
Verification
Access option through multiple paths:
• Prescription processing
• Adverse Reaction Tracking (ART) verifier
menu
• Electronic Health Record (EHR) via
Notifications
Finding Reactions Needing
Verification
• May be found during prescription
processing, the ART verification menu, 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 (or other
group assigned to the bulletin)
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
Verification Via Rx Processing
DEMO,PATIENT ALLEN
PID: 183-17-3440 (HRN: 142507)
DOB: MAY 16,1983 (27)
SEX: MALE
<A>
Ht(cm): _______ (______)
Wt(kg): _______ (______)
Eligibility: DIRECT ONLY
Insurance Information:
Disabilities:
1333 WRIGHTS CREEK RD
CARIBOU
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
DD Detailed Allergy/ADR List
Select Action: Next Screen// EA
PHONE: 555-555-8591
PU
EX
Patient Record Update
Exit Patient List
Verification VIA RX Processing
REACTANT
TYPE
-------MOTRIN
DRUG
(IBUPROFEN)
Reactions:
PENICILLIN V POTASSIUM
DRUG
(PENICILLIN)
Reactions: APNEA, SWELLING-THROAT
RITALIN
DRUG
(METHYLPHENIDATE)
Reactions: TACHYCARDIA
VER.
MECH.
HIST
---YES
------PHARM
---HIST
YES
ALLERGY
HIST
NO
ALLERGY
HIST
Enter Causative Agent: RITALIN
RITALIN
OK? Yes//
(Yes)
PATIENT: DEMO,PATIENT ALLEN
INGREDIENTS: METHYLPHENIDATE
ORIGINATOR:
SIGN OFF:
ID BAND MARKED:
SIGNS/SYMPTOMS:
CAUSATIVE AGENT: RITALIN
VA DRUG CLASSES: OPIOID ANALGESICS
AMPHETAMINE LIKE STIM
USER,YSTUDENT
ORIGINATED: MAY 19, 2010@13:39:13
YES
OBS/HIST: HISTORICAL
CHART MARKED:
TACHYCARDIA (May 19, 2010@13:39:13)
MECHANISM: ALLERGY
Is the reaction information correct? Yes// <enter> (Yes)
Verification VIA RX Processing
Currently you have verifier access.
Would you like to verify this Causative Agent now? Yes// <enter>
CAUSATIVE AGENT: RITALIN
TYPE: DRUG
INGREDIENTS: METHYLPHENIDATE
VA DRUG CLASSES: CN101 - OPIOID ANALGESICS
CN802 - AMPHETAMINE LIKE STIMULANTS
OBS/HIST: HISTORICAL
SIGNS/SYMPTOMS: TACHYCARDIA (May 19, 2010@13:39:13)
MECHANISM: ALLERGY
(Yes)
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// NO
This session you have CHOSEN:
RITALIN
Have the Chart(s) been marked for this CAUSATIVE AGENT? Y (Yes)
Verifier Menu
Adverse Reaction Tracking Verifier Menu
1.
2.
3.
4.
5.
6.
7.
8.
Enter/Edit Patient Reaction Data
Verify Patient Reaction Data
Reports Menu ...
Edit Chart and ID Band
FDA Enter/Edit Menu ...
Online Reference Card
Reactivate Reaction/Allergy
Unable to assess allergies
Verification Using ART Menu
Select Adverse Reaction Tracking Verifier Menu Option: 2
Reaction Data
Would you like to verify a single patient's data? NO//
D Drug
N Non-drug
B Both
Select type of AGENT to verify:(D/N/B): B
PATIENT
------1. DEMO,ALLERGY CHARLES (104836)
2. DEMO,ALLERGY CHARLES (104836)
3. DEMO,ALLERGY CONNIE (110211)
<...>
12. DEMO,PATIENT GIRL (993300)
13. DEMO,PATIENT LYNN (111410)
14. DEMO,PATIENT MADISON (100756)
15. DEMO,PATIENT MADISON (100756)
TYPE '^' TO STOP OR
Select a number between 1-15:
Verify Patient
ALLERGY
-------
OBS/
HIST ADR TYPE
---- --- ----
AMOXICILLIN
WALNUTS
PENICILLIN
HIST NO DRUG
HIST UNK FOOD
OBS NO DRUG
AMOXICILLIN
ACE INHIBITORS
BASCTRIM
SULFA
HIST NO
UNK
HIST UNK
UNK
DRUG
DRUG
DRUG
DRUG
Verification in EHR
1. Double click on a notification to process
2. Select a set of notifications to process
and click the “Process selected” button:
– To select multiple notifications that are
grouped together, click the first in the list,
press and hold the shift key, then click the last
in the list.
– To select multiple notifications not grouped
together, press and hold the control key, then
click each notification to process.
Once the verification dialogue opens, click 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. Click the “Current” button to see a list of the patient’s current active
reactions, to ensure the new entry is not a duplicate.
REPORTS
ART Reports
• Extensive reports are available in the ART
Package.
• The quality of the reports is directly related
to the quality of the data put in.
• Some reports will have little value for sites
not fully utilizing the package:
– For example, if the site is not entering P&T
Committee data, those reports will not be
useful.
ART Reports
• Each ART Menu includes reports.
• The types of reports may vary from menu
to menu.
• The USER menu does not have a
separate “reports” sub menu though some
reports are listed.
• All other menus have a separate “reports”
submenu.
Selected Reports of Interest
• Active Listing of Patient Reactions:
– Provides a listing of the ACTIVE reactions for a
single patient
• Patient Allergies Not Signed Off:
– Provides a list of reactions that have not been
signed off/completed
• List by Location of Undocumented Allergies:
– Provides a list of patient who do not have an allergy
assessment (either “no known allergies” or a
reaction documented)
• Print Patient Reaction Data:
– Provides a list of reaction data for a single patient
– User can choose to include active, inactive, and/or
entered in error
Selected Reports of Interest
• List by Location Not Verified Reactions:
– Provides a list of patients with reactions needing
verification, sorted by location
– This report may be tasked
• List by Location and Date All Signed Reactions:
– Provides a list of all signed/completed reactions over a
date range
• List Autoverified Reaction Data:
– Provides a list of reactions that were auto-verified by date
range, location, and mechanism
Selected Reports of Interest
• List of Fatal Reaction over a Date Range:
– Provides a list of fatal reactions over a date range
– If the date of death is recorded in Patient Registrations,
the report will include that date
• Print Summary of Outcomes:
– Provides a summary report of patient outcomes over a
date range
– No patient list is included
• Frequency Distribution of Causative Agents:
– Provides a list of reactants and the frequency over a date
range
• Frequency Distribution of Drug Classes:
– Provides a list of the VA Drug Class associated with a
reactant and the frequency over a date range
Selected Reports of Interest
• Total Reported Reactions Over a Date Range:
– Provides a number of reported reactions over a date
range
• P&T Committee ADR Outcome Report:
– Provides a list of reactions and summary of outcomes
over a date range
– Only useful if the P&T data was entered
• P&T Committee ADR Report:
– Provides a list of reactions, signs, mechanism,
severity, and comments over a date range
– MUST be printed to a 132 column printer
Reports Outside ART
PLAL Reports:
• Located in the PCC supervisor options.
• Provide a way to search for potential reactions
that are listed on the problem list (includes
INACTIVE problems!).
• The reports may contain items that do not
translate well to entries in the ART package:
– “seasonal allergies” or “environmental allergies”
– Might have coding errors.
• Does NOT check to see if these are already in
the ART package.
PLAL Reports
• List All Patients with Allergies or NKA on Problem
List:
– Provides a list of patients who have an allergy or NKA
entered on the Problem List.
– Can be VERY large – print in sections and after
regular hours.
• List Pts seen in N yrs with Problem List Allergies:
– Essentially the same as the above but allows for
restriction based on when the patient was last seen.
• List Patients with Allergies entered in a Date
Range:
– Provides a list of patients who have had reactions
entered onto the problem list over a date range.
– Can be useful to run after the initial clean up has
been done to catch new entries.
Questions?