Record the Active Medication Allergies – Ambulatory Setting s
(and Inpatient Settings)
If you are unable to edit this and have suggestions, please send an email to nancy at
worldvista dot org
To enter the allergies required by the script:
1 Right click in the Allergy section of the cover sheet and choose “Enter a new
allergy”:
2 In the dialog box provided, choose observed (hover over the Observed-Historical
block to see how to interpret what that means) and complete the entry. Hives is
chosen by double clicking on it. Mild, moderate or severe can be chosen from the
dropdown list, the drug is chosen by clicking on the [ …] next to the “Causative
Agent” block, Nature of the reaction can be entered as Allergy and a time and
comments can be entered as well.
NB. Severity does not appear unless Observed is clicked instead of Historical.
The meaning of historical and observed is displayed by hovering over the
Observed/Historical box and it reads:
EXACT TEXT TO GO HERE:
This is repeated for each of the allergies identified. (see screen capture below)
Page 1 of 14
Page 2 of 14
3 In order to delete the allergy, the user must have the option to use the “Entered in
Error” option that is found when right clicking the allergy section of the cover sheet.
This is done by setting the parameter OR ALLERGY ENTERED IN ERROR for the
user. No Know Allergies or NKA can be entered by any user.
This is done under OR Parameter Coordinator Menu - CPRS Configuration (Clin
Coord), GUI Parameters, GUI Mark Allergies Entered In Error as follows, and only
someone with the Key, ????
can do this. The way to assign this to a user and to
allow a user to access this menu is documented below:
OR PARAM COORDINATOR MENU
AL
KK
DC
GP
GA
CPRS Configuration (Clin Coord)
Allocate OE/RR Security Keys
Check for Multiple Keys
Edit DC Reasons
GUI Parameters ...
GUI Access - Tabs, RPL
Page 3 of 14
MI
NO
OC
MM
LI
FP
PR
RE
US
EX
NA
CM
DO
LO
PM
Miscellaneous Parameters
Notification Mgmt Menu ...
Order Checking Mgmt Menu ...
Order Menu Management ...
Patient List Mgmt Menu ...
Print Formats
Print/Report Parameters ...
Release/Cancel Delayed Orders
Unsigned orders search
Set Unsigned Orders View on Exit
Search orders by Nature or Status
Care Management Menu ...
Event Delayed Orders Menu ...
Lapsed Orders search
Performance Monitor Report
You've got PRIORITY mail!
Select CPRS Configuration (Clin Coord) Option: GUI
1 GUI Access - Tabs, RPL
2 GUI Parameters
CHOOSE 1-2: 2 GUI Parameters
CS GUI Cover Sheet Display Parameters ...
HS GUI Health Summary Types
TM GUI Tool Menu Items
MP GUI Parameters - Miscellaneous
UC GUI Clear Size & Position Settings for User
RE GUI Report Parameters ...
NV GUI Non-VA Med Statements/Reasons
EX GUI Expired Orders Search Hours
RM GUI Remove Button Enabled
NON GUI Remove Button Enabled for Non-OR Alerts
CLOZ GUI Edit Inpatient Clozapine Message
EIE GUI Mark Allergy Entered in Error
You've got PRIORITY mail!
Select GUI Parameters Option: EIE GUI Mark Allergy Entered in Error
Page 4 of 14
Mark allergy/adr as entered in error may be set for the following:
1
2
3
4
User
USR [choose from NEW PERSON]
Class
CLS [choose from USR CLASS]
Division
DIV [choose from INSTITUTION]
System
SYS [BETA.VISTA-OFFICE.ORG]
Enter selection: Press <RETURN> to see more, '^' to exit this list, OR ??
Entering SYSTEM will allow all users with access to the patient chart to delete an
allergy. The following three screen shots show the sequence for deleting the allergy
reaction report (accessed with a right click) and then marking a patient as having No
Know Drug Allergies.
Right click and select “Mark selected Allergy as entered in error”
Page 5 of 14
Enter a comment why it was deleted (Wrong Patient was entered in this example.)
Now shows there has been no allergy assessment.
This must be signed by clicking on “Refreshing the Patient Information” which is
listed under File in the upper right hand corner of CPRS
Page 6 of 14
And with a right click the patient can be marked as having No Know Allergies
No Known Allergies
ORWDAL33
A Pharmacy menu item GMRA Patient A/AR Edit allows the user to edit and
adverse reaction for severity, as well as other parameters and this menu item. An
example follows where an allergy is added and the severity edited from moderate
to mild. Note that the definition of an historical reaction is different than is
displayed in CPRS and this option is more consistent with the description that
physicians generally expect for an historical vs. and observed reaction. See RED
highlighting.
ENTERING AN ALLERGY USING THE MENU OPTION GMRA Patient A/AR
Edit:
OPTION: GMRA Patient A/AR Edit
Select PATIENT NAME:
Select PATIENT NAME: JONES,JODY
Select PATIENT NAME: JONES,JODY,JODY JONES,JODY
1-1-45
002030004
NO NON-VETERAN (OTHER)
Does this patient have any known allergies or adverse reactions? : Yes
This patient has no allergy/adverse reaction data.
Page 7 of 14
Enter Causative Agent: Amoxicillin
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 AMOXICILLIN
2 AMOXICILLIN/CLARITHROMYCIN/LANSOPRAZOLE
3 AMOXICILLIN/CLAVULANATE
CHOOSE 1-3: 1
AMOXICILLIN OK? Yes//
O)bserved or (H)istorical Allergy/Adverse Reaction: ??
Indicates whether this allergy/adverse reaction has been observed by som
e
personnel, or if it is historical data gathered about the patient.
Choose from:
o
OBSERVED
h
HISTORICAL
(O)bserved or (H)istorical Allergy/Adverse Reaction: O OBSERVED
Select date reaction was OBSERVED (Time Optional): ??
Please enter the date (time optional) that a reaction to this particular
causative agent was witnessed.
Select date reaction was OBSERVED (Time Optional): 1/1/2007 (JAN 01,
2007) J
AN 01, 2007 (JAN 01, 2007)
Are you adding 'JAN 01, 2007' as
a new ADVERSE REACTION REPORTING? No// Yes
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,WATERING EYES
8. DRY MOUTH
3. ANOREXIA
9. DRY NOSE
4. DROWSINESS
10. RASH
5. NAUSEA,VOMITING
11. OTHER SIGN/SYMPTOM
Page 8 of 14
6. DIARRHEA
Enter from the list above : 11
Select SIGN/SYMPTOMS NAME: wheezing
NATIONAL
SIGN/SYMPTOM
Select SIGN/SYMPTOMS NAME: cough
1 COUGH
2 COUGHING
NATIONAL SIGN/SYMPTOM
CHOOSE 1-2: 2 COUGHING NATIONAL SIGN/SYMPTOM
Select SIGN/SYMPTOMS NAME:
Date(Time Optional) of appearance of Sign/Symptom(s): Jan 01, 2007//
The following is the list of reported signs/symptoms for this reaction:
Signs/Symptoms
Date Observed
--------------------------------------------------------------------------1 COUGHING
Jan 01, 2007
2 WHEEZING
Jan 01, 2007
Select Action (A)DD, (D)ELETE OR <RET>:
Choose one of the following:
A - ALLERGY
P - PHARMACOLOGICAL
U - UNKNOWN
MECHANISM: UNKNOWN//
COMMENTS:
No existing text
Edit? NO// Yes YES
==[ WRAP ]==[ INSERT ]==============< COMMENTS
>=============[ <PF1>H=Help ]====
Patient presented to the emergency room 5 days after having been given
Amoxicillin for an abscessed tooth. She was treated with albuterol and
recovered and the Amoxicillin was stopped. She has a history of asthma
so it is not clear if the amoxicillin caused the wheezing and cough.
<=======T=======T=======T=======T=======T=======T======
=T=======T=======T>======
Page 9 of 14
────────────────────────────────────────────
────────────────────────────────────
Do you want to save changes? Yes
Complete the observed reaction report? Yes// (Yes)
DATE/TIME OF EVENT: JAN 1,2007//
OBSERVER: ANTHRACITE,NANCY//
SM
SEVERITY: ??
MILD
- Requires minimal therapeutic intervention such as
discontinuation of drug(s).
MODERATE - Requires active treatment of adverse reaction, or
further testing or evaluation to assess
extent of non-serious outcome (see SEVERE for
definition of serious).
SEVERE - Includes any serious outcome, resulting in life or organ
threatening situation or death, significant or permanent
disability, requiring intervention to prevent permanent
impairment or damage, or requiring/prolonging
hospitalization.
This field indicates the severity of this reaction.
Choose from:
1
MILD
2
MODERATE
3
SEVERE
SEVERITY: MODERATE
DATE MD NOTIFIED: Jan 1,2007// (JAN 01, 2007)
Complete the FDA data? Yes// No
Currently you have verifier access.
Would you like to verify this Causative Agent now? Yes// YES
CAUSATIVE AGENT: AMOXICILLIN
TYPE: DRUG
INGREDIENTS: AMOXICILLIN
VA DRUG CLASSES: AM111 - PENICILLINS,AMINO DERIVATIVES
OBS/HIST: OBSERVED
SIGNS/SYMPTOMS: WHEEZING (Jan 01, 2007)
COUGHING (Jan 01, 2007)
MECHANISM: UNKNOWN
Would you like to edit any of this data? NO (No)
Page 10 of 14
PATIENT: JONES,JODY
AMOXICILLIN
INGREDIENTS: AMOXICILLIN
PENICILLINS,AMINO DER
CAUSATIVE AGENT:
VA DRUG CLASSES:
ORIGINATOR: ANTHRACITE,NANCY
ORIGINATED: Dec 12,
2010@15:10
SIGN OFF: NO
OBS/HIST: OBSERVED
SEVERITY: MODERATE
OBS D/T: Jan 01, 2007
ORIGINATOR
COMMENTS:
Date: Dec 12, 2010@15:17:18
Title:
Enter RETURN to continue or '^' to exit:
User: ANTHRACITE,NANCY
Patient presented to the emergency room 5 days after having
been given Amoxicillin for an abscessed tooth. She was
treated with albuterol and recovered and the Amoxicillin
was stopped. She has a history of asthma so it is not
clear if the amoxicillin caused the wheezing and cough.
ID BAND MARKED:
CHART MARKED:
SIGNS/SYMPTOMS: WHEEZING (Jan 01, 2007)
COUGHING (Jan 01, 2007)
Change status of this allergy/adverse reaction to verified? Yes
Browse Document
Dec 12, 2010@15:26:52
Page: 1 of 1
Adverse React/Allergy
JONES,J
002-03-0004
Visit Date: 12/12/2010 15:26
DATE OF NOTE: DEC 12, 2010@15:26:52 ENTRY DATE: DEC 12,
2010@15:26:52
AUTHOR: ANTHRACITE,NANCY EXP COSIGNER:
URGENCY:
STATUS: UNSIGNED
This patient has had an allergy to AMOXICILLIN
verified on Dec 12, 2010@15:26:52.
Page 11 of 14
+ Next Screen - Prev Screen ?? More actions
Find
Sign/Cosign
Link ...
Print
Copy
Encounter Edit
Edit
Identify Signers
Interdiscipl'ry Note
Make Addendum
Delete
Quit
Select Action: Quit//+
Select Action: Quit// sign Sign/Cosign
Enter your Current Signature Code: [Nothing Displayed]
Enter another Causative Agent? YES// No
EDIT AN ALLERGY USING THE MENU OPTION GMRA Patient A/AR Edit:
Select PATIENT NAME: JONES,JODY
REACTANT
VER. MECH. HIST TYPE
----------- ------- ---- ---AMOXICILLIN
YES UNKNOWN OBS DRUG
Reactions: WHEEZING, COUGHING
Enter Causative Agent: AMOXICILLIN
Checking existing PATIENT ALLERGIES (#120.8) file for matches...
,JODY JONES,JODY
1-1-45 002030004 NO NON-VETERAN
(OTHER)
AMOXICILLIN
AMOXICILLIN OK? Yes//
PATIENT: JONES,JODY
AMOXICILLIN
INGREDIENTS: AMOXICILLIN
PENICILLINS,AMINO DER
CAUSATIVE AGENT:
VA DRUG CLASSES:
ORIGINATOR: ANTHRACITE,NANCY
ORIGINATED: Dec 12,
2010@15:10
SIGN OFF: YES
OBS/HIST: OBSERVED
SEVERITY: MODERATE
OBS D/T: Jan 01, 2007
ORIGINATOR
COMMENTS:
Page 12 of 14
Date: Dec 12, 2010@15:17:18
User: ANTHRACITE,NANCY
Title:
Patient presented to the emergency room 5 days after having
been given Amoxicillin for an abscessed tooth. She was
treated with albuterol and recovered and the Amoxicillin
was stopped. She has a history of asthma so it is not
clear if the amoxicillin caused the wheezing and cough.
ID BAND MARKED:
2010@15:29:38
CHART MARKED: Dec 12,
SIGNS/SYMPTOMS: WHEEZING (Jan 01, 2007)
COUGHING (Jan 01, 2007)
Enter RETURN to continue or '^' to exit:
MECHANISM: UNKNOWN
VERIFIER: ANTHRACITE,NANCY
VERIFIED: DEC 12,
2010@15:26:52
Is the reaction information correct? Yes// NO
Mark this reaction as 'Entered-in-Error'? NO
Is the reaction information correct? Yes// (Yes)
DO YOU WISH TO EDIT OBSERVED DATA? NO// Yes
Mark this reaction as 'Entered-in-Error'? no NO
Is the reaction information correct? Yes// (Yes)
DO YOU WISH TO EDIT OBSERVED DATA? NO// Yes YES
Select date reaction was OBSERVED (Time Optional): 1/1/2007 (JAN 01,
2007)
...OK? Yes// (Yes)
DATE/TIME OF EVENT: JAN 1,2007//
OBSERVER: ANTHRACITE,NANCY//
SEVERITY: MODERATE// MILD
DATE MD NOTIFIED: JAN 1,2007//
Complete the FDA data? Yes// No (No)
DO YOU WISH TO EDIT VERIFIED DATA? NO// YES
CAUSATIVE AGENT: AMOXICILLIN
TYPE: DRUG
INGREDIENTS: AMOXICILLIN
VA DRUG CLASSES: AM111 - PENICILLINS,AMINO DERIVATIVES
OBS/HIST: OBSERVED
SIGNS/SYMPTOMS: WHEEZING (Jan 01, 2007)
Page 13 of 14
COUGHING (Jan 01, 2007)
MECHANISM: UNKNOWN
Would you like to edit any of this data? NO
Enter another Causative Agent? YES// NO
Select Patient:
Page 14 of 14