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RPMS Adverse Reaction Tracking (GMRA)

RPMS Adverse Reaction Tracking (GMRA). June 2011. Course Objectives. At 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

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RPMS Adverse Reaction Tracking (GMRA)

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  1. RPMS Adverse Reaction Tracking (GMRA) June 2011

  2. Course Objectives At 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

  3. Adverse Reaction Tracking at Work RPMS EHR CHOOSE 1-2: 1 PENICILLIN VK 250MG TAB AM110 -112926 000 93-5194-10 TEST PHARMACY Now 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//

  4. 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

  5. Adverse Reaction Tracking Package Setup • The key to successful Adverse Reaction screening in EHR • Impacts all disciplines • Providers • Nurses • Pharmacy • etc.

  6. 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

  7. 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

  8. Security Keys GMRA-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 EHR GMRA-PT Allows access to the RPMS ART “P&T” menu

  9. Security Keys GMRA-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

  10. Mailman Groups A 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

  11. 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 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

  12. 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.

  13. Sample Mailman Message Subj: ALLERGY/ADVERSE REACTION TO BE VERIFIED [#275013] 02/09/10@16:26 10 lines From: NIESEN,MARY ANN In 'ALLERGIES' basket. Page 1 Priority! ------------------------------------------------------------------ The following allergy/adverse reaction needs to be verified for the following patient: Patient: DEMO, PATIENT LIZA SSN: 00-29-45 Reaction: INFLUENZA VIRUS (SPLIT) VACCINE OBS/HIS: Historical Location: OUT PATIENT Signs/Symptoms Date Observed ------------------------------------------------------------ ANAPHYLAXIS Feb 09, 2010@16:21:08 Enter message action (in ALLERGIES basket): Ignore//

  14. 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//

  15. Sample Mailman Message Subj: 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 the appropriate action. Be sure to try alternate spellings, etc before requesting new reactants. If this reactant does require review for addition, please submit through the IHS RPMS Feedback page at http://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//

  16. 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

  17. ART MenuOptions This is the main menu that has all options of the Adverse Reaction (ART) package Adverse Reaction Tracking (ART) Enter/Edit Site Configurable Files ... Adverse Reaction Tracking User Menu ... Adverse Reaction Tracking Clinician Menu ... Adverse Reaction Tracking Verifier Menu ... P&T Committee Menu ...

  18. Enter/Edit Site Configurable Files Edit Allergy File Enter/Edit Signs/Symptoms Data Enter/Edit Site Parameters Sign/Symptoms List Allergies File List Allergy clean up utility

  19. 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 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

  20. 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!

  21. 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

  22. 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)

  23. 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)

  24. Sign/Symptom List Prints a list of entries in the Sign/Symptoms file Select Enter/Edit Site Configurable Files Option: Sign/Symptoms List START 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

  25. Allergies File List Prints a captioned list of all entries in the GMR Allergies file START 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: OTHER NATIONAL ALLERGY: NATIONAL ALLERGY NAME: ALCOHOL ALLERGY TYPE: DRUG, FOOD NATIONAL ALLERGY: NATIONAL ALLERGY DRUG INGREDIENT: ALCOHOL NAME: ANIMAL HAIR ALLERGY TYPE: OTHER NATIONAL ALLERGY: NATIONAL ALLERGY

  26. 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 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

  27. 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 Menu 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 Online Reference Card ART User Menu

  28. 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

  29. 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)

  30. 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

  31. 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.

  32. EHR Allergy Dialog Box Enter 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.

  33. “Roll & Scroll” Allergy Entry Enter 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

  34. “Roll & Scroll” 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

  35. “Roll & Scroll” 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)

  36. 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

  37. 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

  38. 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

  39. Patient Allergies Not Signed Off • Adverse Reaction Tracking Verifier Menu Reports MenuPatient 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

  40. 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

  41. 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

  42. Verification • Access option through multiple paths: • Rx processing • ART verifier menu • EHR via Notifications

  43. 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

  44. 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: HISTORICAL ID BAND MARKED: CHART MARKED: SIGNS/SYMPTOMS: TACHYCARDIA (May 19, 2010@13:39:13) MECHANISM: ALLERGY Is the reaction information correct? Yes// <enter> (Yes)

  45. Verification VIA RX Processing Currently you have verifier access. Would you like to verify this Causative Agent now? Yes// <enter> (Yes) 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 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)

  46. Verification Using ART Menu Select Adverse Reaction Tracking Verifier Menu Option: Verify Patient Reaction Data Would you like to verify a single patient's data? NO// YES Select PATIENT NAME: DEMO,PATIENT ALLEN <A> M 05-16-1983 XXX-XX-3440 CI 142507 D Drug N Non-drug B Both Select type of AGENT to verify:(D/N/B): BOTH OBS/ PATIENT ALLERGY HIST ADR TYPE ------- ------- ---- --- ---- 1. DEMO,PATIENT ALLEN (142507) MOTRIN HIST YES DRUG Select 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: PHARMACOLOGIC Is the reaction information correct? Yes// <enter> (Yes)

  47. Verification Using ART Menu CAUSATIVE AGENT: MOTRIN TYPE: DRUG INGREDIENTS: IBUPROFEN VA 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: PHARMACOLOGIC Change status of this allergy/adverse reaction to verified? Y (Yes)

  48. 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

  49. 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.

  50. 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)

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