CERNER MILLENNIUM Allergies & Intolerances

Transcription

1 CERNER MILLENNIUM Allergies & Intolerances This demonstration gives you some tips about entering medicine, food, & environmental allergies & intolerances. This has been prepared for Millennium code level & mpage 6.0. Subsequent updates may display cosmetic & functional changes. Use the keyboard or mouse to advance.

2 Allergies can be viewed & entered in at least 3 places in Cerner. You see them listed on the Banner Bar, & you can also address them from the Table of Contents or workflow tabs (mpages).

3 It is important to enter allergies early in the data-recording process, so that interaction checking can take place as medications & other medical history are recorded. You ll be alerted if allergies have not been documented when you first open the chart, or when you place a medication order. Allergy lists will also display the fact that allergies haven t been recorded.

4 To see the allergy list in full detail, & begin the allergy entry process, click any of the 3 allergy headings: Also note that clicking the + or Add links will take you directly to allergy entry.

5 If the patient has no allergies, click No Known Allergies or No Known Medication Allergies, whichever is most complete & correct. No Known Allergies will display on all the allergy lists, & allergy-entry alerts will cease, since it knows you ve addressed this.

6 To add a new entry, click Add.

7 Type at least part of the substance you wish to enter, then click the Search Binoculars.

8 A list of results appears. Double-click the one you want. Note this is one of the spots where you can choose among Starts with, Contains, or Exact match.

9 There is one required field, a couple that are very important though they re not required, & some that are optional. First click the Category dropdown to address the required field. Select Drug.

10 Next enter Reaction(s). Type at least part of the reaction & click the Search Binoculars. (While there is the opportunity to add the reaction as Free Text, only do this for a truly unusual reaction that cannot be found via search.) Note: There is a bit of a gotcha here. In many places you could hit Enter & it would be the same as clicking the Search Binoculars. That is not the case here. Hitting Enter is the same as clicking Add Free Text, which you usually don t want to do. So avoid that trap.

11 Double-click your desired match.

12 Your chosen reaction appears. Note that you can add more than one reaction.

13 Also note that when your cursor is in the Reaction field, a Common Allergy Reactions folder displays at the bottom. When you click Common Allergy Reactions, you ll see a list you can scroll through, so if the one you want is there you can avoid the search step.

14 Next enter Severity. In this example, obviously, anaphylaxis is severe.

15 Next enter Type. In this example we re entering a true allergy, so we don t need to make a change, but we ll look at this further in another example shortly.

16 You have options to enter info source, date/age of onset, & comments. Though you may often skip them, enter these when known & pertinent.

17 The Add Comment function in particular may be helpful, especially to enter comments when the exact details are unclear, or don t fit neatly into the available boxes. An uncertain allergy dating back to childhood, as illustrated here, would be a common example.

18 When done, if that s your only entry, click OK. In this example we ll add another, so click OK & Add New.

19 The penicillin allergy is added to the list.

20 Using a similar approach, we ve entered a moderately severe environmental allergy to cats, causing itching eyes & runny nose. We ll click OK & Add New to add another entry.

21 This time we ve recorded that the patient has mild nausea when taking doxycycline. We ll change Type to Intolerance, since this is not a true allergic reaction, & thus doesn t carry the same significance. This is often an important clinical detail to note. (In many cases there is little difference between intolerance & side effect. )

22 Here s another example. The patient had a bleeding ulcer while on naproxen, & was told to avoid all NSAIDs. We added NSAIDs as the substance, stomach ulcer as the reaction, & a comment. We ll make the Type contraindication (though side effect might be another possibility). This is the last entry, so click OK.

23 The allergy list displays.

24 You can also modify allergies. Select penicillin & click Modify.

25 You can modify some details & add new ones. You can t remove an existing comment, but you can add a new one to add further details or corrections.

26 You can also resolve or cancel an allergy entry. To do this, click the Status dropdown list. You might Cancel an entry if it was entered in error on the patient. You might Resolve an entry if further clinical history changes the information for example, if a patient has later taken a drug without a reaction.

27 When you change status, Reason becomes a required field. Pick the best reason listed; if you need to clarify further, add a comment. When done, click OK.

28 When you ve changed the status of an allergy, inactive allergies will display with a line through them, & they will no longer be included on the Banner Bar. Workflow tabs (mpages) also only show active allergies.

29 You can also change the allergy list Display from All to Active, to only display active allergies.

30 You can save frequently-used allergens as favorites. Do your search, select the desired entry, then click Add to Favorites.

31 Click Create Folder & give it a name. (Here you can t add favorites directly under the root folder.)

32 With your new folder selected, click OK.

33 You may wish to create a few folders to better-organize your favorites.

34 Now as you start your search, you can click the Favorites button & see your folders displayed. Click one to open it.

35 You see your favorites. Double-click one to select, then proceed as before edit details as necessary & save it.

36 A special case to think about is how to enter combination products. You d like to enter the specific ingredient the patient is allergic to when you can, but sometimes you won t know that with certainty. Let s look at a couple of common examples: Norco (hydrocodone-acetaminophen) & Bactrim (trimethoprim-sulfa)

37 Search for the generic ingredients when you can. But if you don t know the ingredients you can search for the brand name.

38 With hydrocodone-acetaminophen, we know it is vastly more likely the patient is intolerant of hydrocodone than acetaminophen. So ask the patient: Can you take acetaminophen regular old Tylenol? If s/he says yes, select hydrocodone for the allergy. Aside from being the most accurate entry, it will prevent seeing an alert any time you prescribe any acetaminophen-containing med in the future.

39 If the answer is no, the first thing you should do is enter acetaminophen as an allergy. And unless further questioning reveals that the patient has successfully taken a hydrocodone product that doesn t include acetaminophen, you ll probably need to enter hydrocodone as well.

40 Now think about trimethoprim-sulfa. It s likely that sulfa is the offending ingredient, but you may well not have a way to confirm that. Trimethoprim alone is an uncommonly used med, & the patient may not have ever taken sulfa that doesn t include trimethoprim. So in this case, you should add the combination product. Technically, you could add both trimethoprim & sulfa separately, but that implies more knowledge than you actually have at hand you don t know that each, alone, caused a problem.

41 Finally, remember to at least briefly review/confirm allergies at each visit. This is particularly important the first time you see a patient using the Cerner EHR. Data is being imported from old records sometimes from multiple sources. So it s possible we ll see some inaccurate, duplicate, or contradictory information. Take this opportunity to clean up allergy data to ensure that it is accurate & complete.