Resource and Patient Management Systems (RPMS)

Adverse Reaction Tracking (GMRA)

Clean Up Utility2011

Course Objectives

At the end of this session, participants

should be able to:

•Discuss the importance of performing the Allergy Clean Up

•Use the Allergy Clean Up utility

•Understand the risks and benefits of “batch” updating reactions

Why Perform Clean-up?

• Previously, users could enter reactions using a variety of files, or by using a “free text” entry not linked to any specific file.

• These entries may or may not have the correct information to order check.

• These entries do not have the needed information for data exchange and interoperability.

Clean Up Utility

• 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 may be problematic and allows the user to take action on them.

Three Clean Up Options• Free Text

– These entries are not tied to any particular file.– Sites MUST clean these up as soon as possible.

• Ingredient– These entries are tied to the DRUG INGREDIENT

file (#50.416).– These will need clean up at some point, but are

not as urgent.

• Drug Class– These files are tied to the VA DRUG CLASS file

(#50.605).– These also require clean up but are not as urgent.

Free Text Clean Up

• When the user selects a free-text reactant, a list of currently existing free-text entries is displayed in alphabetical order.

• This list may take a few minutes to generate, as all existing entries need to be evaluated to determine which are “free text.”

• The list shows the name of the reactant, and the number of entries for that reactant.

Free Text Clean Up

• When entering the utility, any users who are currently working in the utility are listed.

• If users are listed as working with the utility, the next user will not be allowed to update the list:– In other words, only one user can be updating

the list at any given time.

1 Edit Allergy File

2 Enter/Edit Signs/Symptoms Data

3 Enter/Edit Site Parameters

4 Sign/Symptoms List

5 Allergies File List

6 Allergy clean up utility 

Select Enter/Edit Site Configurable Files Option: 6 Allergy clean up utility

 

Select one of the following: 

1 Free Text

2 Ingredient

3 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 26, 2011 10:33:16 Page: 1 of 18Allergy Tracking Free Text Entries Reactant # Active Entries1 AC I/ARB 12 ACEI 33 ACTIFED 14 ADVERSE DRUG REACTION H202 15 AKE: ACI 16 ALBUTEROL 227 ALENDRONATE 78 ALL ANTIBIOTIC UNKNOWN 19 ALL DYES 110 ALL EYE DROPS 111 ALL NSAIDS 112 ALL TAPES 113 ALLERGIC TO DYE 114 AMITRIPTYLINE 2415 AMLODIPINE 3016 AMOXICILLIN 70017 AMPICILLIN 110+ Select one or more entriesAE Add/Edit Allergy File EE Mark entered in errorDD Detailed Display UR Update to new reactantSelect Item(s): Next Screen//

NOTE: If the list was built previously, the following alternative text is displayed:

Select the list you wish to work with: 1 Free Text

The free text list was last built on Apr 26, 2011

Do you want to rebuild the list? NO// YES

Free Text Clean Up

Once in the list, the user may select one of the following options:•DD: Detailed Display•EE: Mark entered in error•UR: Update to new reactant

Detailed Display• This displays all of the entries for that

particular reaction.

• It includes all the reactions tied to each patient with that reactant:– Can only ACT on the reaction you are

currently working on (look in the top right corner to see which reaction you are on)

– Shows as a string of text separated with the tilde (~)

• Choose additional actions from this screen.

Detailed Display

Detailed DisplayCan choose several options from here:•DD Allergy Detailed Display

– Shows a Fileman style listing of the reaction details for the selected patient

•UR Update to new reactant– Updates the selected patient’s reaction only

•EE Entered in Error– Marks the reaction as “entered-in-error” for the

selected patient only

•PR Add/Edit Patient Reaction– Allows the user to add additional reactions for the

selected patient

Detailed DisplayPATIENT: DEMO,PATIENT MAE REACTANT: ALBUTEROL

GMR ALLERGY: OTHER ALLERGY/ADVERSE REACTION

ORIGINATION DATE/TIME: JUL 12, 2004@17:24

ORIGINATOR: WOFFORD-FARRIS,JAMES CLIFTON III

OBSERVED/HISTORICAL: HISTORICAL ORIGINATOR SIGN OFF: YES

MECHANISM: UNKNOWN VERIFIED: YES

VERIFICATION DATE/TIME: JUL 12, 2004@17:25:41

VERIFIER: WOFFORD-FARRIS,JAMES CLIFTON III

ALLERGY TYPE: DRUG

DRUG INGREDIENT: ALBUTEROL

VA DRUG CLASS: ANTIASTHMA/BRONCHODILATORS

DATE/TIME: JUL 12, 2004@17:27:02

USER ENTERING: WOFFORD-FARRIS,JAMES CLIFTON III

Update to New ReactantSelect Item(s): Next Screen// UR

Select Entries from list: 1

You are about to update the selected patient's

ALBUTEROL allergy to a new reactant.

ARE YOU SURE? NO// YES

For patient DEMO,PATIENT MAE

Enter Causative Agent: ALBUTEROL

Checking GMR ALLERGIES (#120.82) file for matches...

Now checking the National Drug File - Generic Names (#50.6)

1 ALBUTEROL

2 ALBUTEROL/IPRATROPIUM

CHOOSE 1-2: 1 ALBUTEROL

You selected ALBUTEROL

Is this correct? Y//YES

Entered in Error

Select Item(s): Quit// EE

Select Entries from list: 1

You are about to mark the selected patient's

ACEI allergy as entered in error.

 

ARE YOU SURE? NO// Y (YES)

Add/Edit Patient Reaction

• This option can be used to add additional reactions for the patient.

• This option should be used to add NEW reactions only.

• If existing entries are marked as entered in error from within this option it will not update the utility's display until the list is rebuilt upon re-entry of this option:– This could cause confusion as the list will no

longer be accurate.

Batch Updating

• Entries can be “batch” updated from the main screen.

• This should be used with caution, especially for entries that have several patient entries tied to it.

• However, once the details have been reviewed for each patient, this can make the clean up go faster.

Allergy Tracking Update Apr 26, 2011 10:41:45 Page: 1 of 18

Allergy Tracking Free Text Entries

Reactant # Active Entries

1 AC I/ARB 1

2 ACEI 2

3 ACTIFED 1

4 ADVERSE DRUG REACTION H202 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// EE

Select Entries from list: 2

You are about to mark ALL allergies with the selected reactant

as entered in error.

ARE YOU SURE? NO//YES

Allergy Tracking Update Apr 26, 2011 12:41:42 Page: 1 of 18Allergy Tracking Free Text Entries Reactant # Active Entries1 AC I/ARB 12 ACTIFED 13 ADVERSE DRUG REACTION H202 14 AKE: ACI 15 ALBUTEROL 216 ALENDRONATE 77 ALL ANTIBIOTIC UNKNOWN 1<...>17 ANESTHESIA MEDS 1+ Select one or more entriesAE Add/Edit Allergy File EE Mark entered in errorDD Detailed Display UR Update to new reactantSelect Item(s): Next Screen// URSelect Entries from list: 5

You should use the detailed display option to review entries inthis group before doing a mass update. CHANGES CANNOT BE UN-DONE!Press enter to continue:

You are about to update ALL allergies with the selected reactantto a new reactant.ARE YOU SURE? NO// YESUpdating ALBUTEROL reactionsFor patient DEMO,PATIENT LEEEnter Causative Agent: ALBUTEROLChecking GMR ALLERGIES (#120.82) file for matches...

Now checking the National Drug File - Generic Names (#50.6) 1 ALBUTEROL 2 ALBUTEROL/IPRATROPIUMCHOOSE 1-2: 1 ALBUTEROLYou selected ALBUTEROLIs this correct? Y// ESPerforming order checking...patient has no active orders.For patient DEMO,PATIENT KEITHUse reactant ALBUTEROL? Y// ESPerforming order checking...patient has no active orders.

Ingredient and Drug Class• These options work the same as the free

text utility.

• As with Free Text, use the “batch” options with extreme care.

• Though these are not critical to clean NOW, these will eventually need to be cleaned:– It is wise to start on this project as soon as the

free text are cleaned up, to avoid a time crunch later

Questions?