I am guessing you are using the PHA allergies and ado not yet have the MIS
allergies in use (we don't have 5.6 yet so I don't have that either).
The way I have "taught" the pharmacists to enter allergies is to choose the
generic and then "check off" appropriate classes and ingredients.
If they enter Morphine as a generic, they should get morphine as an ingredient
and it would be checked off and that would have issued a flag.
However, their choice for Class would be opiates. If the patient is allergic to
morphine (truly allergic) they would probably be able to tolerate
Demerol, fentanyl or dilaudid under most circumstances. Yet if you check off
the class Opiates, you will get a flag. This is why allergies are so hard to
enter,
because you need to be a pharmacist with a good knowledge of pharmaceutical
chemistry to enter them. I have tried to make sure that the actual drug itself
is also listed as an ingredient in each drug. Medispan tends to put ingredients
such as "benzodiazepines" (a chemical group of drugs) into drugs such as
Valium and alprazolam, but you have to actual enter the ingredients alprazolam
and diazepam yourself. I did this when we got RXM and nursing was entering
allergies, however, this did not work well because if a patient said they were
allergic to ampicillin and the nurse only entered the ingredient ampicillin
they wouldn't get flagged against other penicillins. They wouldn't know which
generic to enter because there are so many listed. Then what I had to do was
to start going through the generics and putting asterisks by the generics that
they should use for allergies (I chose the generics mnemonics that had
generics most commonly associated with drugs in our database). That way nursing
and pharmacy had an easier time choosing the right generic. I also had to
write a list of particular allergies that I considered it important for them to
always put in the "CLASS" regardless of what else they entered. Those were
classes like penicillins and the sulfa antibiotics. In addition, I had to give
them lists of foods that might be incorporated into drugs and class allergic
reactions so that they would know whether or not to enter the food as a Pha
ingredient allergy. As far as pharmacists, it was even difficult to explain
when to enter the "pharmaceutical group" that Medispan had entered as an
ingredient (i.e. phenothiazines or benzodiazepines) rather than the drug
itself or
the class.
Over all I have found this to be the main problem. Drug
allergies are not necessarily determined by AHFS DRUG CLASS. They are determined
by the chemical and physical composition of the drug and crosse reactions occur
with drugs similar in chemical components.
They are chemically related. If a person is allergic to chlorpromazine, he may
be allergic to other phenothiazines, but he is not allergic to
the class of ANTIHISTAMINES (he is not allergic to Benadryl - but he may be
allergic to promethazine). He is also not allergic to the AHFS CLASS of
Neuroleptics because he is only allergic the phenothiazine-moiety containing
chlorpromazine.
This makes it hard enough for pharmacists to enter allergies,
and much harder for nursing. From what I can tell,
The MIS allergy dictionary will be hard to build if it is built right, but in
the end it will probably make entering allergies a little less confusing.
Good luck. Cindy
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Subject
[MEDITECH-L] Allergy Alert
Hello Lr's,
We have a scenario where one of the patient allergies is Morphine HCL.
During order entry, the pharmacist enters an order of Morphine sulfate
but she did not get flagged at all. The allergy was entered as a
Generic. I checked the drug dictionary for MSO4, obviously the
Ingredient is Morphine and on the Ingredient Allergy field, one of them
is Morphine (F05). I called MEDITECH and asked them how come we did not
get the alert. This was their response:
Pellerin,Tracie (MEDITECH) - Mar 22, 2007 - 2004 EDT: The generic
associated as an allergy is not the one associated to the drug MORP0050
that was ordered. If you would like to capture all allergies associated
with Morphine, the allergy should be entered as a class allergy rather
than a generic.
Our Director of Pharmacy does not fully agree with MEDITECH. She
believes that the user should still have gotten the flag as Morphine
(regardless of how the allergy was entered, generic vs class) is clearly
the main Ingredient and is also defined in the Ingred Allergy. If
Pharmacy goes by Class Allergy, it's good in a way that it checks
everything but at the same time they would get unnecessary alerts which
can de-sensitize the user of these flags. Most of our pharmacists select
the generic allergy.
I have emailed MEDITECH again about how our pharmacy feels but hasn't
gotten any response yet. Has this happened to you? How did you resolve
the situation? How do you enter the allergy, generic or class?
We are Magic 5.4 and we have First Data Bank.
Cristina C. Kimball, BSN, RN
Manager, Clinical Informatics
Pacific Alliance Medical Center
531 W. College St.
Los Angeles, Ca 90012
Ph: (213) 437-4214
Fax: (213) 617-9203
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