Adverse Event - Display
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[edit] Description
This section describe the displays required for a Adverse Event in both a portal and detailed view.
The Allergy List
It is important for clinicians to have an “allergy list” for each patient. The “allergy list” is a prominent feature of most electronic health record systems, and an “allergy list” is a critical part of the CCR, and the CCD and is a JCAHO requirement for medical records in general. Despite the agreement about the importance of having easy access to “allergies”, there is considerable dispute about what should be done to facilitate this functionality in electronic health/medical record systems. There are at least two reasons why the controversy continues.
- Clinicians “lump” allergies and non allergenic adverse events together
- EHR/EMR systems each tend to have only one way of eliciting the information required to populate the list (and each differs from the rest)
We need to take a different approach altogether, and we should start by saying that the “allergy list” is a confusing misnomer. It is really a list of things to which we know that this particular patient should not be exposed in the future because he/she has already had documentation of an untoward event from exposure to these things in the past. Naturally, we are excluding things that would cause adverse events in all patients (such as toxic levels of carbon monoxide)
We should now recall the various ways in which information regarding allergic reactions and other adverse reactions is collected.
We ask the patient a number of questions (either in an interview or on a questionnaire)
- “Do you have any allergies?”
- “Are you allergic to any drugs?”
- “Do you have any food allergies?”
- “Are you allergic to insect venom?”
- “Do you get allergic reactions to pollen?”
- “Are you allergic to any animals?”
- “Have you ever had any bad reactions to any medications?”
- And so on
We also report adverse reactions and/or allergic reactions when they occur right under our noses. Such observations may be entered in the medical record; they may also be forwarded to agencies such as the FDA; and they may be forwarded to agencies administering clinical trials. Ironically, the agent causing the reaction being reported may not be listed on the “allergy list” for a prolonged period of time because we have tended to view the allergy list as a document that gets composed during a medical history documentation session rather than a list that gets populated by a variety of observation events.
At the heart of a rational approach to the “allergy list” is the realization that it must be updated every time an authorized user documents an observation of either an allergic reaction or of a non-allergenic adverse event. The EHR/EMR product must always guide the user to document both the reaction (either observed now or articulated from the past) and the agent that caused the reaction. The bottom line is that we must create an easily accessible listing of all of those things which are known to have caused harm to this patient in the past (but may not cause harm to the majority of patients). For the sake of convenience, an EMR/EHR system can either present all agents causing adverse reactions (including allergic reactions) in one list, or the system can present two lists – one for agents causing true allergic reactions and one for agents causing other types of adverse reactions. In wikihit, we have a number of articles that are germane to this discussion.
This article covers both allergic and non-allergic adverse events, and addresses the idea of a composite display of agents causing both allergic and non-allergic adverse events. Missing in the display is the dichotomy between allergic and non-allergic events. I would also suggest that the display include the type of reaction as well as the severity. We will want to populate this display from a variety of Q&A sources. Such application components can be expected to occur at many places in the EHR/EMR.
Allergy provides a nice introduction (in Synopsis) to the topic allergic reactions as a manifestation of triggering the immune system. However, the articulation of the attributes might appear to include non allergenic adverse events.
Adverse Event covers both allergic and non-allergic adverse events
Adverse Reaction covers both allergic and non-allergic adverse events
OBS Adverse Reaction is quite general and we will have to see whether it serves the purpose of being a general stepping off point for instantiation of non allergic adverse events. The link to X adverse reaction will only be helpful if it allows the system to populate a questionnaire with prompts for accurate documentation that are neither obtrusive nor overly complicated.
Allergy to substance is an excellent guide for constructing lists to be presented within questionnaires C clinical finding provides some context for the documentation of an adverse event, but in its present state, it needs massaging to produce application implementation guidance
[[OBS intolerance] is a little odd because it does not seem to permit non allergy food intolerance (such as lactose intolerance). I have no explanation for that deficit. However, its overview includes a very useful statement “Provides a general archetype for indicating a particular adverse interaction with a foreign substance”, which is what we are driving toward.
OBS Food Non-allergy Intolerance actually addresses the concern articulated above.
C drug allergy provides guidance for constrained lists within questionnaires. While our initial approach to eliciting information from patients and clinicians may be to provided the ability to quickly search a very large medication database, in the future, we will want to be able to map any medication chosen back to one (or more – the listing has some confusing redundancies) category listed in this article.
OBS Drug Non-allergy Intolerance covers an area that is often disputed and includes such common events as nausea following oral erythromycin administration.
C anaphylaxis due to substance is an example of how the seriousness of a type of reaction (anaphylaxis) has spawned a plethora of highly specific codes. Lost in the drama is the fact that any anaphylactoid reaction is an allergic reaction, albeit a very serious one.
[edit] Portal Name
| Adverse Events |
[edit] Default Portal Column Headings
| Agent | Reaction Severity | Status | Date/time recorded |
[edit] Default Detailed Column Headings
| Date Time Recorded | Date of Onset | Reaction Severity | Status | Probable Causation | Duration of Exposure |
