History of drug allergy
Users who have added or issued medication on EMIS will have almost certainly come across warnings about the patient's allergy to a particular medication. This is a built-in safety feature of EMIS Web designed to stop users accidentally issuing medication to which the patient has previously experienced an adverse reaction. Options are presented to override or to cancel.
How often have you seen one of these safety popups and overridden it because the warning appeared unrelated to the medication being prescribed?
Often the answer can be traced back to a couple of codes which may have been used in the past - sometimes many years ago - as a generic catch-all code with the actual allergy written in the associated text. Perhaps at the time some of the medications did not have their own allergy codes.
In the above example, we are trying to add a course of amoxicillin, but EMIS has generated a warning about an allergy to chloramphenicol (drops or ointment for the eye or middle ear).
When a generic allergy code is on the record, EMIS only displays a warning when issuing certain types of drug such as antibiotics, not every drug.
Using the same patient as the above example, what if we try to issue chloramphenicol? There is no warning apparent on screen and we can proceed straight to issue.
The warning is still there, but hidden in the Allergies tab where it still doesn't show what drug the patient has an allergy to!
This becomes a clinical safety issue as it could apply to any drug group.
History of allergy to drug [735933002] and
Allergy to drug [416098002] are two codes which should be avoided as much as possible. There are various synonyms such as
H/O: drug allergy and
Drug allergy which share the same SNOMED concept ID. Historically a user may have selected one of these codes and typed the medication and reaction into the descriptive text.
H/O: drug allergy Amoxicillin 250mg - rash
Why does EMIS Web display these extra popups? The answer is that EMIS is unable to recognise the descriptive text, so as a fall-back measure will display the safety popup to allow a human to make the decision.
- What can we do about it?
Build a search - if you have a search for these two codes, a list can be generated to review the record and improve it. By replacing the H/O: drug allergy code with something more specific like Adverse reaction to amoxicillin, the user experience will be more accurate for other prescribers in the future.
The PCIT data quality search and report DQ-006 has been built to help Practices in this regard. The report shows instances of the generic code alongside all instances of specific codes to aid in rapid identification of codes. - Make a protocol - Primary Care IT has considered this in the past, but a protocol carries additional clinical risk as it might popup for staff who do not have the necessary clinical knowledge to safely make a replacement. Fortunately now the generic codes cannot easily be added in consultations, the trigger for add a code is no longer as useful as before.
The initial exercise working through DQ-006 may seem like a lot of work, but the job is not quite over. Newly-registered patients may bring codes in via GP2GP but often these come as Degraded entries. Read more about GP2GP degrades
here.
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