Allergies and Intolerances

Viewing an Allergy or Intolerance

Allergies/Intolerances show in red at the top summary portion of the patient’s information in most chart tabs.

They also show in the Allergies portlet of the Patient Summary chart tab.

They also show in the medication history screen of the E-Meds module and in Allergy sections of encounters.

From any of these screens/modules or encounters, you can enter allergies and/or intolerances.
We would suggest entering any medication/drug and/or environmental allergies in the Allergies section.
Reason is when a user/physician/clinician navigates to the patient’s chart; they see a complete allergy history anywhere in the system by going/viewing the specific Allergies section.  At a glance, clinicians see the patient’s allergy summary and have access to more detailed information.
If you want to also enter in environmental allergies into PMH section as a condition, by all means you can, but we still suggest entering them in allergies section due to the at-a-glance history a clinician would look at for allergies also.  Also when entering them in the PMH section as a condition, it’s then an active condition that will then always populate the “assessment” section /diagnosis section, which may be cumbersome to always “N/A” those etc or shows as a presenting active condition instead of just as an allergy.
FDB (First Data Bank) doesn’t really have environmental factors in the allergies auto-completes, so we can see why a user may want to use conditions for this since they show up there in an auto-complete as “conditions”.  But the problem is that condition lists are not always displayed in all the places where users/clinicians would be checking for allergies.  So if there is some allergy listed in PMH that is actually clinically important, it may not be seen when it should. Specifically (for example: Latex), it’s recommended that allergies entered in the allergies section as we have built-ins to handle alerts for that and coding based on any allergy being entered in the specific allergies section when gets pushed onto a CCD and other places for sharing data, etc.

Adding an Allergy and/or Intolerance

When you are working in a patient’s E-Chart, you can simply click the underlined hyperlink word Allergies from the patient’s summary at the top of the tab you are working in. It will automatically take you then to the E-Meds module where you then can document that the patient has NKDA or enter allergies/intolerances.

OR you can click the patient’s chart tab at the top most likely named E-Meds or Medications/Allergies and it will take you to the patient’s medications history also where you can document NKDA or enter allergies/intolerances for the patient.

Documenting NKDA

If a patient has never had anyone enter allergies or documented that the patient has NKDA, their Allergies summary will say None Entered.

You can document that the patient has NKDA. It will then show their Allergy summary here as NKDA.
Using one of the steps above to get to the Medications History screen, you will see the message in the middle of the patient’s Meds screen that says Allergies have NOT been entered for this patient.

To enter and document that the patient has NO KNOWN DRUG ALLERGIES (NKDA) then simply click the button that says Document patient has No Known Drug Allergies (NKDA). Once you click that button it will document the patient’s chart and reflect to say This patient has no known drug allergies (NKDA).

The patient’s summary information will then show Allergies: as NKDA. This signifies to medical personnel that someone has verified this person does not have any known allergies instead of showing that the patient’s chart just hasn’t been entered for allergies. If you click the UNDO NKDA button, it makes the allergy summary go back to None Entered.

Documenting an Allergy and/or Intolerance

You can get to the Medication/Allergies history screen by going to the Allergies/Medications chart tab or click the manage info icon from the Allergies portlet in Patient Summary tab or enter in allergies in an encounter. In the Medication History screen, click Add Allergy/Intol or Quick Allergy links at the top right of the screen.

• Add Allergy/Intol allows you to add an allergy or intolerance one at a time.
• Quick Allergy allows you to add allergies and/or intolerances 10 at a time. Below shows the steps for both options.

Add Allergy/Intol Link

After you click Add Allergy /Intol link, you will see an Add Allergy/Intolerance fields on the left and Most Commonly Entered on the right side.

(You can check-mark the NKDA box to document the patient has NKDA here, or follow the steps on previous pages).
If patient has known allergies/intolerances, then at the left in Add Allergy / Intolerance fields enter:

• Name: Enter the name of what the patient is allergic to. It will auto-complete your text to show matches of recognized allergies from First DataBank and you can select one. If any allergy you enter relates to a medication the patient has on their active medications list it will popup a warning. These allergies documenting are medication related allergies. If you need to enter in common allergies such as environmental etc and want those to show in the auto-complete as choices (without always free-typing them in and get the “unrecognized” alert), please see next pages of this help in section named “Custom Allergies”.

• You can also free-text an allergy in. A popup to confirm you want to add an unknown allergy will show after you click to add an unrecognized allergy. Adding an unknown allergy will only store in the patient’s chart. It will not save it to the allergy database of recognized allergies. If your practice enters a common known allergy all the time that is not in the First Databank recognized medication allergies, MIE or a superuser at your practice can enter in a custom allergy through the Control Tab, Meds Tab and Custom Allergies editor. Then that custom allergy will show up in the auto-complete for users to select from then on. That will allow users to enter in common allergies such as environmental etc and want those to show in the auto-complete as choices (without always free-typing them in and get the “unrecognized” alert), please see next pages of this help in section named “Custom Allergies”.

• Reaction/Reason: Enter the reaction the patient has to this medication/allergy/intolerance/item, if known. Or the reason for documenting this allergy. This is optional.
• Type: Select the type it is. Either Allergy or Intolerance.
• Start and End Dates: This is optional. You can enter a date in here if there is a specific date known for the start or end of this allergy or intolerance. Click Add. It will then successfully input it into the patient’s medication history screen or ask you to confirm your input.

OR

Most Commonly Entered

At the right of the Add Allergy/Intol screen it has a box/view called Most Commonly Entered.
It gives a list of the most commonly entered names of Allergies/Intolerances for your practice that users have entered in for patients. This is simply another way to quickly find and enter a common allergy/intolerance. If you find an allergy you wish, then click either add intolerance link to add it as an intolerance or add allergy link to add it as an allergy. These links are found in the options column.

After you have chosen an allergy/intolerance from the most common list, it will give you a confirmation that it successfully added the allergy/intolerance and it will ask you to enter a reaction and enter into any other fields.

• Reaction: It may automatically populate this field or give you drop down choices with the most common type of reaction for the allergy/ intolerance you selected. You can select the auto-completed reaction if it is correct in the patient’s case, or you can clear it and free-text the reaction to this allergy/intolerance.
• Type: Automatically populates which type you choose from the previous option when you selected a Most Commonly Entered allergy/intolerance. However, you can change it here also.
• Start and End Dates: This is optional. You can enter a date in here if there is a specific date known for the start or end of this allergy or intolerance. Click Submit. It will then successfully input it into the patient’s medication history screen.

Quick Allergy

After you click Quick Allergy link, you will see Add Allergies / Intolerances fields in the center of the screen. Quick Allergy link allows you to document/add allergies & intolerances 10 at a time (in mass).

• Name: Enter the name of the allergy or intolerance. It will auto-complete your text and can highlight your choice or you can continue to free-text type. A popup warning, when adding an allergy, could appear if that allergy relates to a medication that the patient has on their active medications list.

• Reaction: Enter the reaction the patient has to this medication/allergy/intolerance/item, etc. This is optional.
• Type: Select the radio button for which type it is. Either Allergy or Intolerance. Click Add button. It will then automatically enter it into the patient’s allergies/intolerances summary. It does not ask you confirmation. It automatically enters whatever you typed via this quick add.
  Any allergy or intolerance with an asterisk (*) next to it means the allergy or intolerance was free-typed and not selected from the auto-complete that FDB presents or most common known allergies/intolerances in the database. This is considered an unrecognized medication allergy.

Editing/Deleting/Discontinuing Allergies/Intolerances

If you need to edit or delete an allergy or intolerance, you need to get into the specific allergy or intolerance by clicking on the Allergies link in the patient’s summary from any tab, edit/delete thru an encounter, the “manage info” icon in the Allergies portlet of Patient Summary tab, or go to the Allergies/Medications chart tab.

Once you select the Allergies link or the Allergies/Medications chart tab, you will be opened to the Medication History screen. The first category shown will be the Allergies and Intolerances for this patient.

Editing an Allergy/Intolerance

If you wish to edit an allergy or intolerance, simply click on the specific underlined allergy name in the left column that you wish to make an edit on.

Once you click the underlined allergy name of the one you wish to edit, it will open an edit screen for that specific item. You will also see revision history for that entered allergy below this edit section.

Edit the name of the allergy, reaction, the type, the start or end dates. Click Submit when done.
It will then automatically insert your edits into the allergy/intolerance summary and list.
Allergies & Intolerances store the ‘type’ of allergy/intolerance it is in the background. Example: Occupational, Medication, or Personal allergy/intolerance. The information is from First DataBank. System reports can be created for your database to be able to run reports by ‘type’ or show the ‘type’ of allergy.

Deleting an Allergy/Intolerance

If you wish to delete an allergy or intolerance for the patient, simply find the specific allergy name you wish to delete in the Medication History view and in the right Options column click the Delete link for that specific allergy/intolerance.

Once you click Delete on the one you wish to delete, it will open an edit screen for that specific item it will open the Delete Allergy/Intolerance screen and will require you to type in a reason for deleting this allergy/intolerance. It will try to auto-complete your reason and may give you options you can select from other entries you have done before when deleting allergies/intolerances. Once you have typed or selected a reason for deletion, click the Submit button.

It will give you a confirmation that you successfully deleted the allergy/intolerance and it will take it off of the Allergies/Intolerance summary list for that patient.

It does always keep record of any allergy/intolerance that you delete or discontinue for the patient. If you wish to view deleted or discontinued allergies/intolerances, you can do so by show/hide hyperlinks in the Medication/Allergy History summary in the Allergies/Intolerances category list. Once you discontinue or delete an allergy/intolerance, you cannot make it active again. You would have to re-enter the allergy/intolerance from the steps at the beginning.

Discontinue an Allergy/Intolerance

If you wish to discontinue an allergy or intolerance for the patient, simply find the specific allergy name you wish to discontinue in the Medication History view and in the right Options column click the Discontinue link for that specific allergy/intolerance.

Once you click Discontinue on the one you wish to discontinue, it will open an edit screen for that specific item it will open the Discontinue Allergy/Intolerance screen and will require you to type in an end date (discontinue date) and reason for discontinuing this allergy/intolerance.

It will give you a confirmation that you successfully discontinued the allergy/intolerance and it will take it off of the Allergies/Intolerance summary list for that patient.

It does always keep record of any allergy/intolerance that you delete or discontinue for the patient. If you wish to view discontinued allergies/intolerances, you can do so by show/hide hyperlinks in the Medication History summary in the Allergies/Intolerances category list. Once you discontinue or delete an allergy/intolerance, you cannot make it active again. You would have to re-enter the allergy/intolerance from the steps at the beginning.

Customized Allergies

If you have security permission for Meds Manage then you can access sidemenu Control, then tab Meds Manager.

Using the Meds Manager, a superuser can enter in common known allergies that are not in the First Databank recognized medication allergies and make those allergies (like food or environmental allergies) appear as selections in the allergy auto-complete when users go to document a patient’s allergies. MIE or a superuser at your practice can enter in a custom allergy through the Control Tab, Meds Manager tab and select the Meds Editor of Custom Allergies from the drop-down of choices.

You will see a list of custom allergies that have already been added to your system (if any). You can edit or delete them from the Custom Allergies editor.
If you need to enter in a custom allergy to show in the auto-complete of choices when documenting allergies for patients that aren’t recognized medication allergy choices from FirstDataBanks, then type in the name of the allergy in the Allergen Name field. Click the ADD button and continue to add more.
Click the SUBMIT button to save and submit all of the custom allergies you added to your Enterprise Health system as selections that users can use.
Then that custom allergy will show up in the auto-complete for users to select from then on. That will allow users to enter in common allergies such as environmental etc and want those to show in the auto-complete as choices (without always free-typing them in and get the “unrecognized” alert).