Allergy Basics This handout describes the process for adding and removing allergies from a patient’s chart. Accessing Allergy Information Recording a New Drug Allergy Adding Optional Fields Removing No Known Allergies (NKA) Display Filter Recording Other Allergies Removing an Allergy Labeling No Known Medication Allergies Removing No Known Medication Allergies Page 1 Page 2 Page 3 Page 4 Page 4 Page 5 Page 5 Page 6 Page 7 Accessing Allergy Information The easiest way to access patient’s allergy information is by viewing the Blue banner bar. Allergies are listed below the patient’s name. This text also is a link to the allergies section. Clicking this link is the fastest way to update a patient’s allergies. Another way to access allergies is through the menu. Select Patient Information from the menu. On the Patient Information Tab, Select Allergies Select Allergies from the Patient Information Tab. User Handouts\Allergies\Allergy Basics 4.21.15.docx 1 Recording a New Drug Allergy Clicks add to enter a new allergy. All listed allergies will appear in this box. This patient has no allergies, so the code NKA appears for No Known Allergies. 1. Type the partial or full name of the substance in the search field and click search or press Enter. 3. Click Select to move the item to the substance field. 4. Click the drop down arrow: Select a Category Note: All Yellow Fields are required fields. Fill out any other fields as needed. 2. Select the desired substance (e.g. doxycycline) from the list. 6. Click Ok when all allergies have been added. User Handouts\Allergies\Allergy Basics 4.21.15.docx 5. Click Apply and New to add multiple Allergies. 2 Adding Optional Fields Reaction Type and Symptoms 3. Click Select to move the reaction to the Reaction Symptoms Field. 1. Click the drop down arrow to label the reaction type. 2. Type the reaction in the Search field. Press Enter or Click Search. 4. Click the free text button to type in a reaction symptom. When done, Click the Add Free Text button. Allergy Status, Severity, Info Source and Onset 1. Click the drop down to select the Active status. 2. Click the drop down to select the Severity Level. 3. Click the drop down to select the Info Source. If the source is a physician, the record on behalf of field can be used to select the physician name. 4. Click the drop down to indicate when the Onset of symptoms occurred. Be as specific as possible. User Handouts\Allergies\Allergy Basics 4.21.15.docx 3 Allergy Comments 1. Click the Add comment button to add a comment. 2. Type a comment and click ok. The date/time is displayed to the left of the comment. Removing No Known Allergies (NKA) When saving an allergy to a chart that previously had No Known Allergies (NKA) charted, this pop up box will display. Adding an allergy will cancel the NKA designation on this patient, because an allergy is being recorded. Display Filter Click Yes. Click the Drop down arrow to select a filter. Active = All current allergies Inactive = All historical allergies, which are no longer current All = All allergies (both active and inactive) In the main allergy window the view is set to All. NKA is still shown, but with a red line through it, indicating it was canceled. Doxycycline shows above it with the completed details that were filled in for the allergy. User Handouts\Allergies\Allergy Basics 4.21.15.docx 4 Recording Other Allergies The steps for recording other allergies are identical to recording a drug allergy. For this example, honey has been added as an allergy. When inputting allergies that are not on the Multum Drug list, which can be many allergies that are not drugs, the system is unable to do a drug allergy check. That is indicated by the red circle with a white X on it. For this example, food is the category. Be sure to select the appropriate category for all allergies. Removing an Allergy Right-click on doxycycline to remove the drug from the allergy list of this patient. Click on Cancel doxycycline User Handouts\Allergies\Allergy Basics 4.21.15.docx 5 The status of the drug is now changed to Canceled. A Comment can be left to note why the allergy is being canceled. Labeling No Known Medication Allergies (NKMA) Click No Known Medication Allergies, to update the patient’s record. No Known Medication Allergies will be labeled when the patient has a food or environment allergy, but no medication allergies. User Handouts\Allergies\Allergy Basics 4.21.15.docx 6 A box pops up where the description of NKMA is automatically displayed. Click OK in the bottom right corner to apply NKMA to the patient’s chart. Removing No Known Medication Allergies If a medication allergy is added when NKMA is currently on the patient file, this warning will display. To continue, it will require approval for removing NKMA from the profile. Click Yes. User Handouts\Allergies\Allergy Basics 4.21.15.docx 7
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