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This is unfortunate but I don't see where this is ever going to get to the
point that it is cleared up. The "list" that is supplied in the MIS allergens
dictionary contains many allergens - pollen, trees, foods, etc. None of these
cross reference to any pharmeceuticals. If you have a patient who is allergic
to bananas and someone is entering coded allergies on the patient, they have to
be taught to enter the pharmacy allergy ingredient "bananas" not the MIS
food allergy :banana, otherwise if an MD writes an RX for EryPed or if POM
enters an order and no pharmacist has seen the allergies yet to fix them -
you don't get the flag "Pt allergic to bananas".
I have had to go through the MIS allergy dictionary and put "use pha allergy
banana" or whatever after the text. I guess you can inactivate them but I don't
know if you need them fo something else.
The pharmacy drug allergies are not in the MIS drug dictionary right now. Our
ER nurses who do enter drug allergies enter them by allergy ingredient.
For the most part I went through every drug in the dictionary to make sure that
the drug itself was actually listed in the allergy ingredients section.
This helps, but there are still "holes". If a patient comes in and says they
are allergic to PERCODAN, the nurse may not know that PERCODAN consists of
oxycodone and ASA and that the most likely allergen is oxycodone. IF Percodan
exists in the live pharmacy drug dictionary, they can enter PERCODAN
as an allergy. However, PERCODAN does not exist in our drug dictionary because
it is non-formulary and we never dispense it. We had to add Percodan to the
RXM drug dictionary so they had something to enter for allergies and
home/profile meds.
Another problem with entering allergies through RXM is that you really don't
want non-pharmacy users entering by generic. When you load the formulary tapes
into RXM you also load ALL generics (so that you get the ability to flag
allergies against generic drugs that may not be in the RXM drug dictionary) but
the problem here is that there are many many different generics for what could
be the same drug and how is someone to know which to pick. THat is why we
chose the ingredient allergies. Also , if a nurse is entering ingredient
alergies in RXM, she sees that TEXT rather that the mnemonic. (Pharmacy can do
this too but the default is by mnemonic). Therefore the nurse does not see
MORPHI and MORPHI2 as their ingredient allergies , but they see MORPHINE and
HYDROCODONE and related - so at least that is better for them. (That's stupid
but not related to this topic).
The main problem is that it is humanly impossible to go
through and edit all these dictionaries and cross reference every generic,
ingredient allergy and class so that you have a fail safe system without excess
flagging of clinically insignificant instances. After the 50,000th
clinically insignificant allergy or interaction pops up, it is very easy to
just hit enter or just type in ACKN to get past the flag. We have enough
problems just trying to get our pharmacists to enter the correct allergy
choices much less getting the nurses and doctors to tolerate the flags they are
getting now (esp when they get flagged for erythromycin ophth oint and
theophyliine po). After 10 years I still don't have really really good allergy
flagging because of the difficulty in entering the allergies and because of the
way the drugs were originally built. Ideally - only pharmacists would enter
the allergies and no med would be administered with allergy checking - but until
there are more pharmacist available and hospitals can afford to hire them we
have to work with what we have.
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"Charlie Downs" <[EMAIL PROTECTED]>
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06/21/2006 04:03 PM
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Subject
[MEDITECH-L] Pharmacy - Interaction and allergy checking for non-drug
dictionary items.
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Bob - Since we now have an allergens dictionary in 5.5, I would like to see
Meditech make it possible to take this list and enable us to use any of these
entries to enter non-drug dictionary items so that we could have allergy and
interaction checking. What do others think. It wouldn't even have to be this
list but could be the one that they supply for RXM (I believe that this is the
product). I should probably do a MIX request for this. I would welcome any
input from others out there in crafting this request.
Charlie
Charles R. Downs Pharm.D.
Washington County Hospital
251 E. Antietam Street
Hagerstown, MD, 21740
301-790-8904
[EMAIL PROTECTED]
----- Original Message -----
From: [EMAIL PROTECTED]
To: [email protected]
Sent: Friday, June 16, 2006 5:28 PM
Subject: [MEDITECH-L] Checking Herbal Drug Interactions
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We are on Magic 5.4 and use a specific Order Type of "H" or Home Med for items
that a patient takes at home but was not prescribed at the hospital. I
would like to enter nutraceuticals so that they can be checked for
interactions, but do not want to clutter up my drug dictionary with herbal
products. I
thought about creating a single nutraceutical drug and then attaching all
ingredients to it from the ingredient dictionary that qualify as natural
products. Unfortunately, the natural products are not available in the
generic dictionary, only in the ingredient allergy dictionary. This would flag
allergies, but not drug interactions (as far as I understand it). Has anyone
come up with a solution to checking for interactions with natural products?
Bob Cutter, RPh
Lead Pharmacist
Willamette Falls Hospital
Oregon City, OR 97045
503-650-6243=========================================================
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