CERNER MILLENNIUM Allergies & Intolerances This demonstration gives you some tips about entering medicine, food, & environmental allergies & intolerances. This demonstration has been updated to reflect the appearance & functionality of MPage 6.9. This has been prepared using Millennium base code level 2015.01.21 & MPage 6.9. Subsequent updates may display cosmetic & functional changes. Any names displayed are fictitious. Use the keyboard or mouse to advance.

Allergies can be viewed & entered in at least 3 places in Cerner Allergies can be viewed & entered in at least 3 places in Cerner. You see them listed on the Banner Bar, & you can also address them from the Table of Contents or workflow tabs (MPages).

It is important to enter allergies early in the data-recording process, so that interaction checking can take place as medications & other medical history are recorded. You’ll be alerted if allergies have not been documented when you first open the chart, or when you place a medication order. Allergy lists will also display the fact that allergies haven’t been recorded.

The easiest place to address allergies in on a workflow MPage.

If the patient has no allergies, simply click No Known Allergies or No Known Medication Allergies. That will immediately be reflected on the chart, & allergy alerts will cease.

To add a new entry, click in the search field & start to type the name of the allergen. Results will display as you type. Select your preferred listing as it appears.

A sidebar appears that allows you to enter details as known & pertinent. Required fields are indicated by a red asterisk.

Some items are dropdown lists, while some are search fields Some items are dropdown lists, while some are search fields. Category will pre-populate for most known allergens.

Notice Reaction Type. In this example we’re entering a true allergy, so we can accept the default value of Allergy. We’ll come back to this on another example.

When you’ve completed your entries, click Save.

Your entry now displays on the allergy list. However, notice that the allergy list on the Banner Bar doesn’t update… …until you click Refresh.

Looking at another example, this time we’ve recorded that the patient has mild nausea when taking doxycycline. We’ll change Type to Intolerance, since this is not a true allergic reaction, & thus doesn’t carry the same significance. This is often an important clinical detail to note. (In many cases there is little difference between “intolerance” & “side effect.”)

Here’s another example Here’s another example. The patient had a bleeding ulcer while on naproxen, & was told to avoid all NSAIDs. We added NSAIDs as the substance, stomach ulcer as the reaction, & a comment. We’ll make the Type contraindication (though “side effect” might be another possibility).

Note the value of the Comments field, especially when details about the allergy are uncertain. In this example, we’re able to explain a common scenario: The patient was told by a parent she was allergic to penicillin as a child, so she’s never taken it. But she has no recollection of the reaction, & she knows she’s taken a cephalosporin without problems. All good to know.

When your entries are complete, they display on the allergy list When your entries are complete, they display on the allergy list. Severe reactions are in red.

If you click on an entry, its details will display on the sidebar If you click on an entry, its details will display on the sidebar. And you can click Modify to update them.

You’ll be prompted for a Reason for the status change You’ll be prompted for a Reason for the status change. Here we’ll indicate that the entry was made on the Wrong Patient. In this example we’ll change the Status to Canceled.

The allergy list on the MPage is updated The allergy list on the MPage is updated. Note that only active allergies display.

Finally, the Complete Reconciliation button is available to note that you have reviewed the allergy list, clearing up incomplete or confusing entries as necessary. This activity might be performed by staff or providers. In the future the Allergies component will also allow you to review & import information submitted from outside sources, such as the patient portal or other medical facilities.

Some Comments About Combination Drugs Whenever you can, enter individual drugs, not combination drugs, on the allergy list. It makes allergy-checking & medical decision making a lot clearer if you can distinguish which part of the combination is the problem. But this may not always be possible.

Some Comments About Combination Drugs For example, if someone tells you they’re allergic to Norco (hydrocodone/acetaminophen), there is a high likelihood the problem is the hydrocodone, not the acetaminophen. You might follow up with “OK. Have you ever taken acetaminophen—plain Tylenol? Did you have any problems with that?” If the patient reports taking acetaminophen without problems, enter hydrocodone as the allergy/intolerance.

Some Comments About Combination Drugs On the other hand, if the patient says they’re allergic to Bactrim (trimethoprim-sulfa), it is less likely you’ll be able to distinguish between the two agents, since they’re often used together, and trimethoprim is rarely used alone. In this case, the best thing is to enter the allergy as Bactrim or trimethoprim-sulfa.

Summary That’s really about all you need to know about allergy entry. But for those who wish to review an alternative, older method using the Table of Contents Menu, the following slides are included.

To add a new allergy, click the Allergies + Sign, the Allergies component heading, or Allergies +Add on the Table of Contents Menu.

Type at least part of the name of the substance you wish to enter, then click the Search Binoculars.

A list of results appears. Double-click the one you want. Note this is one of the spots where you can choose among Starts with, Contains, or Exact match.

There is one required field, a couple that are very important though they’re not required, & some that are optional. First, if it doesn’t auto-populate for your selection, click the Category dropdown to address the required field. Select Drug.

Next enter Reaction(s) Next enter Reaction(s). Type at least part of the reaction & click the Search Binoculars. (While there is the opportunity to add the reaction as Free Text, only do this for a truly unusual reaction that cannot be found via search.)

Double-click your desired match.

Your chosen reaction appears Your chosen reaction appears. Note that you can add more than one reaction.

Also note that when your cursor is in the Reaction field, a Common Allergy Reactions folder displays at the bottom. When you click Common Allergy Reactions, you’ll see a list you can scroll through, so if the one you want is there you can avoid the search step.

Next enter Severity. In this example, obviously, anaphylaxis is severe.

Next enter Type. In this example we’re entering a true allergy, so we don’t need to make a change, but we’ll look at this further in another example shortly.

You have options to enter info source, date/age of onset, & comments You have options to enter info source, date/age of onset, & comments. Often you won’t know all these details, & in that case you can skip them. But enter them when known & pertinent.

The Add Comment function in particular may be helpful, especially to enter comments when the exact details are unclear, or don’t fit neatly into the available boxes. An uncertain allergy dating back to childhood, as illustrated here, would be a common example.

When done, if that’s your only entry, click OK When done, if that’s your only entry, click OK. In this example we’ll add another, so click OK & Add New.

The penicillin allergy is added to the list.

Using a similar approach, we’ve entered a moderately severe environmental allergy to cats, causing itching eyes & runny nose. We’ll click OK & Add New to add another entry.

This time we’ve recorded that the patient has mild nausea when taking doxycycline. We’ll change Type to Intolerance, since this is not a true allergic reaction, & thus doesn’t carry the same significance. This is often an important clinical detail to note. (In many cases there is little difference between “intolerance” & “side effect.”)

Here’s another example Here’s another example. The patient had a bleeding ulcer while on naproxen, & was told to avoid all NSAIDs. We added NSAIDs as the substance, stomach ulcer as the reaction, & a comment. We’ll make the Type contraindication (though “side effect” might be another possibility). This is the last entry, so click OK.

The allergy list displays.

You can also modify allergies. Select penicillin & click Modify.

You can modify some details & add new ones You can modify some details & add new ones. You can’t remove an existing comment, but you can add a new one to add further details or corrections.

You can also resolve or cancel an allergy entry You can also resolve or cancel an allergy entry. To do this, click the Status dropdown list. You might Cancel an entry if it was entered in error on the patient. You might Resolve an entry if further clinical history changes the information—for example, if a patient has later taken a drug without a reaction.

When you change status, Reason becomes a required field When you change status, Reason becomes a required field. Pick the best reason listed; if you need to clarify further, add a comment. When done, click OK.

When you’ve changed the status of an allergy, inactive allergies will display with a line through them, & they will no longer be included on the Banner Bar.

You can also change the allergy list Display from All to Active, to only display active allergies.

You can save frequently-used allergens as favorites You can save frequently-used allergens as favorites. Do your search, select the desired entry, then click Add to Favorites.

Click Create Folder & give it a name Click Create Folder & give it a name. (Here you can’t add favorites directly under the root folder.)

With your new folder selected, click OK.

You may wish to create a few folders to better-organize your favorites.

Now as you start your search, you can click the Favorites button & see your folders displayed. Click one to open it.

You see your favorites. Double-click one to select, then proceed as before—edit details as necessary & save it.

The opportunity to use favorites & the ability to view inactive allergies are probably the only edges this older method has over adding allergies via MPages. But most often, the simplicity of the MPage approach outweighs these potential advantages.