Automatic checking of a list of allergies against a proposed
prescription is sensible, but the current handling of allergies is less
than exciting.

Data Entities and Such-like
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As well as drugs patients may be allergic to, for example, pollens,
Nickel and foodstuffs.
Logically one would wish to see all these together, since the patient
will present them together, and they are likely to be input together. 
At the same time the patient may present other reasons for avoidance of
certain drugs or substances, and these may have as much influence upon
choice of prescription as the actual allergies.

Looking at an entry relating to allergy, or "avoid Amoxycillin", there
are various data one might wish to find easily.

What happened when the substance was exhibited previously?
What alternatives have been used previously?

The display of these lists on the screen is useful, although it may
easily be submerged by a string of standard warnings of interactions
from a prescribing dictionary, but it would be sensible to add them to
the prescription form, using a piece of the FP10 counterfoil for this.

Show rather than trap?
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Rather than waiting for a mistake to occur, it would be helpful to
present the list of a patient's allergies on the prescribing screen,
before and as the next item is chosen.

Hide
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Given the linkage between the prescribing dictionary and allergy table
which occurs through the unique code for the preparation, and perhaps
its BNF therapeutic class, one could make a very good case for saying
that drugs to which the pateint has a known allergy should not be
displayed in the picking list, unless a separate additional step is
undertaken by the user.

Thus when trying to prescribe an antibiotic for a patient with
documented Penicillin allergy, the drug dictionary would show nothing
between Penicillamin and Penmix, nor between Amoxipine and and
Amphetamine.  However it would offer the usual choice of a hundred
me-too versions of Erythromycin.

Integrate
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The record of allergies, adverse reactions, lack of enthusiasm and
other less than ideal outcomes from previous treatment should all feed
into the hinting routine, conditioning the picking order and choice of
treatments offered when one pulls up the picking list ready to
prescribe.  The software should contribute to this, unobtrusively,
rather than waiting to catch mistakes.

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comments?



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