Adjusting Prescription Alert Preferences

overview & requirements this article will focus on the prescription alert preferences within profile, and will provide detail around the following the alert level warnings how the alert preferences, and other preferences can be adjusted in profile to suit the needs of your organisation for example, if your staff prefer to only receive level 1 alert warnings on dose validation, that action can be taken to fit the requirements of your practice the alert sections found in the perspectives viewer each of the alert types and their functionality requirements available from profile version 8 8 11 alert level warnings there are three levels of alert warnings that could appear within the perspectives viewer based on the chosen preference for each alert type the details around each alert level is defined in the following table alert level description alert level 1 avoid involved medication the risk of serious problems outweighs any potential benefit alert level 2 if possible, avoid involved medication if not, adjust therapy to prevent potential problems alert level 3 evaluate specific risk based on the clinical situation adjust therapy or monitor as needed note read vigilance santé rxvengine with perspectives docid\ dsdgi4tvz gyijo9e unl to see what the alert level warnings will look like while using profile adjusting the alert preferences the alert preferences for each alert type can be adjusted in organisation / preferences / general / scripts and instructions / general tab / show warnings for field the alert preferences can be changed by clicking on an alert type, and making a selection from the drop down lists each alert type has a different set of alert preferences to choose from the drop down lists could include options like all levels ; level 1 and level 2 only ; level 1 only , none, yes or no alert preferences explanation all levels if the all levels option is selected, then all warnings for this alert type will appear this is similar to the yes option level 1 and level 2 only when the level 1 and level 2 option is chosen, the level 3 warnings are excluded level 1 only when the level 1 option is chosen, the level 2 and level 3 warnings are excluded none if none is selected then no alerts or warnings will appear if this occurs, a green circle with a tick will be visible in the ordering panel yes if yes is selected, then all warnings for this alert type will appear this is similar to the all levels option no if no is selected than no alerts or warnings will appear if this occurs, a green circle with a tick will be visible in the ordering panel changing an alert preference in one alert type, will not affect any of the other un changed alert types adjusting other preferences in the show warnings field preferences description options geriatric age this represents the age high option see "age low/high" in the alert type functionality section of this article numerical representation of age must be entered a default age of 65 is provided this can be altered if necessary analyse prior scripts for the last month(s) this applies to all of the alert types along with the medication being prescribed at that moment, it will also analyse the prior scripts given within the specified (1 12 month) time period for example, if '12' is entered, then along with the medication being prescribed at that moment, it will also analyse the prior scripts given within the last 12 months a number between 1 12 must be included a default is provided the default amount is '12' check for interactions and allergies automatically this checks for interactions with allergies and medication being prescribed if/when indicated by the option selected one of the following options must be selected from the drop down list with every prescription is the default option never if this option is chosen, the system will not check for any allergies on conclusion of prescription if this option is chosen, the system will only check for any alerts when an order is complete and the user is trying to email, fax or print the script with every prescription if this option is chosen, every prescription will be checked for alerts when the user is dragging a prescription into the new encounters script order panel alert sections within the perspectives viewer within the perspectives viewer, there are different alert sections where certain alerts can be found each of the sections are detailed below alert section description selected alerts in this section, you will see alerts relating to the targeted item i e the drug being prescribed at that moment, by the provider unselected alerts in this section, you will see alerts for any of the other medications that are already present in the patient's prior scripts excluded alerts it is possible to adjust the alert preferences in profile so that only certain alert levels will be presented if the user has made any of these adjustments, then the excluded alerts section within the perspectives viewer is where these excluded alerts can still be seen, if needed alert type functionality the alert types and their preferences can be found in organisation / preferences / general / scripts and instructions / general tab / show warnings for field the unique functionality of each alert type is listed below age low/high docid\ vyv5flvjtkssnb1souiczdiagnosis docid\ vyv5flvjtkssnb1souiczdrug to drug interactions docid\ vyv5flvjtkssnb1souicztherapeutic class duplication docid\ vyv5flvjtkssnb1souiczingredient duplication docid\ vyv5flvjtkssnb1souiczalcohol docid\ vyv5flvjtkssnb1souiczpregnancy docid\ vyv5flvjtkssnb1souiczdose validations docid\ vyv5flvjtkssnb1souiczatypical associations docid\ vyv5flvjtkssnb1souicztoxicity alerts docid\ vyv5flvjtkssnb1souiczprescription alerts docid\ vyv5flvjtkssnb1souiczbreast feeding docid\ vyv5flvjtkssnb1souiczrenal failure docid\ vyv5flvjtkssnb1souicz age low/high the age low/high alert type will issue warnings that are associated with a patient's age for instance, if a patient's age is too high or to low for the prescribed drug, a warning will appear depending on the option selected in the age low/high drop down list the drop down list of options includes all levels ; level 1 and level 2 only ; level 1 only ; or none an example of an age high alert would appear if a patient was 70 years old and was prescribed zopicione (din02218313) an example of an age low alert would appear if a patient was 3 years old and was prescribed doxycycline (din 00725250) diagnosis the diagnosis alert type will issue warnings associated with any problems present in the problems list of the patient's medical record the drop down list of options for diagnosis include all levels ; level 1 only ; or none an example of a diagnosis alert would be if a patient who was diagnosed with obstructive intestinal disease was prescribed hydromorphone (din 00705438) drug to drug interactions the drug to drug interactions alert type issues warnings when potential interactions may occur in a patient's therapy due to the concurrent use of two or more drugs the available list of options in the drug to drug interactions drop down list include all levels ; level 1 and level 2 only ; level 1 only ; or none an example of a drug to drug interaction alert type would be if two medications like clarithromycin (din 02266547) and atorvastatin (din 02295261) were prescribed therapeutic class duplication the therapeutic class duplication alert type issues warnings when there is the presence of two or more drugs of the same therapeutic class in the patient's scripts for example, when a user prescribes multiple medications for the same issue without a clear distinction of when one medication should be administered over another the available list of options in the therapeutic class duplication drop down list include yes or no an example of this alert type would be if two antidepressants were prescribed as shown in the example below ingredient duplication the ingredient duplication alert type issues warnings when a user prescribes two or more drugs with the same ingredient the available list of options in the i ngredient duplication drop down list include yes or no an ingredient duplication alert would appear, for example, if both venlafaxine 150 mg (din 02237282) and venlafaxine 37 5 mg (din 02237279) were prescribed alcohol the alcohol alert type issues warnings when a user prescribes a drug that can cause a disulfiram effect, and a drug that contains alcohol the available list of options in the alcohol drop down list include yes or no if in the clinical details section, it has been noted that a patient consumes alcohol on a daily basis, that information will help to trigger an alert warning (depending on the type of medication being prescribed, and what is written in the clinical details section) an alcohol alert type would appear if, for example, the patient was known to consume alcohol on a regular basis and was prescribed a medication like ulone (chlophedianol) din 01966294), unisom (diphenhydramine) (din 02061597) or metronidazole (din 02248562) pregnancy the pregnancy alert type issues warnings when a patient is known to be pregnant and the drug being prescribed can cause issues (specified according to the current trimester) if it has been noted, in the obstetric history tab of the clinical details section, that a patient is pregnant an alert will be triggered depending on the type of medication prescribed the available list of options in the pregnancy drop down list include yes or no a pregnancy alert would appear if the patient is known to be pregnant and was prescribed a drug like ibuprofen (din 02230541) dose validations the perspectives viewer shows dosage related alerts a dose validation alert would occur, for example, if there was any missing patient information that would prevent dosage validation for instance, if a 5 year old patient was prescribed cephalexin (din 02177811) but the patient's weight was not included in their medical record the available list of options in the dose validations drop down list include all or none atypical associations the atypical associations alert type issues warnings when a user is prescribing two drugs that are not meant to be given together for example, if both teva tamoxlfen and armidex were prescribed together, an atypical association alert would appear the available list of options in the atypical association drop down list include all levels ; level 1 and level 2 only ; level 1 only ; none toxicity alerts the toxicity alerts alert type will issue warnings when one or more medications prescribed result in a cumulative toxicity (anticholinergic effects, kalemia, qt interval, nephrotoxicity, sedation, serotonin) the available list of options in the toxicity alerts drop down list include all levels ; level 1 and level 2 only ; level 1 only ; none if for example, all levels was selected, then all alerts relating to toxicity would appear for instance, if two drugs with high levels of potassium were being prescribed like lisinopril and spironolactone, the toxicity alert for kalemia would appear prescription alerts the prescription alerts field will issue warnings when a patient who has a listed allergy selected within the prescription alert factors checkboxes of their medical record is being prescribed medication that would result in an allergic reaction some examples of prescription alerts can be seen in the following table prescription alert factors checkbox scenario causing a prescription alert to appear takes medication crushed needs to crush their medication and a drug that cannot be crushed is prescribed like hydroxyzine (din 00646059), or lansoprazole (din 02165503) prefers liquid forms has difficulty swallowing pills and a better option is available for example cold and sumus plus (chlorpheniramine + pseudoephedrine + ibuprofen) din 02395118), claritin (loratadine) (din 00782696), or acetaminophen, tablet (din 00723908) participates in sport competition takes part in competitive sports and is prescribed darbepoetin alfa (din 02391740) gives blood if the patient is a blood donor and is prescribed clozapine (din 00894737) or methadone (din 02247698) wears contact lenses wears contact lenses but is prescribed sulfasalazine ec (din 00598488), dimenhydrinate (din 02407396), or apo timop (timolol eent) (din 00755826) has a colostomy has been diagnosed with stoma and is prescribed dexilant (dexlansoprazole) (din 02354950) eats/drinks grapefruit consumes grapefruit and is prescribed hydroxyzine (din 00024694) or rupatadine (din 02456451) currently breastfeeding if the patient is breastfeeding and they are prescribed a medication, an alert may be triggered allergy / product to avoid with analysis limits if a patient has a known allergy to centrum (multivitamins) (din02246362) and is prescribed atorvastatin (din 02230711) or sitaglipitin (din02303922) the available list of options in the prescription alerts drop down list to choose from include yes and no if yes has been chosen, then if the patient has a recorded allergy to sulfites or tartrazine, and the medication being prescribed includes either of those ingredients, then a warning will appear if no is chosen, then there will be no warning message despite there being a recorded known allergy listed breastfeeding the breast feeding alert type field generates warnings when a patient identified as breastfeeding in the prescription alert factors checkboxes of their medical record is prescribed medication that could pose risks the available list of options in the breast feeding drop down list to choose from include all levels ; level 1 and level 2 only ; level 1 only ; and none a breastfeeding alert will appear if, for example, a patient is known to be breastfeeding and is prescribed a medication like ramipril + hydrochlorothiazide (din 02283166), or ganciclovir (din 02404761) renal failure the renal failure alert type field generates warnings when a medication is prescribed that can cause renal impairment the available list of options in the renal failure drop down list to choose from include all levels ; level 1 and level 2 only ; level 1 only ; and none an example of a renal failure alert would be if a patient has been diagnosed with renal failure or has the presence of a creatine clearance of 30 ml/min and is prescribed amiodipine + perindoprilarginine (din 02451530)