Requirements Specification for Allergies And Adverse Reactions
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| An Allergy is an acquired hypersensitivity caused by exposure to a particular antigen (allergen) resulting in a marked increase
in reactivity to that antigen upon subsequent exposure. [NPFIT-NCR-DES-0135.07 NHS Care Record Elements]
It covers both propensity as well as the actual occurrence of a known or new allergy or adverse reaction.
This section should include a complete list of the patient’s allergic propensities with a flag to indicate whether a listing
is ‘new’ (identified during this admission).
Any reactions that occurred during this admission should be described in this section.
NOTE: Historical reactions data and their provenance may be held in the patient’s ongoing allergies and adverse reactions
list, managed by their GP.
Requirement References:
- A Clinician’s Guide to Record Standards – Part 2: Standards for the structure and content of medical records and communications
when patients are admitted to hospital (Academy of Medical Royal Colleges, October 2008).
- Requirement for ‘any adverse reactions or allergies to medications or treatments observed in the Patient during admission’
from) 2011/12 Standard Terms and Conditions for Acute Hospital Services (Department of Health, April 2011).
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Causative Agent
Business DefinitionAgents such as food, drugs or substances that have caused or may cause an allergy or adverse reaction in this patient.
Requirement Reference
- A Clinician’s Guide to Record Standards – Part 2: Standards for the structure and content of medical records and communications
when patients are admitted to hospital (Academy of Medical Royal Colleges, October 2008).
- SCG Guidance on the Representation of Allergies and Adverse Reaction Information Using NHS Message Templates (Crown Copyright,
2008).
- Keeping patients safe when they transfer between care providers – getting the medicines right, Part 1: Good practice guidance
for health professions, Royal Pharmaceutical Society (Final Draft 06/06/2011).
Proposed Data ValuesDescription of causative agent.
Data UseInformation for ongoing care, used to check / update allergy alerts in receiving systems.
Data SourceCopied from previous record.
Data Examples
- Amoxicillin
- Latex
- Peanuts
- Floxapen
- Cat dander
- Alder pollen
- Zinc
Available Data StandardsSNOMED CT, NHS dm+d.
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Type Of Causative Agent
Business DefinitionCategory of allergic propensity agent.
Requirement Reference SCG Guidance on the Representation of Allergies and Adverse Reaction Information Using NHS Message Templates (Crown Copyright,
2008).
Proposed Data Values
- Propensity to adverse reactions to drug
- Propensity to adverse reactions to food
- Propensity to adverse reactions to non-drug / non-food substance
Data UseSystems may filter based on type of propensity – e.g. GP systems may prefer to list drug propensities first / separately from
other types.
Data SourceCopied from previous record entry.
Available Data StandardsSNOMED CT.
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Probability Of Causation
Business DefinitionThe probability that an allergic or adverse reaction may occur due to a causative agent.
Requirement Reference
- SCG Guidance on the Representation of Allergies and Adverse Reaction Information Using NHS Message Templates (Crown Copyright,
2008).
- Keeping patients safe when they transfer between care providers – getting the medicines right, Part 1: Good practice guidance
for health professions, Royal Pharmaceutical Society (Final Draft 06/06/2011).
Proposed Data Values
- Probably present
- Suspected
- Definitely present
- Confirmed present
Data UseContinuing care.
Data SourceCopied from previous record entry.
Available Data StandardsAs per SCG Guidelines on Allergies and Adverse Reactions.
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New Propensity Flag
Business DefinitionIndicator that this propensity is an addition to the existing list of allergic propensities.
Requirement Reference LRA DS expert group 2011 – useful to alert GPs as an update to their patient records.
Proposed Data ValuesYes / No.
Data UseAllows receiving systems to filter for new data to update their version of the patient’s allergic propensity list.
Data SourceCopied from previous record entry (or auto-filled at time of entry by system).
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New Reaction Description
Business DefinitionA description of the manifestation of the allergic or adverse reaction experienced by the patient. The expression includes
the name and may also include the severity of the allergic or adverse reaction which has occurred.
NOTE: In Discharge Summary, used only for new allergic propensities (ones identified during this admission).
Requirement Reference
- NHS CFH Standards Consulting Group Guidance on the Representation of Allergies and Adverse Reaction Information Using NHS
Message Templates (Crown Copyright, 2008).
- Adapted from ‘Brief description of reaction’(limited here to new reaction during this hospital stay for Discharge Summaries)
in Keeping patients safe when they transfer between care providers – getting the medicines right, Part 1: Good practice guidance
for health professions, Royal Pharmaceutical Society (Final Draft 06/06/2011).
Proposed Data ValuesCoded expression with Name, Site, Laterality and Severity. The intent is to use codes wherever applicable (to allow automated
record updates and analyses), but where authors want to add free text annotation, this should also be supported. Where no
appropriate code exists, this value should be free text. (Note that free text data would not be accessible to automated interpretation).
- Name
- Site
- Laterality
- Severity concepts:
* Mild
* Moderate
* Severe
Data UsePatient and continuing care information, allows potential update of this patient’s allergies and adverse reactions lists in
receiving systems.
NOTE: Severity level is clinically important as a ‘severe’ reaction may influence decisions (e.g. about future medications)
even when the probability of cause is uncertain.
Data SourceCopied from previous record.
Data Examples
- Blanching rash
- Allergic angioedema
- Otits, external ear
- Hypotension
Available Data StandardsSNOMED CT.
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Date Of Identification
Business DefinitionThe date the propensity was first identified or the reaction first experienced.
Requirement Reference LRA DS expert group 2011 – clinically useful for ongoing primary care.
Proposed Data ValuesA string with the format "YYYYMMDD".
Data UseContinuing care.
Data SourceCopied from previous record entry.
Available Data StandardsISO 11404 - Point in Time, NHS ISB 1502: Common User Interface - Date and Time Input, NHS ISB 1503: Common User Interface
- Date Display.
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Clinical Notes
Business DefinitionA textual description of the reaction as experienced by the patient.
Requirement Reference LRA DS expert group 2011 – allowance for additional detail at the discretion of the author.
Proposed Data ValuesFree text.
Data UsePatient and continuing care information.
Data SourceCopied from previous record.
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