Adding a Drug Allergy/Adverse Reaction
Where an adverse reaction to a drug, immunisation or device is diagnosed or suspected, the diagnosis or symptom should be recorded in the Drug Allergy and Intolerance Structured Data Area (SDA). You can also create a Yellow Card from here which electronically sends Yellow Card information to the MHRA. Where medication is changed because of an adverse reaction or side effects, the indication for any new drugs should be entered.
To add a drug allergy:
- From Consultation Manager , select the patient required and start a consultation if required.
- Select Add - Drug Allergy/Adverse Reaction.
- The Drug Allergy and Intolerance - Add screen displays:
Complete the following as required:
- Date of Recording - Defaults to today, update if required.
- Clinician - Update if required.
- In Practice - If this is a history of previous allergy or intolerance, then enter the approximate date and remove the tick from In Practice.
- READ Term for Allergy - Select a Read term for the allergy from the list.
- Drug Name - Enter the drug details and press enter to search the drug dictionary or double click in Drug, and select the drug to which the patient is allergic to from the drug list. In Name on the Drug Select screen, enter the drug name, for example, amoxicillin, and select Find, locate the drug required and then select OK.
- READ Term for Reaction (optional) - Find and enter a Read code for the patient's reaction to the drug.
- Reaction Type - Select as appropriate.
- Severity - Select as appropriate.
Note - Vision 3 prevents you from prescribing an item with a Potentially Fatal flag.- Certainty - Select as appropriate.
- Send Yellow Card - Tick to create and send an electronic Yellow Card Report, see Electronic Yellow Card Reporting for details.
- Select OK to save and close.
Other ways to add Drug Allergy and Adverse Reaction entries include:
- Right click Navigation Pane - Drug Allergy and Adverse Reaction.
- An existing entry - Simply right click on the entry and select Add.
See Adding a Non-drug Allergy or Intolerance for details of adding other allergy information.
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