$TXT Created by NABER,DAVID A at DEVCUR.FO-SLC.MED.VA.GOV (KIDS) on Wednesday, 07/19/06 at 13:50 ============================================================================= Run Date: SEP 05, 2006 Designation: GMRA*4*20 Package : GMRA - ADVERSE REACTION TRACKING Priority: Mandatory Version : 4 SEQ #31 Status: Released Compliance Date: OCT 06, 2006 ============================================================================= Associated patches: (v)GMRA*4*23 <<= must be installed BEFORE `GMRA*4*20' Subject: Allergy data updates Category: - Routine - Other Description: ============ Documentation for this patch can be found under the name: GMRA_4_20_RN.PDF The Adobe PDF version is available for FTP transfer. The preferred method is to FTP the file from: download.vista.med.va.gov This transmits the file from the first available FTP server. Sites may also elect to retrieve the document directly from a specific server, as shown below. This file MUST be obtained in BINARY mode. CIO FIELD OFFICE FTP ADDRESS DIRECTORY Albany ftp.fo-albany.med.va.gov [anonymous.software] Hines ftp.fo-hines.med.va.gov [anonymous.software] Salt Lake City ftp.fo-slc.med.va.gov [anonymous.software] The document may also be retrieved from the following hyperlink: http://www.va.gov/vdl/ An OI notification called UPDATE - ADVERSE REACTION TRACKING is being issued in conjunction with this patch and can be found at http://vaww.vhaco.va.gov/vhacio/OIPatientSafety.asp The notification addresses issues related to making selections from the ingredient file when entering allergy information. Remedy tickets/Patient Safety Issues addressed: ----------------------------------------------- Ticket #67740 Ticket #131125 Ticket #117610 Ticket #117824 PSI-03-050 PSI-05-075 Test Sites: ----------- Lexington Providence West Palm Beach Portland East Orange North Texas HCS Sheridan Iron Mountain Martinsburg San Antonio Puget Sound This patch updates the free text utility that was distributed in patch GMRA*4*17 so that it can now be used to identify ingredient file based and drug class file based allergies. The remedy tickets and Patient Safety Issues listed above describe situations where order checks did not fire due to the fact that only ingredient information was stored with the patient allergy. While this patch will not stop a user from selecting from the ingredient file while entering an allergy, or reduce the risk associated with not receiving an order check, it does give the site a tool to identify and fix entries that are associated with an ingredient file entry. When reactants are selected from either the ingredient or drug class files only that specific piece of information is stored with the patient's allergy. Order checking looks at both the ingredients and the drug classes when determining if an order check should be fired. As a result, reactants should be selected from either the GMR ALLERGY file or one of the National Drug files, to have the best chance of producing an order check. The order in which the files are searched when looking for reactants was altered in patch GMRA*4*19 so that the ingredient and drug class files were at the bottom. This change helped promote selection from files that include both ingredients and drug classes as part of the definition of the reactant. The ingredient and drug class files are still available to choose from as there are times when selection from one of these files is the best choice. In an effort to identify and update entries related to ingredient or drug class file entries, the free text utility was updated to create and maintain a list of free text, ingredient, and drug class allergies. The same options that were available for updating free text allergies will be available for ingredient and drug class based entries. In addition to the update to the free text utility, which has been renamed to the 'Allergy clean up utility', the bulletin that is sent when a user cannot find a matching term has been updated to include the name of the reactant in the message. This makes the message consistent with what the user sees when requesting the addition of a new term. The progress note that is sent when an allergy has been marked as entered in error has been updated to clarify that the reactant may have been entered in error or may have been found to no longer be an allergy or adverse reaction for the patient. This patch also includes a post-installation routine that will review the site's "top 10" sign/symptom list to make sure it only has 10 entries. In a previously released patch, additional sign/symptoms may have been added at positions 11 or higher. The site is unable to delete or edit these entries and the user never sees these entries as possible choices when adding signs/symptoms. However, when NTRT updates are sent out, it is possible to get an email message telling you that an entry on the top 10 list is now inactive and that you must update the entry. As stated above, you have no way to do that and entries above number 10 shouldn't be part of the definition. This post-install will remove any entries numbered 11 or higher. The post-install also identifies any allergies with an invalid pointer in the GMR ALLERGY field of file 120.8. If invalid data is found the entry is converted to a "free text" entry and an email message with information related to that allergy is sent to the installer after the post-install finishes. The allergy clean up utility can then be used to fix the entry. PROTOCOLS ========= GMRA FIX FREE TEXT LIST GMRA FIX DETAIL IN DETAIL GMRA FIX DETAIL MENU LIST TEMPLATES ============== GMRA FIX GMRA FIX DETAIL OPTIONS ======= GMRA FREE TEXT UTILITY GMRA SITE FILE MENU INSTALLATION ============ This patch may be installed with users on the system although it is recommended that it be installed during non-peak hours to minimize potential disruption to users entering allergy information during the installation process. This patch should take less than 2 minutes to install, but could be longer depending on whether you choose to rebuild menu trees as part of the installation. **NOTE: Please be aware that test accounts are not standardized. As a result, when searching for a term the list produced in the test account may not be the same as the list produced in the production account. 1. Use the INSTALL/CHECK MESSAGE option on the PackMan menu. 2. From the Kernel Installation and Distribution System Menu, select the Installation menu. 3. From this menu, you may elect to use the following options (when prompted for INSTALL NAME, enter GMRA*4.0*20): a. Backup a Transport Global b. Compare Transport Global to Current System c. Verify Checksums in Transport Global 4. Use the Install Package(s) option and select the package GMRA*4.0*20. 5. When prompted 'Want KIDS to Rebuild Menu Trees Upon Completion of Install? YES//' Answer yes if you want the rebuild to occur as part of the installation. If you prefer to do it at a different time, answer 'NO' and rebuild the menus at a time of your choosing. 6. When prompted 'Want KIDS to INHIBIT LOGONs during the install? YES//', you may respond NO. 7. When prompted 'Want to DISABLE Scheduled Options, Menu Options, and Protocols? YES//', respond NO. 8. If prompted 'Delay Install (Minutes): (0-60): 0//; respond '0'. ROUTINE SUMMARY: ================ The following is a list of the routine(s) included in this patch. The second line of each of these routine(s) will look like: ;;4.0;Adverse Reaction Tracking;**[patch list]**;Mar 29, 1996 CHECK^XTSUMBLD results Routine name Before Patch After Patch Patch List ============ ============ =========== ========== GMRAFX 30841213 30808163 17,19,23,20 GMRAFX1 14035522 14490297 17,19,20 GMRAFX3 14784828 22970766 17,19,23,20 GMRAPES0 28682977 29706503 13,17,19,21, 23,20 GMRAPET0 9199688 11522032 6,17,21,20 GMRAY20 N/A 5915501 20 Routine Information: ==================== The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: GMRAFX Before: B91485304 After: B82732558 **17,19,23,20** Routine Name: GMRAFX1 Before: B31454366 After: B32262757 **17,19,20** Routine Name: GMRAFX3 Before: B36523272 After: B68434515 **17,19,23,20** Routine Name: GMRAPES0 Before: B72112674 After: B74006536 **13,17,19,21,23,20** Routine Name: GMRAPET0 Before: B26842733 After: B31689941 **6,17,21,20** Routine Name: GMRAY20 Before: n/a After: B8283807 **20** ============================================================================= User Information: Entered By : NABER,DAVID A Date Entered : FEB 24, 2004 Completed By: SCHLEHUBER,PAM Date Completed: SEP 05, 2006 Released By : CAMPBELL,THOMAS Date Released : SEP 05, 2006 ============================================================================= Packman Mail Message: ===================== $END TXT