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Allergies & Safety

Critical patient safety features for allergy management.

Overview

The Allergy module provides:

  • SNOMED CT allergen autocomplete
  • Criticality-based warnings
  • High-criticality allergy banner on every clinical page
  • Reaction documentation
  • Drug-allergen cross-references

Recording an Allergy

Step 1: Navigate to Allergies

  1. Open patient record
  2. Click Allergies tab
  3. Click Record Allergy button

Step 2: Use SNOMED Allergen Autocomplete

Allergen Name field:

  1. Type allergen name (2+ characters)
  2. Instant dropdown from local SNOMED library
  3. Select allergen
  4. Code auto-fills

Example: Type "peni"

┌─────────────────────────────────────────────┐
│ 387517004                                   │
│ Penicillin                                  │
│ SNOMED-CT                                   │
├─────────────────────────────────────────────┤
│ 227493005                                   │
│ Peanuts                                     │
│ SNOMED-CT                                   │
└─────────────────────────────────────────────┘

Common Allergens

Search Allergen SNOMED Code Category
peni Penicillin 387517004 Medication
amox Amoxicillin 373270004 Medication
sulfa Sulfonamide 387404004 Medication
aspi Aspirin 372756006 Medication
peanut Peanuts 227493005 Food
shellf Shellfish 735029006 Food
latex Latex 111088007 Environment

Step 3: Allergy Details

Category: - Medication - Food - Environment - Biologic

Type: - Allergy (IgE-mediated) - Intolerance (non-immune)

Criticality: ⚠️ IMPORTANT

  • High - Life-threatening risk
  • Low - Minor risk
  • Unable to Assess - Unknown severity

High Criticality Triggers Banner

Setting criticality to "High" displays red warning banner on ALL clinical pages.

Step 4: Reaction Details

Manifestation: What happened? - Anaphylaxis - Rash - Hives - Swelling - Difficulty breathing - Nausea/vomiting

Severity: - Mild - Moderate - Severe

Exposure Route: - Oral - Intravenous - Topical - Inhalation

Step 5: Verification

Clinical Status: - Active - Inactive - Resolved

Verification Status: - Confirmed - Unconfirmed - Refuted

Step 6: Save

Click Save Allergy.

Allergy Safety Banner

High-Criticality Banner

Appears on every clinical page when HIGH criticality allergies exist:

┌─────────────────────────────────────────────────────┐
│ ⚠️ Known Allergies — Verify before prescribing     │
│                                                     │
│ [HIGH] Penicillin (Anaphylaxis)                    │
│ [HIGH] Latex (Severe rash)                         │
│                                                     │
│                                        [Dismiss] ×  │
└─────────────────────────────────────────────────────┘

Features: - Red background - Shows allergen + reaction - HIGH badges for criticality - Dismissible per page (reappears on navigation) - Cannot be permanently disabled (safety)

When Banner Appears

✅ Shows on: - Prescriptions page - Procedures page - Encounters page - All clinical forms - Any page with patient context

❌ Does NOT show when: - No allergies recorded - Only LOW criticality allergies - Viewing patient list - Dashboard

Drug-Allergy Checking

Manual Review

Before prescribing, check:

  1. Review allergy banner
  2. Check medication class
  3. Verify no cross-reactivity

Common Cross-Reactivities:

Allergy Avoid
Penicillin Other beta-lactams (cephalosporins)
Sulfa Sulfonamide antibiotics, thiazides
Aspirin NSAIDs (ibuprofen, naproxen)
Codeine Other opioids

Future: Automated Checking

Planned feature: - Automatic drug-allergy cross-reference - Warning pop-up during prescribing - Override with justification

FHIR AllergyIntolerance Resource

{
  "resourceType": "AllergyIntolerance",
  "clinicalStatus": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical",
        "code": "active"
      }
    ]
  },
  "verificationStatus": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification",
        "code": "confirmed"
      }
    ]
  },
  "type": "allergy",
  "category": ["medication"],
  "criticality": "high",
  "code": {
    "coding": [
      {
        "system": "http://snomed.info/sct",
        "code": "387517004",
        "display": "Penicillin"
      }
    ]
  },
  "patient": {
    "reference": "Patient/patient-123"
  },
  "reaction": [
    {
      "manifestation": [
        {
          "coding": [
            {
              "system": "http://snomed.info/sct",
              "code": "39579001",
              "display": "Anaphylaxis"
            }
          ]
        }
      ],
      "severity": "severe"
    }
  ]
}

Best Practices

Documentation

✅ Do: - Record ALL known allergies - Set HIGH criticality for severe reactions - Document specific reaction - Include date if known - Verify with patient at every visit

❌ Don't: - Rely on memory - Skip allergy verification - Set all as HIGH (reduces effectiveness) - Delete allergies (mark inactive)

Patient Safety

Five Rights of Medication: 1. Right patient 2. Right medication 3. Right dose 4. Right route 5. Right time

Add sixth: Right allergy check

Next Steps