Managing Allergies and Intolerances

In GNUmed three aspects of allergy in a patient are tracked: Allergy state, any actual allergies with details, and date of last reconfirmation of either.

Concepts

Allergy Status

The (suspicion of) presence or absence of allergies and/or intolerances in a patient.

Reconfirmation

The event of ascertaining oneself of the correctness of the allergy state in a patient. Akin to signing the allergy state.

Allergy

Any hypersensitivity in the Gell/Coombs sense. In other words an undesirable reaction produced by the normal immune system. Often also called a sensitivity.

Intolerance

Any undesirable bodily reaction to a voluntary agent exposure not mediated by the immune system.

Therapeutic Precaution

Any condition of the patient which may influence therapeutic decisions, such as "undergoing antiocoagulation".

Caveat

Any attribute or condition of the patient being aware of which is relevant to considering deviation from the standard care process, such as "tends to be aggressive" or "low compliance".

Conceptually there is a tree-like structure of noteworthy conditions (which are not yet fully implemented in GNUmed, however):

• Caveats
  • Therapeutic Precautions
    • Allergies and Intolerances
    • anticoagulation
    • pacemaker in situ
    • ...
  • Unhelpful behaviour
    • aggression
    • low compliance
    • ...
  • Unhealthy substance use
    • nicotin
    • alcohol
    • ...
  • ...

Reviewing allergies

Whenever a potentially allergenic action is commenced (such as administration of a drug in a treatment regime) allergy status should be ascertained. To this end GNUmed offers therapeutic precaution information at various places in the workflow:

the top panel Cave field

This field is always visible within the client and displays either a notification on the allergy state or, if any, a list of abbreviated allergenic agents. A tooltip reveals more complete details. Double-clicking inside the field starts the allergy manager.

the EMR tree

In the tree view of the EMR allergy information is included with the top level node EMR summary displayed on the right hand side.

the substance intake edit area

when adding/editing a substance intake entry allergy information will be displayed at the top

the substance intake list

the tooltip for entries displays a warning if there's an allergy recorded for that entry

documents

documents can include a list of known allergies via a placeholder

the prescription generator

not implemented yet

Various symbols are used to denote certain allergy states and absence/presence of details and/or comments:

• diameter sign: patient does not have any allergies to the best of our knowledge
• ?: the allergy state is unknown
  • unasked
  • asked but still unknown (for any number of reasons)
• !: can appear added to any of the above to denote the existence of a comment over and above the state itself

Editing allergies and allergy state

Double-clicking the Cave field in the top panel opens the allergy manager for the active patient. Within the manager it is possible to modify the relevant allergy information.

Within the Medication plugin (Substance intake) it is possible to turn a documented substance intake entry into an allergy by the click of a single button. Also, from within the edit area for substance intake one can discontinue the entry and mark it allergenic.

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