Notifications and Alerts

ScriptSure Cloud ERX includes the First Databank^® drug databases that allow for medication checking while prescribing to inform users of potential Adverse Drug Events, allergies and interactions.  For several of the checks, users can set preference levels for the threshold of alerts they want to see.  Below you will find descriptions of the drug alerts.

Permissions

In the Settings menu, there are both ADMINISTRATOR settings and USER SETTINGS for Checks and Alerts.  

The ADMINISTRATOR settings, found under the Practice Settings, dictate the alerts and levels that management or an admin requires to be turned on.  For example, if an administrator turns on Patient Allergy Check at the practice, the users CANNOT turn this off for themselves.  If an administrator has not turned on the Drug to Food interaction check, a user CAN turn this on for themselves.  Ultimately, an admin can control the global preferences for the checks and alerts for all users or can leave those settings to the provider preferences. 

Accessing Checks and Alerts

1. Login to ScriptSure.

2. Click your name in the top right of ScriptSure.

3. From the drop-down click "My Profile":

4. Click on the Gear Icon right across the practice that you'd like to edit.
  

NOTE: Depending on your whether or not you are an administrator, the Settings may appear differently. If you are an administrator, you will see the Practice Settings.

Patient Allergy Check

Drug allergy reactions can result in serious and life threatening consequences and should be carefully considered when prescribing drug therapy. The drug allergy check identifies drugs that are known to have a higher incidence of causing clinically significant allergic reactions. Additionally, drug allergy check identifies cross-sensitivities among related drugs that may cause drug allergy reactions in patients allergic to similar compounds.  ScriptSure checks any patient allergy against all drugs within the database.  Potential allergy-causing drugs are identified as an allergy on-screen and/or presented with more information via a pop-up window.

Drug to Drug Interaction Check

Drug interactions can be costly for patients, insurers, and society. These costs can be measured in terms of bodily harm and physical suffering in addition to extended hospital stays and lost workdays. The need for drug interaction screening is present in a variety of healthcare settings.  The Drug to Drug Interaction check is a tool that assists in identifying and preventing drug interactions. The database covers every drug product that is approved for marketing in the United States. The drug to drug interaction databases report the desired level of interactions the user wants to see: from undetermined severity to only the most clinically significant interactions.   ScriptSure checks any current medications entered into ScriptSure for a patient and those that are about to be prescribed.  Potentially interacting drugs are indicated on-screen and/or are presented with a pop-up window and identified as an interaction on-screen.  Different drug to drug interaction tolerance levels can be selected: ranging from flagging only severe interactions to flagging any and all potential interactions. Drug tolerance level selections range from:

• Undetermined severity (default) – will show ALL interactions
• Moderate interaction only
• Severe interactions only
• Contraindicated drug combinations only

Drug to Food Interaction Check

The Drug to Food Interaction check was designed to provide alerts on the potential of interactions occurring between certain drugs and food components when used in combination. In addition, the Drug-Food Interaction check provides the capability for generating cautions and other advisory information specific to each potential drug-food interaction. Users are provided with condensed hard copy messages and complete monograph information on the nature of the drug-food interaction.  It should be noted that the body of evidence available on drug-food interactions is limited and not nearly as extensive, for example, as drug-drug interactions.   Checks are presented with more information via a pop-up window. A specific Drug to Food tolerance can be selected ranging from minor significance to most significant. If you only want to see significant drug to food interactions, select Most significant.

Polypharmacy Check 

Polypharmacy is defined in this application as the use of a drug to treat the side-effect of another drug.  The clinical judgment of the healthcare professional must determine if this therapy is appropriate. For example, amoxicillin is dispensed to a patient on day one, and on day three of antibiotic use, the same patient presents to the pharmacy with a prescription for loperamide. This new drug carries the indication for diarrhea, matching with amoxicillin’s side-effect profile of diarrhea. This case indicates potential polypharmacy conditions. ScriptSure will warn the physician with a polypharmacy warning in this case. Checks are presented with more information via a pop-up window.  Polypharmacy checks have several levels users can set to refine the number of alerts that appear:

• Side effect frequency polypharmacy
  1. Incidence rare or very rare
  2. Incidence less frequent
  3. Incidence more frequent
• Side Effect Severity polypharmacy
  1. Less severe
  2. Severe

Duplicate Therapy Check

Detecting and preventing duplicate therapy improves patient safety and reduces the risk of additive clinical effects by calling the duplications to the attention of healthcare personnel. Additionally, eliminating redundant therapies can reduce the cost of medication therapy.  The Duplicate Therapy check offers point-of-care screening to identify potential duplications of drug therapy by comparing new drug orders to drugs that already exist in a patient drug current medication list (profile). This is achieved using the following components.  Duplicate ingredient checking compares the ingredients of the new drug to the ingredients of the active drugs in a patient profile. Duplicate therapy class checking uses specialized therapeutic drug classes developed specifically for duplicate therapy detection. Checks are presented with more information via a pop-up window.

Additive Side-Effect Check

The Side-Effect check addresses the problem of drug-induced illness/side-effects. The Side-Effect check adheres to OBRA patient consultation requirements for advising patients about common, severe side-effects of their medications.  Detailed and comprehensive lists of side-effects can be generated for use in patient monitoring and counseling. The potential for additive side-effects between two or more medications can be checked.   Situations can be identified where the side-effects of a given drug may complicate a patient’s existing medical condition(s). Drug-induced adverse effects can be detected, which facilitates compliance with Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requirements stating that “medication errors and adverse drug reactions shall be reported immediately.”  A specific side-effect tolerance can be selected ranging from incidence rare or very rare to incidence more frequent. Checks presented with more information via a pop-up window.

• Side effect frequency
  1. Incidence rare or very rare
  2. Incidence less frequent
  3. Incidence more frequent
• Side Effect Severity
  1. Less severe
  2. Severe

Additive Side-Effect Condition Check (via ICD-10)

side effectSimply put, the Additive Condition checks compare a potential side-effect to an existing patient condition.  For example, if a patient is being treated for impotency and a drug is known to have a side-effect of impotency, ScriptSure will warn of this situation. presented with more information via a pop-up window. Checks are presented with more information via a pop-up window.

• Side effect frequency
  1. Incidence rare or very rare
  2. Incidence less frequent
  3. Incidence more frequent
• Side Effect Severity
  1. Less severe
  2. Severe

Drug to Disease Condition Check

The Drug-Disease checks are designed to create warnings concerning the use of certain drugs in patients with specific health-related conditions and diseases, or patients who have had certain procedures or diagnostic tests. Healthcare professionals can use these warnings to make informed decisions about altering a patient’s drug therapy when these conditions exist. For these checks to be performed within ScriptSure, a condition must be manually entered for a patient. Checks are presented with more information via a pop-up window.

Geriatric, Lactation, Pediatric & Pregnancy Precautions Checks

These warnings allow healthcare professionals to make informed decisions about altering a patient’s drug therapy when potential problems exist.    The following four modules make up the Precautions modules:

• Pregnancy Precautions Module™ (PREG)
• Lactation Precautions Module™ (LACT)
• Geriatric Precautions Module™ (GERI)
• Pediatric Precautions Module™ (PEDI)

The Precautions modules are intended for use as screening mechanisms to detect pregnancy, lactation, geriatric, or pediatric drug precautions specific to those patient populations. The precautions are clinically relevant and are generally well documented in the literature. However, Pregnancy and Lactation information may not be as conclusive in the literature and inconclusive precautions or precautions based on very limited data may be presented. Warnings may not be included if there is no data on a particular drug usage in a given population covered by the Precautions modules. Checks are presented with more information via a pop-up window.  Users can set several different levels (thresholds) for the checks that would like to be alerted for.

Drug Comment Check

ScriptSure contains the ability to enter a patient-specific drug comment.  For example, after a drug has been prescribed a comment can be attached to it.  When this check is activated, the comment entered will appear the next time the drug is selected for the same patient.  This allows users to track a drug’s efficacy for a particular patient. Checks are presented with more information via a pop-up window.