CWAD    ICR (10123)

The following information is from patch GMRP*2.5*22,
which describes how this supported reference is used.

A letter from the Regional Director, Western Region, dated January 25, 1994,
subject:  Use of Electronic Mail for Patient Flagging System Among VA
Facilities, requested a utility for flagging and disseminating critical
patient information.  This patch is to inform all sites that such a mechanism
is available within DHCP.  This patch corrects the problem of the (A)llergy
warning being indicated in the CWAD display when the patient has 'No Known
Allergies'.  The variable GMRPHOLD (Supported Reference #10123) will now be
supported by Progress Notes.  If set, this variable will force the user to
enter a carriage return after the CWAD display.  This is designed to be used
when an application clears the screen after a patient lookup.

In response to:  E3R #3056 dtd Oct 5, 1993
NOIS: PROG DEN CWAD  dtd Mar 3, 1994

Through the Progress Notes Application, sites are able to implement a warning
system which notifies users of specific patient conditions.  The system is
called CWAD.  The acronym stands for:

"C" RISIS NOTES
CLINICAL "W"ARNINGS
"A"LLERGIES
ADVANCED "D"IRECTIVES

To Implement the CWAD Warning System:
************************************
To implement the CWAD alert system, the variable "GMRPEN" must be set as an
Entry Action for a particular option.  It may not be appropriate for the CWAD
alerts to be displayed for certain applications.  Which options the CWAD is
implemented with is entirely at the sites' discretion.  The following example
uses the MAS Registration Menu.  This is not to say your site must implement
the CWAD for this option; this is for demonstration purposes only.  It will
work with any menu or option your site deems appropriate.

D P^DI

Select OPTION:  1  ENTER OR EDIT FILE ENTRIES

INPUT TO WHAT FILE:  OPTION// EDIT WHICH FIELD:ALL//ENTRY ACTION THEN EDIT
FIELD:EXIT ACTION

Select OPTION NAME: DG REGISTRATION MENU    Registration Menu ENTRY ACTION: S
(GMRPEN,GMRPHOLD)=1 EXIT ACTION: K GMRPEN,GMRPHOLD Select OPTION NAME: Select
OPTION:
>
Once the variable is initialized the Warnings will be displayed upon patient
look-up.

Select PATIENT NAME:  HOOD,ROBIN  03-04-33   112233444  ACTIVE DUTY

C: 07/01/93   11:53
W: 07/11/93   10:57
A: Known allergies
D: 10/09/93   10:18

Types of Warnings:
*****************

The following are for illustration purposes only.

CRISIS                    CAUTION:  Patient may be homicidal.

CLINICAL WARNING          Patient is HIV positive.

ALLERGY/ADVERSE REACTION  Allergy/Reaction:  Ampicillin

ADVANCE DIRECTIVE         DO NOT RESUSCITATE:  Patient has
Advanced Directive filed in Volume
6 of his medical record.

To Enter Warnings into the CWAD System:
**************************************

With the exception of Allergies, Warnings are entered directly through the
Progress Notes application.

1.  In order for a progress note to be recognized as a Warning, the TITLE of a
note must be linked to one of the following notes types.

a.  CRISIS
b.  CLINICAL WARNING
c.  ADVANCED DIRECTIVES (IMPLEMENTATION OF)

The TITLE narrative is at the discretion of the site.  The important thing to
understand is that the TITLE must be tied to one of the above TYPES.  TITLES
with the same name as the above TYPES were exported with Progress Notes 2.5
already linked together but since the TITLE file is controlled by the site it
is possible your site may have them configured differently.

*NOTE:  Allergy information should be entered through the Allergy Tracking
System.

2.  Once the TITLE is linked with the a warning TYPE, the user may then enter
the Progress Note Option.  Using the Entry of Progress Note option, select the
appropriate title and proceed to enter the warning.  The note must then be
signed.

3.  After signature, the note becomes active on the CWAD Warning System.

How to Access the CWAD Warnings:
*******************************

1.  If the user is assigned the Progress Notes User Menu, the Patient Warning
(CWAD) Display option [GMRPNCW] may be accessed from that menu.  If the user
is not assigned this menu it may be assigned as a secondary menu option. It
would be convenient to the user to make the synonym CWAD.

2.  When a Warning(s) is displayed, review of the warning can be done by
entering CWAD at any option select prompt.  A review screen will be displayed
from which the user can select the warning(s) they wish to view.

After implementation of the CWAD display you may find that the display flashes
by before the user can read it.  This can be corrected by setting the variable
GMRPHOLD, in addition to GMRPEN, in the entry action of the desired
menu/option.  GMRPHOLD must also be killed in the exit action.  WARNING:  Do
not arbitrarily set the variable GMRPHOLD in the entry action without first
checking to see if the option clears does clear the screen after the patient
lookup.  The user may be inconvenienced with an unecessary carriage return.