Clinical Decision Support for Drug Interactions, Allergies, and Pathways

Overview#

A paramedic about to give a drug needs to know in the same second whether it clashes with the patient's existing medications or allergies. The Clinical Decision Support module surfaces drug-drug interactions, drug-allergy contraindications, dose-by-weight calculations, and JRCALC pathway prompts directly inside the ePCR, with every alert and clinician decision logged for governance.

It runs in-tenant against the platform's own PostgreSQL formulary tables joined against the live patient context, so suggestions reflect the actual encounter rather than a generic lookup. Pathway prompts cover scenarios such as ROSC post-arrest care, paediatric resuscitation, and severe asthma, and AI Partner suggestions stay tied to retrievable JRCALC 2024 source guidance.

Last Reviewed: 2026-05-05 Last Updated: 2026-05-05

Key Features#

Drug-Drug Interaction Alerts: Cross-check the proposed drug against the patient's current medication list and surface interactions before administration.
Drug-Allergy Contraindication Alerts: Match the proposed drug against recorded patient allergies and intolerances, including class-level matches via SNOMED CT and RxNorm normalisation.
Dose-by-Weight Calculation: Compute paediatric and weight-based adult doses from the encounter's recorded weight and present the calculated dose alongside the prescribed range.
JRCALC 2024 Pathway Prompts: Trigger pathway-specific suggestions for scenarios such as ROSC post-arrest care, paediatric resuscitation, and severe asthma, retrieved from the JRCALC 2024 clinical practice guideline corpus.
Retrieval-Augmented CPG Suggestions: AI Partner suggestions cite the underlying JRCALC source so the clinician can read the rationale, not just the prompt.
Auto-Flag from PSAP Triage: STEMI, stroke, and arrest flags from the originating PSAP triage feed the same alert stream so a rule does not fire twice and context is preserved across the call chain.
Override Audit Logging: Every alert records the patient context, the rule that fired, the clinician's decision (accepted, overridden, dismissed), and the rationale for clinical governance review.
Encounter-Bound Alert Stream: Alerts are linked to the encounter via the incident foreign key and surface on the unified incident timeline alongside vitals, interventions, and dispatch context.

Use Cases#

Pre-Administration Drug Check: A paramedic about to administer a drug sees an immediate visual alert if it interacts with the patient's existing medication list or allergies, with the clinical rationale visible and the override audit-logged.
Paediatric Resuscitation: Weight-based dose calculation surfaces the correct paediatric dose against the recorded child weight, alongside the JRCALC paediatric resus pathway prompts.
Severe Asthma Pathway: Vitals and presentation trigger the severe asthma pathway prompt, with stepwise guidance retrieved from the JRCALC corpus.
Post-ROSC Care: After return of spontaneous circulation, the post-arrest care pathway prompt is surfaced so temperature management, ventilation targets, and 12-lead ECG steps are not missed.
STEMI / Stroke from Dispatch: A STEMI or stroke flag raised at PSAP triage carries through to the ePCR alert stream, so the receiving crew sees the same clinical context the dispatcher saw.
Clinical Governance Review: A clinical lead reviewing a case sees every alert that fired, what the clinician did, and the linked patient context, all on the unified incident timeline.

Integration#

In-Tenant PostgreSQL Formulary: Drug catalogue, interaction tables, and allergy mappings live in the tenant's own database and are joined against the live encounter context.
ePCR Alerts Panel: The alerts panel UI in the ePCR app renders interaction, allergy, dose, and pathway alerts in priority order with the clinician decision controls.
Mobile Alert Chip: Responder mobile screens for interventions and vital signs surface a compact alert chip so field crews see the alert without leaving the active capture flow.
Unified Incident Timeline: Alerts and clinician decisions appear on the same timeline as dispatch events, vitals, and interventions, giving a single clinical narrative for each incident.
PSAP Triage Bridge: Auto-flags from PSAP triage feed the same alert engine so dispatch-side clinical signals (STEMI, stroke, arrest) are not duplicated downstream.
Audit and Governance Pipeline: Alert fired and alert actioned events emit as CloudEvents for downstream clinical governance, audit, and analytics consumers.

Open Standards#

JRCALC 2024: pathway prompts and clinical practice guideline retrieval are aligned to the Joint Royal Colleges Ambulance Liaison Committee 2024 guidelines used across UK and Ireland ambulance services.
HL7 FHIR R4 MedicationKnowledge: drug catalogue entries map to the standard medication knowledge resource for cross-system interoperability.
HL7 FHIR R4 AllergyIntolerance: patient allergy and intolerance records use the standard FHIR resource so allergy data can flow with the patient.
HL7 FHIR R4 DetectedIssue: clinical alerts are representable as DetectedIssue resources for downstream clinical record exchange.
LOINC: vital sign and laboratory codes feeding pathway triggers use the common clinical observation code system.
SNOMED CT: clinical findings, conditions, and allergy substances use SNOMED CT codes for class-level matching and cross-system meaning.
RxNorm: drug normalisation supports cross-mapping against US reference data where shared formularies are needed.
First Databank / SNOMED CT Drug Refset: drug interaction sources align with the SNOMED CT drug extension, with optional First Databank integration where the tenant holds a commercial licence.
CloudEvents 1.0: alert lifecycle events are emitted as argus.cds.alert_fired and argus.cds.alert_actioned for downstream governance and analytics.
HTTPS / TLS: clinical alert traffic uses the standard secure web transport baseline.
JSON: alert payloads remain easy to exchange across ePCR, mobile, governance, and partner systems using a common structured format.