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Several years later, the patient from scenario 1.1 who has since received an aortic valve replacement is seeing another physician within the organization for consultation on antibiotic prophylaxis for an upcoming dental procedure. The second physician decides that a penicillin class antibiotic is appropriate for the patient.  

When the physician creates an order for amoxicillin 2 g orally as a single dose and commits to the electronic prescription, an alert appears which requires a response by the physician warning him of an allergy history to penicillin. The substance-based alert is generated by the EHR drug-disease interactions software, which uses the Allergy list as a reference. As the patient has not received penicillin class antibiotics for several years, the physician decides to refer the patient to an allergy specialist for clarification of current status of penicillin allergy. 

The specialist performs skin testing for penicillin allergy, the results of which are positive. The patient is confirmed as penicillin allergic and the results of the testing are documented in the patient’s medical record. 

The patient is subsequently prescribed azithromycin for his dental procedure.

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