Pertinent Negatives allow crew members to notate that an assessment or procedure was not performed or that a symptom was not present. There may be alternate definitions of "pertinent negatives" out in the field but this is how NEMSIS (and other entities) currently define it. This feature can be configured on/off by the Service.
Pertinent Negatives have been incorporated into the emsCharts patient record as part of the NEMSIS v3 initiative. The idea is basically that there is an icon for each field that has pertinent negatives. There you can specify the single pertinent negative value for that field. In some cases selecting a pertinent negative code will gray out / disable the field to prevent incorrect data entry. In some cases, such as medications, procedures and exams, the negative code is simply another selection. In general, for dropdown or pick list fields, the values should appear at the end of the pick list of values.
Pertinent Negatives are controlled via Configuration → Service → Chart tab → Use Pertinent Negatives. If set to “Yes” then the pertinent negatives will appear on the chart.
Also, if the chart has any pertinent negatives saved, then the pertinent negatives will appear even if the current setup is set to “No”
Text Fields and Some Single Select Dropdown Fields
For these an icon appears on the appropriate page (i.e. Patient Page, Page 8) to allow the capturing of pertinent negatives. If a pertinent negative value was recorded for a field, that field value would be cleared and disabled.
The pertinent negative value itself would not have to appear on the individual pages - only a notation that one was recorded (The pertinent negative value will appear on the printed page however).
- Patient First & Last Name (Patient Page) (Last Name will also disable Suffix field)
- Date of Birth (Patient Page)
- Estimated Weight (Patient Page) (will also disable Weight Unit dropdown field)
- GCS Eye, Motor, Verbal, and Total (Page 3 & Page 8) If a "pertinent negative" is set for Eye, Motor, or Verbal and a pertinent negative has not been set for Total, the Total pertinent negative will be set to the same value.
- Cardiac Rhythm (also disables REG/IRR dropdown), BP, Heart Rate, Pulse Ox, Respiratory Rate, CO, CO2, Blood Glucose, Total GCS Score, Temperature (also disables temperature scale and method), APGAR, RTS (Page 8)
- Pain Scale (Page 8)
Other Single Select Dropdown Fields
For some fields the negative values should be added at the end of the dropdown list of values. This will naturally prevent selecting a positive and a negative value at the same time.
- Length Based Tape Measure (Page 3; Pediatric patient)
- Pregnancy (Page 5; Obstetrics)
- Stroke Score (Page 8) (maybe, still waiting on clarification from NEMSIS)
- Thrombolytic (Reperfusion; Page 8)
Pick list (Multi-Select) Fields – Negative at Field Level
The pertinent negatives for these fields apply to the field itself, for example "Drug/Alcohol Indicators Unable to Complete". Compare against "Negative at Value Level" below. The values at field level, if selected, will prevent the ability to select ANY "positive" value for this field.
- Patient Medications (Patient Page)
- Patient Allergies (Patient Page)
- Patient Medical History (Patient Page)
Pick list Fields – Negative at Value Level
These fields allow the negative to be applied at the value level. That is, a specific assessment value was not noted.
The pick lists will be updated to display a series of "Not Present" checkboxes in addition to the existing "Present" checkboxes. Example pick list:
- Drug / Alcohol Indicators (Page 2; Drug/Alcohol = Yes)
- Vehicular, Pedestrian or Other Injury Risk Factor (MVI Button)
- Exam (Head, Face, Neck, Arms, etc. – All body locations Page 5)
- Mental & Neurologic (Page 3/4)
Pick list Fields – Negative at Value Level special cases
Procedures and Medications on page 8 are an exception to the previous section. For these, two new procedures have been added – "Pertinent Negative – Procedure" and "Pertinent Negative – Medication".
- Procedures: Displays a list of all NEMSIS v3 procedures, broken down into sections by category (any values with NULL/blank category will be put in a section named Miscellaneous). Each value has a dropdown of pertinent negative values that the user can choose from. Procedures on the prior aid will differ from how emsCharts normally lists procedures. On Page 8, we have them divided into "Action" categories and split out by various fields. On the prior aid we provide the name of the procedures as NEMSIS provided to us. These values are subject to change, however if selected in a chart, will always be shown with the patient record.
- Medications: Lets user enter pertinent negative value and other relevant data for medications. Multiple values can be entered per procedure.