Accuracy of Adverse Drug Reaction Documentation upon Implementation of an Ambulatory Electronic Health Record System

Hui, Caleb; Vaillancourt, Régis; Bair, Lissa; Wong, Elaine; King, James W.

doi:10.1007/s40801-016-0071-8

Cited by 12 publications

(10 citation statements)

References 16 publications

(17 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The results indicated that 44% of patients had incorrectly documented adverse drug reaction information in the EHR. 22 The results of our study, performed in 2 separate adult inpatient units of a community hospital, are consistent with the results of other studies performed in various settings and further clarify which medication classes are most prone to discordance.…”

Section: Discussionsupporting

confidence: 91%

Discrepancies Between Patient Self-Reported and Electronic Health Record Documentation of Medication Allergies and Adverse Reactions in the Acute Care Setting: Room for Improvement

Kabakov

Rhodes

Wenzel

2019

Journal of Pharmacy Technology

View full text Add to dashboard Cite

Background: Allergy information is commonly transcribed into an electronic health record (EHR) for all patients admitted to acute care hospital units by a licensed health care professional. The allergy history is utilized each time a new inpatient medication is prescribed to identify the patient’s risk of having an allergic reaction and/or anaphylaxis. There is potential for negative consequences in cases where the allergy history is incorrectly documented. Objective: The objective of this study was to assess the discordance between documented allergy information in the EHR and verbally reported allergy information from a patient interview. Methods: Prospective, observational, nonrandomized study performed within a 2-month period during the Spring of 2016. The study was performed at a teaching community hospital in Chicago, Illinois. A total of 270 patients were interviewed on the general medicine (n = 216) and headache (n = 54) units regarding their medication allergies and reactions. The outcomes were discordance among EHR-documented and verbally stated medication allergies and reactions. Results: The agreement across all medications and reactions between the EHR and patient self-reported interview was 80.9%. There were 31 reactions (6.7%) that were verbally reported by patients but were not documented in the EHR (omissions) and 57 reactions (12.4%) that were verbally reported but were incorrectly documented in the EHR (incorrect documentations). Only 20 out of the 264 verbally reported reactions (7.5%) met the study definition of anaphylaxis. The highest rate of incorrect documentations occurred with opiate agonists, and the highest rate of omissions occurred with anticonvulsants. EHR documentation was more likely to be incorrect among patients who reported gastrointestinal reactions and was more likely to be correct among patients who reported cutaneous reactions. Conclusion: There was a high rate of discordance amid EHR-documented and verbally stated medication allergies and reactions. Errors among opiate agonists, anticonvulsants, and sulfa drugs were most prevalent.

show abstract

Section: Discussionsupporting

confidence: 91%

Discrepancies Between Patient Self-Reported and Electronic Health Record Documentation of Medication Allergies and Adverse Reactions in the Acute Care Setting: Room for Improvement

Kabakov

Rhodes

Wenzel

2019

Journal of Pharmacy Technology

View full text Add to dashboard Cite

show abstract

“…We report that the presence of a pharmacovigilance service greatly increased timely documentation of ADRs within the medical record. This is consistent with reports from other centers, after incorporation of a prospective pharmacovigilance service 3,7,8,15‐19 . Although the increased detection of ADRs after incorporation of a prospective pharmacovigilance program is well documented, these programs are unfortunately not the standard in all hospitals.…”

Section: Discussionsupporting

confidence: 89%

“…Although the increased detection of ADRs after incorporation of a prospective pharmacovigilance program is well documented, these programs are unfortunately not the standard in all hospitals. Developing standardized EMR alerts or reports to detect ADRs requires time and infrastructure 3,6,16,20,21 . In addition, personnel, typically a clinical pharmacist, are needed to evaluate automated EMR reports and investigate potential ADRs 20,22 …”

Section: Discussionmentioning

confidence: 99%

“…This is consistent with reports from other centers, after incorporation of a prospective pharmacovigilance service. 3,7,8,[15][16][17][18][19] Although the increased detection of ADRs after incorporation of a prospective pharmacovigilance program is well documented, these programs are unfortunately not the standard in all hospitals. Developing standardized EMR alerts or reports to detect ADRs requires time and infrastructure.…”

Section: Discussionmentioning

confidence: 99%

“…Developing standardized EMR alerts or reports to detect ADRs requires time and infrastructure. 3,6,16,20,21 In addition, personnel, typically a clinical pharmacist, are needed to evaluate automated EMR reports and investigate potential ADRs. 20,22 Although personnel, EMR tools, and usability are very important, education and a positive culture of ADR reporting can be invaluable in increasing ADR reporting rates.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Enhancing Pediatric Adverse Drug Reaction Documentation in the Electronic Medical Record

Tillman

Suppes

Feldman

et al. 2020

The Journal of Clinical Pharma

View full text Add to dashboard Cite

Adverse drug reactions (ADRs) often go unreported or are inaccurately documented in the electronic medical recorded (EMR), even when they are severe and life‐threatening. Incomplete reporting can lead to future prescribing challenges and ADR reoccurrence. The aim of this study was to evaluate the documentation of ADRs within the EMR and determine specific factors associated with appropriate and timely ADR documentation. Retrospective data were collected from a pediatric hospital system ADR reports from October 2010 to November 2018. Data included implicated medication, type, and severity of reaction, treatment location, the presence or absence of ADR documentation in the EMR alert profile within 24 hours of the ADR hospital or clinic encounter discharge, ADR identification method, and the presence or absence of pharmacovigilance oversight at the facility where the ADR was treated. A linear regression model was applied to identify factors contributing to optimal ADR documentation. A total of 3065 ADRs requiring medical care were identified. Of these, 961 ADRs (31%) did not have appropriate documentation added to the EMR alert profile prior to discharge. ADRs were documented in the EMR 87% of the time with the presence of pharmacovigilance oversight and only 61% without prospective pharmacovigilance (P < .01). Severity of ADR was not a predictor of ADR documentation in the EMR, yet the implicated medication and location of treatment did impact reporting. An active pharmacovigilance service significantly improved pediatric ADR documentation. Further work is needed to assure timely, accurate ADR documentation.

show abstract

Methods for Detecting Pediatric Adverse Drug Reactions From the Electronic Medical Record

Joyner

Alicea

Goldman

et al. 2021

The Journal of Clinical Pharma

View full text Add to dashboard Cite

Adverse drug reactions (ADRs) are common yet are often underreported, making them difficult to track and study. Prospective pharmacovigilance programs significantly increase detection and reporting of ADRs. The aim of this pilot study was to apply triggers used by a prospective pharmacovigilance program at a freestanding children's hospital to retrospectively detect ADRs at our institution, therefore determining if these methods could be replicated and provide the basis for implementation of a prospective pharmacovigilance program. In 2019, our institution had 22 000 inpatient admissions and 51 000 emergency room visits and had 21 ADRs voluntarily reported in an electronic medication safety tracking system. Additional ADRs were identified by methods including new or modified entries to a patient's allergy profile in the electronic medical record (EMR) and International Classification of Disease (ICD) codes. We identified 754 unique patients with changes to allergy profile and 5719 ICD codes in 3966 unique patients to evaluate. These triggers prompted screening of the EMR to validate the ADR, and we identified 280 ADRs occurring in 2019. Eight (2.8%) were identified solely by the electronic medication safety tracking system, 64 (23%) were identified by the allergy list, 110 (39%) were identified only by ICD coding, and the remaining 98 (35%) were identified by multiple methods. The use of triggers followed by review of the EMR identified 13‐fold more ADRs than were voluntarily reported, illustrating the need for an active pharmacovigilance service and the successful use of multimodal methods to detect and track ADRs.

show abstract

Accuracy of Adverse Drug Reaction Documentation upon Implementation of an Ambulatory Electronic Health Record System

Cited by 12 publications

References 16 publications

Discrepancies Between Patient Self-Reported and Electronic Health Record Documentation of Medication Allergies and Adverse Reactions in the Acute Care Setting: Room for Improvement

Discrepancies Between Patient Self-Reported and Electronic Health Record Documentation of Medication Allergies and Adverse Reactions in the Acute Care Setting: Room for Improvement

Enhancing Pediatric Adverse Drug Reaction Documentation in the Electronic Medical Record

Methods for Detecting Pediatric Adverse Drug Reactions From the Electronic Medical Record

Contact Info

Product

Resources

About