Impact of a Pharmacist-Driven Protocol to Improve Drug Allergy Documentation at a University Hospital

Burrell, Christopher J.; Tsourounis, Candy; Quan, David; Jue, Vicki; Tam, Eunice; Guglielmo, B. Joseph

doi:10.1310/hpj4804-302

Cited by 20 publications

(13 citation statements)

References 8 publications

(17 reference statements)

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“…In 1964, Mills addressed the importance of capturing information on allergies and drugs, proposing a new checklist that served as a guideline in hospitals [ 31 ]. A similar initiative was taken more recently by Burrell et al [ 32 ], who introduced a pharmacist-driven protocol in a hospital to improve the completeness of DA or intolerance documentation. A review of medical notes in a general district hospital demonstrated poor documentation practices where 97.4% (114/117) of drug allergy boxes were only partially completed and 2.6% (3/117) had nothing documented [ 33 ].…”

Section: Resultsmentioning

confidence: 99%

Clinical Decision Support Systems for Drug Allergy Checking: Systematic Review

Légat¹,

Laere²,

Nyssen³

et al. 2018

J Med Internet Res

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BackgroundWorldwide, the burden of allergies—in particular, drug allergies—is growing. In the process of prescribing, dispensing, or administering a drug, a medication error may occur and can have adverse consequences; for example, a drug may be given to a patient with a documented allergy to that particular drug. Computerized physician order entry (CPOE) systems with built-in clinical decision support systems (CDSS) have the potential to prevent such medication errors and adverse events.ObjectiveThe aim of this review is to provide a comprehensive overview regarding all aspects of CDSS for drug allergy, including documenting, coding, rule bases, alerts and alert fatigue, and outcome evaluation.MethodsThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed as much as possible and searches were conducted in 5 databases using CPOE, CDSS, alerts, and allergic or allergy as keywords. Bias could not be evaluated according to PRISMA guidelines due to the heterogeneity of study types included in the review.ResultsOf the 3160 articles considered, 60 met the inclusion criteria. A further 9 articles were added based on expert opinion, resulting in a total of 69 articles. An interrater agreement of 90.9% with a reliability Κ=.787 (95% CI 0.686-0.888) was reached. Large heterogeneity across study objectives, study designs, study populations, and reported results was found. Several key findings were identified. Evidence of the usefulness of clinical decision support for drug allergies has been documented. Nevertheless, there are some important problems associated with their use. Accurate and structured documenting of information on drug allergies in electronic health records (EHRs) is difficult, as it is often not clear to healthcare providers how and where to document drug allergies. Besides the underreporting of drug allergies, outdated or inaccurate drug allergy information in EHRs poses an important problem. Research on the use of coding terminologies for documenting drug allergies is sparse. There is no generally accepted standard terminology for structured documentation of allergy information. The final key finding is the consistently reported low specificity of drug allergy alerts. Current systems have high alert override rates of up to 90%, leading to alert fatigue. Important challenges remain for increasing the specificity of drug allergy alerts. We found only one study specifically reporting outcomes related to CDSS for drug allergies. It showed that adverse drug events resulting from overridden drug allergy alerts do not occur frequently.ConclusionsAccurate and comprehensive recording of drug allergies is required for good use of CDSS for drug allergy screening. We found considerable variation in the way drug allergy are recorded in EHRs. It remains difficult to reduce drug allergy alert overload while maintaining patient safety as the highest priority. Future research should focus on improving alert specificity, thereby reducing override rates and alert fatigue. Als...

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Section: Resultsmentioning

confidence: 99%

Clinical Decision Support Systems for Drug Allergy Checking: Systematic Review

Légat¹,

Laere²,

Nyssen³

et al. 2018

J Med Internet Res

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show abstract

“…Systematic reconciliation together with appropriate evaluation of reported ADR will improve the accuracy and completeness of documentation within EHR. Pharmacist‐led initiatives have shown promise in improving the completeness of ADR documentation, identifying discrepancies between the patient's medical records and performing further evaluation of documented ADR . There are opportunities for dedicated clinical services to manage the documentation of ADR in the hospital setting.…”

Section: Discussionmentioning

confidence: 99%

“…Pharmacist-led initiatives have shown promise in improving the completeness of ADR documentation, identifying discrepancies between the patient's medical records and performing further evaluation of documented ADR. [30][31][32] There are opportunities for dedicated clinical services to manage the documentation of ADR in the hospital setting. Health institutions should implement diagnostic pathways to combat the accumulation of ADR labels over a patient's lifetime.…”

Section: Discussionmentioning

confidence: 99%

Documentation of penicillin adverse drug reactions in electronic health records: inconsistent use of allergy and intolerance labels

Inglis

Caughey

Smith

et al. 2017

Internal Medicine Journal

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The frequency of penicillin allergy label in this data set is consistent with the known overdiagnosis of penicillin allergy in the hospital population. ADR documentation was poor with incomplete entries and inconsistent categorisation. The concepts of allergy and intolerance for ADR classification, whilst mechanistically valid, may not be useful at the point of ADR entry by generalist clinicians. Systematic evaluation of reported ADR is needed to improve the quality of information for future prescribers.

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“…In a BPMH, a patient's medication list and list of allergies and ADRs are corroborated with prescription pill containers, as well as family, outpatient pharmacy, and primary care physician input [17]. Previous research has shown that involvement of the pharmacy team in the medication reconciliation process is effective in reducing discrepancies in the medical record, sometimes more so than physician-or nurse-led efforts [10,18,19]. Better allergic reaction and ADR documentation platforms in the EMR may also reduce discrepancy rates, particularly if outpatient and pharmacy records can be seamlessly integrated.…”

Section: Discussionmentioning

confidence: 99%