Recording of drug allergies: are we doing enough (original) (raw)
2007, Journal of Evaluation in Clinical Practice
Objective To assess the implementation of local and national guidelines concerning documentation of drug/clinical hypersensitivities.Design Audit with retrospective and prospective components used to assess the process of drug hypersensitivity documentation.Patients Fifty surgical inpatients’ notes were retrospectively analysed followed by 63 patients prospectively.Setting West London teaching hospital.Main outcome measures Drug hypersensitivity status correctly indicated on clinical notes, drug ‘Kardex’ charts, and anaesthetic records; these three documents were to concur. Hypersensitivities qualified according to symptoms experienced.Recommendations Standardization of preoperative clinical notes and multidisciplinary responsibility for records between doctor, nurse and pharmacist.Results Hypersensitivity documentation in clinical notes improved by 7% after the introduction of a formalized history sheet for preoperative clinics. These were based upon the anaesthetic charts, which had demonstrated 100% documentation previously. Considerable improvements (70.8%) in the clarification of adverse reaction symptoms post recommendation were shown; this was also attributed to the new history sheet. Concurrence improved by 2%.Conclusions The original study revealed areas for improvement and provided part of the solution – a more standardized preoperative assessment tool. Multidisciplinary cooperation in addition to formalizing the assessment process has led to a more efficient and safer service for patient and medicolegally for health care professionals.Key messages (1) Standardized forms, for the recording of clinical information preoperatively, ensure relevant guidelines are implemented in practice. (2) Multidisciplinary teams provide a vital safety net for their patients and colleagues.
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An audit of drug allergy documentation in a district general hospital
■ Drug allergies are currently an important issue in risk management within the NHS. Are they being documented correctly? ■ Allergy status records and red alert wrist band use across three hospital directorates were checked and compared to the standard set in the trust drug policy ■ Recording of allergy status is not in line with local policy and is often absent from patient records; this includes a clear statement for those patients with no drug allergies. ■ Prominent allergy alert systems such as red wrist bands are not being used in line with local policy
Self-reported drug allergies and the diagnostic work-up in the surgical population
Journal of Evaluation in Clinical Practice, 2010
Objective The diagnostic work-up of a drug hypersensitivity reaction is indeed difficult. In general, medical documentation of allergic reactions in medical reports is usually highly deficient or non-existent. The aim of this study was to analyse the prevalence of selfreported drug allergies in the surgical population as well as the criteria used in the diagnosis of drug hypersensitivity reactions. Methods A prospective study with the consecutive participation of 1439 patients, following surgical intervention, attended the Post-Operative Care Unit. Previously, as a routine process during the pre-anesthesia consultation, all patients were questioned about whether they had any drug allergies to report and diagnostic work-up. Results The prevalence of self-reported drug allergies was 8.3% (119/1439): 3.6% considered themselves allergic to b-lactams and 2.4% to non-steroidal anti-inflammatory drugs. Approximately one-third of the subjects (40 out of the 119) had not been subjected to any allergy diagnostic procedure and with 79 (66.4%), the only diagnostic test used by the Allergy Unit had been the skin prick-test. None of those participating in the study had tryptase, methylhistamine, specific IgE or intradermal tests carried out to characterize the diagnosis of the allergic reaction. Conclusions These results show that self-reported drug allergies are highly prevalent and as yet little explored. It is an important prevalence which should bring about modifications to the prescription of certain medicaments. The medical personnel must be made aware of the need to make an accurate diagnosis of allergies to medicaments. Drug allergies in surgical population E. Tamayo et al.
Pakistan Armed Forces Medical Journal
Objective: To assess whether status of allergies is accurately documented in clinical notes and drug prescription charts in two medical wards in Armed Forces Institute of Cardiology (AFIC) as compared to NICE guidelines. Study Design: We designed a classic audit of measuring current practice against guidelines.Place and duration of Study: Armed Force Institute of Cardiology/National Institute of Heart Disease (AFIC/NIHD), Rawalpindi Pakistan, from May to Oct 2020.Methodology: Each cycle contained of a two weeks’ period in which all new patients admitted in coronary care ward 3 and ward 10 were assessed. A total of 110 patients were assessed in each cycle. Repeat audit cycle was performed after 6 months similarly.Results: In first audit cycle, we assessed 110 patients. The status of allergies for most patients was recorded in clerking proforma (n=103, 93%) but there were deficiencies found in recording of allergies on drug kardex (n=25, 22%). After education and awareness, the second...
The Journal of pharmacy technology, 2019
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.
Pharmacy World & Science, 2009
Allergies to drugs are a major cause for hospitalisation and inappropriate prescriptions to patients. However, allergies can be prevented if the patient's history of drug allergy is known and coded. Assessment of the value of the widely used ICD-10 codes for drug-allergies (e.g. Z88, L27) as triggers for decision support in an electronic prescription system and evaluation of the potential impact of such an alert system. We also evaluated the usefulness of manual drug allergy notes recorded in patients' charts in the prevention of prescribing errors due to drug allergies. University hospital providing primary and tertiary care. Using Anatomical Therapeutic Chemical (ATC) classification codes we allocated to drug specifying ICD-10 codes (i.e. Z88) all drugs belonging to the same group of compounds or those known to induce cross-allergy. In a randomly selected cohort of 200 in-patients we then assessed documentation and coding of drug allergies and incident prescribing errors ignoring patients' drug allergies. Eighteen of the 200 patients had an allergy-related ICD code in the chart, 51 had a written note, and 13 had both. About 21% of patients with documented drug allergies were prescribed a drug potentially triggering the allergy. There was no difference in prescribing errors due to drugs potentially inducing allergies when the allergy was only documented as an ICD-10 code or the information was available in the paper record (P > 0.05). The findings of this study emphasise the necessity of a more precise and efficient documentation system of drug allergies along with the implementation of an electronic CDS for drug allergies that makes physicians aware of patients' drug allergies during the prescribing process.
Background and aim. Adverse drug reactions (ADRs) are common events in medical practice, representing a matter of concern for both outpatient and in hospital care. Understanding and management of ADRs depend on their mechanism and clinical picture, which are complex and highly heterogeneous. Drug hypersensitivity reactions (DHRs) are immunologically-mediated ADRs, which are considered allergies after demonstrating evidence of either drug-specific antibodies or T-cells. The correct diagnosis of a drug allergy in hospital setting is essential for the outcome of treated disease and for the patient future in terms of therapeutic needs. Patients may be labeled as being drug allergic, based on their history and vague symptoms that do not correspond to a true allergic reaction. The aim of our study was to evaluate consequences of drug allergy labelling of female patients hospitalized in the department of obstetrics and gynecology from a university hospital during one year, in terms of medical attitude and therapeutic approach. Method and Results. We found that 159 out of 2395 patients hospitalized in the obstetrics-gynecology department declared a history of drug allergy on admission, but only 3 patients had medical documents and adequate recommendations from the allergist. Hospital medical attitude was significantly influenced in all declared allergic patients, mainly in terms of antimicrobial and anti-inflammatory therapy. Conclusion. We concluded that overestimation of drug allergies in hospital care has important consequences in terms of current and future recommended therapy that should be based on standardized allergist evaluation.
Approaches to Recording Drug Allergies in Electronic Health Records: Qualitative Study
PLoS ONE, 2014
Background: Drug allergy represent an important subset of adverse drug reactions that is worthy of attention because many of these reactions are potentially preventable with use of computerised decision support systems. This is however dependent on the accurate and comprehensive recording of these reactions in the electronic health record. The objectives of this study were to understand approaches to the recording of drug allergies in electronic health record systems.
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