Allergy alerts in electronic health records for hospitalized patients

González-Gregori, Rebeca; Rojas, Mary; López-Salgueiro, Ramón; Díaz-Palacios, Miguel; García, Antonio Nieto

doi:10.1016/j.anai.2012.06.006

Cited by 18 publications

(8 citation statements)

References 24 publications

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“…Antibacterials for systemic use (~53%) and anti‐inflammatory/antirheumatic products together with analgesics (~19%) were the most frequently reported suspected drugs in the database. These results are in line with findings from other investigations . Penicillins and NSAIDs (eg acetylsalicylic acid, ibuprofen and diclofenac) were particularly implicated, whereas tramadol and metoclopramide also deserve attention.…”

Section: Discussionsupporting

confidence: 91%

Drug-induced hypersensitivity: A 5-year retrospective study in a hospital electronic health records database

et al. 2018

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Summary What is known and Objective Hypersensitivity adverse drug reactions (HADRs) are associated with considerable morbidity and mortality. The aim of this study was to identify cases of HADRs within a hospital electronic health records (EHR) database. Methods Data were extracted from EHR through the Portuguese catalogue of allergies and other adverse reactions (CPARA). This registry allows the collection and sharing of information on HADRs in a structured and harmonized way across the healthcare system. This module is used by healthcare professionals to record HADRs within the EHR of each patient. It applies to patients admitted to hospital because of HADRs and also to inpatients developing such reactions during hospitalization. Data recorded from 2013 to 2017 within the Centro Hospitalar de Entre o Douro e Vouga (CHEDV) hospital (397 beds; ≈20 300 inpatients/year) were considered. The MedDRA® classification was used to codify HADRs. The ATC classification system was used to codify drugs. The concept of individual case safety report (ICSR) was considered for performing analyses. Results and discussion The database contained 464 valid cases (severe, n = 330; 71.1%), corresponding to 380 patients and 559 HADRs. Most patients were female (n = 254; 66.8%); the median age was 55 years. Approximately 0.1% local inhabitants and ≈0.4% inpatients have experienced HADRs over the study period. Most cases (n = 245; 52.8%) were associated with systemic antibacterials. Most HADRs were skin and subcutaneous tissue disorders (n = 266; 47.6%) and immune system disorders (n = 231; 41.3%). The pattern of suspected drugs implicated in anaphylactic reactions was the same as those involved in other HADRs. What is new and conclusion This registry contains HADRs that are relevant for the pharmacovigilance system, but none was spontaneously reported. The responsible authorities should address this problem. The results also reinforce the association between systemic antibacterials and HADRs.

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Section: Discussionsupporting

confidence: 91%

Drug-induced hypersensitivity: A 5-year retrospective study in a hospital electronic health records database

et al. 2018

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“…In many large healthcare organisations, penicillin allergy labels are documented in an electronic health record (EHR). A recent European study reported that of over 15 000 hospital patient EHR, 64.4% included allergy information . This provides a unique opportunity to improve the accuracy and documentation of ADR.…”

Section: Introductionmentioning

confidence: 99%

“…A recent European study reported that of over 15 000 hospital patient EHR, 64.4% included allergy information. 16 This provides a unique opportunity to improve the accuracy and documentation of ADR. The benefits of EHR depend on high quality documentation by clinicians based on accurate information from the patient history or previous records.…”

Section: Introductionmentioning

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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“…Taken together these findings lead us to suggest that ADR categorization as allergy or intolerance at the level of the ordinary HCW registering the patient in the EHR is of questionable usefulness. Indeed, a previous report from Spain on allergy documentation in an (unspecified) EHR pooled together allergies and intolerances since “both concepts were used indistinctly.” The obligatory classification of ADRs into allergy or intolerance at the time of entry is redundant since it provides no practical benefit, and may be counterproductive. Strengths of this study are the large number of reactions documented across an enterprise‐wide system.…”

Section: Discussionmentioning

confidence: 99%

Categorization of adverse drug reactions in electronic health records

Foreman

Smith

Caughey

et al. 2020

Pharmacology Res & Perspec

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The purpose of this study was to evaluate the quality of adverse drug reaction (ADR) documentation in a state‐wide electronic health record (EHR), and to assess the impact of the interface design on documentation accuracy and ability to provide decision support. Data were extracted from 43 011 unique records in a state‐wide electronic health record in South Australia, Australia. Information obtained included ADR coding as allergy or intolerance, allergen name, reaction, and occupation of those entering data. Categorization into drug allergy or intolerance was assessed for accuracy. Reactions were entered predominantly by nurses (60.1%), also by doctors (31.0%) and pharmacists (6.1%). Of 27 314 reactions, 86.5% were coded as allergy and 13.5% as intolerance. The majority (78.2%) described reactions to drugs (as opposed to food, environmental or contact allergens), predominantly chosen from the drug database (96.4%). Many entries used free text for the reaction description (27.4%). Terms found in the predefined list under the allergy heading were more likely to be categorized as allergy, even when the mechanism was pharmacological intolerance. Only 45.1% (n = 1671/3705) of reactions consistent with intolerance (eg, “nausea,” “diarrhea”) were correctly categorized as such, although categorization by pharmacists was more accurate (P < .0001). These data suggest that ADR categorization as allergy or intolerance is influenced by the EHR design. The obligatory classification of ADRs into allergy or intolerance was not well understood and does not appear to have practical benefit.

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Allergy alerts in electronic health records for hospitalized patients

Cited by 18 publications

References 24 publications

Drug-induced hypersensitivity: A 5-year retrospective study in a hospital electronic health records database

Drug-induced hypersensitivity: A 5-year retrospective study in a hospital electronic health records database

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

Categorization of adverse drug reactions in electronic health records

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