Identifying opportunities in EHR to improve the quality of antibiotic allergy data

Abstract

Findings suggest that current EHR documentation practices among the health centers reviewed do not provide enough information on allergic reactions to allow providers to discern between true allergies and common, but anticipated, drug side effects. Improved EHR documentation guidance, training that reinforces the use of standardized data and more detailed recording of allergic reactions, combined with initiatives to address patient barriers including health literacy, may help to improve the accuracy of drug allergies in patients' records. These initiatives, combined with antimicrobial stewardship programs, can help to reduce inappropriate prescribing of alternative antibiotics when beta-lactam antibiotics are first-line and can be tolerated.

Poor reporting and documentation in drug‐associated Stevens‐Johnson Syndrome and Toxic Epidermal Necrolysis – Lessons for medication safety

“…Nonetheless, it highlights that commonly employed antibiotics are often implicated in the acute onset of SJS and TEN, and further supports claims by Graudins et al and others for the need to address recording of serious ADRs, especially antibiotics, to ensure medication safety [12]. Overall, greater vigilance is required to engage physicians and pharmacists to report to the ADR committee, ensuring accuracy of allergy documentation in the EMR and that appropriate information is conveyed to both patients and primary care physicians.…”

The 3 Cs of Antibiotic Allergy—Classification, Cross-Reactivity, and Collaboration

“…These concepts centered on clinical phenotyping are essential to the correct reconciliation of allergies in electronic medical records (EMR), enabling decision support for prescribing to be based upon an accurate initial assessment. Improvements in the algorithms used to record allergies in the EMR and incorporating descriptive classifications, are required 38 .…”

“…38, 124–128 Education programs aimed at hospital providers can increase knowledge of penicillin skin testing and preparedness to investigate allergy histories. 126 Sastre et al .…”

“…63, 129, 130 Although penicillin allergy may be recorded in ≥8% of inpatients, a description in the EMR is often missing (36%). 38 Updating electronic medical records (EMR) and ensuring correct AALs are reinforced or removed post testing is also essential to effect change, 38 yet studies evaluating the impact of the EMR on antibiotic allergy are missing.…”

Improving Antimicrobial Stewardship by Antibiotic Allergy Delabeling: Evaluation of Knowledge, Attitude, and Practices Throughout the Emerging Infections Network

“…Whilst often inaccurate, they are also associated with inappropriate antimicrobial prescribing, microbiological resistance, higher antimicrobial costs, and suboptimal patient outcomes [1–4]. Inappropriate labeling of drug side effects, suboptimal allergy history taking, incorrect antibiotic allergy recording in electronic medical records, and poor clinician understanding have previously been identified as contributing factors [5–7]. …”