Medication Allergy and Adverse Drug Reaction Documentation Discrepancies in an Urban, Academic Emergency Department

Kiechle, Eric S.; McKenna, Colleen M; Carter, Hannah; Zeymo, Alexander; Gelfand, Bradley W; DeGeorge, Lindsey; Sauter, Diane; Mazer‐Amirshahi, Maryann

doi:10.1007/s13181-018-0671-7

Cited by 21 publications

(16 citation statements)

References 19 publications

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“…Although we note that many of these ADRs occurred at home, these were documented after receiving care for the ADR and not historic reports of a vague history of an ADR. The lack of accurate documentation in the ED is not unique to our institution 5,14 . The discordance of ADR reporting rates in the ED and outpatient settings compared with inpatient documentation at our institution is likely because of active pharmacovigilance oversight in the inpatient setting.…”

Section: Discussionmentioning

confidence: 92%

“…The lack of accurate documentation in the ED is not unique to our institution. 5,14 The discordance of ADR reporting rates in the ED and outpatient settings compared with inpatient documentation at our institution is likely because of active pharmacovigilance oversight in the inpatient setting.…”

Section: Discussionmentioning

confidence: 99%

“…Accurate ADR documentation requires a medical provider to enter the information into the medical record at the point of reaction occurrence. Access to the correct information regarding a patient's history of ADRs is critical for health care providers to safely prescribe medication and prevent future ADRs 3‐6 …”

mentioning

confidence: 99%

“…Access to the correct information regarding a patient's history of ADRs is critical for health care providers to safely prescribe medication and prevent future ADRs. [3][4][5][6] Despite the importance of complete and accurate documentation, providers often fail to both gather the critical information about ADRs and appropriately document the information in the electronic medical record (EMR). [3][4][5] For example, a provider may document "allergy to penicillin" in the EMR, yet this documentation alone does not clarify if the patient developed life-threating anaphylaxis or a common expected side effect such as diarrhea.…”

mentioning

confidence: 99%

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Enhancing Pediatric Adverse Drug Reaction Documentation in the Electronic Medical Record

Tillman

Suppes

Feldman

et al. 2020

The Journal of Clinical Pharma

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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.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Enhancing Pediatric Adverse Drug Reaction Documentation in the Electronic Medical Record

Tillman

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Feldman

et al. 2020

The Journal of Clinical Pharma

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“…19 Furthermore, Kiechle et al found that 41% of patients admitted to the emergency department had discrepancies between the self-reported allergy or adverse effect and the EHR. 20 Shen et al investigated adverse effects as reported in paper charts and the EHR at a tertiary hospital in New Zealand. They reported that 90% of patients had discrepancies in adverse effect information in the EHR and this number significantly rose to 98% of patients within paper charts.…”

Section: Discussionmentioning

confidence: 99%

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

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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.

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Impact of Prior Drug Allergies on the Risk, Clinical Features, and Outcomes of Idiosyncratic Drug-Induced Liver Injury in Adults

et al. 2022

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Medication Allergy and Adverse Drug Reaction Documentation Discrepancies in an Urban, Academic Emergency Department

Abstract: In this cross-sectional ED study, drug allergies and ADRs were both highly prevalent. There were significant discrepancies in documentation of allergies and ADRs between patient self-report and the EMR.

Cited by 21 publications

References 19 publications

Enhancing Pediatric Adverse Drug Reaction Documentation in the Electronic Medical Record

Enhancing Pediatric Adverse Drug Reaction Documentation in the Electronic Medical Record

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

Impact of Prior Drug Allergies on the Risk, Clinical Features, and Outcomes of Idiosyncratic Drug-Induced Liver Injury in Adults

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