Background and importance Allergies should be visible on all patient specific pages or screens of the electronic medical record in the hospital information system. The computerised physician order entry system must have a tiered severity rating for allergies based on the patient’s reaction to the drug. Limiting alert fatigue from drug intolerances that are not true allergies and providing clear warnings to staff during medication order entry is crucial for a clinical decision support system (CDSS).
Aim and objectives This study analysed the current practice of documentation of information associated with allergic or idiosyncratic adverse drug reactions (ADRs) in patients admitted to the department of dermatology in order to improve documentation of allergy information and establish a CDSS. The secondary objective was to examine the adherence of follow-up appointments for verification of potential ADRs to improve organisational procedures.
Material and methods Medical reports and entries from patients admitted to the department of dermatology over 4 years due to an ADR were retrospectively reviewed. 611 were considered eligible. A subpopulation of 190 ADR related cases was reviewed to examine adherence to follow-up appointments.
Results In 23.2% (n=142) of patients, the documentation was incomplete: in 1.6% (n=10) the tested alternative drug was not entered, in 5.6% (n=34) the verified allergy/intolerance was not documented and in 16% (n=98) both were missing. In 28.8% (n=90), when patients got a permanent allergy pass a corresponding entry was made with the brand name and not with the international non-proprietary name. In 53 (27.9%) of 190 cases, patients with follow-up appointment recommendations did not keep their appointment at the department of dermatology’s outpatient clinic to verify the concern. If patients had to arrange the appointment on their own (n=51), 49.0% (n=25) did not keep their appointment. Only patients with follow-up in the allergy unit of the department were documented completely in the drug allergy/intolerance field.
Conclusion and relevance Any patient’s allergy information entered into the information technology system must be accurate to allow for clinical decision support screening. Both potential and verified ADRs should be documented, but they must be clearly distinguishable. Fixed appointments improve adherence of follow-up appointments for verification of potential ADRs.
Conflict of interest No conflict of interest