Disparity in Patients' Medication Allergy Information
Abstract and Introduction
Objectives: The objective of this study was to compare current adverse drug/allergy reaction reporting in patient electronic medical records/charts against information gathered during patient interviews in the emergency department. Our hypothesis was that current methods for allergy reporting results in significant discrepancy between what is documented and the actual allergy history upon interviewing the patient.
Methods: The study was conducted between December 2011 and April 2012 in an academic emergency department. This was a convenience sample study comparing a prospective patient interview with previously documented allergy histories. Demographics for sex, age, and race were recorded. Patients to be interviewed were adults with at least one documented allergy in their chart. Descriptive statistics and percentages were used for demographic and prevalence data. Agreement between interviews and charts was assessed for both the reaction type and the reaction descriptor.
Results: There were 101 patients interviewed during this 4-month period, and a total of 235 adverse drug reactions were recorded. There were 66 women and 35 men included in this study. The mean age was 51 ± 17 years. The median number of allergy instances for women was 2 (interquartile range 1–3) and for men the median number of allergy instances was 1 (interquartile range 1–2). The percentage of agreements for overall allergies was 85% and 50% for the type of reaction. Total profile agreement occurred in nine patients.
Conclusions: The percentage of agreement between interviews and charting for reaction type was 50%. Even with the use of electronic medical records, better methods are needed to properly record allergies to ensure patient safety and care.
Each year in the United States, 114 million people are admitted to emergency departments (ED). Adverse drug/allergic reactions are experienced by 7% of patients within the hospital setting, with true medication allergies being responsible for 15% of all allergies. Proper documentation of medication allergies plays a critical role in the care of patients, especially upon admission to an ED, given that inaccurate information may affect clinical decision making and result in suboptimal therapy. Healthcare providers in the ED have an especially important job of detailing whether a patient's medication allergy is a true, immune-mediated allergy or an adverse effect.
Our university-affiliated hospital ED uses an electronic medical record (EMR, hereby referred to as chart; Cerner Millenium, FirstNet, Kansas City, MO) to document allergy information. The purpose of this descriptive study was to compare current allergy reporting in patient charts with information gathered during ED patient interviews using the hypothesis that there are significant discrepancies between what is documented and the allergy history/patient interview.