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A novel method to decline the number of inappropriate penicillin allergy alerts in electronic prescription systems

European Statement

Patient Safety and Quality Assurance

Author(s)

Saskia Coenradie, Hans Groot, de, Amy Rieborn, Erna Groot, de, Martti Visbeek, Denise Abswoude, Christian Alderweireld, Annegien Kenter

Why was it done?

Allergies for drugs and especially allergies for antibiotics of the penicillin group are common questions in electronic patient data systems (EPDS) in hospitals. In many cases the verification of an allergy is seldom a thorough process and so many inappropriate penicillin allergies are recorded in EPDS. Literature reports that only 10% of recorded allegies are appropiate. This has a detrimental effect when infections occur and patients have to be treated with antibiotics. When a penicillin allergy is recorded in the EPDS a warning not to prescribe any antibiotic from the penicillin group is given. In most cases the physician has to choose another antibiotic that is normally not first choice. This can have worse patient outcomes. We conducted a feasibility study to investigate if a reported penicillin allergy in a patient’s record was appropriate or not using a standard allergy algorithm consisting of 10 questions with YES or NO as answers.

What was done?

A novel method is tested to decline the number of inappropriate alerts for penicillin allergy in our electronic patient data system

How was it done?

When the reported allergy in a patients record popped up in our EPDS, a pharmacy technician was asked to have a medication – and allergy verification conversation with the patient. Only patients that were admitted to the emergency ward or the acute admittance ward of our hospital were included to test this method on feasibility. The feasibility study started in March 2021 after permission from our board of directors and after a declaration of our medical ethics committee stated that no judgement of this committee was neccessary. We started on the emergency ward in March 2021. Because of slow inclusions we decided in september 2021 that another ward needed to be included in this feasibility study to achieve the number needed to prove this method feasible (80 patients). Statistical analysis was done using IBM SPSS statistics,(vs 25) and the primary outcome was the total number and percentage of inappropriate penicilline allergies.

What has been achieved?

Up till October 2021 29 patients were included in this feasibility study. Most of them had an inappropriate record of penicllin allergy after a pharmacy technician had a medication- and allergy-verfication conversation using the standard algorithm. We will continue with this feasibility study until 80 patients have been included and our statistical analysis can be done appropriately.

What next?

Continue with inclusions until the number needed to statistical analysis has been reached (80 patients). We will then perform our statistical analysis and hope to report back to you at the 27th EAHP congress in 2023 that this method is effective and reproducible. And most importantly, decreases the number of inappropriate penicillin allergy records in hospitals. We are confident that with this method we create a tool to decrease the number of inappropriate allergy records in our electronic prescription system in our hospital.

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