The seeds of an adverse drug interaction can be planted at any point in the care process, by any of the individuals involved. For instance, take a look at these common scenarios:
The chances that any one of these situations may occur is increasing.
Override rates for alerts have been steadily rising, from 50% in the mid-1990s, to almost 90% in 2015. Allergy alerts are an important type of these increasingly overridden alerts. ECRI Institute's Partnership for Health IT Patient Safety convened a workgroup to examine what technology could do to improve capture and communication of drug allergy information.
Access to accurate and up-to-date drug allergy information is a vital component to effective, safe, and timely patient care. Yet, despite the use of technology and its ability to provide many forms of clinical decision support (CDS), such as alerts, adverse events due to drug allergy interactions continue to occur.
Alert overrides can occur because the messaging associated with the alert is unclear or because information is missing. They can also occur because the ingredients, rather than primary drug component, trigger alerts. While evidence suggests the alerts being overridden are often insignificant, the consequences of overriding drug allergy alerts can sometimes be life-threatening.
To ensure this vital information is captured, CDS for drug allergies must be improved. It will take time, but there are safety measures that organizations can take today. Every stakeholder has a role in improving this process: from the patient, who can become better informed about his medical history, to the EHR vendor, who can design systems that ensure alerts are triggered only when they need to be.
Building on a set of core goals, the Partnership's workgroup developed four recommendations:
What is it going to take? There is no simple fix. Gathering and accurately recording information, with an ability to trigger a reminder or an alert when needed, will positively impact safer care. It is a start.
Clinicians, patients, families, caregivers, and those that design and provide technology solutions must continue to work together to improve safe communication of drug allergy information. Otherwise, drug allergy events will continue, with potentially devastating consequences.
To learn more about our drug allergy interaction recommendations, and to download our implementation strategies and drug allergy toolkit, visit our Safe Health IT Practices website or listen to our podcast. Additional resources are available from ECRI Institute’s The Partnership for Health IT Patient Safety.