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Evaluation of ‘Definite’ Anaphylaxis Drug Allergy Alert Overrides in Inpatient and Outpatient Settings

Lookup NU author(s): Dr Sarah Slight

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Abstract

© 2017 Springer International Publishing AG Introduction: Drug–allergy interaction (DAI) alerts are generated when a known adverse sensitivity-inducing substance is prescribed. A recent study at our institution showed that providers overrode most DAI alerts, including those that warned against potentially life-threatening ‘anaphylaxis’. Objective: The aim of this study was to determine the rate of anaphylaxis overrides, the reasons for these overrides, whether the overrides were appropriate, and if harm occurred from overrides. Methods: All DAI alerts, with a reaction of ‘anaphylaxis’, were analysed for inpatients and outpatients within our health system between January 2009 and December 2011. Only alerts that were triggered by ‘definite’ alerts (i.e. same ordered medication as documented allergen) were included. Patient charts were reviewed to assess the appropriateness of overrides and potential harm, according to a predetermined set of criteria. Results: A total of 202 inpatient and 16 outpatient alerts met the inclusion criteria. The rate of overrides for ‘definite’ anaphylaxis DAI alerts was high (inpatient: n = 93, 46.0%; outpatient: n = 11, 68.8%) but appropriate for most overrides in the inpatient (n = 78, 83.9%) and outpatient settings (n = 11, 100%). The most common override reasons in the inpatient and outpatient settings were ‘administer per desensitization protocol’ (n = 64, 31.7%) and ‘patient does not have this allergy’ (n = 7, 63.6%), respectively. No harm was associated with overrides in either setting, particularly because many medications were not administered. Conclusions: Overrides of ‘definite’ anaphylaxis DAI alerts were common and often appropriate. Most overrides were due to desensitizations. Allergy reconciliation for patients could further improve critical decision support.


Publication metadata

Author(s): Wong A, Seger DL, Slight SP, Amato MG, Beeler PE, Fiskio JM, Bates DW

Publication type: Article

Publication status: Published

Journal: Drug Safety

Year: 2018

Volume: 41

Issue: 3

Pages: 297-302

Print publication date: 01/03/2018

Online publication date: 09/11/2017

Acceptance date: 02/04/2016

ISSN (print): 0114-5916

ISSN (electronic): 1179-1942

Publisher: Springer International Publishing

URL: https://doi.org/10.1007/s40264-017-0615-1

DOI: 10.1007/s40264-017-0615-1


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