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Lookup NU author(s): Dr Sarah Slight
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© 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.
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
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
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