Determination of the accuracy of antimicrobial allergy history in the medical records of hospitalized patients

Numerous studies as well as clinical experience has suggested that information regarding medication allergies documented in the medical record is often inaccurate and not reproducible. A cross sectional, randomized chart review of 44 inpatients was performed. Bedside charts were randomly selected and screened for anti-microbial allergies. Identified charts were then reviewed in detail according to four sources of history: admission notes/consults, nursing, pharmacy, and emergency records. These findings were then compared to the personal history obtained by a Board Certified Allergist, or his designee, as the gold standard. Reports of reactions determined to be non-immunologic or unknown were excluded. The accuracy of antimicrobial allergy history varied according to the section of the medical record reviewed. The admission notes & consults were found to be 64% accurate, nursing notes 58% accurate, and pharmacy and emergency center notes 3% accurate. These findings are in agreement with previously published reports and suggest that the medical records of hospitalized patients are often incorrect or incomplete. This incorrect and inadequate documentation of anti-microbial allergies may lead to increased adverse events as recently reported by the Institute of Medicine, inappropriate antibiotic selection contributing to increased microbial resistance, and increased health care costs.