Implications of electronic health record transition on drug allergy labels

Current evidence supports the negative impact of clinically irrelevant penicillin allergy labels including use of less effective, more toxic antimicrobials, development of resistant organisms, higher health care costs, and overall higher morbidity and mortality.2 Therefore, both accurate documentation of confirmed immune-mediated drug allergies and removal of allergy labels after negative evaluation are key elements to maintain patient safety. Drug allergy labels are known to pose problems in EHRs ranging from inaccuracies when transcribing from paper records,3 differences in data entry and storage forms, and inappropriate warning prompts, all of which can lead to patient harm.4 In 2017, Vanderbilt University Medical Center (VUMC) underwent system-wide simultaneous inpatient and outpatient transition from a home-grown legacy EHR to Epic (Verona, Wis). Drug name Former EHR description New EHR description Background of most recent drug allergy reviewer Allopurinol Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) Gastrointestinal intolerance Unknown title∗ Minocycline SJS High severity rash Unknown title Avoid doxycycline (listed as a separate allergy) Changed to dicyclomine Avoid tetracycline (listed as a separate allergy) No longer listed Ceftriaxone SJS/TEN No cephalosporins listed as an allergy Pharmacist Recommend avoidance of cefepime and cefotaxime Amoxicillin Drug reaction with eosinophilia and systemic symptoms Gastrointestinal intolerance Unknown title Ondansetron Anaphylaxis and skin prick test positive “per pt” Registered nurse Ceftriaxone Anaphylaxis and skin prick test positive Ceftriaxone no longer listed Physician Description was listed under the drug name “other” along with 2 additional reaction descriptions Table I Examples of severe allergy discrepancies