Nicole Van Groningen1,2, Ray Duncan2, Galen Cook-Wiens3, Aaron Kwong1, Matthew Sonesen2, Teryl K Nuckols1, Suzanne L Cassel1,4, Joshua M Pevnick1,2. 1. Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA. 2. Enterprise Information Services, Cedars-Sinai Health System, Los Angeles, California, USA. 3. Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, California, USA. 4. Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Abstract
BACKGROUND: Approximately 10% of patients report allergies to penicillin, yet >90% of these allergies are not clinically significant. Patients reporting penicillin allergies are often treated with second-line, non-β-lactam antibiotics that are typically broader spectrum and more toxic. Orders for β-lactam antibiotics for these patients trigger interruptive alerts, even when there is electronic health record (EHR) data indicating prior β-lactam exposure. OBJECTIVE: To describe the rate that interruptive penicillin allergy alerts display for patients who have previously had a β-lactam exposure. DESIGN: Retrospective EHR review from January 2013 through June 2018. SETTING: A nonprofit health system including 1 large tertiary-care medical center, a smaller associated hospital, 2 emergency departments, and ˜250 outpatient clinics. PARTICIPANTS: All patients with EHR-documented of penicillin allergies. METHODS: We examined interruptive penicillin allergy alerts and identified the number and percentage of alerts that display for patients with a prior administration of a penicillin class or other β-lactam antibiotic. RESULTS: Of 115,081 allergy alerts that displayed during the study period, 8% were displayed for patients who had an inpatient administration of a penicillin antibiotic after the allergy was noted, and 49% were displayed for patients with a prior inpatient administration of any β-lactam. CONCLUSIONS: Many interruptive penicillin allergy alerts display for patients who would likely tolerate a penicillin, and half of all alerts display for patients who would likely tolerate another β-lactam.
BACKGROUND: Approximately 10% of patients report allergies to penicillin, yet >90% of these allergies are not clinically significant. Patients reporting penicillin allergies are often treated with second-line, non-β-lactam antibiotics that are typically broader spectrum and more toxic. Orders for β-lactam antibiotics for these patients trigger interruptive alerts, even when there is electronic health record (EHR) data indicating prior β-lactam exposure. OBJECTIVE: To describe the rate that interruptive penicillin allergy alerts display for patients who have previously had a β-lactam exposure. DESIGN: Retrospective EHR review from January 2013 through June 2018. SETTING: A nonprofit health system including 1 large tertiary-care medical center, a smaller associated hospital, 2 emergency departments, and ˜250 outpatient clinics. PARTICIPANTS: All patients with EHR-documented of penicillin allergies. METHODS: We examined interruptive penicillin allergy alerts and identified the number and percentage of alerts that display for patients with a prior administration of a penicillin class or other β-lactam antibiotic. RESULTS: Of 115,081 allergy alerts that displayed during the study period, 8% were displayed for patients who had an inpatient administration of a penicillin antibiotic after the allergy was noted, and 49% were displayed for patients with a prior inpatient administration of any β-lactam. CONCLUSIONS: Many interruptive penicillin allergy alerts display for patients who would likely tolerate a penicillin, and half of all alerts display for patients who would likely tolerate another β-lactam.
Authors: Matthieu Picard; Philippe Bégin; Hugues Bouchard; Jonathan Cloutier; Jonathan Lacombe-Barrios; Jean Paradis; Anne Des Roches; Brian Laufer; Louis Paradis Journal: J Allergy Clin Immunol Pract Date: 2013-02-14
Authors: Derek R MacFadden; Anthony LaDelfa; Jessica Leen; Wayne L Gold; Nick Daneman; Elizabeth Weber; Ibrahim Al-Busaidi; Dan Petrescu; Ilana Saltzman; Megan Devlin; Nisha Andany; Jerome A Leis Journal: Clin Infect Dis Date: 2016-07-11 Impact factor: 9.079