Improving Allergy Documentation: A Retrospective Electronic Health Record System-Wide Patient Safety Initiative

Lily Li, Dinah Foer, Robert K. Hallisey, Carol Hanson, Ashley E. McKee, Gianna Zuccotti, Elizabeth A. Mort, Thomas D. Sequist, Nathan E. Kaufman, Claire M. Seguin, Allen Kachalia, Kimberly G. Blumenthal, Paige G. Wickner

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: Documentation of allergies in a coded, non-free-text format in the electronic health record (EHR) triggers clinical decision support to prevent adverse events. Health system-wide patient safety initiatives to improve EHR allergy documentation by specifically decreasing free-text allergy entries have not been reported. The goal of this initiative was to systematically reduce free-text allergen entries in the EHR allergy module. Methods: We assessed free-text allergy entries in a commercial EHR used at a multihospital integrated health care system in the greater Boston area. Using both manual and automated methods, a multidisciplinary consensus group prioritized high-risk and frequently used free-text allergens for conversion to coded entries, added new allergen entries, and deleted duplicate allergen entries. Environmental allergies were moved to the patient problem list. Results: We identified 242,330 free-text entries, which included a variety of environmental allergies (42%), food allergies (18%), contrast media allergies (13%), “no known allergy” (12%), drug allergies (2%), and “no contrast allergy” (2%). Most free-text entries were entered by medical assistants in ambulatory settings (34%) and registered nurses in perioperative settings (20%). We remediated a total of 52,206 free-text entries with automated methods and 79,578 free-text entries with manual methods. Conclusions: Through this multidisciplinary intervention, we identified and remediated 131,784 free-text entries in our EHR to improve clinical decision support and patient safety. Additional strategies are required to completely eliminate free-text allergy entry, and establish systematic, consistent, and safe guidelines for documenting allergies.

Original languageEnglish (US)
Pages (from-to)E108-E114
JournalJournal of patient safety
Volume18
Issue number1
DOIs
StatePublished - Jan 1 2022

Keywords

  • Adverse drug event
  • Clinical decision support
  • Drug hypersensitivity
  • Electronic health record
  • Free text
  • Remediation

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Leadership and Management

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