The Effect of Improving Ease of Allergy Information Entry on Allergy Alerts

1
The Effect of Improving Ease of Allergy
Information Entry on Allergy Alerts

• Ann Wehmeyer, Pharm.D., BCPS
• Assistant Director, Quality and Safety
• Robert McNutt, M.D. FACP
• Professor of Internal Medicine
• Rush University Medical Center

2
The Team

• Richard Abrams, M.D.
• Scott Hasler, M.D.
• Richard Odwazny
• Chief Residents, Internal Medicine
• Pamela Appavu
• Paula Joseph and IS Team
• Janice Jeong, Pharm.D.
• The Department of Medicine Patient Safety Group

3
Background

• April 2004 Began CPOE allergy checking
• Required Entry of Medication Allergies into CPOE
  Allergy Profile Prior to Placing 1st Medication
  Order
• Look-up or free text entry
• Alerts for allergies and intolerances
• Choice of reasons for override

4
CPOE Allergy Profiles At RUSH

• 80 Override Rate for Allergy Alerts
• Cases identified with NKDA in the profile and
  allergies in the medical record
• User Interface unfriendly
• Requires correct spelling
• Locks up
• Difficult to discontinue an allergy
• Tendency to mistrust allergy profile
• Alerts for drugs with slight potential to
  cross-react

5
We Are Not Alone

• Characteristics and Consequences of Drug Allergy
  Alert Overrides in a CPOE System -Hsieh et al.
  JAMIA 2004
• Allergy Alerts overridden for 80 of orders
• Drug Classes with most overridden alerts
• Narcotics, Cephalosporins, Sulfa-containing drugs
  
• 90 of overridden alerts triggered by a non-exact
  match between drug ordered and drug on allergy
  list
• Most frequent reasons for override
• Aware/Will Monitor or Patient Tolerates
• Mean rate of allergy documentation 56.5

6
Methods

• Design user friendly data entry screen
• Point and Click Data Entry
• Include 90 of Allergies Entered
• Delete Button
• Measurements before and after
• Number of Allergies Entered
• Number of Alerts
• Number of Overrides
• Number of Patients with Allergies Documented but
  not in CPOE Allergy Profile

7
OLD METHOD Free Text Allergy Entry
Free Text Entry
8
NEW METHOD Point-and-Click Allergy Entry
Point-and-Click to Add Allergies
9
NEW METHOD Point-and-Click Deletion
Point and Click to Delete Allergies
10
NEW METHOD Point-and-click Allergy Alert
Override Order
11
RESULTS
12
Results- Number of Allergies Entered
13
Results- Allergy Alert Override Rate
14
Results- Reasons for Override
0
10
20
30
40
50
60
70
After
Before
15
Results Medications Associated With Rejected
Orders vs. Overridden Alerts
16
Agreement Between Allergy Profiles
17
Conclusions

• Number of Medication Allergies entered
• did not change.
• Override Rate
• did not change.
• Reasons for Override
• did not change.
• Extent of Agreement with other sources of allergy
  information
• did not change.

18
Implications

• Changes in Data collection screens alone are
  inadequate
• Define and Train
• Medication Allergy
• Medication Intolerance
• Allergy alerts-What do you want to be alerted
  for?
• Display interruptive alerts for true allergies
  that are exact matches only
• Single site for documentation of allergies and
  reconciliation among providers