Division of General Internal Medicine and Primary Care, The Center for Patient Safety Research and Practice, Brigham and Women's Hospital, 1620 Tremont Street, 75 Francis Street, Boston, MA, 02115, USA.
MCPHS University, Boston, MA, USA.
Drug Saf. 2018 Mar;41(3):297-302. doi: 10.1007/s40264-017-0615-1.
Drug-allergy interaction (DAI) alerts are generated when a known adverse sensitivity-inducing substance is prescribed. A recent study at our institution showed that providers overrode most DAI alerts, including those that warned against potentially life-threatening 'anaphylaxis'.
The aim of this study was to determine the rate of anaphylaxis overrides, the reasons for these overrides, whether the overrides were appropriate, and if harm occurred from overrides.
All DAI alerts, with a reaction of 'anaphylaxis', were analysed for inpatients and outpatients within our health system between January 2009 and December 2011. Only alerts that were triggered by 'definite' alerts (i.e. same ordered medication as documented allergen) were included. Patient charts were reviewed to assess the appropriateness of overrides and potential harm, according to a predetermined set of criteria.
A total of 202 inpatient and 16 outpatient alerts met the inclusion criteria. The rate of overrides for 'definite' anaphylaxis DAI alerts was high (inpatient: n = 93, 46.0%; outpatient: n = 11, 68.8%) but appropriate for most overrides in the inpatient (n = 78, 83.9%) and outpatient settings (n = 11, 100%). The most common override reasons in the inpatient and outpatient settings were 'administer per desensitization protocol' (n = 64, 31.7%) and 'patient does not have this allergy' (n = 7, 63.6%), respectively. No harm was associated with overrides in either setting, particularly because many medications were not administered.
Overrides of 'definite' anaphylaxis DAI alerts were common and often appropriate. Most overrides were due to desensitizations. Allergy reconciliation for patients could further improve critical decision support.
当开出处方的药物与已知的不良敏感诱导物质相同时，就会生成药物过敏反应（DAI）警报。我们机构最近的一项研究表明，大多数 DAI 警报都被医护人员忽视了，其中包括那些可能导致危及生命的“过敏反应”的警报。
本研究旨在确定过敏反应警报被忽视的比率、忽视这些警报的原因、忽视是否合理，以及忽视是否会带来危害。
在我们的医疗系统中，对 2009 年 1 月至 2011 年 12 月期间的住院和门诊患者的所有 DAI 警报（反应为“过敏反应”）进行分析。仅包括因“明确”警报（即与记录的过敏原相同的预定药物）而触发的警报。根据预先设定的标准，审查患者病历以评估忽视的合理性和潜在危害。
共有 202 例住院和 16 例门诊警报符合纳入标准。“明确”过敏反应 DAI 警报的忽视率很高（住院：n=93，46.0%；门诊：n=11，68.8%），但大多数忽视在住院（n=78，83.9%）和门诊环境中都是合理的（n=11，100%）。住院和门诊环境中最常见的忽视原因分别是“按照脱敏方案给药”（n=64，31.7%）和“患者没有这种过敏症”（n=7，63.6%）。在这两种情况下，忽视都没有带来危害，特别是因为许多药物并未使用。
“明确”过敏反应 DAI 警报的忽视很常见，而且往往是合理的。大多数忽视是由于脱敏治疗引起的。对患者进行过敏史核对可以进一步改善关键决策支持。
