Luri Marta, Leache Leire, Gastaminza Gabriel, Idoate Antonio, Ortega Ana
Hospital Pharmacy Services, Clínica Universidad de Navarra, Pio XII Avenue 36, Zip code: 31008, Pamplona, Spain.
Unit of Innovation and Organization, Navarre Health Service, Tudela Street 20, 1(st) floor, Zip code: 31003, Pamplona, Spain.
Int J Med Inform. 2022 Mar;159:104673. doi: 10.1016/j.ijmedinf.2021.104673. Epub 2021 Dec 26.
Drug allergy alert systems (DAAS), have been considered an effective strategy to reduce preventable adverse drug events (ADEs), improving patient's safety. To date, no review has been conducted analyzing characteristics of DAAS in the hospital setting. Therefore, the aim of this study is to identify, describe and summarize the DAAS used in hospitals. The secondary objectives are to analyse drug allergy alerts (DAA) characteristics, the override rate (OvR) and the clinical consequences of alert overrides.
Searches were conducted in Medline and Cochrane Library to identify studies describing DAAS. Systems characteristics, generated alerts, DAA, OvR, and its clinical consequences were extracted and analyzed.
Twenty-eight articles were included in the review. Seventeen different electronic DAAS were identified, of which 53% were commercially available. Systems differed in drug allergy information and rules for generating alerts. DAA were generally interruptive, triggered by non-exact match at drug prescribing and when ignored, an override reason was mandatory. The OvR ranged from 43.7% to 97%. The main override reason given by providers was that 'patient had previously tolerated or had taken the drug without allergic reaction'. Clinical consequences of overriding DAA were only analyzed in four studies, with an ADE incidence between 0% and 6%.
Different DAAS are used in hospitals with some degree of heterogeneity. Accurate and updated drug allergy information is important to generate only high value alerts. A regular review of DAAS and a standardization of alert rules, alert information and override reasons are necessary to optimize systems. Future studies should evaluate the impact of the DAAS aspects on preventing ADEs.
药物过敏警报系统（DAAS）被认为是减少可预防药物不良事件（ADEs）、提高患者安全的有效策略。迄今为止，尚未有对医院环境中DAAS特征进行分析的综述。因此，本研究的目的是识别、描述和总结医院中使用的DAAS。次要目标是分析药物过敏警报（DAA）的特征、忽略率（OvR）以及警报忽略的临床后果。
在Medline和Cochrane图书馆进行检索，以识别描述DAAS的研究。提取并分析系统特征、生成的警报、DAA、OvR及其临床后果。
该综述纳入了28篇文章。识别出17种不同的电子DAAS，其中53%为商业可用。各系统在药物过敏信息和生成警报的规则方面存在差异。DAA通常具有干扰性，在药物处方时由不精确匹配触发，当被忽略时，必须给出忽略原因。OvR范围为43.7%至97%。提供者给出的主要忽略原因是“患者以前耐受该药物或服用该药物无过敏反应”。仅在四项研究中分析了忽略DAA的临床后果，ADE发生率在0%至6%之间。
医院使用不同的DAAS，存在一定程度的异质性。准确和最新的药物过敏信息对于仅生成高价值警报很重要。定期审查DAAS并对警报规则、警报信息和忽略原因进行标准化对于优化系统是必要的。未来的研究应评估DAAS各方面对预防ADEs的影响。
