From the Hospital Pharmacy Services.
Allergology Department, Clínica Universidad de Navarra, Pamplona, Spain.
J Patient Saf. 2022 Sep 1;18(6):630-636. doi: 10.1097/PTS.0000000000001034. Epub 2022 May 28.
This study aimed to assess how often overridden drug allergy alerts (ODAAs) lead to allergic adverse drug events (All-ADEs) and to evaluate the frequency with which drug allergy alerts (DAAs) were overridden and the reasons, as well as appropriateness of these overrides.
A retrospective observational study of DAA generated between 2014 and 2016 was conducted. The corresponding DAA records were reviewed to determine the frequency of alert overrides. A chart review was performed on a subset of 194 ODAA (the first of every 3 chronologically ordered ODAA) to identify All-ADEs and to evaluate the override reasons and the appropriateness of these overrides.
A total of 2044 DAAs were overridden (override rate of 44.8%). Most were triggered by a nonexact match (93.81%), when ordering nervous system (21.1%) and cardiovascular system (19.6%) drugs and were generated by physicians (72.7%). The main override reason was that the patient was already taking the drug or had previously tolerated the drug. Only 9.28% of ODAAs were inappropriately overridden. Six All-ADEs (3.09%) were identified and were due to anti-infective (1), antineoplastic (1), and iodinated-contrast (4) drug administration. Most All-ADEs were cutaneous and were mild. None was life-threatening or fatal. The All-ADEs rate was higher among inappropriately ODAA (15.79%, P = 0.013).
Alert overrides are not exempt from clinical consequences, although few are associated with All-ADEs. It is necessary to identify the drugs involved in those reactions and to update allergy lists to generate only specific and important DAA and to avoid the negative consequences of overrides.
本研究旨在评估药物过敏警示（DAA）被 override 的频率，以及由此引发过敏不良药物事件（All-ADEs）的频率，同时评价这些 override 的合理性。
对 2014 年至 2016 年生成的 DAA 进行回顾性观察研究。评估 DAA 记录，以确定 alert 被 override 的频率。对 194 个 ODAAs（按时间顺序每 3 个中的第一个）进行图表回顾，以确定 All-ADEs，评估 override 的原因和合理性。
共 2044 个 DAA 被 override（override 率为 44.8%）。大多数是因为非精确匹配（93.81%）而触发的，在神经系统（21.1%）和心血管系统（19.6%）药物中更为常见，这些 DAA 主要由医生（72.7%）生成。主要的 override 原因是患者正在使用该药物或之前已耐受该药物。仅有 9.28%的 ODAAs 被不合理地 override。共发现 6 例 All-ADEs（3.09%），均与抗感染（1 例）、抗肿瘤（1 例）和碘造影剂（4 例）药物的使用有关。大多数 All-ADEs 为皮肤表现，且症状轻微。均无生命威胁或致命。不合理 override 的 ODAAs 发生 All-ADEs 的风险更高（15.79%，P = 0.013）。
尽管 alert override 不一定导致 All-ADEs，但也并非没有临床后果。有必要识别与这些反应相关的药物，并更新过敏清单，以生成更具体和重要的 DAA，并避免 override 的负面后果。
