Wasserman Rachel L, Edrees Heba H, Seger Diane L, Goss Foster R, Blumenthal Kimberly G, Lo Ying-Chih, Blackley Suzanne, Bates David W, Zhou Li
Brigham and Women's Hospital United States; MCPHS University United States.
Brigham and Women's Hospital United States; Harvard Medical School United States; Mass General Brigham United States.
Int J Med Inform. 2025 Mar;195:105789. doi: 10.1016/j.ijmedinf.2025.105789. Epub 2025 Jan 10.
Limited research is available regarding recommendations about which drug allergy alerts (DAAs) in clinical decision support (CDS) systems should interrupt provider workflow. The objective was to evaluate the frequency of penicillin and cephalosporin DAA overrides at two institutions. A secondary objective was to redesign DAAs using a new tiered alerting system based on patient factors.
A retrospective, observational study evaluated CDS DAA overrides for penicillins and cephalosporins at two large academic medical centers. Included patients were at least 18 years of age and had a penicillin or cephalosporin DAA fired at the time of medication ordering. We developed a rule-based algorithm to classify DAAs into three groups: no alerts presented to user, non-interruptive (informational) alerts, and interruptive alerts requiring a coded response. The rule-based algorithm includes drug class or cross-sensitivity matches and reaction types with designated severities (high, medium, or low).
DAAs for penicillin and cephalosporins were overridden 55% of the time at each institution. Of the DAAs overrides, 85% were cross sensitivity matches and 15% were drug class matches. Reactions were classified as 22% high severity, 29% medium, and 48% low. Most low severity reactions were rash (25%), unspecified reactions with no comments (13%), nausea/vomiting (4%), and GI upset (3%). High severity reactions were mostly other reactions with comments (19%) and anaphylaxis (4%). Approximately 30% of the penicillin and cephalosporin alert overrides could have been non-interruptive alerts based on the penicillin or cephalosporin allergic reaction documented in the EHR at each institution.
The majority of penicillin and cephalosporin DAAs were overridden, largely for cross sensitivity in lower severity reactions. The data can be used to inform DAA redesign, reduce override rates, and improve patient safety.
关于临床决策支持（CDS）系统中的哪些药物过敏警报（DAA）应中断医护人员工作流程的建议，现有研究有限。目的是评估两家机构中青霉素和头孢菌素DAA被忽略的频率。次要目的是使用基于患者因素的新型分层警报系统重新设计DAA。
一项回顾性观察研究评估了两家大型学术医疗中心中CDS对青霉素和头孢菌素DAA的忽略情况。纳入的患者年龄至少为18岁，且在开药时触发了青霉素或头孢菌素DAA。我们开发了一种基于规则的算法，将DAA分为三组：未向用户显示警报、非中断性（信息性）警报以及需要编码响应的中断性警报。基于规则的算法包括药物类别或交叉敏感性匹配以及具有指定严重程度（高、中或低）的反应类型。
每家机构中，青霉素和头孢菌素的DAA有55%的时间被忽略。在被忽略的DAA中，85%是交叉敏感性匹配，15%是药物类别匹配。反应被分类为22%高严重度、29%中严重度和48%低严重度。大多数低严重度反应是皮疹（25%）、未注明且无评论的反应（13%）、恶心/呕吐（4%）和胃肠道不适（3%）。高严重度反应主要是有评论的其他反应（19%）和过敏反应（4%）。根据每家机构电子健康记录（EHR）中记录的青霉素或头孢菌素过敏反应，约30%的青霉素和头孢菌素警报被忽略情况本可设置为非中断性警报。
大多数青霉素和头孢菌素DAA被忽略，主要是因为低严重度反应中的交叉敏感性。这些数据可用于指导DAA重新设计、降低忽略率并提高患者安全性。
