Impact of a Pharmacist-Driven Protocol to Improve Drug Allergy Documentation at a University Hospital

Adverse drug reactions (ADRs) occur in 15% of hospitalized patients in the United States.1 ADRs can be broadly categorized into type A and B reactions. Type B reactions, of which drug allergies are a subset, account for 20% of all ADRs.2 Previous studies have identified poor medical record documentation as the nature of the drug reaction.3-8 Nonallergic reactions, such as gastrointestinal intolerance (ie, nausea/vomiting) or other side effects, are commonly reported inappropriately as allergy by both patients and medical personnel.3-9 Labeling a patient as “allergic” to a medication can result in significant challenges to the delivery of optimal therapy. Alternative therapeutic options may be less effective and can lead to increased length of stay, unintended side effects, limitation of future treatment options, and increased cost.3 Conversely, an incomplete description of drug allergies or intolerance may result in the administration of drugs that present a danger to a particular patient. An internal evaluation of our institution’s pharmacy order entry database (WORx; Mediware Information Systems, Lenexa, KS) revealed that the records of only 47% of patients with a documented drug allergy/intolerance included corresponding reaction information. The purpose of this study was to determine the impact of a pharmacist-driven protocol on the quality of inpatient drug allergy/intolerance documentation at a tertiary academic medical center. The primary outcome was to increase the percentage of drug allergy/intolerances with corresponding reaction information in our pharmacy database with a target completion of 95%. This study did not attempt to differentiate between drug allergy and intolerance. The word “allergy” or “allergies” will be used in place of “drug allergy/intolerance” from this point on in this article.