Survey recommends improvements for drug allergy alert systems

By including more clinically relevant alerts and improving usability, practices can better facilitate drug allergy screening in their clinical decision support systems, according to a letter published in Clinical and Translational Allergy.

Physicians also were dissatisfied with their allergy documentation system but appreciated being asked for feedback and for ideas for improvement, Katoo M. Muylle, MS, PhD student with the department of pharmaceutical and pharmacological sciences, Vrije Universiteit Brussel, Research Group Clinical Pharmacology and Clinical Pharmacy, in Brussels, and colleagues wrote.

The researchers examined the self-developed electronic health records at a general university teaching hospital that records allergens via free-text or through selection from a limited list. Date and severity level can be recorded as well.

The hospital does not have a clinical decision support system (CDSS) for allergy screening, the researchers said, but its physicians receive safety alerts for drug-drug interactions when prescriptions are issued.

The researchers used the electronic LimeSurvey platform to anonymously survey 169 prescribing physicians at the facility, including 97 (57.4%) women and 128 (75.7%) physicians from nonsurgical departments.  The respondents’ experience levels were evenly distributed.

According to the survey, 26 (15.4%) found their current allergy documentation module satisfactory, while 75 (44.4%) called it insufficient and unclear in terms of how and where allergies should be documented in EHRs. In qualitative responses, physicians said allergy information often is wrong, incomplete and hard to find.

The current system only lets users select drug classes such as penicillin, but 86 (50.9%) physicians preferred including substances and drug classes. Also, 101 (59.8%) wanted a separate field for documenting allergy symptoms, while 111 (65.7%) wanted a field indicating whether a physician and/or a diagnostic test had confirmed the allergy.

Further, 63 (37.3%) wanted a separate field to indicate if the allergic reaction was immediate or delayed. Compared with a passive system, 143 (84.6%) preferred an active system such as pop-up alerts.

The barriers to using CDSS included the time investment in handling alerts (n = 108; 63.9%) and receiving too many alerts (n = 98; 58%). The most important facilitators in using CDSS for drug allergy screening were clinically relevant alerts (n = 120; 71%) and usability (n = 117; 69.23%).

Nearly all the respondents (n = 160; 94.7%) said the usability and correct use of these applications would be improved if physicians were involved in their development and testing, with some respondents volunteering to help redesign the allergy documentation.

Additionally, 121 (71.6%) said they felt they would benefit from extra training in drug allergies, indicating that they are open to educational offers, the researchers said.

By standardizing allergy documentation and avoiding free-text entries, the researchers said, practices can improve the quality of their information as well as how that information is shared across different institutions.

Detailed specifications should include the allergen, a clinical description of the reaction, and the event date and status indicating whether the association is confirmed or suspected, the researchers continued. Substances should be documented instead of drug classes, and good graphical user interfaces are crucial as well, the researchers said.