This article originally appeared on WoltersKluwer.com. It is reprinted with permission. For more articles like this, visit Wolters Kluwer Health Expert Insights.
Any clinician who has a role in medication therapy is affected by allergen screening. Until the advent of electronic health records (EHR), allergen screening was performed manually.
With the widespread adoption of EHRs, embedded drug allergy screening has been well incorporated and has significantly improved medication therapy safety. But there are ways to further optimize screening to improve the sensitivity and effectiveness of alerts.
Common scenarios in which potential allergen interactions need to be considered include:
However, drug allergy screening is not limited to specific sectors. It impacts a wide range of healthcare roles and areas including hospice, home healthcare, and imaging/radiology, just to name a few.
In some scenarios, along with an increase in patient safety, we have also seen an increase in undesirable alerts leading to alert fatigue. One cause of this rise in irrelevant EHR notifications is that non-specific or broad drug concepts, which can include unintended ingredients, are being used during the allergen selection process. By employing best practices and optimizing the capabilities of drug data and EHR software, the sensitivity of allergen screening can be improved to enhance patient outcomes and reduce alert fatigue.
Two common medication concepts that are used in practice and lead to alert fatigue are NDC and Drug Name.
Using the NDC, or packaged drug concept, to post patient allergens can lead to several issues:
The Drug Name concept was designed as a grouping concept used to identify collections of drugs or health-related items. It is independent of route, strength, and dosage form and not directly linked to a specific active ingredient. Whereas the Drug Name concept seems to be a good choice when posting allergens, its use can also lead to alert fatigue:
Organizations can employ best practices when setting up allergen screening that can help improve its effectiveness.
An allergen picklist provides clinicians with medication names that are linked to the best concept for allergen screening. It is also designed to give clinicians a concise search that reduces duplicative or confusing drug names. The most effective allergen picklists contain common generic names with allergenic potential, select trade names associated with minimal inactive ingredients, select allergen classes, and some inactive ingredients if they are proven to have significant allergic potential (e.g., peanut-containing drugs).
Some inputs incorporated into the EHR may be helpful in addition to screening. These could include:
Medical conditions can be associated with allergens to record reactions and give further context to clinicians. A clinician-assigned designation of allergy versus an adverse drug reaction or intolerance can also be included. For example, anaphylaxis is an allergic reaction, compared to nausea, which a patient may call an allergic reaction, but is more appropriately defined as an ADE or intolerance.
Timing and overrides
Best practices also include performing allergen screening early in the medication order entry process. This design allows the clinician to be alerted before taking further, time-consuming steps.
Allergy alerts should be allowed to be overridden with the opportunity or requirement for the clinician to document a reason. If possible, this override message should be displayed to subsequent users. For example, if a physician overrides an allergy in an EHR, the recorded override reason should be passed to the pharmacist at order verification and the nurse at administration.
An option to enter No Known Drug Allergies, or “NKDA,” should be easily accessible to the end user. One convenient method to achieve this is adding a one-click NKDA radio button close to the search bar.
Allowing other options, such as “Unknown” or “Not available at this time,” is debatable. It may be beneficial in some scenarios, such as an emergency room where a patient may be admitted unconscious or confused. However, offering a prompt to the clinician to update allergens when additional information is available has the potential to create obstacles.
Free-text allergen input should only be allowed after all search options have been exhausted. Free-text allergens will not screen because they are not linked to an ingredient in the system’s data. Therefore, it is always recommended to incorporate extra steps for the user before they are permitted to enter a free-text allergen. Also, free-text entries should be easily identifiable in the patient’s profile. This might include displaying the allergen in a different colored text or marking it with an indicator such as an asterisk. These easily recognizable free-text entries should also include a general disclaimer, so all clinicians are aware they are unscreenable allergens and manual screening is required.
It is worthwhile to speak with your implementation specialist or customer support department for more information about ways you could optimize drug allergy data and screening within your EHR.
Please note: All these recommendations apply to drug allergen screening in the U.S. International best practice recommendations may differ. Consult your implementation specialist for additional considerations.