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Incidence of interruptive penicillin allergy alerts in patients with previously documented beta-lactam exposure: Potential for leveraging the electronic health record to identify erroneous allergies

Published online by Cambridge University Press:  13 August 2021

Nicole Van Groningen Open the ORCID record for Nicole Van Groningen [Opens in a new window] ,
Ray Duncan ,
Galen Cook-Wiens ,
Aaron Kwong ,
Matthew Sonesen ,
Teryl K. Nuckols ,
Suzanne L. Cassel  and
Joshua M. Pevnick
Nicole Van Groningen*
Affiliation:
Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA Enterprise Information Services, Cedars-Sinai Health System, Los Angeles, California, USA
Ray Duncan
Affiliation:
Enterprise Information Services, Cedars-Sinai Health System, Los Angeles, California, USA
Galen Cook-Wiens
Affiliation:
Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, California, USA
Aaron Kwong
Affiliation:
Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
Matthew Sonesen
Affiliation:
Enterprise Information Services, Cedars-Sinai Health System, Los Angeles, California, USA
Teryl K. Nuckols
Affiliation:
Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
Suzanne L. Cassel
Affiliation:
Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA Women’s Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
Joshua M. Pevnick
Affiliation:
Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA Enterprise Information Services, Cedars-Sinai Health System, Los Angeles, California, USA
*
Author for correspondence: Nicole Van Groningen, E-mail: Nicole.vangroningen@cshs.org
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Abstract

Background:

Approximately 10% of patients report allergies to penicillin, yet >90% of these allergies are not clinically significant. Patients reporting penicillin allergies are often treated with second-line, non–β-lactam antibiotics that are typically broader spectrum and more toxic. Orders for β-lactam antibiotics for these patients trigger interruptive alerts, even when there is electronic health record (EHR) data indicating prior β-lactam exposure.

Objective:

To describe the rate that interruptive penicillin allergy alerts display for patients who have previously had a β-lactam exposure.

Design:

Retrospective EHR review from January 2013 through June 2018.

Setting:

A nonprofit health system including 1 large tertiary-care medical center, a smaller associated hospital, 2 emergency departments, and ˜250 outpatient clinics.

Participants:

All patients with EHR-documented of penicillin allergies.

Methods:

We examined interruptive penicillin allergy alerts and identified the number and percentage of alerts that display for patients with a prior administration of a penicillin class or other β-lactam antibiotic.

Results:

Of 115,081 allergy alerts that displayed during the study period, 8% were displayed for patients who had an inpatient administration of a penicillin antibiotic after the allergy was noted, and 49% were displayed for patients with a prior inpatient administration of any β-lactam.

Conclusions:

Many interruptive penicillin allergy alerts display for patients who would likely tolerate a penicillin, and half of all alerts display for patients who would likely tolerate another β-lactam.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 9 , September 2022 , pp. 1108 - 1111
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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