ABSTRACT
The purpose of this study was to evaluate the quality of adverse drug reaction (ADR) documentation in a state-wide electronic health record (EHR), and to assess the impact of the interface design on documentation accuracy and ability to provide decision support. Data were extracted from 43 011 unique records in a state-wide electronic health record in South Australia, Australia. Information obtained included ADR coding as allergy or intolerance, allergen name, reaction, and occupation of those entering data. Categorization into drug allergy or intolerance was assessed for accuracy. Reactions were entered predominantly by nurses (60.1%), also by doctors (31.0%) and pharmacists (6.1%). Of 27 314 reactions, 86.5% were coded as allergy and 13.5% as intolerance. The majority (78.2%) described reactions to drugs (as opposed to food, environmental or contact allergens), predominantly chosen from the drug database (96.4%). Many entries used free text for the reaction description (27.4%). Terms found in the predefined list under the allergy heading were more likely to be categorized as allergy, even when the mechanism was pharmacological intolerance. Only 45.1% (n = 1671/3705) of reactions consistent with intolerance (eg, "nausea," "diarrhea") were correctly categorized as such, although categorization by pharmacists was more accurate (P < .0001). These data suggest that ADR categorization as allergy or intolerance is influenced by the EHR design. The obligatory classification of ADRs into allergy or intolerance was not well understood and does not appear to have practical benefit.
Subject(s)
Drug Hypersensitivity/classification , Drug-Related Side Effects and Adverse Reactions/classification , Electronic Health Records , HumansSubject(s)
Emergency Medical Tags , Hypersensitivity , Jewelry , Medication Errors/prevention & control , Adolescent , Adult , Aged , Aged, 80 and over , Australia , Child , Female , Health Communication/methods , Humans , Hypersensitivity/prevention & control , Male , Middle Aged , Young AdultABSTRACT
In South Australia, between 2000 and 2014, 57 patients with idiopathic inflammatory myositis (IIM) were treated with intravenous immunoglobulin (IVIg). We reviewed disease characteristics to determine predictors of response to therapy and IVIg dosing and duration to identify opportunities to rationalise IVIg use. Patients with dermatomyositis/polymyositis had a response rate of 77% and were more likely than inclusion body myositis to respond to therapy. Consideration should be given to the use of the lowest possible dose of IVIg and to the undertaking of trials of cessation of IVIg in patients with stable IIM.
