Information technology–based approaches to reducing repeat drug exposure in patients with known drug allergies

doi:10.1016/j.jaci.2007.12.1180

Journal of Allergy and Clinical Immunology

Volume 121, Issue 5, May 2008, Pages 1112-1117.e7

https://doi.org/10.1016/j.jaci.2007.12.1180 Get rights and content

There is increasing interest internationally in ways of reducing the high disease burden resulting from errors in medicine management. Repeat exposure to drugs to which patients have a known allergy has been a repeatedly identified error, often with disastrous consequences. Drug allergies are immunologically mediated reactions that are characterized by specificity and recurrence on reexposure. These repeat reactions should therefore be preventable. We argue that there is insufficient attention being paid to studying and implementing system-based approaches to reducing the risk of such accidental reexposure. Drawing on recent and ongoing research, we discuss a number of information technology–based interventions that can be used to reduce the risk of recurrent exposure. Proven to be effective in this respect are interventions that provide real-time clinical decision support; also promising are interventions aiming to enhance patient recognition, such as bar coding, radiofrequency identification, and biometric technologies.

Section snippets

Epidemiology

Obtaining epidemiologic data on the frequency of reexposure to drugs in those with known drug allergies is difficult for a number of reasons. First, there is a problem with underreporting in schemes that collect information on ADRs, such as the Yellow Card system run by the United Kingdom (UK) Medicines and Healthcare products Regulatory Agency,⁵ the US Food and Drug Administration's MedWatch Program (http://www.fda.gov/medwatch/index.html), or the recently established National Reporting and

Information technology–based approaches to reducing medication errors

Information technology (IT)–based solutions are particularly promising in reducing the risk of reexposure because they can help in overcoming some of the underlying systemic failings, particularly in relation to managing, processing, retaining, and making accessible large amounts of disparate data to multiple end users.

Below we consider theoretic and, where available, empiric evidence of a number of key IT-based approaches currently under investigation, with the aim of reducing the risk of

Conclusions

There is an increasing body of epidemiologic work indicating that ADRs caused by known drug allergies are relatively common and potentially preventable. Alongside the need for increased research into investigating the underlying mechanisms and processes involved in allergic reactions to drugs and the accompanying need to develop improved screening and diagnostic tests,⁴ there is, we believe, the pressing need to investigate and, where found to be effective, implement systems-based approaches to

References (43)

N.F. Adkinson et al.
Drug Allergy
N.F. Adkinson et al.
Task force report: future research needs for the prevention and management of immune-mediated drug hypersensitivity reactions
J Allergy Clin Immunol
(2002)
T.C. Hsieh et al.
Characteristics and consequences of drug allergy alert overrides in a computerized physician order entry system
J Am Med Inform Assoc
(2004)
G.J. Kuperman et al.
Effective drug-allergy checking: methodological and operational issues
J Biomed Inform
(2003)
D. Vervloet et al.
ABC of allergies: adverse reactions to drugs
BMJ
(1998)
R.R.A. Coombs et al.
Classification of allergic reactions responsible for drug hypersensitivity reactions
Monitoring the safety and quality of medicines: the Yellow Card Scheme
(2007)
The National Reporting and Learning System
(2007)
T.S. Lesar et al.
Medication prescribing errors in a teaching hospital
JAMA
(1990)
T.S. Lesar et al.
Factors related to errors in medication prescribing
JAMA
(1997)

L.L. Leape et al.

Systems analysis of adverse drug events. ADE Prevention Study Group

JAMA

(1995)

T.K. Gandhi et al.

Adverse drug events in ambulatory care

N Engl J Med

(2003)

National Patient Safety Agency

Safety in doses: medication safety incidents in the NHS. The fourth report from the Patient Safety Observatory

(2007)

Chief Pharmaceutical Officer

Building a safer NHS for patients—improving medication safety

(2004)

I. Bernstein et al.

Executive summary of disease management of drug hypersensitivity: a practice parameter. Joint Task Force on Practice Parameters, the American Academy of Allergy, Asthma and Immunology, the American Academy of Allergy, Asthma and Immunology, and the Joint Council of Allergy, Asthma and Immunology

Ann Allergy Asthma Immunol

(1999)

M. Alrasbi et al.

Comparison of international guidelines for the emergency medical management of anaphylaxis

Allergy

(2007)

E. Rebelo Gomes et al.

The Drug Ambassador Project—the diversity of diagnostic procedures for drug allergy around Europe

Allergy Clin Immunol Int J World Allergy Org

(2005)

D.W. Bates et al.

Effect of computerized physician order entry and a team intervention on prevention of serious medication errors

JAMA

(1998)

R.S. Evans et al.

A computer-assisted management program for antibiotics and other anti-infective agents

N Engl J Med

(1998)

C.J. Morris et al.

Patient safety features of clinical computer systems: questionnaire survey of GP views

Qual Saf Health Care

(2005)

B. Fernando et al.

Prescribing safety features of general practice computer systems: evaluation using simulated test cases

BMJ

(2004)

Cited by (33)

Real-time clinical decision support at the point of care
2018, Implementing Precision Medicine in Best Practices of Chronic Airway Diseases
This chapter starts by introducing the complex process of shared clinical decision-making, the value of incorporating patient-reported outcome measures into clinical decisions and the increasing usefulness of clinical decision support systems to enhance the quality and safety of healthcare. It then gives examples of three tools for clinical decision support at the point of care, which were designed to support health professionals and patients in the assessment, treatment and long-term management of chronic respiratory diseases.
A literature review of RFID-enabled healthcare applications and issues
2013, International Journal of Information Management
Citation Excerpt :
For example, the technology can enable healthcare stakeholders to monitor all steps related to the patient blood collection and transfusion process, including the identification of blood bags at the collection point, the tracking and tracing of products from the collection point to the healthcare facility, and blood transfusion to a dedicated patient (Najera et al., 2011). Also, this technology makes it easier to manage patients with chronic conditions (Cresswell & Sheikh, 2008; Michael et al., 2008). Early studies show that RFID technology represents a viable means of checking, tracking, and tracing pharmaceutical products, while allowing a proper management of incident audit trails between the medical equipment and the healthcare staff (Booth et al., 2006).
Despite the rising implementation of RFID technology-based healthcare services, few empirical studies have been conducted to assess the potential of this technology within the healthcare sector. The purpose of this study is to help initiate and direct such empirical research by both conducting a review of the extant literature and using the findings to provide a discussion of current trends and future directions in this domain. In this paper, we develop a conceptual framework that can be used to classify publications on RFID applications and issues in the healthcare industry. We then use this framework to systematically summarize relevant articles. We conclude by highlighting future research directions where the deployment of RFID technology is likely to transform the healthcare sector.
Advances in allergic skin disease, anaphylaxis, and hypersensitivity reactions to foods, drugs, and insects in 2008
2009, Journal of Allergy and Clinical Immunology
Citation Excerpt :
Drug hypersensitivity remains a major focus of care and research for allergists. To promote better care for individual patients and for all persons with drug hypersensitivity, the reader is encouraged to review a Current Perspectives article by Davis and Shearer46 that presents diagnosis and management of HIV drug hypersensitivity and a Rostrum by Cresswell and Sheikh47 describing how information technologies can improve safety for persons with drug allergies. Regarding advances in risk assessment, Apter et al48 sought to identify clinical and genetic risk factors for penicillin allergy by evaluating atopy genes (IL4, IL4 receptor, IL10) and genes involved in penicillin metabolism (β-lactamase [LACTB]) as candidates in a case (n = 23)/control (n = 39) study.
This review highlights some of the research advances in anaphylaxis, and hypersensitivity reactions to foods, drugs, and insects and in allergic skin disease that were reported in the Journal in 2008. Key epidemiologic observations include a rise in anaphylaxis in a population-based study and lower rates of peanut allergy in Israel, where infants consume peanut early compared with the United Kingdom, where dietary introduction is generally delayed. Advances in food allergy diagnosis include IgE epitope mapping that discloses the likelihood and severity of allergy; studies correlating likelihood of clinical reactivity on the basis of food-specific IgE to sesame, peanut, milk, and tree nuts; and an observation that a low baseline angiotensin-converting enzyme level may be associated with having pharyngeal edema during a reaction. Molecular, immunologic, and genetic studies are discerning pathways that are key in development of food allergy, identifying new modalities to interrupt mast cell degranulation, and elucidating risks associated with penicillin allergy. Regarding treatment, clinical studies show a majority of children with milk and egg allergy tolerate these proteins in modest amounts when they are extensively heated in baked goods, and studies show promise for oral immunotherapy to treat milk allergy and sublingual immunotherapy for honey bee venom hypersensitivity. The importance of skin barrier dysfunction has continued to be highlighted in the pathophysiology of atopic dermatitis (AD). Research has also continued to identify immunologic defects that contribute to the propensity of patients with AD to develop viral and bacterial infection. New therapeutic approaches to AD, urticaria, and angioedema have been reported including use of probiotics, biologics, vitamin D, and skin barrier creams.
Identifying and Reconciling Patients' Allergy Information Within the Electronic Health Record
2022, Studies in Health Technology and Informatics
Leapfrogging with technology: introduction of a monitoring platform to support a large-scale Ebola vaccination program in Rwanda
2021, Human Vaccines and Immunotherapeutics
Overcoming the challenges of iris scanning to identify minors (1-4 years) in the real-world setting
2019, BMC Research Notes

View all citing articles on Scopus

: Disclosure of potential conflict of interest: The authors have declared that they have no conflict of interest.

View full text

Reviews and feature articleInformation technology–based approaches to reducing repeat drug exposure in patients with known drug allergies

Section snippets

Epidemiology

Information technology–based approaches to reducing medication errors

Conclusions

J Allergy Clin Immunol

J Am Med Inform Assoc

J Biomed Inform

ABC of allergies: adverse reactions to drugs

BMJ

Classification of allergic reactions responsible for drug hypersensitivity reactions

Monitoring the safety and quality of medicines: the Yellow Card Scheme

The National Reporting and Learning System

Medication prescribing errors in a teaching hospital

JAMA

Factors related to errors in medication prescribing

JAMA

Systems analysis of adverse drug events. ADE Prevention Study Group

JAMA

Adverse drug events in ambulatory care

N Engl J Med

Safety in doses: medication safety incidents in the NHS. The fourth report from the Patient Safety Observatory

Building a safer NHS for patients—improving medication safety

Executive summary of disease management of drug hypersensitivity: a practice parameter. Joint Task Force on Practice Parameters, the American Academy of Allergy, Asthma and Immunology, the American Academy of Allergy, Asthma and Immunology, and the Joint Council of Allergy, Asthma and Immunology

Ann Allergy Asthma Immunol

Comparison of international guidelines for the emergency medical management of anaphylaxis

Allergy

The Drug Ambassador Project—the diversity of diagnostic procedures for drug allergy around Europe

Allergy Clin Immunol Int J World Allergy Org

Effect of computerized physician order entry and a team intervention on prevention of serious medication errors

JAMA

A computer-assisted management program for antibiotics and other anti-infective agents

N Engl J Med

Patient safety features of clinical computer systems: questionnaire survey of GP views

Qual Saf Health Care

Prescribing safety features of general practice computer systems: evaluation using simulated test cases

BMJ

Reviews and feature article
Information technology–based approaches to reducing repeat drug exposure in patients with known drug allergies