Use of quality improvement science to improve the accuracy of drug allergy status in pediatric patients after allergist assessments

Background: Documentation of drug allergy status (allergic versus not allergic) of pediatric patients following assessment by an allergist can vary among electronic medical record systems. Inaccurate documentation can affect future medication selection, and lead to suboptimal and potentially dangerous treatment being administered to the patient. Methods: A prospective, single-centre quality improvement study of drug allergy labeling in children referred to the BC Children's Hospital Allergy Clinic was conducted. Electronic medical records of drug allergy status in two systems, BCCH Cerner and PharmaNet, were analyzed to capture hospital care and community settings, respectively. Current state analysis was performed to determine the proportion of patients who had an accurate drug allergy status in Cerner and PharmaNet. An aim statement was then created: the intent was to increase the percentage of patients who were assessed for a drug allergy and had an accurate allergy status on Cerner and PharmaNet within 30 days of being seen by an allergist to 90%. A series of iterative data collection, assessment, and improvement cycles was completed over 12 months. Data were analyzed using time series charts to assess progress and determine if changes made resulted in improvements in drug allergy labeling. Results: Current state analysis showed drug allergy status after formal allergist assessment was correct in between 60% and 90% of the consults by month in Cerner and between 45% and 100% in PharmaNet at baseline. Sustained improvement in documentation of drug allergy status in the hospital electronic medical record was achieved, but there were challenges in improving documentation in the community electronic medical record because allergists do not have access to it. Conclusions: Documenting drug allergy status in multiple electronic medical records results in difficulty in ensuring the records are up to date in all systems. More work needs to be done to ensure that the results of drug allergy assessments are documented in a centralized fashion and are clearly communicated among health care practitioners.