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Impact of Clinical Decision Support on Time to Order Resolution for Patients with Documented Allergies
Tenielle Watkins1, Sandra M Aguero2, Michael Jaecks3
1Einstein Medical Center- Philadelphia, 5501 Old York Road, Philadelphia, PA 19141, USA. Tuf20297@temple.edu.
Abstract:
Failure to appropriately document patient medical information, such as allergies, is an important cause of medication errors. Lack of allergy details in the electronic medical record (EMR) may prolong the pharmacist order verification process. A retrospective chart review was conducted in October 2017, to evaluate the impact of incomplete allergy details on time to antibiotic order resolution at the Einstein Medical Center Philadelphia. Details were present on 71% of orders. The difference in median time to order resolution, for orders with versus without details, was ⁻21 min (95% CI (confidence interval), ⁻39 to ⁻2.9; p = 0.02). The difference in median time to order resolution for orders, based on pharmacist work shift was, ⁻21 min for the first shift (95% CI, ⁻41.2 to ⁻0.8; p = 0.04), ⁻50 min for the second shift (95% CI, ⁻109.8 to 9.8; p = 0.10), and +3 min for the third shift (95% CI, ⁻36.1 to 30.1; p = 0.85). Orders with an allergy intervention by a pharmacist were 2.75 times more likely (adjusted odds ratio = 2.75; 95% CI, 0.98 to 7.7; p = 0.06) to have a therapy change than orders without allergy interventions. Based on the results, when information about antibiotic allergies lacks details, it takes more time for pharmacists to resolve alerted orders.
Insights
Incomplete patient allergy documentation in electronic medical records (EMR) significantly delays antibiotic order resolution by pharmacists. Providing detailed allergy information is crucial for efficient medication safety processes.
Area of Science:
- Medical Informatics
- Pharmacology
- Patient Safety
Background:
- Incomplete patient medical information, particularly allergies, is a significant contributor to medication errors.
- Lack of detailed allergy information within the electronic medical record (EMR) can impede the pharmacist's order verification workflow.
Purpose of the Study:
- To assess the impact of incomplete allergy documentation on the time required for antibiotic order resolution.
- To analyze the effect of detailed allergy information on pharmacist order verification efficiency.
Main Methods:
- A retrospective chart review was conducted at Einstein Medical Center Philadelphia in October 2017.
- The study analyzed the time to antibiotic order resolution based on the presence or absence of detailed allergy information in the EMR.
Main Results:
- Detailed allergy information was available for only 71% of antibiotic orders.
- Orders with detailed allergy information showed a significantly shorter median time to resolution (⁻21 min, p=0.02).
- Pharmacist interventions for allergies increased the likelihood of therapy changes (aOR=2.75, p=0.06).
Conclusions:
- Incomplete antibiotic allergy details in EMRs lead to prolonged order resolution times for pharmacists.
- Enhancing the documentation of patient allergies is essential for improving medication safety and workflow efficiency.
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