Clinical Decision Support Systems for Drug Allergy Checking: Systematic Review

Area of Science:

• Health Informatics
• Clinical Pharmacy
• Patient Safety

Background:

• Growing global burden of drug allergies necessitates improved medication safety.
• Medication errors, including administering drugs to allergic patients, have adverse consequences.
• Computerized physician order entry (CPOE) systems with clinical decision support systems (CDSS) can prevent such errors.

Purpose of the Study:

• To provide a comprehensive overview of CDSS for drug allergy management.
• To examine aspects including documentation, coding, rule bases, alerts, alert fatigue, and outcome evaluation.

Main Methods:

• Systematic review following PRISMA guidelines.
• Searches conducted in 5 databases using keywords: CPOE, CDSS, alerts, allergic, allergy.
• Included 69 articles after initial screening of 3160, with expert opinion additions.

Main Results:

• Evidence supports the usefulness of CDSS for drug allergies.
• Challenges include inaccurate/incomplete allergy documentation in electronic health records (EHRs) and lack of standard terminology.
• Low specificity of drug allergy alerts leads to high override rates (up to 90%) and alert fatigue.

Conclusions:

• Accurate and comprehensive drug allergy recording is essential for effective CDSS.
• Reducing alert overload while maintaining patient safety is difficult.
• Future research should focus on improving alert specificity, reducing overrides, and evaluating patient outcomes and cost-effectiveness.