Penicillin Allergy Documentation Completeness in a Large US Healthcare System

Incomplete penicillin allergy documentation impedes risk stratification necessary for safe and efficient delabeling efforts.

To examine completeness of penicillin allergy documentation across domains in electronic health record allergy modules.

We considered coded and free-text electronic health record data within the allergy module documented from January 2019 to April 2022 among adults with active penicillin allergy labels at a large academic medical center. We assessed completeness of coded domains individually and considered optimal quality documentation, defined as completion of all coded domains plus the presence of a free-text comment. We assessed the relation of patient characteristics to documentation completeness, reporting univariable odds ratios (ORs) with 95% CI.

Of 47,799 penicillin allergy labels, 10,956 (23%) were complete across all coded domains and 5,185 (11%) demonstrated optimal quality documentation. Older age and female sex were associated with increased odds of optimal documentation (P for trend < .001 with increasing age; OR, 1.27; 95% CI, 1.19-1.36 for female sex). Patients with higher Charlson comorbidity index, visit to an allergist, visit to an emergency department, or hospitalization had increased odds of optimal documentation (OR, 2.96 [95% CI, 2.62-3.35], 2.02 [95% CI, 1.87-2.18], 1.42 [95% CI, 1.33-1.52], 2.19 [95% CI, 2.01-2.38], respectively), as did patients with 5 or more other (ie, non-penicillin) allergy labels (OR, 2.10; 95% CI, 1.93-2.29). Across manual review of 1000 penicillin allergy label free-text comments, 785 (79%) contained clinically useful information that corresponded to at least 1 key allergy history domain.

Most patients with penicillin allergy labels lack sufficient detail in the electronic health record allergy module. Considering that documentation quality varies by patient characteristics, some patient groups may face additional barriers to penicillin allergy delabeling. Thoughtful utilization of free-text comment entries may improve penicillin allergy label completeness and offer better delabeling access.