Penicillin Allergy Documentation Completeness in a Large US Healthcare System.

Area of Science:

• Clinical Informatics
• Pharmacology
• Patient Safety

Background:

• Incomplete penicillin allergy documentation hinders accurate risk stratification.
• This impedes safe and efficient penicillin allergy de-labeling efforts.

Purpose of the Study:

• To examine the completeness of penicillin allergy documentation within electronic health record allergy modules.
• To assess documentation quality across various domains, including coded fields and free-text comments.

Main Methods:

• Retrospective review of electronic health record data (1/2019-4/2022) for adults with penicillin allergy labels.
• Assessed completeness of coded domains and optimal quality documentation (coded domains + free-text).
• Analyzed patient characteristics associated with documentation completeness using univariable odds ratios.

Main Results:

• Only 23% of 47,799 penicillin allergy labels were complete across coded domains; 11% had optimal quality.
• Older age, female sex, higher comorbidity index, and specific healthcare encounters were linked to better documentation.
• Free-text comments in 79% of reviewed labels contained clinically useful information.

Conclusions:

• The majority of patients have insufficient detail in their electronic penicillin allergy documentation.
• Variations in documentation quality by patient characteristics may create barriers to de-labeling.
• Optimizing the use of free-text comments can improve penicillin allergy documentation and de-labeling access.