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Penicillin Allergy Documentation Completeness in a Large US Healthcare System
Hagen F Puller1, Bohang Jiang2, Madelyn L Eippert3
1Department of Medicine, Brigham and Women's Hospital, Boston Mass.
Summary
Most penicillin allergy documentation lacks detail, hindering safe de-labeling. Improving electronic health record allergy module entries, especially free-text comments, can enhance penicillin allergy documentation completeness and de-labeling access.
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.
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