Documentation of Adverse Drug Reactions in Electronic Medical Records: Areas for Improvement and Impact on Clinical Outcomes

Abstract

Documentation of adverse drug reactions (ADRs) is a high-priority area for quality improvement per the National Institute for Health and Care Excellence. Understanding the current state of ADR documentation is essential to guide improvements. ADR reports were extracted from electronic medical records (Epic) of 46,425 patients with healthcare encounters at a tertiary academic medical center between 7/1/17–7/24/17. In Epic, ADRs are entered using four pre-set reaction types, 27 pre-set reaction descriptions, and free text comments. Patients with ADRs (74.0%, 34,371/46,425) had a mean of 4.1 ADRs (range 1-42). There were 65,535 unique ADR reports of which 57.4% (23,290/40,565) were entered with reaction type without free text comments, 41.9% (12,451/29,726) without reaction type with comments, and 19.1% (12,519/65,535) without either. Of 7,908 reports entered as reaction type ‘intolerance,’ 5.9% (465/7,908) had descriptions consistent with allergy (anaphylaxis, hives). Of 16,198 ‘allergy’ reports, 7.4% (1,200/16,198) had descriptions consistent with intolerance (anxiety, delirium). Frequent antibiotic utilizers per CDC definition represented 10.8% (3,729/34,371) of patients with ADRs—immunodeficiency 1.8% (631/34,371), dialysis 1.2% (409/34,371), chemotherapy 2.0% (696/34,371), and organ transplant 5.8% (1,993/34,371). Of frequent antibiotic utilizers, 7.2% (269/3,729) had beta-lactam antibiotic ADRs. Accurate ADR documentation is crucial to prevent inadvertent re-exposure and avoid unnecessary use of expensive and less effective second-line therapies. This study highlights a need for improved documentation. Many ADR reports are incomplete or inaccurately categorized. Frequent antibiotic utilizers represent a number of patients with reported ADRs. Ongoing investigation suggests that inaccurate ADR documentation significantly impacts antibiotic use and length of hospital stay.