Pharmacist use of the electronic medical record to identify adults at risk for anaphylaxis without epinephrine for self-administration

Abstract

ObjectivesTo describe an innovative pharmacist-led approach, with the use of electronic medical record (EMR) data, to identify patients at risk of anaphylaxis in need of epinephrine auto-injector (EAI) for self-administration. SettingAn urban free health care center for an uninsured indigent adult population in Pittsburgh, PA. Practice innovationIn this pilot service, patients with allergy history fields containing the words “anaphylaxis,” “nut,” “bee,” or “shellfish” were screened for inclusion. Practice descriptionPatients were identified with the use of a report generated by the EMR vendor and were contacted via telephone by a clinical pharmacist. Using the patient-reported clinical history related to anaphylaxis and allergies, the pharmacist assessed the need for EAI, counseled the patient, and provided physician referral when appropriate. EvaluationThe service was evaluated with the use of a cross-sectional study of patients with electronic records at the health center during the time period studied. Data obtained from patient interviews were used to classify patients who were candidates for EAI and to assess prescribing and access to EAI. Demographic data and outcomes related to the availability of non-expired EAI were collected and analyzed using descriptive statistics. ResultsNinety-five patients were identified as potential candidates for the service, and 20 patients were able to be contacted via telephone. Fourteen participants provided consent for their data to be used in the program evaluation. A treatment gap likely existed for 11 of the 14 participants (79%) owing to history of anaphylaxis (57%) or history of systemic reaction (29%). The most common indication for EAI was anaphylaxis in response to bee stings. ConclusionThe findings from this project demonstrate that pharmacist use of EMR data, coupled with patient interview, may be an effective means for identifying treatment gaps in the long-term management of anaphylaxis and has the potential to ultimately improve management of anaphylaxis in patients within the community.