A Simple Intervention Significantly Improves Electronic Documentation of Medication Reactions in the Allergy Clinic

Rationale: When documenting medication reactions, it is important to list the reaction symptoms, as this helps distinguish allergies from side effects/intolerances. Improper documentation could lead to unnecessary avoidance of medications. We sought to evaluate and improve reaction symptom documentation in our allergy clinic.

Methods: A 10-minute presentation was prepared that discussed the importance of reaction symptom documentation and reviewed how to electronically enter this information for systemwide viewing. We then evaluated reaction documentation for 50 new patients at each of 3 time points: 1) prior to any intervention, 2) after intervention with the physicians, and 3) after intervention with the clinic nurses. Comparisons were made using chi-squared tests.

Results: Prior to intervention, 39/150 (26%) of reported medication reactions had symptoms documented following the clinic visit. We only entered 1 of these, and the remaining 38 had been entered prior to seeing us. After intervention with the physicians, 28/113 (24%) of reported reactions had symptoms documented following the visit (p=0.8867). Again, only 1 reaction had symptoms documented by us. After intervention with the clinic nurses, 107/142 (75%) of reported medication reactions had symptoms documented (p<0.0001 compared to both prior time points), and our nurses were responsible for entering the symptoms for 61 (57%) of these. Of the 107 reactions, 35 had clearly non-allergic symptoms and 20 were “unknown” or “can’t recall.”

Conclusions: A simple intervention with nurses, but not physicians, was successful in improving medication reaction documentation in the allergy clinic. Better documentation may lead to improvements in prescribing, allergy testing/challenges, and counselling of patients.