Documentation of Adverse Drug Reactions in Electronic Medical Records: Areas for Improvement and Impact on Clinical Outcomes
Sunday, March 4, 2018
South Hall A2 (Convention Center)
Jenna T. Nguyen, MD, Iris M. Otani, MD
RATIONALE: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.