hospitalizations (95% CI 2.93-5.46) and the estimated mortality attributable to DA was 0. In a general hospital in Singapore, the estimated incidence of DAs was 4. Looking at the clinical investigations of suspected reactions, the results demonstrate that these numbers are overvalued. A study in a tertiary care academic medical center in Chicago reported a DA prevalence of 25% in the general adult population. In a study conducted by the European Network on Drug Allergy and the EAACI Drug Allergy Interest group, 10% of parents reported that their child was allergic to a drug. ĭAs are perceived as an important problem. DAs can be categorized as abnormal immunoglobulin E-mediated reactions (eg, anaphylaxis) or delayed, nonimmunoglobulin E-mediated reactions, which are generally less severe (eg, intolerances). Worldwide, the burden of allergies is growing-in particular, drug allergies (DAs) are becoming increasingly common. Also, the effect on patient outcomes and cost-effectiveness should be evaluated. Future research should focus on improving alert specificity, thereby reducing override rates and alert fatigue. It remains difficult to reduce drug allergy alert overload while maintaining patient safety as the highest priority. We found considerable variation in the way drug allergy are recorded in EHRs. It showed that adverse drug events resulting from overridden drug allergy alerts do not occur frequently.Ĭonclusions: Accurate and comprehensive recording of drug allergies is required for good use of CDSS for drug allergy screening. We found only one study specifically reporting outcomes related to CDSS for drug allergies. Important challenges remain for increasing the specificity of drug allergy alerts. Current systems have high alert override rates of up to 90%, leading to alert fatigue. The final key finding is the consistently reported low specificity of drug allergy alerts. There is no generally accepted standard terminology for structured documentation of allergy information. Research on the use of coding terminologies for documenting drug allergies is sparse. Besides the underreporting of drug allergies, outdated or inaccurate drug allergy information in EHRs poses an important problem. Accurate and structured documenting of information on drug allergies in electronic health records (EHRs) is difficult, as it is often not clear to healthcare providers how and where to document drug allergies. Nevertheless, there are some important problems associated with their use. Evidence of the usefulness of clinical decision support for drug allergies has been documented. Large heterogeneity across study objectives, study designs, study populations, and reported results was found. An interrater agreement of 90.9% with a reliability Κ=.787 (95% CI 0.686-0.888) was reached. A further 9 articles were added based on expert opinion, resulting in a total of 69 articles. Results: Of the 3160 articles considered, 60 met the inclusion criteria. Bias could not be evaluated according to PRISMA guidelines due to the heterogeneity of study types included in the review.
Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed as much as possible and searches were conducted in 5 databases using CPOE, CDSS, alerts, and allergic or allergy as keywords. Objective: The aim of this review is to provide a comprehensive overview regarding all aspects of CDSS for drug allergy, including documenting, coding, rule bases, alerts and alert fatigue, and outcome evaluation. Computerized physician order entry (CPOE) systems with built-in clinical decision support systems (CDSS) have the potential to prevent such medication errors and adverse events. In the process of prescribing, dispensing, or administering a drug, a medication error may occur and can have adverse consequences for example, a drug may be given to a patient with a documented allergy to that particular drug. Research Group Clinical Pharmacology and Clinical PharmacyĮmail: Worldwide, the burden of allergies-in particular, drug allergies-is growing. JMIR Bioinformatics and Biotechnology 16 articles.JMIR Biomedical Engineering 59 articles.JMIR Perioperative Medicine 65 articles.Journal of Participatory Medicine 69 articles.JMIR Rehabilitation and Assistive Technologies 168 articles.JMIR Pediatrics and Parenting 224 articles.Interactive Journal of Medical Research 244 articles.JMIR Public Health and Surveillance 940 articles.Journal of Medical Internet Research 6775 articles.