Medication errors associated with documented allergies
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Pennsylvania patient safety advisory
- Contributor(s):
- Pennsylvania. Patient Safety Authority. ECRI (Organization) Institute for Safe Medication Practices.
- Publication:
- [Harrisburg, Pa.] : Pennsylvania Patient Safety Authority, c2008
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Drug Hypersensitivity -- prevention & control Medication Errors Analgesics, Opioid -- administration & dosage Analgesics, Opioid -- adverse effects Anti-Bacterial Agents -- administration & dosage Anti-Bacterial Agents -- adverse effects Communication Documentation Health Records, Personal Risk Management Humans Pennsylvania United States
- Genre(s):
- Technical Report
- Abstract:
- The selection of appropriate medications and dosages is dependent upon the availability and review of critical patient information. Without patient-specific clinical information, such as age, weight, allergies, diagnosis, and laboratory values, healthcare practitioners cannot develop safe and effective treatment plans. As many as 18% of serious, preventable adverse drug events stem from practitioners having insufficient information about the patient before prescribing, dispensing, and administering medications. Review of data from PA-PSRS reveals more than 3,800 reports of cases in which patients received medications to which they had documented allergies. Narcotics and antibiotics were the most common medications listed in reports. Types of breakdowns in the communication of allergy information include documentation of patients' allergies on paper but not entered into the organization's computerized order-entry systems, allergy information not consistently documented in expected locations, organizations' attempts to list every drug allergen on the wristband, and allergies arising during episodes of care but not documented in the medical record or communicated to appropriate staff. Strategies to address problems with patients' documented allergies include adding clear and visible prompts in consistent and prominent locations; listing patient allergies, as well as a description of the reaction to the allergen, on all admission order forms; eliminating the practice of writing drug allergens on allergy arm bracelets; and making the allergy reaction selection a mandatory entry in the organization's order-entry systems.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY-NC-DC license. (More information)
- NLM Unique ID:
- 101569944 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/101569944