Margaret  Verrico, RPh, Drug Information Pharmacist, Department of Pharmacy and Therapeutics
Heena Sheth, MD, MPH, Research Assistant Professor, Department of Medicine
Christa Bartos, RN, Systems Analyst, Electronic Health Record
Charles Boucek, MD, Anesthesiologist, Department of Anesthesiology
Sarah Bradford, RN, Nurse Supervisor, Department of Radiology
Karen Fielding, PharmD, Pharmacy Director, Western Psychiatric Institute and Clinic
Cheryl Janov, RN, Risk Management Specialist, Risk Management
Laurie Rack, RN, Nurse Administrator, Department of Nursing
Timothy Silfies, RPh, Systems Analyst, Electronic Health Record
Adele Towers, MD, MPH, Vice Chair of Quality Improvement, Department of Medicine
Kelley Wasicek, RPh, Pharmacy Manager, Department of Pharmacy

• Frequency of medication errors related to allergy over 12 months before and after implementation of the Allergy Task Force (ATF)
• Frequency of adverse drug events (ADEs) related to medication allergy over 12 months before and after implementation of ATF
• Percentage of intercepted errors
• Percentage of medication errors involving allergy as compared to total medication errors reported by month for 18 months (6 months before and 12 months after the initiation of ATF actions)

• Recommended emergency department process:
  • Review existing allergy information in electronic health record (EHR)
  • Apply allergy bracelet to all patients with known allergies
  • Complete allergy information within the patient history database
• Developed a “New Allergy Notification Form.”  A copy is given to the patient at discharge. Pharmacist enters allergy information into the permanent EHR.
• Nursing initiatives:
  • Admitting nurse checks allergy bracelet and applies bracelet if missing
  • Allergy information verification, documentation in the nursing assessment form and fax form to the pharmacy
  • Place allergy information on the cover of the patient’s paper medical record
  • Discussed concerns regarding “override” medications that bypass allergy review by pharmacy
• Physician initiatives:
  • Education regarding antibiotic cross-sensitivity, re-challenge and desensitization guidelines
  • Computer training for documenting allergy correctly
  • Patient care conferences to discuss preventable allergic events
• Pharmacy education:
  • Electronic prompt reminding pharmacists to obtain allergy information before entering orders
  • Document a reason before overriding a computerized allergy warning
  • Communication with physicians and nurses when a medication contraindicated due to allergy is prescribed
  • Emphasis on entering allergy using codified terms versus free text
• System initiatives:
  • Proposed wallet card with allergy list for patient use
  • Development of computer interfaces to import allergy information
  • Bar coding and computerized physician order entry to include allergy check when available

• 12 percent increase in interception of medication errors related to allergy
• 22.5 percent reduction in medication errors related to allergy
• Educating staff regarding allergy documentation and related issues (cross-sensitivity, desensitization, rechallenge consent) and streamlining the communication process reduced preventable allergic ADEs

Margaret M Verrico, RPh
Drug Information Pharmacist
University of Pittsburgh Drug Information Center
verricomm@upmc.edu

[Storyboard presentation at IHI's National Forum, December 2004]