435 - Labeling and Entry of Penicillin Allergy into the Electronic Medical Record During a Pediatric Emergency Department Visit

Poster Number: 435
Publication Number: 435.2896

Background: Penicillin (PCN) allergy is the most commonly reported medication allergy. 10% of patients report PCN allergy yet 95% could tolerate it if given again. Our most recent 3-site Pediatric ED (PED) study showed that over an 18-month period of time we were able to delabel 115/117 patients with low-risk PCN allergy symptoms. However, further review of our single-site PED showed that over a 1-year period of time 416 children who had no reported PCN allergy left their visit labeled as allergic within our electronic medical record (EMR). This represents a significant problem and there must be a comprehensive understanding of how and why these are entered into the EMR.

Objective: Gain insight into the reasons behind a new PCN allergy entry into the EMR during a PED visit.

Design/Methods: Retrospective chart review of children presenting to a PED over a 1-year period with a new PCN allergy diagnosis within the EMR at time of discharge. Chart review was completed using a data collection form and data were entered in REDCap. Review questions sought to examine the role of the person entering the allergy (MD/DO, NP/PA, RN, MA), symptom and risk level designation of the allergy, current status of the allergy, as well as whether the reaction was witnessed, acute antibiotic management was changed, or referral for allergy delabeling occurred. Variables were described using frequencies and proportions.

Results: Preliminary review of 100/416 charts. PCN allergy was entered into the EMR by these providers: RN (86), MD/DO (7), NP/PA (6) and MA (1). The top reported allergy symptoms listed were rash (53), hives (30), nausea/vomiting (6), and diarrhea (3). 53 patients were deemed low-risk. The allergic reaction was witnessed 13 times, and this led to changes in antibiotics 5 times. At time of discharge 4 patients were referred to our PCN allergy delabeling clinic. Since these encounters, 5 patients have been delabled overall in either the PED, inpatient or clinic setting.

Conclusion(s): The entry of a PCN allergy label into the EMR is a poorly understood yet very significant problem. Most of these reported allergies are unwitnessed and non-allergic symptoms such as nausea/vomiting/diarrhea are frequently reported. Very few patients were referred for allergy evaluation or eventually delabeled in the PED, inpatient or clinic setting. Understanding PCN allergy entry into the EMR can inform quality improvement interventions aimed at preventing unfounded allergy labeling while increasing allergy delabeling.