Accuracy of medication allergy documentation in My Health Record after severe adverse drug reactions

Background Inaccurate or incomplete documentation of severe medication allergies, such as anaphylaxis and severe cutaneous adverse drug reactions (SCAR), may lead to harm from inadvertent re-exposure to implicated medications. My Health Record (MHR) is a national patient-controlled electronic health record in Australia linking hospital, general practitioner and community pharmacy records. The medication allergy/adverse reaction section should contain accurate information to aid prescribing. Objective To investigate the accuracy of documentation in MHR of confirmed medication-related anaphylaxis and SCAR and to determine barriers and facilitators to documentation. Methods A retrospective cohort study of patients with medication-related anaphylaxis and SCAR, validated between January 2019 and June 2023. Medication allergy documentation in MHR was reviewed after patient consent to determine accuracy with medication and reaction type, against the assessment made by the hospital Adverse Drug Reaction Review Committee and/or allergy clinic consultation. Results Forty-eight patients with anaphylaxis and 40 patients with SCAR (total 88) were included, involving 134 medications. Fourteen (15.9%) patients had their reactions documented accurately in MHR. When analysed per medication, 21 medications (15.7%) were documented accurately. Anaphylaxis, allergy clinic follow-up and life-threatening severity were factors significantly associated with a higher frequency of accurate allergy documentation in the MHR. Conclusion The accuracy of medication allergy documentation for severe allergies in the MHR is low, representing a risk of harm from inadvertent re-exposure. This study identifies several system level issues and makes recommendations to improve patient safety.