Enhancing Drug Hypersensitivity Reaction Documentation Through a Clinical Surveillance Tool

Drug hypersensitivity reactions (DHRs) are potentially life-threatening, immune-mediated responses resulting from use of a medicinal product often requiring emergency department (ED) triage. For patient safety, DHR documentation in the electronic health record (EHR) is imperative-ensuring the health care team is alerted to patient risks with the offending drug. A Veterans Affairs Health Care System medication safety team uncovered that only 25.6% of patients treated for a DHR in their local ED had appropriate documentation of the DHR. To address this critical issue, a Quality Improvement (QI) project was designed with the aim of using a clinical surveillance tool to increase the DHR documentation rate in a single VA ED from 25.6% to ≥ 50% over 6 months. The DHR documentation rate was measured monthly and calculated by dividing the number of patients with appropriate DHR documentation after an ED visit for treatment of the DHR by the total number of patients visiting the ED for DHR treatment. Six months of postintervention data revealed an increase in appropriate DHR to 65.4%, through Exponentially Weighted Moving Averages Statistical Process Control analyses. This pharmacist-led QI project uses software already available at many institutions and illustrates one low-cost solution to address underreported DHRs.