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Management of emergency department information on children's medication allergies needs improvement

Identifying a child's allergies to certain medications is critical to their safety in the hospital emergency department (ED). However, there are significant gaps in the quality of information management of medication allergies in the pediatric ED, concludes a new study. Researchers found errors in medication allergy identification introduced at triage that persisted despite interactions with subsequent ED clinical personnel. Nursing triage in the typically noisy and hurried ED accurately identified children's medication allergies with a 74 percent sensitivity of detecting true medication allergy and specificity of 93 percent for determining that no allergy existed.

More followup was clearly needed to completely capture children's medication allergies. Yet based on parental reports, in 10 to 25 percent of cases, no additional allergy history was solicited or reviewed by either the treating physician or nurse. These interrelated and error-prone steps can lead to patient harm, notes Stephen C. Porter, M.D., M.P.H., of Children's Hospital Boston in a study supported in part by the Agency for Healthcare Research and Quality (HS11660). He and colleagues observed 256 parent-child dyads at one pediatric ED. They evaluated errors associated with ED information management of allergy data at five points: triage assessment, treating physician's discussion with the parent, treating nurse's discussion with the parent, use of an allergy bracelet, and documentation of allergy history on medication order sheets.

Overall, 28 of 48 patient cases (that parents thought were allergies or were "not sure") were true allergies by guideline-based assessment. Of these 28 cases, only 16 children (57 percent) wore an allergy bracelet, and 2 bracelets had incorrect information. Also, five children with a true medication allergy had a medication order sheet on which the allergy history was documented as negative or was missing.

More details are in "Getting the data right: Information accuracy in pediatric emergency medicine," by Dr. Porter, Shannon F. Manzi, Pharm.D., D. Volpe, and Anne M. Stack, M.D., in the August 2006 Quality and Safety in Health Care 15, pp. 296-301.

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