384 / A computer alert system to prevent allergic reactions to drugs due to administration errors in the Hospital

SPAIN
Classification of the PSP
Type of Patient Safety Practice Not Evaluated
 
Clinical Risk Management Practice (CRMP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Implementation of Patient Safety initiatives / Activities
Surveillance of Patient Safety There is no specified text here
Topic of the reported practice
Clinical risk management
Aim and the benefit of the Patient Safety Practice
 
Drug allergic reactions are a frequent cause of morbimortality in in- and out-patients. Sometimes these reactions are due to the mistaken administration of the drug to a patient already diagnosed of allergy.
A computer system has been designed that, when the prescription is being prepared, authomatically checks the information about drug allergy included in the computarized medical history of the patient. If a patient is being prescribed a drug to which he/she has already been diagnosed or relates an allergy, the system emits an alert to the doctor, who must decide whether the drug should be substituted by another one.

Description of the Patient Safety Practice
 
In our Hospital, an electronic medical history system has been implemented since several years. A window with drug allergies of the patient that has to be filled has been included in each in- or out-patient medical history. This window include the main group of drugs that use to be involved in drug allergic reactions. Also, you can select as allergenic any drug available to be used, searching by pharmacologic or commercial names.
The system use the database BOTPLUS.
When a doctor do a drug prescription for a patient, the system check if the drug prescribed is contraindicated to the patient because of a previous drug allergy. In the case that the doctor prescribe a drug that belong to a group of drugs to which the patient is allergic (i.e amoxycillin to a patient allergic to penicillin), and that had been marked in the electronic patient history, an allert window appear in the screen, indicating to the doctor the allergy. The doctor is free to continue the prescription, but an explanation for skipping the alert is needed.
The system is simple, and don't need to be maintained.
Attachment of relevant written information and/or photos, as appropriate
There is no specified text here
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Effectiveness of the Patient Safety Practice
 
Degree of implementation of reported practice
Yes, fully
Level of implementation of reported practice
Institution level
Specific and measurable outcome for the reported practice were defined
Yes
A baseline measurement before implementation of the reported practice was obtained
No
A measurement after full implementation of the reported practice was obtained
Yes
Evaluation of a "positive" effect of the reported practice on Patient Safety
The evaluation showed improvements in Patient Safety outcomes
Type of before-and after evaluation
Not known
Enclosure of a reference or attachment in case of published evaluation's results
A computer alert system to prevent allergic reactions to drugs due to administration errors in the Hospital.

Gastaminza G, Idoate AJ, Goikoetxea MJ, Ferrer M.

Introduction
Drug allergic reactions are a frequent cause of morbimortality in in- and out-patients. Sometimes these reactions are due to the mistaken administration of the drug to a patient already diagnosed of allergy.

Methods:
A computer system has been designed that, when the prescription is being prepared, authomatically checks the information about drug allergy included in the computarized medical history. If a patient is being prescribed a drug to which he/she has already been diagnosed or relates an allergy, the system emits an alert to the doctor, who must decide whether the drug should be substituted by another one.
The results of the system have been analysed six months after its implementation (July-December 2007): number of attempts stopped or not, causes, most frequent drugs, system errors (wrong alert).

Results:
In these six months, a total of 535 attempts to prescribe a drug to which the patient is presumably allergic were recorded. Out of these, 445 attempts were stopped in 224 different patients; 41% of the drugs were NSAIDs, 38% antibiotics and 21% other drugs. In 52% of the cases, the drug prescribed was directly forbidden, in 25% it belonged to a family related to the patient’s allergy and in 17% the patients were intolerant to NSAIDs. Only 2% were considered errors of the system.
In 90 attempts in 75 different patients, the doctor decided to continue with the administration of the drug (31% antibiotics, 29% NSAIDs, 12% anaesthetics and opiates, 11% iodinated contrast media and 17% other drugs). The reasons to continue the administration were: good previous tolerance (35%), “medical criteria” (28%), allergological study (24%), error in the history documents (7%), error in the administration (2%), other reasons (4%).

Conclusions:
By means of a simple computer system, the mistaken administration of a drug was avoided in an important number of patients allergic to that drug and therefore it could prevent the appearance of a sizeable number of allergic reactions to drugs. The number of system errors is small.


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Health care context where the Patient Safety Practices was implemented
 
Hospital
Transferability
 
Successful implementation of this Patient Safety Practice in other health care settings than above stated
No
Specification of implementation in another health care setting(s)
There is no specified text here
Successful implementation's level  of this Patient Safety Practice across settings
There is no specified text here
Involved health care staff
 
Physicians
Nurses
Pharmacists
Clinical support
Technical support / technician
Clinical manager
Quality manager
Risk manager
Patient Involvement
 
Direct service user's involvement as integral part of this Patient Safety Practice
No
Specification of the service users or their representatives' involvement in the implementation of this Patient Safety Practice
There is no specified text here
Point of time in which service user or their reprasentatives' involvement takes place
There is no specified text here
Active seeking of service users' opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
There is no specified text here
Short description of the service users' level of involvement
There is no specified text here
Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
Yes
List of sources where public information is accessible
Web site
Implementation of the Patient Safety Practice
 
Existing collaboration with other countries or international organisations related to implementation of this Patient Safety Practice
No
Problems encountering in the implememntation course of this Patient Safety Practice like lack of motivation, no management support, etc.
No
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
There is no specified text here
List of the most prevalent drivers for a successful implemetation of this Patient Safety Practice
Motivated staff
Use of any specific incentives to enhance motivation while implementing this Patient Safety Practice
No
Description of used incentives, if any.
There is no specified text here
Existence of support or approval by the clinical or hospital management or any other hihg level authority in the implementation process of this Patient Safety Practice
Yes
Costs of the Patient Safety Practices
 
Completion of cost calculation related to this Patient Safety Practice
No
Total number of person days required to implement this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total number of person days required for training as preparation for implementation of this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total cost in Euro of specific equipment (machines, software, communications supplies, etc.) needed to support implementation of this Patient Safety Practice
There is no specified text here
Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice
There is no specified text here
Contact information
 
Name: Gabriel Gastaminza
Country: SPAIN
Organisation: Clínica Universidad de Navarra, Navarre
E-mail: gastaminza@unav.es
Phone: There is no specified text here
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