| Summary: | 碩士 === 長庚大學 === 醫務管理學研究所 === 94 === Computerized systems can effectively prevent adverse reactions due to known allergies, but building an effective prevention of allergy alerting system is still a challenge to hospital.
The aim of this study was to construct a drug allergy alerting system, evaluate effectiveness of this system and suggest methods for improving the allergy alerting system. First, we rebuilding the patient’s drug allergy database, knowledge base database of relationships between medications and improve allergy documentation feature. When medications are ordered by clinicians in the computerized physician order entry system（CPOE) system, the orders are electronically compared with the patient’s allergy list. If the alert informs the clinician, he can either discontinue the order or continue with the medication order by overriding the alert, which requires entering a free-text (uncoded) reason for the override action.
When the system started to operate, we collected all the drug allergy alerts generated in the first two months and analyzed the clinician’s reaction to the drug allergy alerts. In the first month, there were 82% of alerts had been overridden. After discussed the reason for overriding alerts, we decide to cancel of the same drug repeat alerting and some groups of the same family drug checking. In the second month, we found the alerts override rates were reduced to 67%. The clinicians mostly accepted alerts of these semantic links from the ingredient knowledge base category was penicillin, cephalosporin and antimicrobial sulfonamide. We also examined the reasons given by physicians for overriding drug allergy alerts and the clinical consequences of such override actions. The fact that over half of the override reasons were ‘‘Aware/Will monitor’’ reflects the complex calculus involved in the risk–benefit analysis of therapeutic decision making, particularly with nonexact match allergy alerts.
The important elements of drug allergy alerting system are the accuracy of the allergy database at any point in time, standardization of the documentation screen, suppression of certain cross-sensitivity checks, performing vary drug-allergy alert screen based on severity of the documented reaction and improvement of allergy documentation.
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