Documentation of Adverse Drug Reactions to Opioids in an Electronic Health Record.

Research paper by Joshua M JM Inglis, Gillian E GE Caughey, William W Smith, Sepehr S Shakib

Indexed on: 24 Jan '21Published on: 20 Jan '21Published in: Internal Medicine Journal


Allergy to opioids is the second most common drug allergy label in electronic health records (EHR). Adverse drug reactions (ADRs) to opioids cause significant morbidity and contribute to healthcare costs, whilst incorrect opioid allergy labels may unnecessarily complicate patient management. To examine the documentation of opioid ADRs in a large-scale hospital-based EHR. A cross-sectional retrospective review of EHR documentation of opioid ADRs at four public hospitals in South Australia was conducted. Data was extracted from all ADR entries including the reported allergen, ADR category (allergy or intolerance) and reaction details. Expert criteria were used to determine consistency of ADR categorisation as allergy or intolerance. Of 86,727 unique ADR reports, there were 13,781 ADRs to opioids with most being entered as allergy (n=8913, 64.7%) rather than intolerance (n=4868, 35.3%). The most commonly documented reactions were nausea/vomiting (n=3912, 28%), rash (n=647, 5%), itch (n=642, 5%) and hallucinations (n=527, 4%). There were 362 (3%) ADR labels of anaphylaxis. Of those ADRs containing a reaction description (n=11,868), 89% of reports entered as allergy had a reaction description that was consistent with intolerance and 8% of the entered intolerances had descriptions consistent with allergy when assessed using pre-defined criteria. This large EHR-based study demonstrates the high rate of opioid ADR labels in EHRs. The majority of these labels were for symptoms suggestive of pharmacological intolerance. Reactions consistent with true allergy were uncommon. Systematic review of ADRs by a dedicated clinical service would improve the accuracy of documentation. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.