DRUG ALLERGY ASSESSMENT AT A UNIVERSITY HOSPITAL AND CLINIC

The accuracy of drug allergies reported in patients' medical records a nd the cost-effectiveness of pharmacist interviews to clarify these re ports were studied. Fourteen pharmacists interviewed hospital and clin ic patients about reported allergies and noted their assessments in th e patients' charts. The patient's physician was notified of discrepanc ies between previous allergy documentation and the pharmacist's assess ment. The pharmacy resident re-interviewed a convenience sample of the patients to determine consistency among the pharmacists. The reported reactions were classified as true allergies, severe adverse effects, or vague reactions (drug should be avoided); drug intolerance and mild or moderate adverse effects; excessive pharmacologic effects; or no r eaction experienced. The medication profile for each patient was revie wed after discharge to identify the pharmacists' prevention of adverse effects or allergic reactions; cost avoidance was then estimated. The pharmacists assessed 347 reports of allergies in 195 patients. Anti-i nfective agents accounted for 53% of the stated allergies, followed by narcotics (18%), psychotropic medications (7%), nonsteroidal anti-inf lammatory drugs (6%), cardiovascular medications (5%), and others (11% ). For more than 80% of the reports of allergies to beta-lactam antibi otics and sulfonamides, pharmacists either found or could not rule out true allergies; this was the case for only 31% of reported allergies to narcotics. Nine percent of patients who reported allergy to a beta- lactam or sulfonamide had never experienced a reaction to the drug. Ph armacists intervened in four cases to prevent adverse reactions and a total of 4.4 additional hospital days, and in five instances the use o f a less suitable or more expensive drug was avoided. Pharmacists foun d a large discrepancy between reported allergies and true allergies an d helped prevent uses of drugs that could have prolonged patients' hos pital stay.