Table 3.

Summary of articles related to clinical documentation

Drugs of interest assessed	Study design	Articles	Summary of findings
Assessing documentation accuracy (n=17)
General	Retrospective review	Hsu et al. (2011)67 Goldblatt et al. (2017)68 Blumenthal et al. (2017)71 Foremen et al. (2020)69 Rukasin et al. (2020)70	Drug allergy histories on smart cards are incomplete in many cases and have inconsistent formats 67. Only 27% of SJS/TEN patients had all implicated drugs noted in the outpatient (primary care) record 68. Allergies tend to accumulate over time with comparatively few allergy deletions 71. Only 45.1% (n = 1671/3705) of reactions consistent with intolerance (e.g., “nausea,” “diarrhea”) were correctly categorized as such 69. EHR transitions pose a significant risk for EHR-related errors which can be compounded by human error. 70
	Cross-sectional	Reinhart et al. (2008)75 Lyons et al. (2015)73 Kiechle et al. (2018)72 Kabakov et al. (2019)74	Allergy information was successfully entered in 84.6 % of hospital admissions with a significantly lower rate (37.5%) among whose ethnicity groups, on average, have lower rates of English fluency 75. Three studies 72-74 reported that discrepancies between medication allergies recorded in EHRs and those elicited in interviews are common.
	Qualitative interview	Fernando et al. (2014)77 De Clercq et al. (2020)76	Most drug reactions are likely to go unreported to and/or unrecognized by healthcare professionals or are inaccurately recorded. 77 Family physicians and pharmacists perceive that few documented antibiotic allergies are in fact correct 76
Beta-lactam	Retrospective review	Moskow et al. (2016)78	Among all patients with a documented beta-lactam allergy, 36.2% had an empty or missing allergy reaction description in their EHR. 78
Penicillin	Retrospective review	Rimawi et al. (2013)79 Inglis et al. (2017)80	36% of the 55 patients with proven penicillin tolerance who revisited the hospital within a year had penicillin allergy redocumented. 79 Penicillin adverse drug reaction categorization was inconsistent. 10.1% of reports entered as allergy had reaction descriptions that were consistent with intolerance and 31.0% of the entered intolerances had descriptions consistent with allergy. 80
	Prospective/ interventional	Staicu et al. (2017)81	Severe or life-threatening penicillin allergies were underreported in nearly half of patients (43%). 81
Contrast agents		Deng et al. (2019)82 Ananthakrishnan et al. (2021)83	The majority of the 40,669 contrast allergen records were low quality (69.1%) rather than intermediate (19.4%) or high quality (11.5%). 82 Iodinated contrast media premedication prompts in the EHR are often erroneous because of inaccurate coding, incomplete data, and reaction misclassification. 83
Improving drug allergy documentation (n=10)
General	Prospective/interventional	Young et al. (2011)87 Burrell et al. (2013)84 Lesselroth et al. (2015)85 Masaharu et al. (2018)86 Goss et al. (2018)93 Soyer et al. (2019)89 Wang et al. (2020)90	Using an electronic version of a drug calendar considerably increased the ease and efficiency of completing dermatology consultations. 87 A pharmacy-driven initiative intended to improve the completeness of drug allergy/intolerance documentation was associated with modest success. 84 A patient-facing medication reconciliation and allergy review kiosk. 85 A novel standard format for recording allergy information resulted in increased allergy documentation and decreased adverse drug events. 86 A comprehensive value set to improve the consistency and accuracy of adverse reaction documentation in the allergy module was developed including 1106 concepts. 93 Structured intervention led to an increase in quality of coding and reduction in discrepancies coded by medical record technicians and pharmacovigilance teams. 89 A dynamic reaction picklist developed using EHR data and a statistical measure was superior to the static picklist and suggested proper reactions for allergy documentation. 90
	Retrospective review	Vethody et al. (2021)91	Patients with multiple drug allergy labels can be safely delabeled to multiple drugs in 1 visit. 91
Beta-lactam	Prospective/interventional	Wright et al. (2019)88	Allergy documentation of antibiotic test dose results increased with use of CDS. The addition of electronic alerting increased allergy documentation to 66.7% from 51.3% in the pre alert period. In addition to a greater likelihood of updating, updates were made significantly faster in the post alert period. 88
Penicillin	Retrospective review	Lachover-Roth et al. (2019)92	Penicillin allergy annulling via oral challenge test proved to be safe and effective. 92

Abbreviations: SJS, Stevens Johnson Syndrome; TEN, Toxic Epidermal Necrolysis