124 Chapter 5 allergy. Both registration of a new allergy and retrieval of information on previously reported allergies is time consuming. Interviewees mentioned that miscommunication between different EMRs resulted in missing information and hindered removal of incorrect antibiotic allergy registrations. None of the interviewed healthcare providers used a protocol or specific procedure for registering antibiotic allergies, although some expressed a wish for a guideline. According to the interviewees, a guideline should be accompanied by a decision support system in an EMR and together these were seen as an effective solution. Capacity for organizational change Incorrect antibiotic allergy registrations were not deemed to be problematic by PCP’s and hence they gave little priority to improving the verification of existing antibiotic allergies. They stated there is “no need as there is always an alternative antibiotic available”. In contrast, ECPs more frequently perceived allergy registrations as a problem as they frequently encountered patients with multiple antibiotic allergy registrations, hindering the selection of an appropriate antibiotic. An ECP also commented that high staff turnover impeded the necessary changes in policy to ensure correct registration of antibiotic allergies. Social, political and legal factors One interviewee also stated that, based on previous personal experience, fear of medical liability can lead to incorrect registration of antibiotic allergies or omission to remove a previous registration. Discussion The main finding of our study is that in the majority of cases (56.3%) recorded information was insufficient to determine whether the reaction was of an allergic nature. Main causes of insufficient quality of registrations were lack of knowledge, lack of priority, limitations of registration features in EMRs and patients interpreting side effects as allergies.
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