One Term at a Time: Removing a Racist Term from the Electronic Health Record

From the 2022 HVPA National Conference

Talene Metjian Pharm.D. (Children’s Hospital of Philadelphia), Linda Tague (Graduate), Sanjeev Swami MD, Kathleen Chiotos MD, MSCE

Background

Vancomycin is an antibiotic that is used to treat serious bacterial infections and is the second most prescribed antimicrobial at the Children’s Hospital of Philadelphia (CHOP). “Red man syndrome” is a term used to describe an infusion related reaction that can occur with vancomycin administration characterized by a maculopapular rash, flushing, redness, and/or itching on the face, neck, trunk, and/or upper extremities due to histamine release. While not a true allergic reaction, this syndrome is documented in the electronic health record (EHR) as an allergy, as well as in other clinical documentation. “Red man syndrome” is a racially charged term. First, is a pejorative term referring to persons of Native American descent. Second, this terminology describes the reaction as it would manifest in patients with light skin, which could lead to under-recognition of skin findings in patients with dark skin. In May 2021, the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America published a joint statement endorsing the term “vancomycin infusion reaction” to replace the term “red man syndrome.”

Objective

To remove the term “red man syndrome” and replace it with vancomycin infusion reaction” across the enterprise.

Methods

The removal of this term impacts many areas within the enterprise. The Antimicrobial Stewardship Program (ASP) and the Division of Infectious Diseases met with key stakeholders to provide education on the change in terminology.

A query was performed in the EHR to check the allergy field for any records with the specified term, and the allergic reactions were automatically replaced with the new phrase.

The ASP partnered with CHOP Marketing to prepare an enterprise-wide communication campaign that entailed announcements, screen savers, banners, and a QR code. In addition to the CHOP collaborations, outreach to local medical, pharmacy, nursing and allied health schools occurred to recommend curriculum updates.

Results

A total of 986 patient allergies were updated in the EHR in December 2021. Eight-hundred and thirty-three records were changed through IS coding and 153 records were updated manually. Four pathways, one procedure, the CHOP formulary, and the enterprises safety reporting system (KAPS) were revised to reflect the correct terminology.

Conclusion

Medical terminology can contribute to implicant bias. This initiative to change one term took eight months to implement and required modifications in five electronic platforms. The depth of medical terminology that needs revision is unknown. A systematic and efficient approach should be developed to review and eliminate biased language in the EHR.

Clinical Implications

Healthcare has a history of using words that are offensive often leading to stigmatization. Recognizing and removing derogatory terminology from medical care is one step towards equitable medical care.

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