Flushing an Offensive Term for Vancomycin Infusion Reaction From the Electronic Medical Record

Abstract

BACKGROUND The medical establishment continues to be complicit in the degradation of native peoples of the United States through the use of the racist phrase “red man syndrome” (RMS) to describe the histamine-release syndrome that accompanies vancomycin infusion. METHODS Five months after the transition from 1 electronic health record to another at our freestanding children’s hospital, our antimicrobial stewardship team reviewed all active allergy records to identify and then replace use of RMS terminology with preferred alternative “vancomycin flushing syndrome.” In partnership with institutional stakeholders, we also launched an educational campaign and instituted in the electronic health record an autocorrect functionality to prevent new RMS entries. RESULTS We identified allergy records for 21 034 individual patients. Vancomycin was an allergen for 445 (2.1%) patients, and RMS-related terminology appeared in 274 (61.6%) of these records; we replaced all RMS instances with the vancomycin flushing syndrome term. During the 3-month period after the intervention, we identified allergy records for 8648 additional patients, with vancomycin as allergen in 65 (0.7%) and with RMS terminology identified and replaced in 29 (44.6%). In addition to the lower rate of RMS among allergy records after the intervention, we detected 3 instances of alternative terminology use. CONCLUSIONS Implementing an institutional-level change in terminology, even for racist language, requires education, reinforcement, and continued surveillance. To effectively replace this term, we need the support of national stakeholders to remove this language from our medical education systems, our textbooks, and our clinical lexicon.