RPS Conference 2010, Abstracts 2010 - Royal Pharmaceutical Society

36
A Clinical Audit on Reporting and Documentation of Penicillin Allergy at an NHS
Foundation Trust Hospital.
Wasan Amin 1 , Geeta Hitch 1 , Shingayi Molai 2 , Imran Khan 2 , Rohinton Mulla 2
1 University of Hertfordshire, Hatfield, United Kingdom, 2 Luton and Dunstable Hospital NHS
Foundation Trust, Lewsey Road, Luton, Beds, LU4 0DZ, UK., Luton, United Kingdom
Focal points:
• The current practice regarding documentation and reporting of penicillin allergy
by healthcare professionals (HCPs) and to evaluate whether over-reporting of
penicillin allergy was audited by examining prospective and retrospective
patient data.
• Although the use of an alert card and red/white stickers in patients’ hospital
documentation was employed, no formal guidelines on documentation of
penicillin allergy were identified as was a significant (p≤0.0001) lack of
implementation of these procedures.
• No set criteria were identified to enable HCPs to interpret patients’ accounts of
self reported penicillin allergy as either IgE- or non IgE-mediated, the latter
being an adverse side effect resulting in an over-reporting of penicillin allergy by
10% in 59 cases (p≤0.035).
Introduction: Inaccurate documentation of drug allergies can result in patients being given
drugs to which they are allergic. The reported incidence of allergic reactions to penicillin
ranges from 1% to 10% however, the true incidence of anaphylactic reactions is in the range
of 0.004% to 0.015% 1 and patients are labelled as allergic to penicillin without a detailed
investigation to the nature of their reaction 2 .
Method: An audit was carried out to assess the current practice regarding documentation
and reporting of penicillin allergy by HCPs as set out by NICE 3 . Retrospective data (n=100)
were analysed and significant differences between current practice and set standards for
this study were evaluated.
Data from patients’ medical notes and drug charts (n=100) were examined to ascertain the
completeness of the information. As there was no documentation defining differences
between a true allergic reaction and a side effect, criteria were established to identify IgEand
non-IgE-mediated responses. Records were also examined to establish existing
antibiotic policy recommendations. Pre-piloted questionnaires were distributed to both
patients (n=100) and HCPs (n=30) for their perceptions and knowledge regarding allergic
reactions. Ethics approval was granted by the R&D committee at this institution.
Results: No formal guidelines on documentation of penicillin allergy were identified,
although use of an alert card or red/white stickers in patients’ drug charts did exist. No set
criteria were identified to enable (HCPs) to interpret patients’ accounts of self reported
allergy as being either IgE-or non-IgE-mediated. A lack of documentation existed in 9% of
patients’ notes (n=100) with (p≤ 0.03). Also, there was a lack of implementation of policies
regarding insertion of an alert card in the medical notes and placing a red/white sticker on
the drug chart (p≤0.0001). There appeared to be an over-reporting of penicillin allergy by
10% in the validated cases (n=59, p≤0.035) with 87% of the patients (p≤0.035) stating an
allergy to penicillin. Although 63.3% of HCPs were aware of the true penicillin allergy
reaction signs and symptoms, 23.3% considered the side effects as an allergic reaction and
13.3% were unaware of the characteristics of an allergic reaction (p≤ 0.048). From the
HCPs questionnaires (n=30), 57% had not received any formal training in this area, 43%
were pharmacists and only 62% had an input on drug allergy documentation (p≤0.009).