03.09.14
NICE identifies ‘major issues’ in drug allergy documentation
There are “major issues” in how doctors document the drug allergies of their patients, which could be putting them at risk of serious allergic reactions, according to the National Institute for Health and Care Excellence (NICE).
The watchdog has now published its first guideline on drug allergy in adults, children and young people, which aims to dispel confusion around best practice in assessment, documentation, communication and referral to specialist services.
Every year about 62,000 people in England have a serious allergic reaction to a drug that puts them in hospital, according to Hospital Episode Statistics from 1996 to 2000.
Analysis of patient safety incidents reported to the National Reporting and Learning System between 2005 and 2013 also identified 18,079 incidents involving drug allergy. These included six deaths, 19 ‘severe harms’, 4,980 ‘other harms’ and 13,071 ‘near-misses’. The majority of these incidents involved a drug that was prescribed, dispensed or administered to a patient with a previously known allergy to that drug or drug class.
Prior to launching the guideline, NICE identified major issues in the clinical documentation of drug allergies with insufficient information being recorded and shared with other healthcare professionals or people with allergies themselves.
Under the new guideline – ‘Drug allergy: diagnosis and management of drug allergy in adults, children and young people’ – NICE has recommended a redesign of prescriptions (paper or electronic) issued in any setting to include information on drugs or drug classes people with a known drug allergy should avoid.
It has also been suggested that doctors should prioritise the thorough assessment of any person who is suspected of having a drug allergy.
Professor Mark Baker, director of the centre for clinical practice at NICE, said: “About half a million people admitted into NHS hospitals each year will have a diagnosed drug allergy. If we know that giving someone a particular drug could cause them harm, or in the worst instances may even kill them, the utmost care must be taken to ensure they are not prescribed or administered that drug.
“This new guideline encourages all healthcare professionals to be alert to the possibility of drug allergies and offers best practice on clinical management to ensure every individual is spared from serious harm.”
All drugs have the potential to cause side effects (adverse drug reactions), but not all of these side effects are considered to be allergic. An allergic reaction occurs when the body thinks the medicine is a threat and the immune system responds to it.
Dr Shuaib Nasser, consultant allergist at Addenbrooke’s Hospital, Cambridge, and chair of the Guideline Development Group, said: “Wrongly prescribing drugs to people with known allergies puts them at serious risk of harm but we know this can be avoided. It is important that this is done, as some allergic reactions can be fatal.”
The NICE recommendations highlight the importance of referring people, who have had severe reactions or need ongoing treatment, to find out what alternatives can be taken safely.
Maureen Jenkins, clinical director of Allergy UK, said: “We welcome these NICE guidelines, which will lay the foundation stone for better understanding and management of drug allergy across primary, secondary and tertiary care.”
“At Allergy UK, we frequently have calls about the lack of awareness about drug allergy, inadequate documentation and communication between health professionals, which can put patients’ lives at risk.”
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