A qualitative study exploring how undergraduate pharmacy students undertake a drug allergy history
Authors: Ghattas J , Lim R , Dunsmure L , Kildonaviciute K , Ng B Y 
Published: April 2024

Abstract

Introduction
If antimicrobial resistance (AMR) is not controlled, a post-antibiotic era could result in common infections and minor injuries becoming fatal. One way to combat AMR is the ‘de-labelling’ or removal of incorrect antibiotic allergy labels. At least 92% of labels corresponding to penicillin allergy are incorrect when tested.[1] This means that patients may not be receiving the correct antibiotic treatment and take longer to recover. Therefore, taking an accurate allergy history is important. Pharmacists routinely take drug allergy histories. From 2026, pharmacy students in England will graduate as prescribers, highlighting the importance of drug allergy knowledge and skills.

Aim
To explore how undergraduate pharmacy students undertake a drug allergy history.

Methods
A qualitative study utilising a constructivist approach involving a low-fidelity simulation followed by a one-to-one face-to-face semi-structured interview was conducted. Final year undergraduate Master of Pharmacy students of an English school of pharmacy were recruited via email and word-of-mouth to take part in this study. Following informed consent, participants simulated taking a drug allergy history with a student researcher. The simulation was audio-recorded and then played back to the participant as a cue for a subsequent audio-recorded semi-structured interview that explored their thought-process when taking a drug allergy history. All audio-recordings were transcribed verbatim. Transcripts were analysed using reflexive thematic analysis.[2]

Results
Nine participants took part in the study. The simulation and interview lasted seven minutes on average. Four themes were generated through the analysis. Theme 1: taking drug allergy history is learnt mainly through practice-based learning. Theme 2: nature, type and severity of allergic reactions information were deemed important for making clinical judgements. Theme 3: skills for taking drug allergy history are underdeveloped despite having knowledge. Theme 4: real patient contact exposure is needed to translate learning into practice. Most participants remembered learning about taking drug allergy history through practice-based learning sessions such as workshops, objective structured clinical examinations (OSCEs) and hospital placements. Participants seemed to follow a set of ‘rules’ when undertaking the simulation. For example, they stopped asking questions about allergies and decide not to dispense penicillin when they were informed that the patient was allergic to penicillin. Most participants recognised the risk of serious harm to patients if they made a mistake about patient allergies, and the need to have more real-world experiences to help translate their learning into practice.

Conclusion
Pharmacy students appeared to have the theoretical knowledge about drug allergies, but they were not yet able to make an appropriate clinical judgement in real-world situations. An increase in real-world clinical experience such as patient consultations in work-based placements can provide pharmacy students with valuable opportunities. By knowing how to undertake an accurate allergy history, fewer people will be inaccurately labelled as allergic, promoting antimicrobial stewardship. To our knowledge, this is the first study investigating how United Kingdom undergraduate pharmacy students undertake a drug allergy history. Our participants studied in one pharmacy school and undergraduate pharmacy students studying in other pharmacy schools may have different experiences around drug allergy history taking.

References
1. Savic L, Gurr L, Kaura V, Toolan J, Sandoe JAT, Hopkins PM et al. (2019). Penicillin allergy de-labelling ahead of elective surgery: feasibility and barriers. British Journal of Anaesthesia;123(1):e110–6.
2. Braun, V and Clarke, V. Thematic analysis: A practical guide. Sage; 2022.