A review of the quality and completeness of the allergy status documented during the transfer of care
Authors: Odetunde T , Shah P , Kausi R 
Published: November 2023

Abstract

Introduction
The implementation of NICE Clinical Guidance, Drug Allergy: Diagnosis and Management across all care settings is crucial to improve prescribing practices and ensure safer care throughout the NHS. This study is of great significance as incorrect allergy status leading to treatment delay and adverse drug reactions (ADRs) is a cause for hospital admission.

Aim
This study aimed to ascertain whether the allergy status of patients admitted to three community hospitals was consistent with NICE recommendations. Additionally, the study explored the advice and information provided to patients regarding their allergies.

Methods
The First Community research team and the Health Research Authority (HRA) online decision tool were used to determine if ethical approval was required. It was concluded that no approval was necessary. A retrospective analysis of the discharge summaries, GP summaries, and Drug Charts was conducted to determine consistency in allergy recording across the interface. Medical records of 61 patients admitted to three community hospitals were reviewed over three days in December 2022. Four patients with missing records or non-drug allergies were excluded. The information about allergy status was categorized using a data collection form based on NICE guidelines. 22 patients were administered a questionnaire to explore if they had a consultation regarding their allergy and if any written information was provided. All results were analysed using Microsoft Excel.

Results
The analysis covered 57 patient discharge summaries, GP summaries, and drug charts. The results indicated that 98.3% of patients had their allergy status documented. However, to comply fully with NICE guidance, all elements of allergy documentation must be recorded, which was not the case for any of the patients. The lowest compliance rate was for "the need to state the class of medicines" (0%). 86.4% (19) of the 22 patients who completed the questionnaire acknowledged that their doctor did not address their drug allergy with them at the time it occurred. 95.5% (21) of patients did not receive structured written information while 72.7% (16) of patients are not aware of the drug(s) or drug classes to avoid. Only 27.2% (5) of patients discussed the information offered with pertinent healthcare personnel, and none of the patients carried the information given with them.

Discussion/Conclusion
This study highlighted that NICE guidance is not always followed in its entirety during the transfer of care. The sample size is a limitation of this study; therefore, more research is needed in a community hospital environment with a larger sample size. Caterham Dene Community Hospital has responded to this study by changing its drug chart to include a distinct box for allergy, side effects, and intolerance. Prescribers must evaluate allergy lists and classify medications as either allergy, side effects, or intolerance upon admission. The study's results were shared in the Surrey Heartlands Newsletter to remind prescribers of the requirement to document allergy status accurately and encourage healthcare professionals to improve communication with patients about their allergies to minimize adverse drug reactions.

References
1. National Institute for Health and Care Excellence, Drug Allergy: Diagnosis and Management, Clinical Guidance 183: Published: 03 September 2014. http://www.nice.org.uk/guidance/cg183