D1.251 - Documentation of drug allergy in the Electronic Health Record (EHR) at a Tertiary paediatric allergy service in the UK
Background
Accurate documentation of drug allergy for safe prescription and antimicrobial stewardship is well recognised. Our hospital introduced an electronic health record (EHR) in August 2022 with specific provision for recording allergy status. We audited the existing drug allergy documentation practice leading up to, and following drug provocation test (DPT), within the EHR, against the relevant NICE guidance (CG183). The aim was to evaluate drug allergy documentation in the EHR and communication with referrer /general practitioner (GP) regarding outcome of drug provocation test (DPT).
Method
A retrospective review of records for patients who underwent DPT since the introduction of EHR in 2022 was conducted. Cases were identified from the allergy department database. Compliance with recording the allergy status pre DPT, allergy status following DPT and, communication of the outcome with the referrer were reviewed.
Results
Eighty-three children between the ages of 1-16 years had DPT between October 2022 – December 2024, with a median age of 7 years (IQR 3.5-10). Among the 83 patients, 77 (92.8%) had negative drug provocation tests (DPTs) and were deemed not allergic, while 5 (6.0%) had positive DPTs, including one case of anaphylaxis, confirming allergy. In 1 case (1.2%), the DPT result was inconclusive. The DPTs were conducted for 65 beta-lactam antibiotics, 11 NSAIDs, 6 macrolide antibiotics, and 1 case of clindamycin.
Prior to the DPT, 44 out of 83 (53.0%) were documented in the EHR as "allergic" to the culprit medication. Of these, 12 out of 44 (27.3%) were de-labelled following the DPT. Among those with negative DPTs, 76 out of 77 (98.7%) had a delabelling letter documenting the tolerated drug sent to the referrer.
Conclusion
There was a deficiency identified in the record of drug allergy status in the hospital EHR. The majority of DPT results were distributed to relevant health professionals.
The current NICE (CG183) recommends record of drug allergy status within three categories ‘drug allergy’, ‘none known’ and ‘unable to ascertain’. An additional ‘concern regarding (specific drug name) allergy being evaluated’ category, may be valuable, in the interest of accurate documentation.
