The International Journal of Pharmacy Practice 2007; Supplement 2
Practice and development audit
tion that no allergy exists. Patients with documented drug allergy were checked to see if a red alert wrist band had been issued. Information present in clinical notes or admission documentation was cross-referenced with the drug chart to ensure both documents contained the same information. Patients with no known drug allergies should have this confirmed on their documentation; this was also recorded as being absent or present.
An audit of drug allergy documentation in a district general hospital AK Husband1, C Lloyd1, AJ Worsley1 and DM Skelly2 1
University of Sunderland, Pasteur Building, Wharnecliffe Street, Sunderland SR1 3SD, UK and 2 Queen Elizabeth Hospital, Sherriff Hill, Gateshead NE9 6SX, UK. E-mail:
[email protected]
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Drug allergies are currently an important issue in risk management within the NHS. Are they being documented correctly? Allergy status records and red alert wrist band use across three hospital directorates were checked and compared to the standard set in the trust drug policy Recording of allergy status is not in line with local policy and is often absent from patient records; this includes a clear statement for those patients with no drug allergies. Prominent allergy alert systems such as red wrist bands are not being used in line with local policy
Introduction Drug allergies are a significant cause of avoidable adverse drug reactions amongst hospital in-patients and continue to result in fatal events.1 Management of drug allergies can be achieved through maintenance of accurate and accessible information with reference to patients’ allergy status. Such records are paramount for good patient care and for effective risk management within the NHS.2 Hospitals should have a drug policy in place detailing exactly how to process a patient with a drug allergy. Allergy status should be recorded within clinical notes according to agreed case-note architecture and, where applicable, on the drug chart or electronic prescribing system. The aim of this project was to audit the current standard of drug allergy recording on the inpatient wards of a district general hospital and the level of adherence to the trust drug policy.3
Method Six inpatient wards; two from surgery, two from medicine and two from care of the elderly were visited over a 3-month period to examine drug allergy notation. Patients were randomly selected from each ward. For each patient the clinical notes and specific section for allergy on the drug kardex was checked for any reference to a drug allergy or for confirma-
Results Of 369 patients reviewed across three directorates, 99 (26.8%) had a history of a drug allergy confirmed using previous notes, discussion with the patient and information from the general practitioner. Ninety-five (25.7%) had a definitive record of drug allergy in the clinical notes or the drug chart. Of these patients, 42 (44.2%) had been issued a red alert wristband. Allergy recording was subject to variation between directorates: for care of the elderly wards 6 (1.6%) patients had a definite record of allergy, for medicine 17 (4.6%) had a definite record and for surgery 72 (19.5%); 274 (74.3%) had no drug allergy status recorded in the clinical notes or drug chart.
Discussion This study shows that recording of drug allergy status among hospital inpatients is subject to variation within the same trust. The notation of drug allergy varied substantially across the three directorates, with the surgical directorate demonstrating a much higher rate of allergy notation than either medicine or care of the elderly. The contribution of preadmission review for elective surgical procedures to this higher rate of documentation is not clear, but must be a consideration. Absent, illegible or incomplete documentation can lead to errors in treatment and diagnosis.4 The study clearly shows that most patients (74.3%) do not have any drug allergy status recorded in either the clinical notes or drug chart. The study shows that records for patients who do have a definite history of drug allergy are poor, and that these patients were not routinely issued a red alert wrist band. Forty-two (44.2%) of the patients with a definite allergy were issued an alert wrist band.
References 1 BBC News. Coroner critical of allergy check. http://news. bbc.co.uk/1/hi/england/bradford/4842422.stm (accessed June 14, 2007). 2 Renvoize E, Grange A, Pinder J et al. Patient documentation. On the records. Health Serv J1997;107:30–1. 3 Gateshead Health NHS Trust Policy DP23. Trust drug policy October 2006. 4 A spoonful of sugar: medicines management in NHS hospitals. London: Audit Commission; 2001.
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The International Journal of Pharmacy Practice 2007; Supplement 2
Secondary prevention of osteoporosis and compliance with bone-protection treatments
Tyneside was searched for patients with documented fragility fractures and osteoporosis. Records of these at-risk patients were reviewed by the researcher to identify the number of fractures, whether DEXA scanning was undertaken and what bone-protection treatments were being used. Poor or no compliance with bone-protection treatment was defined as having not ordered at least one prescription or not ordering any prescriptions, in the last 6 months, respectively.
R Purohit2, A Worlsey2,1, W Baqir1,2 and D Campbell1,2 1
Northumbria Healthcare NHS Foundation Trust, Pharmacy, North Tyneside Hospital, Rake Lane, North Shields NE29 8NH, UK and 2Sunderland University, Health and Natural Sciences School Office, Fleming Building, The Science Complex, Wharncliffe Street, Sunderland SR1 3SD, UK. E-mail:
[email protected]
Results
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Half the patients at risk of fragility fractures are not receiving bone-protection treatments In younger patients (≤75 years), DEXA scanning is not being done Compliance with bone-protection treatments (especially bisphosphonates) is poor
There were 128 patients at risk of future fractures (aged 75 years and over; n = 79, aged 65–74 years; n = 23, aged 64 years and under; n = 26). Of these, 113 (88.3%) had a documented diagnosis of osteoporosis. In the
