Allergy documentation and transfer within critical care

Introduction

Allergies to medication are common and potentially life-threatening [1]. Patients enter critical care with incomplete information about their history. It is essential for safety that accurate allergy status is documented early in the critical care stay. This clinical audit (CA) was undertaken in a 43-bed, level 3 critical care unit to explore compliance with local guidelines on allergy documentation.

Methods

Critical care patient episodes were obtained retrospectively for a 1-month period. Timing of allergy documentation and drug prescribing was noted from the critical care electronic system (ICIP). Allergy status prior to the critical care admission and after discharge was noted from the ward drug chart. Additional allergy data were identified from the hospital electronic patient record (EPR). The CA was repeated 1 year after implementation of recommendations.

Results

Patient episodes were collated (initial CA n = 58, repeat CA n = 79). A known drug/nondrug allergy was stated in 29.3% patient episodes during the initial CA and 39.2% patient episodes in the repeat CA. Allergy status was incomplete 24 hours after critical care admission for two patients at the initial CA with a reduction to zero during the repeat. Allergy status was incomplete prior to prescribing of a new drug in critical care (excludes fluids, drugs required for emergency intubation) for 51.7% of patient episodes in the initial CA. This figure reduced to 19.0% in the repeat CA. Concordance between EPR and ICIP allergy at the outset was 68.8%, which increased to 76.5% in the repeat CA. Concordance with the ward drug chart pre-admission and ICIP was 77.6%, increased to 93.9% at re-audit.

Conclusions

This CA suggests that up to one in three critical care patients have a known allergy. The potential for harm is high. More than one-half of patients admitted to critical care did not have an allergy status documented prior to prescribing a new drug. There was significant discordance between the paper medication chart and ICIP allergy. A number of factors were introduced following initial findings, including making the allergy status mandatory on ICIP, not allowing the admission summary to be saved prior to allergy documentation and ensuring current allergy documentation on EPR.