Antibiotic allergies often inaccurately documented in tertiary pediatric hospital setting
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Antibiotic allergies frequently were incompletely and inconsistently documented in a tertiary pediatric hospital setting, according to a study presented at the European Academy of Allergy and Clinical Immunology Hybrid Congress.
Culprit antibiotics were then prescribed and administered relatively frequently, Annabelle Arnold, DipHE, a clinical nurse specialist in drug allergy in the department of immunology at Perth Children’s Hospital in Western Australia, and colleagues wrote.
The researchers noted that inadequate allergy documentation is rare but can lead to adverse events when patients receive medications to which they are allergic, and poor understanding among hospital staff is the primary cause of these errors.
“I knew that documentation around allergies to medications was an issue within health care,” Arnold said in a press release. “However, until we did this study, I had not realized the extent of the problem.”
The retrospective study examined the data of 335 children (52% male; mean age at first presentation, 5.4 years) with 1,650 admissions to Perth Children’s Hospital between 2006 and 2017, including an audit of 2,241 medication charts.
Each of these patients had a reported antibiotic allergy, including 47.1% to penicillin, 16.4% to amoxicillin and 4.2% to cephalexin, and 19.7% had multiple allergies including nonantibiotic drug allergies.
Although 68.9% of the medical charts identified an allergy, 17.8% of them did not document the reaction, and 25% were inconsistent across admissions. These inconsistences included that 27.2% documented a different reaction, 45.1% added a drug and 25% omitted a drug.
Specifically, 13.4% of children with a beta-lactam allergy were prescribed a beta-lactam drug, and a beta-lactam drug was administered to 10.4%. Also, the same reported culprit antibiotic was prescribed and administered to 8.9% of these patients.
However, there were no incorrect prescriptions for nonantibiotic medications, suggesting that mistakes may be due to staff not understanding cross-reactivity within antibiotic classes.
The researchers further found inconsistencies between in-patient notes and medication charts in 26.7% of admissions, and 26.9% of charts did not have an adverse drug reaction alert sticker that aligned with hospital policy.
According to the researchers, these findings reflect the consequences of a poor understanding of drug allergy while demonstrating the need to increase education and standardize documentation practices among all the staff in the hospital, adding that these problems may be widespread and not limited to their facility.
Whereas inaccurate documentation could harm patients, the researchers wrote, accurate documentation could optimize therapy, decrease adverse drug reactions, improve inappropriate prescribing and improve overall care. It also can enable appropriate clinical alerts and notifications to prevent future errors.
Reference:
- Drug allergy reporting: Are we playing it safe in paediatrics? https://eaaci-cdn-annual2022-media.azureedge.net/media-library-uploads/10_Drug_Allergy_Reporting_Are_we_playing_it_safe_in_paediatrics_0defe336e8.pdf. Posted: July 1, 2022. Accessed: July 1, 2022.
Perspective
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Unfortunately, this is very consistent with what we see in the United States: inaccurate recording and lack of information regarding drug allergies. It often starts in childhood, and then the allergy “follows” the patient throughout life without being re-evaluated. Ideally, the allergy section of the chart should be continuously revisited for accuracy, but unfortunately, this is not usually done.
Another important point is that kids often get viral rashes while on antibiotics, so they accrue “allergies” when they were never truly allergic to the drug.
As a result of these errors, patients unnecessarily avoid antibiotics that are often more effective for their infections, and they may be at risk for more side effects from second-line antibiotics.
My main recommendation is that the allergy field should be thought of as fluid and that patients should be referred to an allergist to have their drug allergies verified.
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Arnold A, et al. Drug allergy reporting: Are we playing it safe in paediatrics? Presented at: EAACI Hybrid Congress; July 1-3, 2022; Prague (hybrid meeting).
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