Impact of junior doctor education on drug allergy documentation

Abstract

Inaccurate documentation of drug allergies can result in patients being given drugs to which they are allergic.1 This presents serious risk of harm to patients, as well as serious medicolegal implications. Prescribing errors account for up to 25% of litigation claims in medical practice.2 The UK Department of Health has aimed to reduce by 40% the number of serious errors in the use of prescribed drugs by the end of 2005.2 We performed a snapshot audit of current practice in drug allergy documentation. Consultant approval was obtained though none of the junior doctors concerned had prior knowledge of the audit. The study group comprised of all general surgery (colorectal, breast and vascular surgery) and urology in-patients. Information about drug allergies was collected from: the patient; the clerking for the current admission; and the drug allergies’ box on the drug chart. Patients with drug allergies were checked for the presence of a drug allergies’ wristband. Drug allergy documentation in the medical notes and on the drug charts was recorded as correct or incorrect depending on whether or not the information correlated with what the patient said. A letter was sent by a consultant surgeon to all PRHOs and SHOs in general surgery and urology (12 doctors). It summarised the results of the first audit and stated: (i) it was their responsibility to document patients drug allergies in the medical notes and on the drug chart; (ii) that it was insufficient to leave drug allergies boxes blank on the premise that in a court of law ‘if it isn’t documented it hasn’t been asked’; and (iii), finally, that they must check the allergies’ box on the drug chart before prescribing any drugs. The letter also warned that there would be a re-audit in the future; this was performed 3 months after sending the letter. The first audit (92 patients) showed that 20% of notes and 24% of drug charts contained inaccurate drug allergy documentation. Twenty-three patients (25%) had one or more drug allergies (most commonly to penicillin); 20/23 patients (87%) with a drug allergy were wearing a drug allergy bracelet. The second audit (89 patients) showed that the documentation of drug allergies was accurate in all notes and drug charts. Twenty-one (24%) had one or more drug allergies (most commonly to penicillin); 18/21 (86%) of patients with drug allergies were wearing a drug allergy wrist bracelet. The first audit showed that documentation of drug allergies in the medical notes and on the drug charts for general surgery and urology inpatients was imperfect. The considerable improvement in the documentation was due to the education of junior doctors about their roles and responsibilities, and also due to the threat of re-audit. There was little difference between documentation of the patient’s drug allergies on the drug allergy wristband between the first and second audits. This is probably because documentation of drug allergies on the patient’s wristband is performed by the nursing staff who did not receive the letter sent to the junior doctors. Reducing errors in the documentation of patient’s drug allergies should reduce the chance of patients being given medications to which they are allergic. This, in turn, will reduce the number of adverse drug reactions suffered. As a result of this audit, junior doctors will receive a letter stating their responsibilities to document drug allergies accurately before they start work in the department. In summary, documentation of drug allergies in the medical notes and on drug charts on the general surgery and urology wards at a district general hospital was imperfect, but was improved by education of junior doctors and the prospect of reaudit. The Royal College of Surgeons of England