Maguire on Marx

Abstract

We performed a snapshot audit of current practice in drugallergy documentation. Consultant approval was obtainedthough none of the junior doctors concerned had prior knowl-edge of the audit. The study group comprised of all generalsurgery (colorectal, breast and vascular surgery) and urologyin-patients. Information about drug allergies was collectedfrom: the patient; the clerking for the current admission; andthe drug allergies’ box on the drug chart. Patients with drugallergies were checked for the presence of a drug allergies’wristband. Drug allergy documentation in the medical notesand on the drug charts was recorded as correct or incorrectdepending on whether or not the information correlated withwhat the patient said.A letter was sent by a consultant surgeon to all PRHOs andSHOs in general surgery and urology (12 doctors). It sum-marised the results of the first audit and stated: (i) it was theirresponsibility to document patients drug allergies in the med-ical notes and on the drug chart; (ii) that it was insufficient toleave drug allergies boxes blank on the premise that in a courtof law ‘if it isn’t documented it hasn’t been asked’; and (iii),finally, that they must check the allergies’ box on the drugchart before prescribing any drugs. The letter also warned thatthere would be a re-audit in the future; this was performed 3months after sending the letter.The first audit (92 patients) showed that 20% of notes and24% of drug charts contained inaccurate drug allergy docu-mentation. Twenty-three patients (25%) had one or more drugallergies (most commonly to penicillin); 20/23 patients (87%)with a drug allergy were wearing a drug allergy bracelet. Thesecond audit (89 patients) showed that the documentation ofdrug allergies was accurate in all notes and drug charts.Twenty-one (24%) had one or more drug allergies (most com-monly to penicillin); 18/21 (86%) of patients with drug aller-gies were wearing a drug allergy wrist bracelet.The first audit showed that documentation of drug allergiesin the medical notes and on the drug charts for general surgeryand urology inpatients was imperfect. The considerableimprovement in the documentation was due to the educationof junior doctors about their roles and responsibilities, and alsodue to the threat of re-audit. There was little differencebetween documentation of the patient’s drug allergies on thedrug allergy wristband between the first and second audits.This is probably because documentation of drug allergies onthe patient’s wristband is performed by the nursing staff whodid not receive the letter sent to the junior doctors. Reducingerrors in the documentation of patient’s drug allergies shouldreduce the chance of patients being given medications towhich they are allergic. This, in turn, will reduce the numberof adverse drug reactions suffered. As a result of this audit, jun-ior doctors will receive a letter stating their responsibilities todocument drug allergies accurately before they start work inthe department.In summary, documentation of drug allergies in the med-ical notes and on drug charts on the general surgery and urol-ogy wards at a district general hospital was imperfect, but wasimproved by education of junior doctors and the prospect of re-audit.The Royal College of Surgeons of England