Quality standard
Quality statement 1: Documentation using the structured assessment guide
Quality statement 1: Documentation using the structured assessment guide
Quality statement
People with suspected drug allergy have their drug reaction documented using the structured assessment guide.
Rationale
After a person has a suspected allergic reaction to a drug, it is important that full and accurate information is recorded so that prescribing errors and adverse drug reactions can be avoided in the future. A healthcare professional can achieve this by following the structured assessment guide when recording the drug reaction and its severity. The guide is also important for educating patients about the signs, patterns and timings of allergic reactions. This should prevent morbidity and improve health outcomes.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
Evidence of local arrangements to ensure that people with suspected drug allergy have their drug reaction documented using the structured assessment guide.
Data source: Local data collection.
Process
Proportion of people with suspected drug allergy who have their drug reaction documented using the structured assessment guide.
Numerator – the number in the denominator who have their drug reaction documented using the structured assessment guide.
Denominator – the number of people with suspected drug allergy.
Data source: Local data collection.
What the quality statement means for different audiences
Service providers (GPs, A&E departments and secondary care services) ensure that people with suspected drug allergy have their drug reaction documented using the structured assessment guide.
Healthcare professionals use the structured assessment guide to document drug reactions of people with suspected drug allergy.
Commissioners (NHS England area teams) commission services in which people with suspected drug allergy have their drug reaction documented using the structured assessment guide.
People with suspected drug allergy should be examined by their GP or, for severe reactions, by A&E staff, who should also ask questions about the symptoms. They should record details of the reaction using a standard approach. They should ask how soon the symptoms started after taking the drug or how many doses were taken, and whether the person has had a similar reaction to that drug or type of drug before. If the doctor thinks that a person might have a drug allergy they should discuss what this means with them (and their family members or carers as appropriate). They should also give them some written information.
Source guidance
Drug allergy: diagnosis and management. NICE guideline CG183 (2014), recommendations 1.1.1 (key priority for implementation) and 1.2.3 (key priority for implementation)
Definitions of terms used in this quality statement
Structured assessment guide
The structured assessment guide (tables 1 to 3) sets out the signs, allergic patterns and timing of onset of allergic reactions. Healthcare professionals should use tables 1 to 3 as an assessment guide when deciding whether symptoms may be caused by a drug allergy.
Signs and allergic patterns of suspected drug allergy |
Timing of onset |
---|---|
Anaphylaxis – a severe multi‑system reaction characterised by:
|
Onset usually less than 1 hour after drug exposure (previous exposure not always confirmed) |
Urticaria or angioedema without systemic features |
Onset usually less than 1 hour after drug exposure (previous exposure not always confirmed) |
Exacerbation of asthma (for example, with non‑steroidal anti‑inflammatory drugs [NSAIDs]) |
Onset usually less than 1 hour after drug exposure (previous exposure not always confirmed) |
Signs and allergic patterns of suspected drug allergy |
Timing of onset |
---|---|
Widespread red macules or papules (exanthema‑like) |
Onset usually 6 to 10 days after first drug exposure or within 3 days of second exposure |
Fixed drug eruption (localised inflamed skin) |
Onset usually 6 to 10 days after first drug exposure or within 3 days of second exposure |
Signs and allergic patterns of suspected drug allergy |
Timing of onset |
---|---|
Drug reaction with eosinophilia and systemic symptoms (DRESS) or drug hypersensitivity syndrome (DHS) characterised by:
|
Onset usually 2 to 6 weeks after first drug exposure or within 3 days of second exposure |
Toxic epidermal necrolysis or Stevens–Johnson syndrome characterised by:
|
Onset usually 7 to 14 days after first drug exposure or within 3 days of second exposure |
Acute generalised exanthematous pustulosis (AGEP) characterised by:
|
Onset usually 3 to 5 days after first drug exposure |
Common disorders caused, rarely, by drug allergy:
|
Time of onset variable |
[NICE's guideline on drug allergy, recommendation 1.1.1 (key priority for implementation)]