Patel F, Elkhalifa S
Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, U.K.
Department of Immunology, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, U.K.
Eur Ann Allergy Clin Immunol. 2022 Dec 2. doi: 10.23822/EurAnnACI.1764-1489.274.
Penicillin allergy is the most prevalent drug allergy. Its overdiagnosis has been associated with inappropriate antibiotic prescribing, increased antimicrobial resistance, worse clinical outcomes, and increased healthcare costs. 403 inpatients were audited against National Institute of Clinical Excellence (NICE) Clinical Guidance 183 (CG183) on diagnosis, investigations, documentation, and management of penicillin allergy. 50 junior doctors were surveyed to explore barriers to best practice, investigating their knowledge of, and confidence using the NICE CG183 guidelines. Their views on potential solutions were also explored. The audit identified: 13% (54/403) of patients labelled penicillin allergic; 24% (13/54) fulfilled criteria for referral but none were referred to specialists. With regards to documentation: 33% (18/54) documented exact drug name; 72% (39/54) documented signs and symptoms; 20% (11/54) documented reaction severity; 2% (1/54) documented indication for the drug taken; 4% (2/54) documented number of doses taken or days before onset of the reaction and 0% documented route of administration. The survey revealed barriers including: 1- lack of awareness and confidence in applying the NICE CG183 on diagnosis and management; 2- tendency to err on the side of caution when de-labelling patients. All agreed that decision support tools would address barriers to best practice and appropriate penicillin allergy de-labelling The current practice of diagnosing, documenting, and managing penicillin allergies does not meet NICE CG183. A lack of awareness and confidence using NICE CG183 are the main contributing barriers to best practice. Decision support tools, including a drug allergy app, would help overcome these barriers.
青霉素过敏是最常见的药物过敏。对其过度诊断与不恰当的抗生素处方、抗菌药物耐药性增加、更差的临床结局以及医疗成本增加有关。根据国家临床优化研究所（NICE）关于青霉素过敏诊断、检查、记录和管理的临床指南183（CG183），对403名住院患者进行了审核。对50名初级医生进行了调查，以探究最佳实践的障碍，调查他们对NICE CG183指南的了解程度以及使用该指南的信心。还探讨了他们对潜在解决方案的看法。审核发现：13%（54/403）的患者被标记为青霉素过敏；24%（13/54）符合转诊标准，但无人被转诊至专科医生处。在记录方面：33%（18/54）记录了确切的药物名称；72%（39/54）记录了体征和症状；20%（11/54）记录了反应严重程度；2%（1/54）记录了用药指征；4%（2/54）记录了用药剂量或反应出现前的天数，而0%记录了给药途径。调查揭示的障碍包括：1. 对应用NICE CG183进行诊断和管理缺乏认识和信心；2. 在去除患者过敏标签时倾向于过于谨慎。所有人都认为决策支持工具将消除最佳实践和适当去除青霉素过敏标签的障碍。目前青霉素过敏的诊断、记录和管理实践不符合NICE CG183。对使用NICE CG183缺乏认识和信心是最佳实践的主要障碍。包括药物过敏应用程序在内的决策支持工具将有助于克服这些障碍。
