P26: Drug allergy reporting: Are we playing it safe in paediatrics?

Introduction: Accurate documentation of drug allergies is a recognised quality measure and inadequate allergy documentation a significant healthcare issue. Patients can suffer adverse effects following administration of medications they report an allergy to. There is currently no data available within paediatrics. Method/Cohort: We retrospectively audited children with a reported antibiotic drug allergy, who had one or more admissions to a tertiary paediatric hospital in Western Australia between 2006 and 2017. 335 children (52% male) with a total of 1650 admissions were reviewed, and 2241 medication charts were retrospectively audited for drug allergies. Mean age at first presentation was 5.4 years. Data collected included demographics, medication chart and inpatient note drug allergy documentation, culprit drug prescribing, consistency of drug allergy documentation throughout admissions and Adverse Drug Reaction (ADR) alerts. Results: All patients had a reported antibiotic allergy, (19.7%) had multiple allergies including non-antibiotic drug allergies. The most common allergies were penicillin (47.1%), amoxicillin (16.4%) and cephalexin (4.2%). 1543 (68.9%) medical charts had an allergy identified, 17.8% of medical charts did not have the reaction documented, 25.0% were inconsistent across admissions. 105 (27.2%) were inconsistent, documenting a different reaction, 45.1% had an additional drug added, 25.0% had a drug missing. 45 (13.4%) children with a beta-lactam allergy had a beta-lactam drug prescribed, 10.4% had a beta-lactam drug administered. Of these patients 4 (8.9%) were prescribed and administered the same reported culprit antibiotic. No non-antibiotic medications were incorrectly prescribed. 441 (26.7%) of admissions had inconsistency between in-patient notes and medication charts. 602 (26.9%) charts did not have an ADR alert sticker as per hospital policy. Conclusion: Our audit showed documentation of antibiotic allergies was frequently incomplete and inconsistent. There was a relatively high incidence of culprit antibiotics being prescribed and administered. These findings reflect the consequences and risk that arise from poor understanding of drug allergy amongst general medical staff and demonstrates the need for increased education and standardised documentation practices amongst all hospital staff.