Allergy

To the Editor: We read with interest the article by Drewett and colleagues,1 on anaphylaxis presentations to emergency departments in Victoria, and the linked editorial by Lucas and Vale,2 which proposes a comprehensive adverse drug reaction registry to improve patient safety and care. Re‐exposure of a patient to a medicine to which they have had a previously documented allergy or adverse drug reaction (ADR) is a preventable clinical incident. The Australian sentinel events list includes “medication error resulting in serious harm or death” to ensure public accountability and transparency and drive national improvements in patient safety.3 The availability of accurate and up to date allergy/ADR information for prescribers is vital to support the decision on appropriate treatment and to prescribe a medicine. It is also critical that health professionals who administer medicines and pharmacists who dispense medicines have access to accurate allergy/ADR information, as they provide redundancy within the medication management system to prevent unintentional re‐exposure. We recently undertook an audit to assess the accuracy of medication history documentation performed by pharmacists. Our methodology has been published elsewhere.4 As part of this work, we assessed the quality of pharmacist‐documented allergy/ADR information. Allergy/ADR documentation best practice suggests documentation of the medication name, reaction details and reaction date.5 New findings from our audit identified a total of 108 allergies/ADRs across 99 patients. Of the 52 patients with a previous history of allergy/ADR, only 31% (n = 16) had complete and correct allergy/ADR information documented. These results highlight that the current systems do not adequately support clinicians to provide safe and high quality care. Moreover, these systems risk patient harm through inadvertent re‐exposure to a medicine where there is a previously documented allergy/ADR, given that, at the point of prescribing, administration or dispensing, data are not available, disparate, incorrect or incomplete. We believe the national allergy/ADR registry proposed by Lucas and Vale2 should go one step further, and legislation should mandate interoperability between all electronic prescribing, administration and dispensing systems in Australia. A further challenge will be populating accurate historical allergy/ADR information into the registry. It would require high quality documentation to assist informed clinical decision making. An additional challenge is the complex, hybrid paper and electronic prescribing and documentation systems used across health care settings. Even though these may be challenges to overcome, there are potential opportunities through patient engagement, incentive schemes and machine learning. There needs to be a national consumer‐focused education campaign so the public can be active participants in their own care to support optimal medicine choice based on their allergy/ADR history. We believe a national allergy/ADR registry is of key importance to further enhance patient safety and will be a true system change to overcome the barriers we face in day‐to‐day clinical practice.

Martin L Canning · Andrew Munns · Bonnie Tai