Allergy Recording - FOI Response Register

FoI Number
2024-564
Subject
Allergy Recording
Date Received
11/12/2024
Request and Response
  1. Board Name

NHS Shetland

  1. Type of Healthcare Facilities

District General Hospital

  1. Demographic of Hospital Care

General Hospital (Both Adult and Paediatric)

  1. Respondent’s Role in the Board

Clinician

  1. Does your Board use Electronic Patient Records (EPR)?

Partial use of EPR. Paper notes used for nursing and medical notes at ward level.

  1. Which EPR system does your Board use?

Trakcare and HEPMA

  1. Does the EPR system used by your Board include a specific section for recording food, drug, latex and other allergies?

Yes – but EPR is only partially used for patient records. Not full EPR. Paper records still kept for medical and nursing notes.

  1. If yes to Q7, how is the initial allergy information typically entered into the system?

N/A

  1. If yes to Q7, who is responsible for updating and / or checking allergy information in the patient’s electronic record?

N/A

Clinicians (eg doctors, nurses)

Administrative Staff

Pharmacists

  1. How is the allergy information flagged or highlighted in the patient’s record to alert healthcare providers?

Pop up Alert

  1. What training, if any, is provided to staff on the correct recording of allergies in patient records?

HEPMA training for medications

Staff nurse induction

  1. If training is provided on allergy documentation, does it specifically cover different types of allergies in the training materials?

Drug, food and other non-drug allergy recording (eg Latex)

  1. Does your Board have a Local Guideline or Standard Operating Procedure (SOP) in place covering allergy documentation on the EPR?

Yes, latex

  1. If yes to Q13, does this guideline / SOP include documentation for allergens below? (select all that are relevant)

Food

Other non-drug substances (eg Latex)

  1. Does your hospital have access to specialist allergy advice for Paediatric patients?

Yes – Please specify if this service is available through In-House, Local Centre or Regional Centre

There is a National service for allergy in children to which we can refer.

  1. Does your hospital have access to specialist allergy advice for adult patients?

Yes – Please specify if this service is available through In-House, Local Centre or Regional Centre

There is no local allergy service for adults or children

  1. Does the incident reporting platform have a specific category for recording food or other non-drug allergy incidents?

Yes

  1. In the last 10 years, has your Board recorded any incidents where a patient was administered a food, drug or other substance (eg Latex) they were known to be allergic to?

Yes

  1. If yes to Q18, how many such incidents have been reported in the last 10 years?

16

  1. If yes to Q18, please indicate the number of incidents for each category

Drug allergy incidents

15

Incidents to other allergic substances

1

  1. Considering the start date of your EPR system, how many years’ worth of incident data have you been able to search for this survey? (Ideally, up to 10 years eg 2014-2024)

Searched from 01/01/2014

  1. For reported DRUG ALLERGY incidents, what are the drugs involved, age group (<17 or >17 years), and level of harm (no harm, low harm, moderate harm, severe harm or death), listing up to 10 cases, prioritised by severity of harm, followed by most recent incidents.

Case 1 (Flu Vaccine, >17yo, Moderate) 

Case 2 (Nuvaxovid, >17yo, Moderate)

Case 3 (Lisinopril, >17yo, Moderate) 

Case 4 (Pfizer BioNTech vaccination, >17yo, Moderate) 

Case 5 (Infliximab, <17yo, Minor) 

Case 6 (Amoxicillin, >17yo, Minor)

Case 7 (Prochlorperazine, >17yo, Negligible) 

Case 8 (Amoxicillin, >17yo, Negligible) 

Case 9 (aQIV Flu Vaccine, >17yo, Negligible) 

Case 10 (Amoxicillin, >17yo, Negligible)

Please indicate the total cases below if more than 10 cases were reported.

15

  1. For reported FOOD and OTHER NON-DRUG ALLERGY incidents, what are the allergencs involved, age, reactions, if serious incident reported and level of harm (no harm, low harm, moderate harm, severe harm or death), listing up to 10 cases, prioritised by severity of harm, and followed by most recent incidents.

Case 1 (Latex, >17, None, No, Negligible) 

Reliance on paper records which we cannot audit for this FOI.

  1. For FOOD and other NON-DRUG ALLERGY incidents, how many of the incidents was the allergen clearly documented in patient’s notes / correspondence, prior to the incident?

Non-drug allergies documented correctly

In accordance with FOISA s 17(1), NHS Shetland confirms that it does not hold the information requested.

Reliance on paper records which we cannot audit for this FOI.

For FOOD and OTHER NON-DRUG ALLERGY incidents, how many of the incidents was the allergen correctly documented on the relevant field in the EPR prior to the incident (Cerner, Epic, Other)?  Reliance on paper records which we cannot audit for this FOI.

  1. What were the causes identified in the food or other non-drug incidents? (Multiple answers allowed)

Equipment used contained Latex

  1. What challenges, if any, does your Board face in accurately recording and managing allergy information in EPR systems? EPR is not fully implemented, paper records still in use.

Relies on user to input – often penicillamine may be entered instead of penicillin, for example

Not drawn from primary care systems automatically – patient reports allergy and cross-referenced against Emergency Care Summary which may not include full details of reaction

Drop down list of possible reactions – often “other” selected if reaction does not easily fit into drop-down list, and reaction not fully documented

Sensitivity confused with allergy – but also depends on user to input

Only appears in HEPMA (electronic prescribing) system as full EPR not yet implemented in the Board. Would highlight if a drug is prescribed the patient is allergic to, but may not help to prevent non-drug allergens being administered

  1. What improvements do you suggest could be made at a National level to better manage allergy information in patient records? National solution for EPR.

Improved interface between primary and secondary care electronic prescribing systems

Use of a full EPR which would link to HEPMA and ECS/primary care for allergy information