Policy number: DP 23

Version Number: 1.0

Allergy documentation
Policy name:

Effective from: October 2006

Approved by: Drug & Therapeutics Committee

This policy applies to all staff who are involved with the prescribing, supply and
administration of medicines.

The standard:
The allergy status of all patients should be available to all healthcare
professionals at the point of prescribing, dispensing and drug administration.
No patient should receive a product to which they have a known allergy.

Date of policy review: Reviewed by:

This policy supersedes all previous issues.

 DP23

Documentation of Drug allergies

23.1 INTRODUCTION

Allergic reactions are a serious risk and a common source of error. Serious
harm has occurred when patients have been prescribed drugs – mainly
penicillins – to which they have a pre-existing allergy. Prevention of such
errors relies on patient and medicine information being available and acted on
at the time of prescribing, dispensing and administration. (Department of
Health, ‘Building a Safer NHS for Patients – Improving Medicine Safety. Feb
2004).

23.2 ALLERGY STATUS DOCUMENTATION

23.2.1 It is a mandatory requirement that the allergy status of patients

is available at the point of prescribing, dispensing and drug
administration. This should be documented in full, using
approved medication names, and not abbreviated in any way.

23.2.2 All prescribers are responsible for endorsing any known allergy
or intolerance, including complementary medicines, iodine and
latex on the front of the in-patient prescription Kardex and out
– patient prescriptions. For in –patients this information must
be transferred to subsequent prescription charts where multiple
charts are in use during an episode of care. On all in-patient
prescription charts the date and identity of the person
completing the allergy box must be stated. Prescribers must
check the allergy status of the patient each time a new medicine
is prescribed.

23.2.3 The nature of the allergy /intolerance should

be cross checked from two sources wherever possible. This can
include:-

ƒ Patient
ƒ Patient’s hospital notes
ƒ Patient’s next of kin
ƒ GP referral letter.
ƒ Direct contact with GP.

23.2.4 It is not acceptable to leave the allergy box

blank. The Kardex must be marked with
either of the following:

™ The specific medication or substance to which the patient is

known to be allergic/intolerant must be documented clearly.
 ™ No Known Allergies - suitable documentation if the patient
is able to confirm

™ Unknown - only suitable in situations in which it is not

possible to verify the allergy status of the patient.

23.2.5 In order to distinguish between serious allergy and less harmful

drug intolerance, the symptoms of any reported allergy must be
documented e.g. mild skin rash, GI disturbance, anaphylactic
shock. A serious allergic reaction is defined as a reaction
requiring medical intervention

23.2.6 Documentation of the allergy is NOT the sole responsibility of

medical staff. Nurses, midwives and pharmacists are authorised
to complete the allergy box of the prescription chart as
described in paragraphs 23.2.3 to 23.2.5 above. Medicines
should never be administered to patients if the allergy box has
NOT been completed. The drug allergy box must be checked
on each occasion before drug administration. Pharmacists
should ensure the allergy box has been completed as part of a
clinical check of the medicine Kardex.

23.2.7 If a patient experiences a new or different reaction during a

later episode of care the medical record MUST be updated to
reflect the most recent allergy status. This should be
documented in the confirmed allergies box on the page inside
the front cover of the notes as stated in the Trust Health
Records policy.

23.3 POSITIVE PATIENT IDENTIFICATION

23.3.1 For ALL patients presenting with an identified

allergy/intolerance the following process should be observed as
outlined in trust policy RM40 (patient identification policy).

23.3.2 The red allergy wristband must be present on all patients with a
confirmed or suspected allergy. Appropriate endorsements
should be made on the wrist band; the name of the drug
/allergen should be documented in block capital letters, with a
complete generic drug name and brand name as required.
Medical abbreviations are not to be used.

23.3.3 The red allergy wrist band must be worn on the same wrist/limb
as the white patient identification wristband in a location which
is easily accessible.
23.4 PHARMACOLOGY OF THE MEDICATION

23.4.1 All staff must make themselves aware of the medications they
are prescribing and administering to patients with allergies
including knowledge of the pharmacology of the medication.

23.4.2 Errors have occurred even when the allergy

status of a patient been clearly documented,
because both the prescriber and the person
administering the medicine were unaware of the constituent
products. This is particularly the case for penicillins where
many products have names that do NOT immediately suggest
they contain a penicillin.

23.4.3 There is currently no requirement for a

manufacturer’s drug labels to include the
warning “CONTAINS A PENICILLIN”.
Orally dispensed drugs for an individual patient by the Trust
pharmacy will carry this supplementary label but this facility is
not available on I V or oral products held as ward stock.

23.4.4 Approximately 10% of penicillin-sensitive patients may also be

allergic to cephalosporins and other beta-lactam antibiotics,
which are structurally similar to the penicillins.

23.4.5 The current formulary Penicillins & Cephalosporins are listed

at Appendix 1 and a poster highlighting the commonly
prescribed medicines containing penicillin is available for
display on wards and departments.
Appendix 1- current formulary Penicillins & Cephalosporins

Penicillins
• Benzylpenicillin 600mg injection

• Tazocin 2.25g injection (piperacillin 2g / tazobactam 250mg)

• Co-flumampicil 125/125 supension

• Phenoxymethylpenicillin 250mg tablets

• Phenoxymethylpenicillin 125mg/5ml, 250mg/5ml syrup

• Flucloxacillin 250mg, 500mg injection

• Flucloxacillin 250mg, 500mg capsules

• Flucloxacillin 125mg/5ml, 250mg/5ml syrup

• Amoxycillin 250mg, 500mg injection

• Amoxycillin 250mg, 500mg capsules

• Amoxycillin 125mg/5ml, 250mg/5ml syrup

• Amoxycillin 3g sachet

• Co-amoxiclav 1.2g injection

• Co-amoxiclav 250/125 tablets

• Co-amoxiclav 250/125 dispersbile tablets

• Co-amoxiclav 125/31, 250/62 suspension

• Co-amoxiclav 400/57 (Augmentin Duo) suspension - Paediatric use in cystic

fibrosis ONLY

• Azlocillin 2g, 5g injection

Cephalosporins, cephamycins and other beta-lactams

• Cefotaxime 1g injection

• Cefixime 200mg tablets

• Cefixime 100mg/5ml suspension

• Ceftazidime 500mg,1g, 2g injection

• Cefuroxime 750mg and 1.5g injection

• Cephalexin 250mg, 500mg capsules

• Cephalexin 125mg/5ml, 250mg/5ml syrup

• Ceftriaxone 250mg, 1g and 2g injection

• Aztreonam 1g, 2g injection

• Meropenem 500mg, 1g injection

• Ertapenem 1g injection