Improving the accuracy and timeliness of medication allergy documentation in the intensive care unit

McKenzie, Cathrine, Hatton, Katie and Barrett, Nicholas (2011) Improving the accuracy and timeliness of medication allergy documentation in the intensive care unit. Pharmaceutical Journal.

Abstract

Aim: To ascertain the adherence to allergy policy within the intensive care unit, to put in place robust processes to improve the timeliness and accuracy of allergy documentation, and to assess the impact of any interventions.
Design: A retrospective audit of patients’ electronic ICU and hospital written medical records with implementation of key process changes followed by a reaudit 11 months later.

Setting: A 30-bedded tertiary referral adult intensive care unit.
Results: Allergy was common (29–39%). In the initial audit medicines (excluding emergency medicines) were prescribed for 30 patients (52%) before allergy status was documented, with antimicrobials being prescribed for 12 patients (21%); these were reduced to 15 (19%) and four (5%), respectively, in the repeat audit (p=0.01). Agreement between the written medical record before ICU and the ICU medical record improved from 78% to 94% (p=0.01). The key process changes implemented were: mandatory documentation of allergy in the electronic medical record; clinical pharmacists undertaking responsibility for allergy reconciliation as part of medicines reconciliation; and ongoing education of the junior doctors at ICU induction.

Conclusions: The accuracy and timeliness of allergy documentation improved with a systems-wide approach encompassing education, enhanced back-up processes and software solutions. Allergy documentation should be considered as a marker for safety and quality within ICU.

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Contributors

Author: Cathrine McKenzie

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