Policy for the safer use of medicines in people with allergies
Background
Serious harm has occurred when patients have been prescribed medication to
which they have a pre-existing allergy. Prevention of such incidents relies on
patient and medication information being available and acted on at the time of
prescribing, dispensing and administration. This type of error can be easily
prevented. The recent Department of Health report “Building a safer NHS for
patients; Improving Medication Safety”, recommends that the Trust implements a
written standard for the documentation of drug allergies, including roles and
responsibilities of different health care professionals involved in the medication
process. The issue is also a high priority for the National Patient Safety Agency.
The relevant sections of the Medicines Code cover some of the issues. Although
this policy deals with medication some food allergies may be relevant, such as
lactose as an additive and nut oils as carriers of injections and topical products.
Medicines Code
Prescribing
4.5.8 Allergies and Sensitivities:
The prescriber is responsible for entering any known allergy or sensitivity in the
appropriate section of the prescription sheet and transferring these to
subsequent sheets.
Where there are no known allergies or medicine sensitivities, "No reported
allergies" must be entered into this prescription sheet box and signed. Leaving
this section blank could lead to an interpretation that the allergy status has not
been considered when prescribing medication.
This is essential data and if not completed may result in delay in obtaining
treatment for the patient.
It is also important for a warning label concerning known medicine sensitivity to
be attached to the outside cover of both the patient's medical and nursing notes,
to highlight this information to other prescribers in the future. Nurses and other
practitioners should assist in identifying medicine sensitivities.
Medicines should not be prescribed, administered, or dispensed when the allergy
status is not known, unless in an emergency.
Dispensing
Pharmacy staff will refer back to the prescriber if the required information is not
documented.
Administration
Nursing staff will refer back to the prescriber if the required information is not
documented.
Clinical Information
Anaphylaxis
Anaphylaxis is a serious allergic drug reaction that may be fatal.
Medications frequently associated with anaphylactic reactions
 Aspirin and other non-steroidal anti-inflammatory drugs
 Heparin
 Amoxicillin (an antibiotic, a penicillin)
 Vaccines
 Suxamethonium (a muscle relaxant used in anaesthetics)
 Allergen extract (used for allergy testing)
 Trimethoprim (an antibiotic)
 Atracurium (a muscle relaxant)
 Ciprofloxacin (an antibiotic)
 Intravenous iron
 Intravenous vitamins (Pabrinex) and to a lesser extent intramuscular
vitamins
 Lidocaine (a local anaesthetic)
 Propofol (an intravenous sedative)
 Thiopental (an intravenous sedative)
 Blood products
 Colourants, preservatives and excipients, such as lactose, used as
additives
Particular care should be taken with those people who report a penicillin allergy,
as the nomenclature of many products does not immediately suggest that it
contains a penicillin.
Some penicillins and penicillin-containing antibiotics
 Benzylpenicillin (penicillin G)
 Procaine benzylpenicillin (procaine penicillin)
 Phenoxymethylpenicillin (penicillin V)
 Flucloxacillin
 Ampicillin
 Amoxicillin (amoxycillin)
 Co-amoxiclav (amoxicillin with clavulanic acid) = Augmentin
 Co-fluampicil (flucloxacillin with amoxicillin) = Magnapen
 Piperacillin
Penicillin sensitive patients may also be allergic to cephalosporins and other
beta-lactam antibiotics, which are structurally related to the penicillins
Cephalosporins; Cefaclor, cefadroxil, cephalexin, cephamandole, cefazolin,
cefixime, cefotaxime, cefoxitin, cefpirome, cefpodoxime, cefprozil, ceftazidime,
cefriaxone, cefuroxime
Other beta-lactam antibiotics; azteonam, imipenem with cilastin, meropenem
Reducing the risks
Recommendations from the Improving Medication Safety report
 Implement a written standard
 Audit allergy documentation against this standard.
 Allergy status of every patient should be written in a prominent position in
the medical notes and be referred to each time the patient is reviewed.
This should even be done when the patient has no known allergies.
 All paperwork used for prescribing medicines should include a section for
documenting allergy status
 Allergy status should be documented on all hospital charts used for
prescribing medicines so that it is visible at the point of prescribing,
dispensing and drug administration.
 All staff should be made aware of their responsibilities with regard to
allergy status documentation.
 Consideration should be given to a universal symbol that denote penicillin
allergy, which could be used on packaging, notes, inpatient identity bands
and medical alert bracelets. This would make the allergy status readily
distinguishable.
 If an allergy develops during the hospital stay the medical records must be
updated to reflect the current allergy status.
SWYMHT recommendations
 As above
 Reasonable steps should be taken to check the allergy status of all
patients prior to the prescribing of any medication. This includes
inpatients, out patients, those on long term repeat prescriptions and those
receiving drug treatment via a community-based team.
The steps taken to check allergy status should include as a minimum:
o Asking the service user or carer.
Other useful sources of information which should be considered
o Checking the relevant section of case notes (for some years in many
Trusts this has been the front or inside front cover of the notes)
o Checking the allergy section of previous prescription and administration
charts.
o Contacting the GP
 If no record of a proven allergy is found then the prescriber should write
“No allergies reported” and date the entry in the allergy section of the
prescription. The steps taken should be clearly recorded in the notes.
 If a report of an allergy is evident the name of the drug or group of drugs
and any known reaction should be entered on the prescription and the
entry dated.
 Each time a new prescription is written the allergy status should be
transcribed onto the new prescription, including discharge prescriptions.
 Audit of completion of prescribing documentation on an annual basis as
required by the Clinical Negligence Standards for Trusts

Encourage GPs to include allergy status information in referrals to
secondary care.
Limitations of the Policy
It is acknowledged that users of mental health services often have many volumes
of notes, dating back many years, which are often incomplete. Recording of
allergy status routinely and in a consistent manner has only recently become the
norm. Mental health and medical notes are kept separately and the latter are not
always available at mental health consultations or admissions. We cannot
guarantee completeness of primary care allergy status records.
Approved by the Drug and Therapeutics Policy Action Group February 2005
For Review February 2007.