Prescriptions should be redesigned to include information on patients' drug allergies, Nice has advised.

The independent health body called for all electronic and paper prescriptions to be standardised to record information about any drug classes the patient should not take, in the final version of its first guidelines on drug allergies, published yesterday (September 3).

The suggestion for redesigning prescriptions was an addition to the draft version of the guidance published in April. In both versions, Nice called for pharmacists to check whether a person is allergic to any drugs each time they dispense a medicine.

The guidelines were designed to improve the assessment of suspected allergies and "dispel confusion" in best practice, said Nice, which highlighted that the National Reporting and Learning System (NRLS) had identified more than 18,000 incidents involving drug allergies in England and Wales between 2005 and 2013.

Patients should carry information about their drug allergy at all times and check with a pharmacist about which drugs to avoid before taking any over-the-counter medicines, said Nice. 

It advised that a patient's drug allergy status should be documented separately from any adverse reactions and be "clearly visible" to all prescribers.

Nice identified "major issues" around the poor recording of drug allergies and a lack of patient information. Computerised primary care records were often unable to distinguish between a patient's intolerance and an allergy, which could result in them being incorrectly labelled as allergic, it said.

The 18,079 incidents involving drug allergies reported to the NRLS included six deaths, 19 ‘severe harms' and more than 13,000 ‘near misses', Nice said. The majority of these involved a treatment being dispensed to a patient with a known allergy to that drug class, it said.  

62,000 hospital admissions

Nice also pointed to figures from the Health and Social Care Information Centre which showed that there was an average of 62,000 hospital admissions a year in England due to adverse drug reactions, including allergic reactions, between 1996 and 2000.

The guidance also listed the symptoms of drug allergies - such as anaphylactic, angioedema or asthmatic reaction - and the time it takes for these to appear in a patient. If an allergy to a drug was suspected, the drug should be stopped and the symptoms treated. A patient with one of the three listed reactions should be referred to a specialist drug allergy service and those with severe reactions should be sent to hospital, Nice said in the guidance.

In April, pharmacists criticised Nice's draft guidance for not going far enough. Contractors said their management of patients with drug allergies would be limited until they had access to summary care records and training to deal with "worst-case scenarios".

	Is the new guidance useful for improving patient care?