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Identify and avoid potential cross-reacting drugs.

Record precise details of the reaction and its treatment.

Identify a safe alternative. In some cases this may not be possible so where the case is less severe, it may be decided to continue with the medication with suppression of the symptoms with, for example, a corticosteroid and an antihistamine.

See also Complications of intravenous injections and infusions.

(Mirakian et al. 2009)

In some cases, desensitization may be considered but this is rarely indicated.

In addition to the treatment of drug allergies, it is extremely important that the patient is given information regarding what medication they should avoid. The drugs to avoid should also be recorded clearly in medical records, including paper and electronic records. All inpatients should have their allergy indicated by wearing a red-coloured identity band (NPSA 2007b). Allergic drug reactions should be reported using the Yellow Card Scheme (Mirakian et al. 2009).

Self-administration of medicines

Evidence-based approaches

Rationale

The report by the Audit Commission, A Spoonful of Sugar – Medicines Management in NHS Hospitals (2001) recommended self-administration of medicines by patients. This report detailed how studies have shown that only one-half of patients take their medicines properly when they get home. The National Institute for Clinical Excellence (NICE) published Clinical Guideline 76 on medicines adherence (NICE 2009) which states that between a third and a half of medicines that are prescribed for long-term conditions are not used. This non-adherence has quality and cost implications for the NHS due to wasted medicines and readmissions for patients.

The Audit Commission states that self-administration is beneficial to patients because it allows the patient to take medication when they should, for example painkillers when they are in pain and medicines to be taken before and after food. It simplifies the medicine regimen for patients, especially those who take many medicines, as it allows a fuller assessment of the benefits of all the medicines that a patient may be taking. It allows patients to practise taking their medicines in hospital under supervision so that any problems that may arise can be dealt with. It has also been found that patients who had administered their own medications in hospital were more likely to report that their overall care was excellent and that they were satisfied with the discharge process than patients who had not (Deeks and Byatt 2000).

The Healthcare Commission report, The Best Medicine – The Management of Medicines in Acute and Specialist Trusts (2007) states that where patients are self-administering, it is important that medicines are stored securely in suitable storage near to the bedside and that procedures and training will need to be in place which should cover the assessment process and the patient’s suitability for self-administration. Although, by definition, self-administration of medicines shifts the balance of responsibility for this part of care towards the patient, it in no way diminishes the fundamental professional duty of care. It is therefore essential that local policies, procedures and records are adequate to ensure that this duty is, and can be shown to be, discharged. The revised Duthie Report (RPSGB 2005) states that any transfer of responsibility should occur on the basis of an assessment of the patient’s ability to manage the tasks involved and with the patient’s agreement. The patient’s agreement should be recorded with the date and time.

The NMC sets out the responsibilities of the nurse regarding the self-administration of medicines which includes viewing the medicines, checking the suitability of use and that they have been prescribed, assessment of the patient, what should be documented and how they should be stored (NMC 2008a).

Assessments of patients for self-administration normally results in the allocation of a level of supervision. Examples of levels of supervision can be seen in Table 13.4.

Table 13.4 Examples