Introduction

This quality standard covers the diagnosis and management of drug allergy in adults, young people and children. It does not cover treatment of the acute phase, including anaphylaxis, because this will be covered by a separate quality standard. For more information see the drug allergy topic overview.

Why this quality standard is needed

All drugs can cause side effects, also known as 'adverse drug reactions', but not all of these are allergic in nature. Some reactions are idiosyncratic (rare and unpredictable), some are pseudo-allergic (with similar presentation to allergic reactions but different causes) and some are caused by drug intolerance. The British Society for Allergy and Clinical Immunology (BSACI) defines drug allergy as an adverse drug reaction with an established immunological mechanism. It is not always clear from a person's clinical history whether a drug reaction is allergic or non-allergic without investigation. The NICE guideline on drug allergy (CG183) defines drug allergy as any drug reaction with clinical features compatible with an immunological mechanism.

Hospital Episode Statistics (HES) for 1996 to 2000 show that drug allergies and adverse drug reactions accounted for approximately 62,000 hospital admissions each year in England. Between 1998 and 2005, there was an increase in these reactions, with serious adverse drug reactions rising 2.6-fold. Importantly, up to 15% of inpatients have their hospital stay prolonged by an adverse drug reaction.

Diagnosing drug allergy can be challenging and there is considerable variation in management and in access to specialist drug allergy services. This can lead to under diagnosis, misdiagnosis and self-diagnosis. This variation may be caused by a lack of local drug allergy centres or awareness of available services. Some people are never offered a referral to specialist services and stay in primary care. Others have their drug allergy managed in other disciplines. Only a small proportion of people are treated in specialist allergy centres.

The quality standard is expected to contribute to improvements in the following outcomes:

  • patient experience of care

  • patient safety incidents reported

  • mortality from causes considered preventable

  • patient exposure to unnecessary broad-spectrum antibiotics

  • antibiotic prescribing and antimicrobial resistance rates.

How this quality standard supports delivery of outcome frameworks

NICE quality standards are a concise set of prioritised statements designed to drive measurable improvements in the 3 dimensions of quality – patient safety, patient experience and clinical effectiveness – for a particular area of health or care. They are derived from high‑quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following 3 outcomes frameworks published by the Department of Health:

Tables 1–3 show the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving.

Table 1 The Adult Social Care Outcomes Framework 2015–16

Domain

Overarching and outcome measures

1 Enhancing quality of life for people with care and support needs

Overarching measure

1A Social care‑related quality of life*

Outcome measures

People manage their own support as much as they wish, so that are in control of what, how and when support is delivered to match their needs

1B Proportion of people who use services who have control over their daily life

Aligning across the health and care system

* Indicator complementary

Table 2 NHS Outcomes Framework 2015–16

Domain

Overarching indicators and improvement areas

2 Enhancing quality of life for people with long‑term conditions

Overarching indicator

2 Health‑related quality of life for people with long‑term conditions**

Improvement areas

Ensuring people feel supported to manage their condition

2.1 Proportion of people feeling supported to manage their condition**

4 Ensuring that people have a positive experience of care

Overarching indicator

4a Patient experience of primary care

i GP services

4b Patient experience of hospital care

Improvement areas

Improving people's experience of outpatient care

4.1 Patient experience of outpatient services

Improving access to primary care services

4.4 Access to i GP services

5 Treating and caring for people in a safe environment and protecting them from avoidable harm

Overarching indicators

5a Deaths attributable to problems in healthcare

5b Severe harm attributable to problems in healthcare

Improvement areas

Improving the culture of safety reporting

5.6 Patient safety incidents reported

Alignment with Adult Social Care Outcomes Framework

** Indicator is complementary

Indicators in italics are in development

Table 3 Public health outcomes framework for England, 2013–16

Domain

Objective and indicator

4 Healthcare public health and preventing premature mortality

Objective

Reduced numbers of people living with preventable ill health and people dying prematurely, while reducing the gap between communities

Indicator

4.3 Mortality rate from causes considered preventable**

Alignment with NHS Outcomes Framework

**Indicator is complementary

Patient experience and safety issues

Ensuring that care is safe and that people have a positive experience of care is vital in a high‑quality service. It is important to consider these factors when planning and delivering services relevant to drug allergy.

NICE has developed guidance and an associated quality standard on patient experience in adult NHS services (see the NICE pathway on patient experience in adult NHS services), which should be considered alongside this quality standard. They specify that people receiving care should be treated with dignity, have opportunities to discuss their preferences, and be supported to understand their options and make fully informed decisions. They also cover the provision of information to patients and service users. Quality statements on these aspects of patient experience are not usually included in topic‑specific quality standards. However, recommendations in the development source for quality standards that affect patient experience and are specific to the topic are considered during quality statement development.

Coordinated services

The quality standard for drug allergy specifies that services should be commissioned from and coordinated across all relevant agencies encompassing the whole drug allergy care pathway. A person‑centred, integrated approach to providing services is fundamental to delivering high‑quality care to people, including children and young people, with a drug allergy.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high‑quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high‑quality drug allergy service are listed in related quality standards.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All healthcare professionals involved in assessing, caring for and treating people with drug allergy should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard. Quality statements on staff training and competency are not usually included in quality standards. However, recommendations in the development source on specific types of training for the topic that exceed standard professional training are considered during quality statement development.

Role of families and carers

Quality standards recognise the important role families and carers have in supporting people with a drug allergy. If appropriate, healthcare professionals should ensure that family members and carers are involved in the decision‑making process about investigations, treatment and care.