Browsing by Author "Alqahtani, Abdulaziz Hussain"

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DRUG ALLERGY LABELS IN ELECTRONIC PRESCRIBING AND THERAPEUTIC PRACTICE
(Saudi Digital Library, 2025) Alqahtani, Abdulaziz Hussain; Marriott, John
Drug allergy labels are critical for patient safety, yet their widespread mislabelling poses significant risks in clinical practice, leading to inappropriate prescribing and increased healthcare costs. This thesis investigated drug allergy labelling practices in electronic prescribing systems at the national and international levels. It proposed a novel algorithm that aimed at enhancing the accuracy of allergy labelling. A narrative literature review was conducted to elucidate the challenges and existing strategies for drug allergy labelling. Several challenges were identified, including gaps in healthcare professionals' knowledge and skills, poor documentation and communication, family and patients' perceptions and systemic issues within the healthcare system, such as the absence of policies and guidelines. The review highlighted several strategies to enhance accuracy, such as the implementation of structured de-labelling programs (with risk assessment tools and confirmatory testing) and the integration of clinical decision support systems (CDSS). Enhanced education, improved patient engagement and the implementation of clinical guidelines may offer promising avenues for optimising the accuracy and management of drug allergy labels. International focus groups were conducted in Trinidad and Tobago, Barbados, Egypt, and Sri Lanka. Data from 90 participants were analysed, representing physicians, pharmacists and nurses. Four major themes emerged: (a) structure of healthcare services, (b) clinical governance, (c) clinical allergy practice and (d) willingness to use a CDSS. This study revealed significant gaps in the management of drug allergies, with some common themes and subthemes underpinning the sub-optimal clinical care. A gap analysis was also performed comparing the findings from international focus groups with consolidated international drug allergy guidelines from the UK, USA, Europe and Australia, The study indentified four systemic gaps: (1) inconsistent documentation lacking detail on reaction type, severity, and timing; (2) absence of structured allergy invistgation; (3) limited access to allergy specialists and referral mechanisms; and (4) poor communication between primary and secondary care, exacerbated by low interoperability of health records. An online national survey of the National Health Service (NHS) was conducted, with 17 secondary care hospitals in England and Wales fully participating in the survey, yielding an 8% completion rate. Of these participants, 12 (5.9%) were located in England and 5 (71.4%) in Wales. Documentation of drug allergies was universally high (100%) across all hospitals, but documentation of drug intolerance (83% in England, 60% in Wales) and adverse drug reactions (ADRs) (75% in England, 40% in Wales) was inconsistent. Wales relied exclusively on paper-based systems, whereas most English hospitals used both paper and electronic prescribing platforms. Verification protocols for allergy information existed in 75% of English hospitals, but were largely absent in Wales (80%). Active de-labelling of inaccurate allergy records was rare (16.7% in England; 0% in Wales). Respondents expressed strong support for implementing CDSS to facilitate taking history, categorisation and providing recommendations for safe drug alternatives. Finally, a qualitative acceptability study was conducted within 17 healthcare professionals (HCPs) through two focus groups. This study evaluated a newly developed drug allergy labelling algorithm using the Theoretical Framework of Acceptability (TFA). Participants valued the algorithm’s clarity, logical structure, and potential to standardise allergy documentation, improve prescribing safety, and reduce unnecessary penicillin avoidance. While the tool was seen as educational and clinically valuable, concerns were raised over workflow integration, stepwise complexity, and resource requirements. Participants emphasised the need for clear terminology and case-based training.. Overall, the algorithm was considered highly acceptable with refinement and training support. In combination, these studies provide robust evidence that there is an urgent need to address existing challenges in drug allergy labelling practices. Implementing a standardised drug allergy labelling algorithm represents a promising solution and offers valuable insights for policy reform, clinical practice and future research directions.
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