The importance of risk communication and documentation for patients with cutaneous adverse drug reactions

Abstract

DEAR EDITOR, We read with interest Teo et al.'s recently published article examining cutaneous adverse drug reactions (cADR) referred to an inpatient liaison dermatology service. 1 The authors assessed the number and types of cADR encountered and subsequent documentation. 1 The diagnosis and management of cADR has been recognised by National Institute for Health and Care Excellence (NICE) Guidelines on Drug Allergy as a high-priority area for quality improvement. 2 We commend Teo and colleagues 1 for examining an essential, yet often overlooked, component of health service quality. We would like to further highlight the importance of risk communication, documentation and patient-centred care, aspects that are imperative for severe cADR.To ensure prompt causality assessment, documentation and risk communication, we suggest a model of care with a resourced, centralized, multidisciplinary adverse drug reaction review committee (ADRRC) within each health service that is responsible for systematically reviewing cADR episodes, particularly those that are severe in nature, such as Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) and drug rash with eosinophilia and systemic symptoms (DRESS). 3 Members of the ADRRC should ideally include dermatologists, internal medicine physicians, clinical pharmacologists, pharmacists, immunologists and infectious diseases specialists. The ADRRC should address follow-up arrangements and refer patients for further allergy testing as required.In Teo et al.'s study, only one in five (19%) inpatient discharge summaries included the cADR episode. 1 As discharge summaries are the principal document for conveying information to community doctors, 1,3 incomplete risk communication on discharge may lead to inadvertent re-exposure and subsequent development of more serious outcomes. We recommend that health systems explore innovative solutions to benchmark and improve risk communication, for example, specialist pharmacist involvement in timely assessment and reporting of cADR, within healthcare resource limitations.As well as implementing enhanced systematic platforms to improve communication across the hospital-community interface, we propose the addition of a consumer-centred approach, whereby patients are provided with both written and verbal information. 3 A drug allergy passport, alert card or certificate with a discharge letter after medical evaluation are recommended for patients with drug hypersensitivity. 4 Clear risk communication highlighting the nature of the reaction, causal medication(s) and structurally related medications for avoidance, while also providing therapeutic options, is essential to inform clinicians and provide patient-centred care.

Adverse drug reaction management in hospital settings: review on practice variations, quality indicators and education focus

“…Risk communication, whereby HCPs communicate regarding an ADR episode in a written/verbal form to patient, family and other health practitioners, is an important aspect of ADR management. The key goal is to provide specific information to eliminate or minimise re-exposure to the offending and structurally related medications [ 45 ]. Examples of risk communication include a medication alert card/bracelet for the patient and a concise hospital discharge summary.…”

Development and application of Adverse drug reactions reports QUality Algorithm (AQUA-12) score: a single-centre quality improvement initiative

“…An incomplete or a low-quality report undermines the strength of the association between a medication and a reaction. Comprehensive and accurate risk communication, with recommendations to patients and healthcare professionals is not possible without a high-quality assessment [ 9 ].…”