The perceptions of hospital inpatients and healthcare staff on the management of patients’ reported histories of adverse drug reactions, allergies and intolerances: an exploratory qualitative study

Abstract Introduction An adverse drug reaction (ADR) is a response to a medication that is noxious and unintended. ADRs represent a significant burden on patients and healthcare services.1 However, confusion may exist among ADRs, allergies and intolerances, with variation in documentation. However, only one UK study has used qualitative methods to explore why and how healthcare professionals document such information in electronic patient health records.2 That study’s focus was on primary care, with no consideration of patient perspective. Little is known about patients’ and healthcare providers’ perspectives on documentation and management of ADRs, allergies and intolerances in the inpatient setting. Aim To understand current practices of the management of inpatients’ ADRs, allergies and intolerances, and the associated expectations and experiences of patients, and healthcare staff. Methods A descriptive, qualitative study was conducted in an NHS teaching hospital trust, involving interviews with patients and healthcare staff. A patient partner was involved in writing the protocol and topic guides. Patient participants (aged 18 years or older and able to communicate in English) were identified by members of the ward pharmacy team. Healthcare staff participants involved in confirming and/or documenting reported ADRs, allergies and intolerances were identified through volunteer and convenience sampling. Interviews were analysed inductively using reflexive thematic analysis. One researcher coded the interview transcripts line by line, and two researchers revised the codes and identified the main themes and sub-themes. The findings were then discussed with the patient partner. Results Twelve participants were interviewed, all in-person, comprising ten healthcare staff (two pharmacists, two nurses, four doctors and two medicines management pharmacy technicians) and two patients. There was variation in age (24–89 years), gender (7 females, 3 males, 2 not stated) and ethnic background (White British, Indian British, White Australian, Indian, Asian, Italian, South African). Mean interview duration was 22 minutes. We identified four themes: (1) variation in perceptions and understanding of terms: allergy, intolerance and adverse drug reaction; (2) diverse approaches to documentation and practices in providing care to patients with allergies; (3) challenges and advantages of using an electronic patient record system in recording ADR, allergies and intolerances; and (4) patients’ experiences of how healthcare staff enquire, document and react to their ADRs, allergies and intolerances in practice. The findings showed variation in the understanding of reactions to medication among patients and healthcare staff alike. Patients’ experiences revealed variation in how healthcare staff approach ADRs, allergies and intolerances. While healthcare staff thought that documenting these was a shared responsibility among healthcare staff, patients thought that it was the sole responsibility of doctors. Conclusion This is the first qualitative study that explored practices associated with documenting ADRs, allergies and intolerances in a hospital setting; a further strength is the inclusion of patients. A limitation is the small sample size, particularly for patients, due to challenges in recruiting those with a history of ADRs, allergies and intolerances. Findings highlight the need to increase understanding among staff and patients regarding terms associated with reactions to medication, and awareness of the policies for documentation.