Allergy Documentation Audit

DEMO DATA

Audit whether allergy status, suspected drug allergy details, reaction history and allergy communication are documented clearly and safely across clinical records.

Cases reviewed
48
Sample data
Allergy status documented
89.6%
Target ≥ 90%
In prescribing system
83.3%
Target ≥ 90%
In discharge communication
79.2%
Target ≥ 90%
Aim
To assess whether adult patients have allergy status and suspected drug allergy details documented accurately, consistently and visibly across admission records, prescribing systems and discharge communication in line with local policy and NICE drug allergy guidance.
Standards
NICE CG183 · NICE QS97 — Allergy status and drug allergy details documented accurately and consistently across clinical records (local target ≥ 90%)
Sample
Target sample 100 adult inpatient episodes across participating wards, departments and specialties. Pseudonymised only — no direct patient identifiers.

Tool workflow

    Step 1
    Project setup
    Wards, departments, leads, local policy references and audit cycle.
    Step 2
    Team
    Supervisors, contributors, pharmacy leads and governance leads.
    Step 3
    Inclusion / criteria
    Who is in scope and the 26 audit criteria.
    Step 4
    Collect data
    Structured form per allergy documentation review.
    Step 5
    Dashboard
    Compliance, location breakdown, trends and safety concerns.
    Step 6
    Findings
    Interpret good practice and gaps.
    Step 7
    Improvement
    Plan actions, PDSA cycles and re-audit.
    Step 8
    Resources
    NICE CG183, QS97 and local policy references.
    Step 9
    Export centre
    Editable Word, PowerPoint, Excel and ARCP outputs.
Add a case
Open the structured data collection form.
Plan improvement
PDSA cycles, actions and re-audit plan.
Generate outputs
Word, PowerPoint, Excel and ARCP evidence.
Clinical safety note
This tool supports local audit, quality improvement and governance review of allergy documentation. It does not replace clinical judgement, local drug allergy policy, prescribing guidance, pharmacist advice, specialist allergy referral, incident reporting or urgent escalation pathways. Do not enter patient names, NHS numbers, hospital numbers, dates of birth, addresses or other direct identifiers.