Specialist perioperative allergy clinic services in the UK 2016: Results from the Royal College of Anaesthetists Sixth National Audit Project
Summary Background Guidelines for investigation of perioperative drug allergy exist, but the quality of services is unknown. Specialist perioperative anaphylaxis services were surveyed through the Royal College of Anaesthetists 6th National Audit Project. Objectives We compare self‐declared UK pract...
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| Veröffentlicht in: | Clinical and experimental allergy 2017-10, Vol.47 (10), p.1318-1330 |
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| container_title | Clinical and experimental allergy |
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| creator | Egner, W. Cook, T. Harper, N. Garcez, T. Marinho, S. Kong, K. L. Nasser, S. Thomas, M. Warner, A. Hitchman, J. Floss, K. Farmer, Laura Lourtie, Jose Goodwin, James |
| description | Summary
Background
Guidelines for investigation of perioperative drug allergy exist, but the quality of services is unknown. Specialist perioperative anaphylaxis services were surveyed through the Royal College of Anaesthetists 6th National Audit Project.
Objectives
We compare self‐declared UK practice in specialist perioperative allergy services with national recommendations.
Methods
A SurveyMonkey™ questionnaire was distributed to providers of allergy services in the UK. Responses were assessed for adherence to the best practice recommendations of the British Society for Allergy and Clinical Immunology (BSACI), the Association of Anaesthetists of Great Britain and Ireland and the National Institute for Health and Care Excellence (NICE) Guidance on Drug Allergy—CG183.
Results
Over 1200 patients were evaluated in 44 centres annually. Variation in workload, waiting times, access, staffing and diagnostic approach was noted. Paediatric centres had the longest routine waiting times (most wait >13 weeks) in contrast to adult centres (most wait |
| doi_str_mv | 10.1111/cea.12993 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1927603040</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1943574351</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3883-2791adc951f9b08295dacf9aecdfc776cc8d7a9b5f51e66989ea0b3a7f33e9853</originalsourceid><addsrcrecordid>eNp1kcFuFDEMhiNERbeFAy-AInGhh2mTyWSScFutClStALX0PMpmnDar7GSbzBT2IXhn3G7pAQlLsQ_-_NvRT8hbzo45xokDe8xrY8QLMuOilVWN8ZLMmJFNpbRp9slBKSvGmJBGvyL7tVZaqbaZkd9XG3DBxlBGuoEcEiY7hnugNkbIN1vqYhiCowXyfXBQaBjoeAv0-pzWjLcf6SWUKY6F-pzWj53LtLWRLhLO3wBNns4HCwU7Iy4p9Cr8Gm_pV1ySBuTmUx9G-j2nFbjxNdnzNhZ481QPyfWn0x-LL9XFt89ni_lF5YTWoqqV4bZ3RnJvlkzXRvbWeWPB9d7hv5zTvbJmKb3k0LZGG7BsKazyQoDRUhySDzvdTU53Ex7XrUNxEKMdIE2l46ZWLROsYYi-_wddpSnj5Q9UI6TCx5E62lEup1Iy-G6Tw9rmbcdZ9-BRhx51jx4h--5JcVquoX8m_5qCwMkO-BkibP-v1C1O5zvJP4L1nAE</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1943574351</pqid></control><display><type>article</type><title>Specialist perioperative allergy clinic services in the UK 2016: Results from the Royal College of Anaesthetists Sixth National Audit Project</title><source>Wiley Online Library - AutoHoldings Journals</source><source>MEDLINE</source><creator>Egner, W. ; Cook, T. ; Harper, N. ; Garcez, T. ; Marinho, S. ; Kong, K. L. ; Nasser, S. ; Thomas, M. ; Warner, A. ; Hitchman, J. ; Floss, K. ; Farmer, Laura ; Lourtie, Jose ; Goodwin, James</creator><creatorcontrib>Egner, W. ; Cook, T. ; Harper, N. ; Garcez, T. ; Marinho, S. ; Kong, K. L. ; Nasser, S. ; Thomas, M. ; Warner, A. ; Hitchman, J. ; Floss, K. ; Farmer, Laura ; Lourtie, Jose ; Goodwin, James ; Sixth national audit project (NAP6) steering & Case Review panel, RCoA</creatorcontrib><description>Summary
Background
Guidelines for investigation of perioperative drug allergy exist, but the quality of services is unknown. Specialist perioperative anaphylaxis services were surveyed through the Royal College of Anaesthetists 6th National Audit Project.
Objectives
We compare self‐declared UK practice in specialist perioperative allergy services with national recommendations.
Methods
A SurveyMonkey™ questionnaire was distributed to providers of allergy services in the UK. Responses were assessed for adherence to the best practice recommendations of the British Society for Allergy and Clinical Immunology (BSACI), the Association of Anaesthetists of Great Britain and Ireland and the National Institute for Health and Care Excellence (NICE) Guidance on Drug Allergy—CG183.
Results
Over 1200 patients were evaluated in 44 centres annually. Variation in workload, waiting times, access, staffing and diagnostic approach was noted. Paediatric centres had the longest routine waiting times (most wait >13 weeks) in contrast to adult centres (most wait <12 weeks). Service leads are allergists/immunologists (91%) or anaesthetists (7%).
Potentially important differences were seen in: testing repertoire [10/44 (23%) lacked BSACI compliant neuromuscular blocking agent (NMBA) panels and 17/44 (39%) lacked a NAP6‐defined extended panel; many failed to screen all cases for chlorhexidine 19/44 (43%) or latex 21/44 (48%)], staffing [only 26/44 (59%) had specialist nurses and 18/44 (41%) an anaesthetist] and provision of information [18/44 (41%) gave immediate information in clinic and 5/44 (11%) sign‐posted support groups].
Most centres were able to provide diagnostic challenges to antibiotics [40/44 (91%]) and local anaesthetics [41/44 (93%)].
Conclusions and Clinical Relevance
Diagnostic testing is not harmonized, with marked variability in the NMBA panels used to identify safe alternatives. Chlorhexidine and latex are not part of routine testing in many centres.
Poor access to services and patient information provision require attention. Harmonization of diagnostic approach is desirable, particularly with regard to a minimum NMBA panel for identification of safe alternatives.</description><identifier>ISSN: 0954-7894</identifier><identifier>EISSN: 1365-2222</identifier><identifier>DOI: 10.1111/cea.12993</identifier><identifier>PMID: 28787764</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Age Factors ; Allergies ; Anaphylaxis ; Anesthetics ; Anesthetics - adverse effects ; Anesthetists ; Antibiotics ; Chlorhexidine ; clinical immunology ; Databases, Factual ; drug allergy ; Drug Hypersensitivity - diagnosis ; Drug Hypersensitivity - epidemiology ; education ; Guideline Adherence ; Health Care Surveys ; Humans ; Hypersensitivity ; immunologic tests ; Immunology ; Latex ; Medical personnel ; Nurse Anesthetists ; Occupational health ; pediatrics ; Perioperative Period ; Skin Tests ; Spatial Analysis ; Specialization ; Training ; United Kingdom - epidemiology ; Workforce planning ; Workload</subject><ispartof>Clinical and experimental allergy, 2017-10, Vol.47 (10), p.1318-1330</ispartof><rights>2017 John Wiley & Sons Ltd</rights><rights>2017 John Wiley & Sons Ltd.</rights><rights>Copyright © 2017 John Wiley & Sons Ltd</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3883-2791adc951f9b08295dacf9aecdfc776cc8d7a9b5f51e66989ea0b3a7f33e9853</citedby><cites>FETCH-LOGICAL-c3883-2791adc951f9b08295dacf9aecdfc776cc8d7a9b5f51e66989ea0b3a7f33e9853</cites><orcidid>0000-0002-2654-9881</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fcea.12993$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fcea.12993$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28787764$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Egner, W.</creatorcontrib><creatorcontrib>Cook, T.</creatorcontrib><creatorcontrib>Harper, N.</creatorcontrib><creatorcontrib>Garcez, T.</creatorcontrib><creatorcontrib>Marinho, S.</creatorcontrib><creatorcontrib>Kong, K. L.</creatorcontrib><creatorcontrib>Nasser, S.</creatorcontrib><creatorcontrib>Thomas, M.</creatorcontrib><creatorcontrib>Warner, A.</creatorcontrib><creatorcontrib>Hitchman, J.</creatorcontrib><creatorcontrib>Floss, K.</creatorcontrib><creatorcontrib>Farmer, Laura</creatorcontrib><creatorcontrib>Lourtie, Jose</creatorcontrib><creatorcontrib>Goodwin, James</creatorcontrib><creatorcontrib>Sixth national audit project (NAP6) steering & Case Review panel, RCoA</creatorcontrib><title>Specialist perioperative allergy clinic services in the UK 2016: Results from the Royal College of Anaesthetists Sixth National Audit Project</title><title>Clinical and experimental allergy</title><addtitle>Clin Exp Allergy</addtitle><description>Summary
Background
Guidelines for investigation of perioperative drug allergy exist, but the quality of services is unknown. Specialist perioperative anaphylaxis services were surveyed through the Royal College of Anaesthetists 6th National Audit Project.
Objectives
We compare self‐declared UK practice in specialist perioperative allergy services with national recommendations.
Methods
A SurveyMonkey™ questionnaire was distributed to providers of allergy services in the UK. Responses were assessed for adherence to the best practice recommendations of the British Society for Allergy and Clinical Immunology (BSACI), the Association of Anaesthetists of Great Britain and Ireland and the National Institute for Health and Care Excellence (NICE) Guidance on Drug Allergy—CG183.
Results
Over 1200 patients were evaluated in 44 centres annually. Variation in workload, waiting times, access, staffing and diagnostic approach was noted. Paediatric centres had the longest routine waiting times (most wait >13 weeks) in contrast to adult centres (most wait <12 weeks). Service leads are allergists/immunologists (91%) or anaesthetists (7%).
Potentially important differences were seen in: testing repertoire [10/44 (23%) lacked BSACI compliant neuromuscular blocking agent (NMBA) panels and 17/44 (39%) lacked a NAP6‐defined extended panel; many failed to screen all cases for chlorhexidine 19/44 (43%) or latex 21/44 (48%)], staffing [only 26/44 (59%) had specialist nurses and 18/44 (41%) an anaesthetist] and provision of information [18/44 (41%) gave immediate information in clinic and 5/44 (11%) sign‐posted support groups].
Most centres were able to provide diagnostic challenges to antibiotics [40/44 (91%]) and local anaesthetics [41/44 (93%)].
Conclusions and Clinical Relevance
Diagnostic testing is not harmonized, with marked variability in the NMBA panels used to identify safe alternatives. Chlorhexidine and latex are not part of routine testing in many centres.
Poor access to services and patient information provision require attention. Harmonization of diagnostic approach is desirable, particularly with regard to a minimum NMBA panel for identification of safe alternatives.</description><subject>Age Factors</subject><subject>Allergies</subject><subject>Anaphylaxis</subject><subject>Anesthetics</subject><subject>Anesthetics - adverse effects</subject><subject>Anesthetists</subject><subject>Antibiotics</subject><subject>Chlorhexidine</subject><subject>clinical immunology</subject><subject>Databases, Factual</subject><subject>drug allergy</subject><subject>Drug Hypersensitivity - diagnosis</subject><subject>Drug Hypersensitivity - epidemiology</subject><subject>education</subject><subject>Guideline Adherence</subject><subject>Health Care Surveys</subject><subject>Humans</subject><subject>Hypersensitivity</subject><subject>immunologic tests</subject><subject>Immunology</subject><subject>Latex</subject><subject>Medical personnel</subject><subject>Nurse Anesthetists</subject><subject>Occupational health</subject><subject>pediatrics</subject><subject>Perioperative Period</subject><subject>Skin Tests</subject><subject>Spatial Analysis</subject><subject>Specialization</subject><subject>Training</subject><subject>United Kingdom - epidemiology</subject><subject>Workforce planning</subject><subject>Workload</subject><issn>0954-7894</issn><issn>1365-2222</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kcFuFDEMhiNERbeFAy-AInGhh2mTyWSScFutClStALX0PMpmnDar7GSbzBT2IXhn3G7pAQlLsQ_-_NvRT8hbzo45xokDe8xrY8QLMuOilVWN8ZLMmJFNpbRp9slBKSvGmJBGvyL7tVZaqbaZkd9XG3DBxlBGuoEcEiY7hnugNkbIN1vqYhiCowXyfXBQaBjoeAv0-pzWjLcf6SWUKY6F-pzWj53LtLWRLhLO3wBNns4HCwU7Iy4p9Cr8Gm_pV1ySBuTmUx9G-j2nFbjxNdnzNhZ481QPyfWn0x-LL9XFt89ni_lF5YTWoqqV4bZ3RnJvlkzXRvbWeWPB9d7hv5zTvbJmKb3k0LZGG7BsKazyQoDRUhySDzvdTU53Ex7XrUNxEKMdIE2l46ZWLROsYYi-_wddpSnj5Q9UI6TCx5E62lEup1Iy-G6Tw9rmbcdZ9-BRhx51jx4h--5JcVquoX8m_5qCwMkO-BkibP-v1C1O5zvJP4L1nAE</recordid><startdate>201710</startdate><enddate>201710</enddate><creator>Egner, W.</creator><creator>Cook, T.</creator><creator>Harper, N.</creator><creator>Garcez, T.</creator><creator>Marinho, S.</creator><creator>Kong, K. L.</creator><creator>Nasser, S.</creator><creator>Thomas, M.</creator><creator>Warner, A.</creator><creator>Hitchman, J.</creator><creator>Floss, K.</creator><creator>Farmer, Laura</creator><creator>Lourtie, Jose</creator><creator>Goodwin, James</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2654-9881</orcidid></search><sort><creationdate>201710</creationdate><title>Specialist perioperative allergy clinic services in the UK 2016: Results from the Royal College of Anaesthetists Sixth National Audit Project</title><author>Egner, W. ; Cook, T. ; Harper, N. ; Garcez, T. ; Marinho, S. ; Kong, K. L. ; Nasser, S. ; Thomas, M. ; Warner, A. ; Hitchman, J. ; Floss, K. ; Farmer, Laura ; Lourtie, Jose ; Goodwin, James</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3883-2791adc951f9b08295dacf9aecdfc776cc8d7a9b5f51e66989ea0b3a7f33e9853</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Age Factors</topic><topic>Allergies</topic><topic>Anaphylaxis</topic><topic>Anesthetics</topic><topic>Anesthetics - adverse effects</topic><topic>Anesthetists</topic><topic>Antibiotics</topic><topic>Chlorhexidine</topic><topic>clinical immunology</topic><topic>Databases, Factual</topic><topic>drug allergy</topic><topic>Drug Hypersensitivity - diagnosis</topic><topic>Drug Hypersensitivity - epidemiology</topic><topic>education</topic><topic>Guideline Adherence</topic><topic>Health Care Surveys</topic><topic>Humans</topic><topic>Hypersensitivity</topic><topic>immunologic tests</topic><topic>Immunology</topic><topic>Latex</topic><topic>Medical personnel</topic><topic>Nurse Anesthetists</topic><topic>Occupational health</topic><topic>pediatrics</topic><topic>Perioperative Period</topic><topic>Skin Tests</topic><topic>Spatial Analysis</topic><topic>Specialization</topic><topic>Training</topic><topic>United Kingdom - epidemiology</topic><topic>Workforce planning</topic><topic>Workload</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Egner, W.</creatorcontrib><creatorcontrib>Cook, T.</creatorcontrib><creatorcontrib>Harper, N.</creatorcontrib><creatorcontrib>Garcez, T.</creatorcontrib><creatorcontrib>Marinho, S.</creatorcontrib><creatorcontrib>Kong, K. L.</creatorcontrib><creatorcontrib>Nasser, S.</creatorcontrib><creatorcontrib>Thomas, M.</creatorcontrib><creatorcontrib>Warner, A.</creatorcontrib><creatorcontrib>Hitchman, J.</creatorcontrib><creatorcontrib>Floss, K.</creatorcontrib><creatorcontrib>Farmer, Laura</creatorcontrib><creatorcontrib>Lourtie, Jose</creatorcontrib><creatorcontrib>Goodwin, James</creatorcontrib><creatorcontrib>Sixth national audit project (NAP6) steering & Case Review panel, RCoA</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical and experimental allergy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Egner, W.</au><au>Cook, T.</au><au>Harper, N.</au><au>Garcez, T.</au><au>Marinho, S.</au><au>Kong, K. L.</au><au>Nasser, S.</au><au>Thomas, M.</au><au>Warner, A.</au><au>Hitchman, J.</au><au>Floss, K.</au><au>Farmer, Laura</au><au>Lourtie, Jose</au><au>Goodwin, James</au><aucorp>Sixth national audit project (NAP6) steering & Case Review panel, RCoA</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Specialist perioperative allergy clinic services in the UK 2016: Results from the Royal College of Anaesthetists Sixth National Audit Project</atitle><jtitle>Clinical and experimental allergy</jtitle><addtitle>Clin Exp Allergy</addtitle><date>2017-10</date><risdate>2017</risdate><volume>47</volume><issue>10</issue><spage>1318</spage><epage>1330</epage><pages>1318-1330</pages><issn>0954-7894</issn><eissn>1365-2222</eissn><abstract>Summary
Background
Guidelines for investigation of perioperative drug allergy exist, but the quality of services is unknown. Specialist perioperative anaphylaxis services were surveyed through the Royal College of Anaesthetists 6th National Audit Project.
Objectives
We compare self‐declared UK practice in specialist perioperative allergy services with national recommendations.
Methods
A SurveyMonkey™ questionnaire was distributed to providers of allergy services in the UK. Responses were assessed for adherence to the best practice recommendations of the British Society for Allergy and Clinical Immunology (BSACI), the Association of Anaesthetists of Great Britain and Ireland and the National Institute for Health and Care Excellence (NICE) Guidance on Drug Allergy—CG183.
Results
Over 1200 patients were evaluated in 44 centres annually. Variation in workload, waiting times, access, staffing and diagnostic approach was noted. Paediatric centres had the longest routine waiting times (most wait >13 weeks) in contrast to adult centres (most wait <12 weeks). Service leads are allergists/immunologists (91%) or anaesthetists (7%).
Potentially important differences were seen in: testing repertoire [10/44 (23%) lacked BSACI compliant neuromuscular blocking agent (NMBA) panels and 17/44 (39%) lacked a NAP6‐defined extended panel; many failed to screen all cases for chlorhexidine 19/44 (43%) or latex 21/44 (48%)], staffing [only 26/44 (59%) had specialist nurses and 18/44 (41%) an anaesthetist] and provision of information [18/44 (41%) gave immediate information in clinic and 5/44 (11%) sign‐posted support groups].
Most centres were able to provide diagnostic challenges to antibiotics [40/44 (91%]) and local anaesthetics [41/44 (93%)].
Conclusions and Clinical Relevance
Diagnostic testing is not harmonized, with marked variability in the NMBA panels used to identify safe alternatives. Chlorhexidine and latex are not part of routine testing in many centres.
Poor access to services and patient information provision require attention. Harmonization of diagnostic approach is desirable, particularly with regard to a minimum NMBA panel for identification of safe alternatives.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>28787764</pmid><doi>10.1111/cea.12993</doi><tpages>13</tpages><orcidid>https://orcid.org/0000-0002-2654-9881</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0954-7894 |
| ispartof | Clinical and experimental allergy, 2017-10, Vol.47 (10), p.1318-1330 |
| issn | 0954-7894 1365-2222 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1927603040 |
| source | Wiley Online Library - AutoHoldings Journals; MEDLINE |
| subjects | Age Factors Allergies Anaphylaxis Anesthetics Anesthetics - adverse effects Anesthetists Antibiotics Chlorhexidine clinical immunology Databases, Factual drug allergy Drug Hypersensitivity - diagnosis Drug Hypersensitivity - epidemiology education Guideline Adherence Health Care Surveys Humans Hypersensitivity immunologic tests Immunology Latex Medical personnel Nurse Anesthetists Occupational health pediatrics Perioperative Period Skin Tests Spatial Analysis Specialization Training United Kingdom - epidemiology Workforce planning Workload |
| title | Specialist perioperative allergy clinic services in the UK 2016: Results from the Royal College of Anaesthetists Sixth National Audit Project |
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