Adverse reactions to antimicrobials
Quality statement 3 - Antimicrobial Stewardship Clinical Care Standard
When an adverse reaction (including an allergy) to an antimicrobial is reported by a patient or recorded in their healthcare record, the active ingredient(s), date, nature and severity of the reaction are assessed and documented. This enables the most appropriate antimicrobial to be used when required.
Purpose
To ensure the accurate assessment and documentation of patient adverse reaction information to allow for optimal antimicrobial prescribing. This means using the most appropriate and narrow-spectrum antimicrobial possible, while ensuring that potential harms (such as anaphylaxis) are avoided.
For patients
Adverse reactions are any unwanted effects of a medicine. Many adverse reactions are expected side effects of medicines, and can range from mild to severe. An ‘allergic reaction’ is one type of adverse reaction.
If you have ever had an unwanted response to a medicine used to treat an infection, even if it was many years ago, talk to your clinician. They will ask you about what happened to find out whether it was because of the medicine, how severe it was and what it means for your care. As a result, your treatment may change and your healthcare record will be updated. Important changes will be communicated to you and your regular doctor.
If you have had an adverse reaction to a medicine, it is important that this information is added to your healthcare record. You can also review and update your information in your My Health Record. Carry a list of your medicines with you, and make sure that it includes the most up-to-date information about your previous adverse reactions to medicines, including allergies.
For clinicians
Before prescribing, dispensing or administering an antimicrobial, consider the patient’s previous adverse reactions to medicines. Check the healthcare record and ask the patient about their previous adverse reactions, including the active ingredient(s), date the adverse event occurred, nature and severity of the reaction (including how it was managed), and where they recorded it, such as on an allergy bracelet or a medicines list. If any of the essential elements for assessing an adverse reaction are unknown (see below), this should be explicitly documented in the patient’s healthcare record.
The essential elements for assessing an adverse reaction are the:
- Patient’s description of the event (what happened to the patient)
- Nature of the reaction (diagnosis of the reaction)
- Active ingredient(s) thought to have caused the adverse reaction
- Assessment of likelihood (certainty it was caused by the active ingredient)
- Severity of event (consequence to the patient, for example hospitalisation)
- Date and location of the care (because the original record may have more detail).
Assess the likelihood of the adverse reaction being caused by the active ingredient(s). Factors relevant to your decision about whether to use an antimicrobial or not include the potential for the adverse reaction to recur and the likely consequences to the patient. Use information about the patient’s adverse reaction history, along with evidence-based guidelines, to assess the most appropriate antimicrobial to use. Review the accuracy of the documentation and update the patient’s healthcare record.
Communicate any changes to a patient’s adverse reaction or allergy status to the patient and their regular clinician (for example, in My Health Record or a discharge summary for the general practitioner). It may also be necessary to update the patient’s medicines list.
If a patient experiences a new adverse reaction to an antimicrobial, document the essential elements (as above) in the patient’s healthcare record. Any new or suspected adverse reactions should also be recorded in the organisation-wide incident reporting system and reported to the Therapeutic Goods Administration.1
For health service organisations
Ensure processes are in place to support clinicians to document adverse reactions to medicines that are reported or experienced by a patient in the patient’s healthcare record.
The essential elements to document for an adverse reaction are the:
- Patient’s description of the event (what happened to the patient)
- Nature of the reaction (diagnosis of the reaction)
- Active ingredient(s) thought to have caused the adverse reaction
- Assessment of likelihood (certainty it was caused by the active ingredient)
- Severity of event (consequence to the patient, for example hospitalisation)
- Date and location of the care (because the original record may have more detail).
Ensure processes are in place for clinicians to review and update information about patients’ adverse reactions to medicines in their healthcare records at each encounter including the My Health Record system.
Ensure guidelines are available for clinicians to assess adverse reactions to antimicrobials and to use the most appropriate antimicrobial when required.
Ensure relevant information about adverse reactions to medicines is available for clinicians to provide to patients.
Ensure processes are in place to review adverse reactions to antimicrobials in the organisation-wide incident reporting system and report them to the Therapeutic Goods Administration.1
For patients
Adverse reactions are any unwanted effects of a medicine. Many adverse reactions are expected side effects of medicines, and can range from mild to severe. An ‘allergic reaction’ is one type of adverse reaction.
If you have ever had an unwanted response to a medicine used to treat an infection, even if it was many years ago, talk to your clinician. They will ask you about what happened to find out whether it was because of the medicine, how severe it was and what it means for your care. As a result, your treatment may change and your healthcare record will be updated. Important changes will be communicated to you and your regular doctor.
If you have had an adverse reaction to a medicine, it is important that this information is added to your healthcare record. You can also review and update your information in your My Health Record. Carry a list of your medicines with you, and make sure that it includes the most up-to-date information about your previous adverse reactions to medicines, including allergies.
For clinicians
Before prescribing, dispensing or administering an antimicrobial, consider the patient’s previous adverse reactions to medicines. Check the healthcare record and ask the patient about their previous adverse reactions, including the active ingredient(s), date the adverse event occurred, nature and severity of the reaction (including how it was managed), and where they recorded it, such as on an allergy bracelet or a medicines list. If any of the essential elements for assessing an adverse reaction are unknown (see below), this should be explicitly documented in the patient’s healthcare record.
The essential elements for assessing an adverse reaction are the:
- Patient’s description of the event (what happened to the patient)
- Nature of the reaction (diagnosis of the reaction)
- Active ingredient(s) thought to have caused the adverse reaction
- Assessment of likelihood (certainty it was caused by the active ingredient)
- Severity of event (consequence to the patient, for example hospitalisation)
- Date and location of the care (because the original record may have more detail).
Assess the likelihood of the adverse reaction being caused by the active ingredient(s). Factors relevant to your decision about whether to use an antimicrobial or not include the potential for the adverse reaction to recur and the likely consequences to the patient. Use information about the patient’s adverse reaction history, along with evidence-based guidelines, to assess the most appropriate antimicrobial to use. Review the accuracy of the documentation and update the patient’s healthcare record.
Communicate any changes to a patient’s adverse reaction or allergy status to the patient and their regular clinician (for example, in My Health Record or a discharge summary for the general practitioner). It may also be necessary to update the patient’s medicines list.
If a patient experiences a new adverse reaction to an antimicrobial, document the essential elements (as above) in the patient’s healthcare record. Any new or suspected adverse reactions should also be recorded in the organisation-wide incident reporting system and reported to the Therapeutic Goods Administration.1
For health service organisations
Ensure processes are in place to support clinicians to document adverse reactions to medicines that are reported or experienced by a patient in the patient’s healthcare record.
The essential elements to document for an adverse reaction are the:
- Patient’s description of the event (what happened to the patient)
- Nature of the reaction (diagnosis of the reaction)
- Active ingredient(s) thought to have caused the adverse reaction
- Assessment of likelihood (certainty it was caused by the active ingredient)
- Severity of event (consequence to the patient, for example hospitalisation)
- Date and location of the care (because the original record may have more detail).
Ensure processes are in place for clinicians to review and update information about patients’ adverse reactions to medicines in their healthcare records at each encounter including the My Health Record system.
Ensure guidelines are available for clinicians to assess adverse reactions to antimicrobials and to use the most appropriate antimicrobial when required.
Ensure relevant information about adverse reactions to medicines is available for clinicians to provide to patients.
Ensure processes are in place to review adverse reactions to antimicrobials in the organisation-wide incident reporting system and report them to the Therapeutic Goods Administration.1
Quality Statement 3 has an indicator for local monitoring.
Read Quality Statement 4 - Microbiological testing.