Documentation of Drug and Non-Drug Allergies in Public Hospital Electronic Health Records: A National Survey

Inconsistent documentation of known allergies in electronic patient records (EPRs) poses a major patient safety risk. Unlike drug allergies, food and non-drug allergens lack standardised documentation frameworks. This study evaluated how such allergies are recorded across NHS Trusts and the extent of avoidable harm from exposures.

We conducted a national cross-sectional, study. Freedom of Information (FOI) requests were sent to all 209 public (NHS) hospital Trusts (December 2024) to collect data on allergy-related incidents, EPR availability, training and governance. An online survey was distributed to British Society for Allergy & Clinical Immunology (BSACI) members (February 2025) to capture clinician experiences, challenges and suggestions. Quantitative data were analysed using non-parametric statistics; qualitative data were analysed using thematic analysis.

Responses were received from 194 Trusts (93%), with 145 providing complete datasets (582 hospitals). Sixty-one different EPR platforms were identified, with 44 Trusts operating multiple systems. Across a median 10-year span, 12,385 allergy-related incidents were reported: 7724 (62%) drugs and 1277 (10%) food/non-drug allergens. Over half of Trusts (54%) lacked a dedicated incident-reporting category for food/non-drug allergens, suggesting underestimation. Trusts without EPRs reported 140% more incidents than those with EPRs (p = 0.002). Those with in-house allergy services, training and guidance recorded higher incident rates, consistent with enhanced recognition and reporting. The BSACI survey revealed challenges including poor EPR usability, limited coding options, weak alert systems and reliance on free text. Ninety percent of respondents supported national guidance on allergy documentation.

Marked heterogeneity exists in NHS EPR systems and food/non-drug allergy documentation practices. Trusts without EPRs experience higher reporting rates, while training and specialist services are associated with improved recognition. The absence of dedicated categories for food and non-drug allergies contributes to systematic underreporting. These findings demonstrate how fragmented systems and inconsistent governance directly compromise allergy safety across UK hospitals.