DALES: Drug Allergy Labels in the Elective Surgical Population

The 3rd RAFT national collaborative project involving all networks was DALES, Drug Allergy Labels in the Elective Surgical population.

It was a three-day study commencing mid-2018 comprising Patient Questionnaire, Anaesthetist Survey and Patient Follow-Up on the day.

The Study

DALES was designed to evaluate the prevalence of patient-reported and documented allergy to drugs relevant to anaesthesia and to learn more about anaesthetists’ knowledge and attitudes to allergy.

The study took the form of questionnaires / interviews for quantitative analysis. This was a cross sectional, observational and descriptive study design:

Patient Questionnaire

• This occurred across the country in multiple sites over 3 days within a 6-week study window

• When patients attended hospital for planned surgery they were consented for a questionnaire about their allergies

• Baseline data was collected from all patients attending for elective surgery, regardless of allergy status

• Data was collected electronically at the bedside using the REDCap system and securely stored

Targeted Patient Follow-Up

• Patients who reported allergy to B-lactams or opioids were followed up post-op if they were due to receive these drugs

• An investigator reviewed the anaesthetic and drug charts and note how the drug allergy was documented and what was given

• Any changes to the documentation of allergy were recorded

• Any episode of unexpected patient instability that took place in the peri-operative period was recorded

Anaesthetist Survey

• All anaesthetists and prescribing anaesthetic practitioners working during the study period were invited to take part in a survey about attitudes to drug allergy labels in the elective perioperative setting

Which hospitals in Wales took part?

• Cardiff and Vale UHB:  University Hospital of Wales

Collaborators:  Anna Williams, Jessica Phillips, Emily Murphy, Matthew Soanes, Laura Allen

PI:  Danielle Huckle

• Abertawe Bro Morgannwg UHB:

Morriston, Singleton

Collaborators:  Nadine Jones, Benjamin O'Donovan, Harriet Pudge, Alexandra Cormack, Catherine Chapman, Sean O'Beirn

PI:  Nathan Tweed

Princess of Wales

Collaborators:  Tanya Smith, Mike Cooper

PI:  Rhidian Jones

• Betsi Cadwaldr UHB: Wrexham Maelor

Collaborators:  Amanda Skingle, Jana Anandarajah, Nowfal Rahman

PI:  Andy Campbell

• Hywel Dda UHB: Prince Philip, West Wales General

Collaborators:  Brigitte Baxter, Gareth James

PI:  Alun Thomas

• Cwm Taf UHB: Royal Glamorgan, Prince Charles

Collaborators:

PI:

• Aneurin Bevan UHB:

Royal Gwent

Collaborators:  Alexander Photiou, Anthony Rimmer, Nicholas Gibson, Roisin Flanaghan, Nitin Bhalla

PI:  Tamas Szakamy

Neville Hall

Collaborators:  Pete Collett, Jake Moss, Helen Ross

PI:  Vincent Hamlyn

Publications

Published in December 2020:

https://www.sciencedirect.com/science/article/abs/pii/S0007091220306413

Published in July 2021:

https://bjanaesthesia.org/article/S0007-0912(21)00345-7/fulltext