More than skin deep. Ten year follow-up of delayed cutaneous adverse drug reactions (CADR).
To determine the gaps in practice regarding appropriate ADR documentation and risk communication for patients diagnosed with severe cutaneous adverse drug reactions (CADR).



This was a retrospective observational cohort study conducted using hospital coding and databases to identify inpatients diagnosed with CADR from January 2004 to August 2014. Hospital discharge summaries, ADR reports and pharmacy dispensing records were reviewed for ADR documentation. Patients still living in Australia and who did not opt out of being contacted were invited to be surveyed by telephone to determine their understanding of recommendations, re-exposure rates and long-term effects.



Of 85 patients identified, median age was 59 (IQR 44-72) years and 47.1% were male. The most common diagnosis was TENS (49.4%). Ten patients (11.8%) died as inpatients. Of the 81 patients with a drug-related causality, 47 (58%) had appropriate documentation in all three required medical record platforms. Of the 56 eligible patients, 38 (67.9%) were surveyed; 13% had no information provided upon discharge and 26.3% patients had a mismatch in knowledge of implicated medications. No surveyed patient had a relapse of CADR, but 23.7% had a subsequent unrelated allergic reaction. Thirteen patients (34.2%) reported long-term effects.



We found gaps in the accuracy of ADR documentation and communication of risk at discharge, which indicated risks to patient safety. Electronic systems are being developed to improve documentation. Written information about CADR is being provided at discharge to improve patient understanding and knowledge.
Pharmacy Department, Alfred Health, 55 Commercial Road, Melbourne, 3004, Victoria, Australia. l.graudins@alfred.org.au.
Linda Velta
LV
Graudins
Pharmacy Department, Alfred Health, 55 Commercial Road, Melbourne, 3004, Victoria, Australia.
Jenny
J
Ly
Department of Infectious Diseases, Alfred Health, 55 Commercial Road, Melbourne, 3004, Victoria, Australia.|Department of Infectious Diseases, Peter MacCallum Cancer Centre, Victoria, Australia.|Department of Infectious Diseases, Austin Health, 145 Studley Road, Heidelberg, 3184, Victoria, Australia.|Department of Medicine, University of Melbourne, Victoria, Australia.
Jason
J
Trubiano
Department of Infectious Diseases, Alfred Health, 55 Commercial Road, Melbourne, 3004, Victoria, Australia.|Department of General Medicine, Alfred Health and Monash University, Victoria, Australia.
Ar Kar
AK
Aung
D000328:Adult; D000368:Aged; D001315:Australia; D003142:Communication; D064420:Drug-Related Side Effects and Adverse Reactions / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D012189:Retrospective Studies; D012867:Skin / Q000187:drug effects*
CADR; Steven-Johnson syndrome; adverse drug reaction; cutaneous reactions; drug allergy; medication safety