A regional patch test audit against the 2019 British Association of Dermatologists’ Cutaneous Allergy Service Standards
Published Date: 01st September 2020
Publication Authors: Pang E
Abstract
The aim of this audit was to assess regional patch testing services in accordance with the British Association of Dermatology's (BAD) Cutaneous Allergy Service Standards, published in July 2019. Audit points incorporated recommendations from a regional audit carried out after the publication of the 2017 BAD contact dermatitis guidelines, in addition to the above standards. Six centres in the region provided data on their patch testing services in 2019. Standards assessed included those relating to service capacity, patient assessment, prior information given to patients and obtaining consent prior to patch testing. Sixty per cent of patients referred routinely were seen within the recommended 12 weeks. A range of 4–20 patients were patch tested per centre per month, with an average of 139 patients patch tested per centre annually across the region in 2019. In five of six centres, the consultant sees the required number of patients to maintain their practice. The estimated population catchment area ranged from 258 000 to 500 000. Of the last 240 patients patch tested across the region, 91% of patients received a patient information leaflet. Seven patients presenting with hand dermatitis were documented to be hairdressers and all were tested to the hairdressing series. Of the 83 patients who had facial dermatitis, 59 (71%) were tested to cosmetic series; 14 (17%) to fragrance series; and 15 (18%) to the nail acrylate series. Of 69 patients presenting with atopic dermatitis, 19 (27%) were tested to medicament series and 21 (30%) to steroid series. Four of six centres document verbal or written consent, with an 88% compliance rate, with the rest assuming implied consent if the patient attended for patch testing. This audit provides a baseline for focused service improvement into timely access to patch testing as centres are still falling short on seeing a minimum of 150 patients per year. Potential reasons for centres not reaching the minimum capacity of 150 patients patch tested per year are complex and varied between units, including limited physical capacity of the department, a high nonattendance rate, appropriately skilled nursing availability and periods of absence of the lead clinician. There are several areas identified that, seemingly, lack compliance with regard to selection of appropriate series, reflecting the clinical history obtained and the individual clinician's varying experience, when thus far there has been no such detailed best practice published. Addressing these aspects prior to reauditing will endeavour to improve concordance, collaboration and standardize practice.
Harnett, C; Pang, E et al. (2020). A regional patch test audit against the 2019 British Association of Dermatologists’ Cutaneous Allergy Service Standards. British Journal of Dermatology. 183 (S1), 167