The authors of a study found problems in allergy documentation at ambulatory surgical and primary care organizations.1

The Accreditation Association for Ambulatory Health Care (AAAHC) Institute for Quality Improvement allergy study included an analysis of 73 surgical procedural organizations and eight primary care organizations. Researchers wanted to determine how well these organizations documented allergies.

Among surgery centers, 98% of participating organizations indicated a uniform location in their clinical record for allergy documentation. Also, 86% have created a policy or procedure requiring documentation of allergy symptoms and severity. However, the researchers uncovered some inconsistencies:

  • Allergies sometimes were not verified or updated at each visit.
  • There was a reliance on using the acronym NKDA (no known drug allergies), without references to other allergies or sensitivities.
  • Overall allergic reaction documentation was inconsistent.

More than 50 million Americans suffer from allergies every year, and there are multiple risks of medical issues related to their surgery and medication. For example, patient allergies can result in symptoms that range from mild skin rashes or itching to gastrointestinal upset to severe, life-threatening reactions, says Belle Lerner, MA, director of research at the AAAHC Institute for Quality Improvement.

“People could have cardiovascular reactions like tachycardia ... which can be extremely dangerous,” Lerner says. “That is why this is an important issue.”

Researchers found some of these organizations might only be telling part of the allergy story in documentation. “We also asked if they documented the severity of the reaction. Was it mild, moderate, severe?” Lerner says. “When we asked if they [described] both — symptoms and severity — only 41% of charts found that this occurred. They are documenting the reaction — the person getting hives — but are not saying whether it was severe or mild. This can impact healthcare decisions, the quality of patient care, and the patient’s health.” The allergic reaction severity is important to assess and document because it can determine the physician’s next step.

Organizations reported some inconsistency in allergy documentation in about 12% of charts, Lerner says. “The inconsistency was resolved in 70%. Someone caught it, or maybe the nurse made a handwritten note that was not what it said in the chart, and it was resolved,” Lerner says.

The use of NKDA also can be problematic. “It would be better to have a list of [allergies] you ask about and have their answers of yes or no,” Lerner says. “They need to ask about more than drug allergies. The NKDA acronym is not good enough; you need food and environmental allergies listed, too.” For example, someone who lists a banana allergy but no known medication allergies could develop an allergy to latex, she adds.

The allergy benchmarking study was conducted as part of AAAHC’s quality roadmap work that highlights areas that need improvement and identified allergy documentation as a problem. “We put together webinars and toolkits, and this is the first allergy study,” Lerner adds.


  1. Accreditation Association for Ambulatory Health Care. AAAHC publishes allergy documentation benchmarking study. Nov. 19, 2020.