Safety Checks in Patch Clinic: 5 Hurdles in the Patch Testing Obstacle Course

Abstract

Accuracy in patch testing is critical for correct allergen identification. This multistep process is prone to error and risk increases with more staff (physicians, residents, fellows, technicians), antigens, and patients. Standardized safety checkpoints increase efficiency, consistency, and safety. In this article, we outline workflows developed for 20 years of experience, which maximize productivity and communication among team members to minimize system errors. We organize patch safety into 5 key “hurdles,” or steps, and outline the specific safety procedures of each step via the use of checklists, easy visual cues, and double verification. The 5 hurdles include the following: (a) inventory (stocking sufficient antigens, maintaining chemical viability through appropriate storage, systematizing correct antigen identification); (b) patch preparation (consistent order communication, standardizing conformation and numbering of patches, accurate placement of antigens on patches); (c) application (maximizing patch contact with suitable skin on patient, minimizing risk of interference with patch test reactions); (d) documentation (accurate maps, avoiding “frame shift” misreads); and (e) education (promoting patient partnership, allergen avoidance).