scholarly journals Improving Aztreonam Stewardship and Cost Through a Penicillin Allergy Testing Clinical Guideline

2018 ◽  
Vol 5 (6) ◽  
Author(s):  
Justin R Chen ◽  
Scott A Tarver ◽  
Kristin S Alvarez ◽  
Wenjing Wei ◽  
David A Khan
Keyword(s):  
Skin Testing ◽  
Cost Savings ◽  
Cost Effective ◽  
Clinical Decision ◽  
Economic Benefits ◽  
Penicillin Allergy ◽  
Negative Consequences ◽  
Allergy Testing ◽  
Stewardship Program ◽  
Before And After

Abstract Background Patients reporting penicillin allergy often receive unnecessary and costly broad-spectrum alternatives such as aztreonam with negative consequences. Penicillin allergy testing improves antimicrobial therapy but is not broadly used in hospitals due to insufficient testing resources and short-term expenses. We describe a clinical decision support (CDS) tool promoting pharmacist-administered penicillin allergy testing in patients receiving aztreonam and its benefits toward antimicrobial stewardship and costs. Methods A CDS tool was incorporated into the electronic medical record, directing providers to order penicillin allergy testing for patients receiving aztreonam. An allergy-trained pharmacist reviewed orders placed through this new guideline and performed skin testing and oral challenges to determine whether these patients could safely take penicillin. Data on tests performed, antibiotic utilization, and cost-savings were compared with patients tested outside the new guideline as part of our institution’s standard stewardship program. Results The guideline significantly increased penicillin allergy testing among patients receiving aztreonam from 24% to 85% (P < .001) while reducing the median delay between admission and testing completion from 3.31 to 1.05 days (P = 0.008). Patients tested under the guideline saw a 58% increase in penicillin exposure (P = .046). Institutional aztreonam administration declined from 2.54 to 1.47 administrations per 1000 patient-days (P = .016). Average antibiotic costs per patient tested before and after CDS decreased from $1265.81 to $592.08 USD, a 53% savings. Conclusions Targeting penicillin allergy testing to patients on aztreonam yields therapeutic and economic benefits during a single admission. This provides a cost-effective model for inpatient testing.

scholarly journals The Clinical and Financial Impact of a Pharmacist-Driven Penicillin Skin Testing Program on Antimicrobial Stewardship Practices

2018 ◽  
Vol 55 (1) ◽  
pp. 58-63 ◽  
Author(s):  
Stacy Harmon ◽  
Thomas Richardson ◽  
Heidi Simons ◽  
Summer Monforte ◽  
Shea Fanning ◽  
...  
Keyword(s):  
Antimicrobial Agent ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Therapy ◽  
Skin Testing ◽  
Cost Savings ◽  
Clinical Decision ◽  
Penicillin Allergy ◽  
Stevens Johnson Syndrome ◽  
Johnson Syndrome ◽  
Days Of Therapy

Purpose: Pharmacist-led penicillin skin testing (PST) was incorporated into antimicrobial stewardship at a community hospital to increase use of optimal antimicrobial therapy, reduce use of broad-spectrum agents, and reduce antimicrobial therapy–related costs. Methods: A clinical decision support software alert identified qualifying patients with penicillin allergies. Patients receiving a nonoptimal antimicrobial agent were prioritized for PST. Patients were excluded if they reported a history of extreme hypersensitivity to a penicillin agent, such as Stevens-Johnson syndrome, toxic epidermal necrolysis, or mucocutaneous eruption with epidermal detachment. Pediatric patients less than 18 years old and pregnant patients were excluded. Data collected for each patient included the medication that precipitated the reaction; reaction type; age when the reaction occurred; current antibiotic therapy; indication for therapy; preferred antimicrobial agent; days of therapy on each agent used; positive, negative, or ambiguous PST result; recent antihistamine use; and any adverse events that occurred. Outcomes of the PST results, pharmacist interventions made after PST, and resulting cost savings to patients were all reported. Results: Among 31 patients tested, 27 were negative for penicillin allergy, 1 was positive for penicillin allergy, and 3 yielded an indeterminate test. Pharmacist recommendation to change therapy based on PST results was accepted in 13 of 15 patients where recommendations were made. Cost savings in antimicrobial therapy alone for patients who received PST was US $74.75 per day. Conclusion: Pharmacist-driven PST provided opportunities to clarify allergies, optimize antimicrobial therapy, and save antimicrobial therapy–related costs to patients.

Assessment of Cost-Effective Antibiotic Therapy in the Management of Infections in Cancer Patients

1994 ◽  
Vol 28 (1) ◽  
pp. 105-111 ◽  
Author(s):  
Michael A. Cimino ◽  
Coleman M. Rotstein ◽  
Jason E. Moser
Keyword(s):  
Quality Improvement ◽  
Antibiotic Therapy ◽  
Clinical Pharmacist ◽  
Hospital Setting ◽  
Cost Savings ◽  
Cost Effective ◽  
Baseline Period ◽  
Economic Benefits ◽  
Consensus Approach ◽  
Quality Improvement Effort

OBJECTIVE: To describe the economic benefits of a quality improvement effort directed at optimizing clinical outcome. DESIGN: A before—after observational design was used to evaluate the cost-effectiveness of a consensus approach to antimicrobial therapy. SETTING: The evaluation was conducted at a cancer research hospital. PATIENTS: Oncology patients requiring parenteral antibiotic therapy were consecutively observed. MAIN OUTCOME MEASURES: Outcome (clinical and microbiologic response), safety, and cost of therapy were assessed during a baseline period and compared to a period during which the consensus approach was used. INTERVENTIONS: The influence of a designated individual, in this case a clinical pharmacist, responsible for promotion of the consensus approach was explored. RESULTS: The consensus approach in combination with the promotional efforts of the clinical pharmacist was associated with a 13 percent increase in overall clinical response and a reduction of pathogen persistence from 22 to 11 percent. No difference in the average number of adverse effects per patient was observed over the two observation periods. These findings were associated with an estimated $22000/month cost savings. The consensus approach alone, without benefit of the clinical pharmacist, was not associated with improved therapeutic outcome or cost savings over the same observation periods. CONCLUSIONS: These data suggest that a consensus approach to antibiotic therapy can be cost-effective. An individual, such as a clinical pharmacist, may add significantly to quality improvement and cost-effective efforts in a hospital setting.

scholarly journals AI-Based Physical and Virtual Platform with 5-Layered Architecture for Sustainable Smart Energy City Development

2019 ◽  
Vol 11 (16) ◽  
pp. 4479 ◽  
Author(s):  
Sanguk Park ◽  
Sanghoon Lee ◽  
Sangmin Park ◽  
Sehyun Park
Keyword(s):  
Return On Investment ◽  
Cost Savings ◽  
Economic Benefits ◽  
Urban Environments ◽  
Sustainable Cities ◽  
City Development ◽  
Layered Architecture ◽  
Before And After ◽  
Virtual Platform ◽  
Energy Element

To build sustainable smart energy cities (SECs) around the world, many countries are now combining customized services and businesses within their energy infrastructure and urban environments. Such changes could then promote the development of platforms that ultimately provide benefits for citizens such as convenience, safety, and cost savings. Currently, the development of technologies for SECs focuses on independent products and unit technology. However, this is problematic, as it may not be possible to develop sustainable cities if there is a lack of connectivity between various elements within the SEC. To solve such problems, this paper presents an AI-based physical and virtual platform using a 5-layer architecture to develop a sustainable smart energy city (SSEC). The architecture employs both a top-down and bottom-up approach and the links between each energy element in the SSEC can readily be analyzed. The economic analysis based on return on investment (ROI) is carried out by comparing the economic benefits before and after the application of this system. Deploying the proposed platform will enable the speedy development and application of new services for SSECs and will provide SSECs with measures to ensure sustainable development, such as rapid urban development, and cost reductions.

Review of Pharmacist Driven Penicillin Allergy Assessments and Skin Testing: A Multi-Center Case-Series

2021 ◽  
pp. 001857872110468
Author(s):  
Hanna M. Harper ◽  
Michael Sanchez
Keyword(s):  
Skin Testing ◽  
Case Series ◽  
Cost Savings ◽  
Penicillin Allergy ◽  
Teaching Hospitals ◽  
Beta Lactam ◽  
Retrospective Case ◽  
Beta Lactam Antibiotics ◽  
Case Series Study ◽  
The Impact

Objective: To describe the impact of pharmacy driven penicillin allergy assessments on de-labeling penicillin allergies and antibiotic streamlining opportunities for hospitalized patients. Design: Multi-center, retrospective case-series study. Setting: A health system of 4 non-teaching hospitals. Participants: Patients aged 18 years and older with a physician order for a pharmacist penicillin allergy assessment. Exclusion criteria consisted of patients with anaphylaxis or a type II penicillin allergy, anaphylaxis of any cause within 4 weeks, refusal of penicillin allergy skin test (PAST), antihistamine use within 24 hours, penicillin intolerance, immunosuppression or immunosuppressive medications, or skin conditions that could interfere with PAST. Interventions: The primary endpoint evaluated the number of de-labeled penicillin allergies after pharmacists provided penicillin allergy assessments. Secondary endpoints evaluated the percent of patients with antibiotics deescalated to beta-lactam antibiotics and classification of notable interventions made by pharmacists. Measurements and Main Results: There were 35 patients who met inclusion criteria. Twenty-four patients underwent both penicillin allergy skin testing and oral (PO) amoxicillin challenge. Five patients had allergies de-labeled only after a pharmacist interview. Four patients received only the PO amoxicillin challenge and 2 patients received only PAST. Penicillin allergies were de-labeled from the electronic health record (EHR) in 31 (89%) patients despite all testing negative for a penicillin allergy from PAST or a PO amoxicillin challenge. Four patients had the allergy re-added to the chart on subsequent admissions. No patients experienced a reaction from PAST, PO amoxicillin challenge, or subsequent beta-lactam antibiotics. Twenty-eight (80%) patients had their antibiotic therapy changed as a result of the allergy assessment. Seventeen patients were de-escalated onto beta-lactam antibiotics and aztreonam was stopped in 6 patients. Conclusion: Results from this study suggests that pharmacists expanding their scope of practice with PAST is a safe and effective allergy de-labeling tool. Pharmacist-driven penicillin allergy assessments could provide antibiotic cost savings and avoid aztreonam use. The study supports the need to emphasize education for patients and caretakers regarding allergy testing results to avoid relabeling in future hospital visits.

scholarly journals Penicillin Allergy Assessment and Skin Testing in the Outpatient Setting

Pharmacy ◽  
2019 ◽  
Vol 7 (3) ◽  
pp. 136 ◽  
Author(s):  
Wesley D. Kufel ◽  
Julie Ann Justo ◽  
P. Brandon Bookstaver ◽  
Lisa M. Avery
Keyword(s):  
Skin Testing ◽  
Management Strategies ◽  
Treatment Decisions ◽  
Outpatient Setting ◽  
Penicillin Allergy ◽  
Inpatient Setting ◽  
Negative Consequences ◽  
Beta Lactam ◽  
Beta Lactam Antibiotics ◽  
Antibiotic Management

Penicillin allergies are among of the most commonly reported allergies, yet only 10% of these patients are truly allergic. This leads to potential inadvertent negative consequences for patients and makes treatment decisions challenging for clinicians. Thus, allergy assessment and penicillin skin testing (PST) are important management strategies to reconcile and clarify labeled penicillin allergies. While PST is more common in the inpatient setting where the results will immediately impact antibiotic management, this process is becoming of increasing importance in the outpatient setting. PST in the outpatient setting allows clinicians to proactively de-label and educate patients accordingly so beta-lactam antibiotics may be appropriately prescribed when necessary for future infections. While allergists have primarily been responsible for PST in the outpatient setting, there is an increasing role for pharmacist involvement in the process. This review highlights the importance of penicillin allergy assessments, considerations for PST in the outpatient setting, education and advocacy for patients and clinicians, and the pharmacist’s role in outpatient PST.

Description of a pharmacist-managed/administered penicillin allergy skin testing service at a community hospital

2021 ◽  
Author(s):  
Nicholas P Torney ◽  
Michael D Tiberg
Keyword(s):  
Allergic Reaction ◽  
Antimicrobial Stewardship ◽  
Community Hospital ◽  
Skin Testing ◽  
Penicillin Allergy ◽  
Type I ◽  
Antimicrobial Stewardship Program ◽  
Stewardship Program ◽  
History Of ◽  
Allergy Skin Testing

Abstract Purpose To describe how a pharmacist-managed and pharmacist-administered penicillin allergy skin testing (PAST) service was incorporated into an antimicrobial stewardship program at a community hospital. Methods A pharmacist-managed/administered PAST service was initiated in October 2015. Patients 18 years of age or older were considered for PAST if they had a reported history of a type I or unknown type of allergic reaction to penicillin that occurred more than 5 years previously. Patients with a vague allergy history were considered for PAST if the provider was uncomfortable prescribing a preferred β-lactam out of concern for penicillin allergy. Patients were excluded if they were pregnant, had a history of a non–type I allergic reaction, or recently received antihistamines. The primary outcome was the percentage of patients who underwent PAST and were subsequently transitioned to a preferred β-lactam. Results PAST was initiated in 90 patients from October 2015 to December 2019. Eighty-five out of 90 patients (94%) completed PAST. Seventy-six out of 90 patients (84.4%) who underwent PAST were transitioned to a preferred β-lactam. The most commonly administered antibiotics prior to PAST were vancomycin, cefepime, and metronidazole. The most commonly used antibiotics after PAST were penicillin, piperacillin/tazobactam, and ampicillin/sulbactam. Among the 90 patients who underwent PAST, alternative antibiotics were avoided for a total of 1,568 days, with a median of 11 days (interquartile range, 6-18 days) avoided per patient. Conclusion Incorporating a pharmacist-managed/administered PAST service into a community hospital’s antimicrobial stewardship program can improve the utilization of preferred antimicrobial therapy and help avoid use of more toxic, costly antimicrobials.

scholarly journals Implementation of an Infectious Disease Fellow-Managed Penicillin Allergy Skin Testing Service

2016 ◽  
Vol 3 (3) ◽  
Author(s):  
Emily L. Heil ◽  
Jacqueline T. Bork ◽  
Sarah A. Schmalzle ◽  
Michael Kleinberg ◽  
Anupama Kewalramani ◽  
...  
Keyword(s):  
Skin Testing ◽  
Cost Effective ◽  
Antibiotic Use ◽  
The United States ◽  
Effective Therapy ◽  
Penicillin Allergy ◽  
Antibiotic Selection ◽  
Testing Service ◽  
Acute Care Facilities ◽  
Allergy Skin Testing

Abstract Background.  A large percentage of patients presenting to acute care facilities report penicillin allergies that are associated with suboptimal antibiotic therapy. Penicillin skin testing (PST) can clarify allergy histories but is often limited by access to testing. We aimed to implement an infectious diseases (ID) fellow-managed PST program and to assess the need for PST via national survey. Methods.  We conducted a prospective observational study of the implementation of an ID fellow-managed penicillin allergy skin testing service. The primary outcome of the study was to assess the feasibility and acceptability of an ID fellow-managed PST service and its impact on the optimization of antibiotic selection. In addition, a survey of PST practices was sent out to all ID fellowship program directors in the United States. Results.  In the first 11 months of the program, 90 patients were assessed for PST and 76 patients were tested. Of the valid tests, 96% were negative, and 84% with a negative test had antibiotic changes; 63% received a narrower spectrum antibiotic, 80% received more effective therapy, and 61% received more cost-effective therapy. The majority of survey of respondents (n = 50) indicated that overreporting of penicillin allergy is a problem in their practice that affects antibiotic selection but listed inadequate personnel and time as the main barriers to PST. Conclusions.  Inpatient PST can be successfully managed by ID fellows, thereby promoting optimal antibiotic use in patients reporting penicillin allergies. This model can increase access to PST at institutions without adequate access to allergists while also providing an important educational experience to ID trainees.

scholarly journals 118. Feasibility of a Proactive Amoxicillin Oral Challenge Program for Inpatients with Penicillin Allergy at the Miami VAMC

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S173-S173
Author(s):  
Michael J Piazza ◽  
Paola Lichtenberger ◽  
Lauren Bjork ◽  
Alex Lazo-Vasquez ◽  
Minh Hoang ◽  
...  
Keyword(s):  
Medical Center ◽  
Beta Blockers ◽  
Skin Testing ◽  
Hospital Medicine ◽  
Low Risk ◽  
Oral Challenge ◽  
Penicillin Allergy ◽  
Total N ◽  
Stewardship Program ◽  
Patient Reported

Abstract Background Ninety percent of patients who report penicillin (PCN) allergy are not truly allergic. Penicillin skin testing (PST) followed by oral challenge (OC) with amoxicillin (AMX) can evaluate unconfirmed PCN allergy. PST is taxing and requires trained staff, while OC is an acceptable alternative in patients with low-risk histories, who can safely undergo OC without PST. OC is performed in the outpatient Miami Veterans Affairs Medical Center (MVAMC) setting. Collaboration between Allergy, Antimicrobial Stewardship Program (ASP), and Hospital Medicine identified patients with low-risk histories and offered OC to inpatients. Methods A daily report of MVAMC inpatients with PCN allergy was reviewed for appropriateness of OC (Fig 1). Hospice patients and those medically unstable or unable to consent were excluded. Appropriate consenting patients were challenged with AMX 500mg PO and observed for 60 minutes. If no reaction resulted, the PCN allergy label was removed. Epinephrine and diphenhydramine were available in case of adverse reaction. Those who were not OC candidates were offered outpatient PST (Fig 1). Figure 1. Penicillin allergy history evaluation algorithm Results We evaluated 39 inpatients with PCN allergy from 3/10 - 5/27/21. Median age was 68 years; 94.9% were male (Table 1). The most common recorded reaction was unknown (Table 2). Thirteen (33.3%) did not qualify for OC, 7 (17.9%) refused, 2 (5.1%) were receiving a penicillin-derivative, 1 (2.6%) patient’s primary team refused consult, 2 (5.1%) patients were discharged prior to OC. Fourteen (38%) patients underwent OC with 0 adverse reactions; 0 patients required epinephrine or diphenhydramine. After OC, 5 patients had changes to their antibiotic regimen as a result of a negative OC. Limitations included 5 patients on beta-blockers, and 5 patients unable to consent. Table 1. Demographics of Evaluated Inpatients, N = 39 (%) Note that 1 patient out of the 39, underwent DPC with cefpodoxime 200mg PO instead of amoxicillin for a reported allergy to ceftriaxone. Table 2. Reported Reactions, N = 41 (%) Total N exceeds evaluated patient number as one patient reported multiple reactions to receiving penicillin. Conclusion Removing unnecessary PCN allergy labels using inpatient OC with AMX is safe and effective for those with low-risk allergy histories. Zero patients undergoing OC developed a reaction, suggesting that OC may be safely performed per our algorithm. Our protocol does not require specialized training and is reproducible in settings without an Allergy specialist. In the 3 months prior to this program there were 0 inpatient consults to evaluate PCN. Future plans include forming a multidisciplinary consult service. Disclosures All Authors: No reported disclosures

Using a cost-effective approach to increase background ensemble member size within the GSI-based EnVar system for improved radar analyses and forecasts of convective systems

2022 ◽  
Keyword(s):  
Computational Cost ◽  
Cost Savings ◽  
Cost Effective ◽  
Ensemble Member ◽  
Radar Reflectivity ◽  
Ensemble Size ◽  
Convective Systems ◽  
Common Time ◽  
Before And After ◽  
Similar Accuracy

Abstract A Valid Time Shifting (VTS) method is explored for the GSI-based ensemble variational (EnVar) system modified to directly assimilate radar reflectivity at convective scales. VTS is a cost-efficient method to increase ensemble size by including subensembles before and after the central analysis time. Additionally, VTS addresses common time and phase model error uncertainties within the ensemble. VTS is examined here for assimilating radar reflectivity in a continuous hourly analysis system for a case study of 1-2 May 2019. The VTS implementation is compared against a 36-member control experiment (ENS-36), to increase ensemble size (3×36 VTS), and as a cost-savings method (3×12 VTS), with time-shifting intervals τ between 15 and 120 min. The 3×36 VTS experiments increased the ensemble spread, with largest subjective benefits in early cycle analyses during convective development. The 3×12 VTS experiments captured analysis with similar accuracy as ENS-36 by the third hourly analysis. Control forecasts launched from hourly EnVar analyses show significant skill increases in 1-h precipitation over ENS-36 out to hour 12 for 3×36 VTS experiments, subjectively attributable to more accurate placement of the convective line. For 3×12 VTS, experiments with τ ≥ 60 min met and exceeded the skill of ENS-36 out to forecast hour 15, with VTS-3×12τ90 maximizing skill. Sensitivity results demonstrate preference to τ = 30–60 min for 3x36 VTS and 60 – 120 min for 3×12 VTS. The best 3×36 VTS experiments add a computational cost of 45-67%, compared to the near tripling of costs when directly increasing ensemble size, while best 3×12 VTS experiments save about 24-41% costs over ENS-36.

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