Appropriateness of Beta-Lactam Allergy Record Updates After an Allergy Service Consult

2018 ◽  
Vol 33 (3) ◽  
pp. 243-246 ◽  
Author(s):  
Bryan G. Shaw ◽  
Inela Masic ◽  
Nancy Gorgi ◽  
Niree Kalfayan ◽  
Elise M. Gilbert ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Hospital Admission ◽  
Penicillin Allergy ◽  
Memorial Hospital ◽  
Inclusion Criteria ◽  
Beta Lactam ◽  
Outpatient Hospital ◽  
Future Treatment ◽  
Beta Lactam Antibiotics ◽  
Antibiotic Allergy

Background: Many patients with a self-reported penicillin allergy go on to tolerate beta-lactam antibiotics. Allergy specialists may be consulted to determine the nature and extent of the allergy. However, electronic allergy records must be appropriately updated such that recommendations are carried forward. Objective: To determine the percentage of patients who have their electronic allergy record updated after an allergy service consult (ASC). Methods: This was a retrospective study of patients with at least 1 documented beta-lactam allergy and had an ASC during (inpatient) or prior to (outpatient) hospital admission at Northwestern Memorial Hospital and Prentice Women’s Hospital in Chicago, Illinois. Results: Within the study period, a total of 26 526 patients were identified as having a documented antibiotic allergy, with 21 657 patients (81.6% of patients with allergies) having a listed beta-lactam allergy. Of these patients, 1689 (7.8%) patients were identified as having an ASC during or prior to admission, with 598 patients meeting inclusion criteria. Changes in the allergy record were recommended by the ASC for 62% (n = 371) of patients; however, the allergy record was updated after the ASC in 74.9% (n = 278) of patients. Conclusion: ASC recommendations to delabel a patient as beta-lactam allergic must result in updating the allergy record in order to optimize future treatment. Given the low proportion of allergy-labeled patients tested, programs outside formal ASCs should be considered.

scholarly journals DRUG UTILIZATION STUDY IN THE ORTHOPEDICS OUTPATIENT DEPARTMENT OF A TERTIARY CARE HOSPITAL IN MAHARASHTRA

2018 ◽  
Vol 11 (9) ◽  
pp. 224
Author(s):  
Madhuri Kulkarni ◽  
Anant Patil
Keyword(s):  
Retrospective Study ◽  
Drug Utilization ◽  
Antimicrobial Agents ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Beta Lactam ◽  
Drug Utilization Study ◽  
Beta Lactam Antibiotics ◽  
Prescribed Medicines

Objective: The objective of this study was to analyze the pattern of drug utilization in outpatients of orthopedics department from a tertiary care hospital.Material and Methods: In this retrospective study, prescriptions of randomly selected patients attending orthopedics clinic were screened to analyze a number of medicines per prescription. Number and percentages of prescribed medicines were calculated.Results: In this study, 512 patients (male 260 [50.8%] and females 252 [49.2%]) were included in the study. The total number of prescribed medicines was 1562, accounting for 3.1 medicines per patient. A total number of oral, parenteral, and topical medicines were 1375 (88%), 176 (11.3%), and 11 (0.7%), respectively. Nonsteroidal anti-inflammatory agents (NSAIDs), antacid/anti-ulcerants, and antimicrobial agents were 641 (41%), 371 (23.8%), and 102 (6.5%), respectively. A total of 54 (52.9%), 29 (28.4%), 9 (8.8%), 6 (5.9%), 3 (2.9%), and 1 (1%) patients were prescribed fluoroquinolones, beta-lactam antibiotics, metronidazole, trimethoprim plus sulfamethoxazole, macrolides, and doxycycline, respectively. For 371 (23.8%) patients, anti-ulcerant and antiulcer were prescribed, among which ranitidine was the most common prescription [353 (95.1%)]Conclusion: Number of medicines prescribed per patient in orthopedic clinic was 3.1. NSAIDs and antacid/anti-ulcerants were the most commonly prescribed medicines.

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.

scholarly journals 153. Development of a Pathway for Removal of Inappropriate Penicillin Allergy Labels in Hospitalized Patients

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S86-S87
Author(s):  
Fnu Shweta ◽  
Pooja Gurram ◽  
Natalia E Castillo Almeida ◽  
Douglas Challener ◽  
Edison J Cano ◽  
...  
Keyword(s):  
Pilot Project ◽  
Study Data ◽  
Hospitalized Patients ◽  
Penicillin Allergy ◽  
Skin Tests ◽  
Control Group ◽  
Allergic Reactions ◽  
Beta Lactam ◽  
Beta Lactam Antibiotics ◽  
Pdsa Cycle

Abstract Background More than 90% of reported penicillin allergies are found inaccurate when formally assessed. These allergy labels lead to decreased utilization of first-line beta-lactam antibiotics, and adverse clinical outcomes. The objective of this study was to develop a multi-disciplinary approach to decrease inaccurate labeling among hospitalized patients with documented penicillin allergy. Methods A team of clinicians, pharmacists, and nurses utilized the DMAIC quality strategy to improve accuracy of penicillin allergy labeling. Allergic reactions were stratified to develop a penicillin allergy de-labeling algorithm (Figure 1). Admission to the intensive care unit (ICU) for anaphylaxis was defined as a balancing measure. We reviewed baseline data from patients with a documented penicillin allergy admitted to a single inpatient floor at Mayo Clinic, Rochester between June and October 2019. A cause and effect diagram was used to conduct a root cause analysis. The intervention was then applied to patients who reported penicillin allergy admitted to the same floor from November 2019 to January 2020. Study data were collected and basic descriptive statistics generated. Figure 1: Penicillin allergy delabeling algorithm Results 96 patients were included in the control group with mean age of 71 years (range 65–84 years) and 55% females. Breakdown of documented allergic reactions are represented in Figure 2. 58 (60%) received an antibiotic for a median duration of 1.5 days (IQR: 0 – 6). Of these, 7(12%) received penicillin-class antibiotics, and 41 (70.6%) received non-beta-lactam antibiotics. 2 (2%) of these patients were de-labeled without any penicillin skin tests. Detailed metrics of each PDSA cycle are shown in Table 1. During PDSA cycle 2, inaccurate penicillin documentation was removed in 9/19 (47.4%) of hospitalized patients. There were no ICU admissions for anaphylaxis. Figure 2: Graphic representation of proportion of type of documented allergic reactions to penicillin Table 1: Metrics and outcomes at baseline and during successive PDSA cycles Conclusion Various factors contribute to penicillin allergy mislabeling. Our comprehensive algorithm addresses nuances of penicillin allergic reactions and increased accurate penicillin allergy labeling in 47.4% of the cases. Beta-lactam use also increased to 37% through our pilot project while maintaining patient safety. A multi-disciplinary and patient-centered approach aligned with institutional workflows is necessary to improve patient outcomes. Disclosures All Authors: No reported disclosures

OR092 Utility of inpatient penicillin allergy testing at reducing exposure to non-beta lactam antibiotics

2017 ◽  
Vol 119 (5) ◽  
pp. S13
Author(s):  
K. Sacco ◽  
R. Chirila ◽  
C. Libertin ◽  
A. Bhasin ◽  
T. Pongdee ◽  
...  
Keyword(s):  
Penicillin Allergy ◽  
Beta Lactam ◽  
Allergy Testing ◽  
Beta Lactam Antibiotics

scholarly journals The Awareness of Beta-Lactam Antibiotics Prescription among Dental Students

2020 ◽  
pp. 22-33
Author(s):  
Nor Syakirah Binti Shahroom ◽  
Dhanraj Ganapathy ◽  
Revathi Duraisamy
Keyword(s):  
Dental Students ◽  
Penicillin Allergy ◽  
Beta Lactam ◽  
Lactating Women ◽  
Actual Knowledge ◽  
Beta Lactam Antibiotic ◽  
Beta Lactam Antibiotics ◽  
Drug Of Choice ◽  
Lactam Antibiotic ◽  
Public Health Challenge

Beta-lactam antibiotic is the most common antibiotic prescribed by dental students. However, the actual knowledge on beta lactam is important as antimicrobial resistance is currently an alarming and growing phenomenon and in turn becoming a public health challenge. A survey was conducted to assess the knowledge and awareness of beta-lactam antibiotics prescriptions among dental students in their third years, final years and interns. A total of 145 responses were obtained and the results were analyzed using the SPSS statistical software. Based on their knowledge on beta-lactam antibiotics, 59.3% of the participants knew exactly the mechanisms of action of beta-lactam antibiotic which was by interfering with the synthesis of the bacterial cell wall. In the case of penicillin allergy, 40% of the participants chose erythromycin as the alternative for penicillin allergy. 84% of the participants were aware that the combination of amoxicillin with clavulanic acid may increase its effectiveness. Meanwhile, 98% of the participants were aware that amoxicillin is the drug of choice for bacterial endocarditis prophylaxis. 72% of the participants were aware that most beta-lactam antibiotics are considered safe for pregnant and lactating women which was statistically significant (p<0.05). In conclusion, the students had quite a good knowledge and awareness regarding the prescription of beta-lactam antibiotics since they have been practicing under guidance from the practitioner in the college.

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