Abstract
Objective
: To remove inaccurate penicillin allergy labels in the general pediatric clinic setting.
Methods
: From October 2017 through December 2021, this collaborative, quality improvement
project used education, feedback, electronic health record alerts, and the introduction
of oral amoxicillin challenges in a general pediatric clinic setting with the primary
aim of decreasing the proportion of penicillin allergy labeled patients. Control charts
were used to track the relationship between interventions and improvements in referral
rates to allergy clinic, removal of the allergy label at clinic visits and the overall
proportion of clinic patients labeled as PCN allergic.
Results
: Referral rates to allergy clinic for penicillin allergy labeled patients increased
from a baseline mean of 1.9% to 20.4%. The proportion of PCN allergy labeled patients
who had the label removed during a pediatric clinic visit increased from a baseline
of 1.1% to 6.6%. The overall proportion of penicillin allergy labeled clinic patients
decreased from a baseline of 3.4% to 2.2%.
Conclusion
: With adequate education and collaboration with allergists, general pediatric practitioners
can play a significant role in removing inaccurate penicillin allergy labels. Pediatricians
can remove some of the burden placed on allergists by evaluating low risk patients
in the primary care setting while referring higher risk patients to the specialist.
Key Words
Abbreviations:
PCN ((penicillin)), QI ((quality improvement)), IT ((information technology)), KDD ((key driver diagram)), EHR ((electronic health record)), DPT ((drug provocation challenge)), BPA ((best practice alert)), SMART ((specific, measurable, achievable, realistic, and time-bound))To read this article in full you will need to make a payment
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References
- Changes in US Outpatient Antibiotic Prescriptions From 2011-2016.Clin Infect Dis. 2020; 70: 370-377
- Penicillin Allergy.N Engl J Med. 2019; 381: 2338-2351
- Penicillin Allergy Delabeling: A Multidisciplinary Opportunity.J Allergy Clin Immunol Pract. 2020; 8 (e2816): 2858-2868
- Parent-Reported Penicillin Allergy Symptoms in the Pediatric Emergency Department.Acad Pediatr. 2017; 17: 251-255
- Prevalence of beta-lactam allergy: a retrospective chart review of drug allergy assessment in a predominantly pediatric population.Allergy Asthma Clin Immunol. 2016; 12: 59
- Practical guide for evaluation and management of beta-lactam allergy: position statement from the Canadian Society of Allergy and Clinical Immunology.Allergy Asthma Clin Immunol. 2020; 16: 95
- The challenge of de-labeling penicillin allergy.Allergy. 2020; 75: 273-288
- Penicillin Allergy in Antibiotic Resistance W. Penicillin Allergy Testing Should Be Performed Routinely in Patients with Self-Reported Penicillin Allergy.J Allergy Clin Immunol Pract. 2017; 5: 333-334
- Management of allergy to penicillins and other beta-lactams.Clin Exp Allergy. 2015; 45: 300-327
- Practical Guidance for the Evaluation and Management of Drug Hypersensitivity: Specific Drugs.J Allergy Clin Immunol Pract. 2020; 8: S16-S116
- Safety and efficacy of direct two-step penicillin challenges with an inpatient pharmacist-driven allergy evaluation.Allergy Asthma Proc. 2021; 42: 153-159
- A Multidisciplinary Quality Improvement Initiative to Facilitate Penicillin Allergy Delabeling Among Hospitalized Pediatric Patients.Hosp Pediatr. 2021; 11: 427-434
- Amoxicillin challenge without penicillin skin testing in evaluation of penicillin allergy in a cohort of Marine recruits.J Allergy Clin Immunol Pract. 2017; 5: 813-815
- Oral amoxicillin challenges in low-risk children during a pediatric emergency department visit.J Allergy Clin Immunol Pract. 2020; 8 (e1121): 1126-1128
- Effect of a drug allergy educational program and antibiotic prescribing guideline on inpatient clinical providers' antibiotic prescribing knowledge.J Allergy Clin Immunol Pract. 2014; 2: 407-413
- A quality improvement initiative to improve primary care referral rates for penicillin allergy delabeling.Ann Allergy Asthma Immunol. 2021;
- How to Improve. Boston, Massachusetts: Institute for Healthcare Improvement.2022 (Available on www.IHI.org) Last accessed January 2022
- Single-dose prolonged drug provocation test, without previous skin testing, is safe for diagnosing children with mild non-immediate reactions to beta-lactams.Allergy. 2021; 76: 2544-2554
- Single-step direct drug provocation testing is safe for delabelling selected non-low-risk penicillin allergy labels.Ann Allergy Asthma Immunol. 2021; 127: 232-235
- The Improvement Guide: A Practical Approach to Enhancing Organizational Performance.2nd Edition. Jossey-Bass, San Francisco, CA2009
- Improving Antibiotic Stewardship for Inpatients with Reported Beta-Lactam Allergies and Limited Access to Penicillin Skin Testing.Jt Comm J Qual Patient Saf. 2022; 48: 147-153
- Establishing Amoxicillin Allergy in Children Through Direct Graded Oral Challenge (GOC): Evaluating Risk Factors for Positive Challenges, Safety, and Risk of Cross-Reactivity to Cephalosporines.J Allergy Clin Immunol Pract. 2021; 9: 4060-4066
- Controversies in Drug Allergy: Beta-Lactam Hypersensitivity Testing.J Allergy Clin Immunol Pract. 2019; 7: 40-45
- Twenty-year comparison of de-labeling penicillin allergic pediatric patients with and without prior skin testing.Ann Allergy Asthma Immunol. 2022;
- An EAACI task force report: recognising the potential of the primary care physician in the diagnosis and management of drug hypersensitivity.Clin Transl Allergy. 2018; 8: 16
- Reported Knowledge and Management of Potential Penicillin Allergy in Children.Acad Pediatr. 2019; 19: 684-690
- Management of penicillin allergy in primary care: a qualitative study with patients and primary care physicians.BMC Fam Pract. 2021; 22: 112
- Number of People per Active Physician by Specialty, 2019.Association of American Medical Colleges, 2019
Article Info
Publication History
Accepted:
May 23,
2022
Received:
March 30,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
Copyright © 2022 by Academic Pediatric Association
