Category: Federal Forum Posters
Purpose: Over 90 percent of patients with a documented allergic reaction to penicillin (PCN) can tolerate PCNs without an Ig-E mediated reaction. Such documentation of allergies can lead to the unnecessary use of broad-spectrum antibiotics, increased healthcare costs, and longer hospital stays. The CDC and the recently published Antimicrobial Stewardship Guidelines recommend to assess allergies and implement penicillin skin testing (PST) to optimize appropriate antimicrobial prescribing. In this facility, over 400 patients have a documented PCN allergy. This project will develop a process to review PCN allergies in the patients’ charts and to implement PST for qualifying patients.
Methods: The first phase of this project involves a retrospective chart review of all patients with a documented penicillin allergy. The pharmacist and the provider will inactivate the alert of patients with drug intolerances and those exposed to penicillins after the documentation of such allergies. However, no action will be taken in the patient’s charts with documented reactions such as anaphylaxis, serious non-IgE-mediated reactions, pulmonary reaction, hepatitis, angioedema, or neurotoxicity. Those patients with a documentation of unknown symptoms, hives, rash and pruritus will be included in PST during the second phase of this project. Patients who are pregnant, nonconsenting, immunocompromised, unable to temporarily discontinue ACE-inhibitors, antihistamines, or beta-blockers, or have skin conditions that may interfere with PST will be excluded. A sample of 30 percent of the included population will be contacted by phone and scheduled for the PST. Once the patient is enrolled in the PST, patients who test negative and tolerate the oral dose challenge will have their allergy deactivated from the patient’s chart. The primary endpoint will be the number of patients who have the allergy removed from the patient’s chart. Secondary endpoints will be the number of patients who test positive for PST.
Results: not applicable
Conclusion: not applicable
Frederick Jaeger– PGY1 Resident, Whiteriver Indian Hospital, Fort Myers, FL