Penicillin allergy - legit or legacy?

Abstract

Background/aim: Patient-reported Antibiotic Allergy Labels (AALs) are a public health issue, with an estimated 10% of hospital inpatients reporting an allergy to a penicillin. However, less than 1% will be truly allergic. Incorrectly applied AALs create barriers to optimal antibiotic therapy, leading to increased use of restricted or inappropriate antibiotics, increased rates of readmission, increased risk of surgical site infections and increased length of stay. With appropriate antibiotic assessment and allergy testing, it may be possible to remove the inaccurate AALs. This project implemented a model of care for assessing penicillin allergies, including the offer of penicillin allergy de-labelling to patients with low-risk penicillin allergies. Population/setting: Hospitalised adult inpatients with a penicillin allergy, admitted to a surgical ward. Methods: From 09/2022-08/2023, Grampians Health-Ballarat participated in a breakthrough series collaborative model offered by Safer Care Victoria. PDSA (Plan, Do, Study, Act) cycle was used to determine which interventions afforded improvement in penicillin allergy assessment and de-labelling. Convenience sampling utilising small sequential samples was used for data collection. Results/findings: Data were collected from 152 patients with a penicillin allergy in the intervention phase. Allergy documentation including the penicillin antibiotic, reaction, timing and severity was 5% at baseline (n=2/20), increasing to 82% (n=32/39) in the final 8 weeks of the project. 27 patients with a no-risk allergy (e.g. nausea) were identified, with 6 patients consenting to direct de-labelling. Five supervised penicillin oral challenges in inpatients with a low-risk penicillin allergy were completed with no adverse reactions. Eighty percent of patients proceeded to receive a course of penicillin following oral challenge. Conclusion: A penicillin allergy de-labelling pathway can be safely implemented on an inpatient ward, utilising an antibiotic allergy assessment tool to capture key penicillin allergy information, improve documentation and identify patients who may be suitable for penicillin allergy de-labelling. Translational impact/implications for future practice: This project demonstrates a successful penicillin allergy delabelling pathway that can be scaled to other adult inpatient wards and Grampians Health sites. Access to the pathway will facilitate optimal antibiotic prescribing and reduce morbidity associated with the use of unoptimised treatment.