Maureen Egan Bauer1, Christine MacBrayne2, Amy Stein3, Justin Searns4, Allison Hicks3, Tara Sarin3, Taylor Lin3, Hannah Duffey5, Michael Rannie6, Kaylee Wickstrom6, Cheryl Yang5, Lalit Bajaj7, Kirstin Carel3. 1. Department of Pediatrics, Sections of Allergy and Immunology, maureen.bauer@childrenscolorado.org. 2. Section of Infectious Disease and Antimicrobial Stewardship, Children's Hospital Colorado, Aurora, Colorado; and. 3. Department of Pediatrics, Sections of Allergy and Immunology. 4. Infectious Disease and Hospital Medicine, and. 5. Department of Pediatrics, University of Utah, Salt Lake City, Utah. 6. Department of Pediatrics. 7. Pediatric Emergency Medicine, Children's Hospital Colorado and School of Medicine, University of Colorado, Aurora, Colorado.
Abstract
BACKGROUND: Penicillin allergy is reported in up to 10% of the general population; however, >90% of patients reporting an allergy are tolerant. Patients labeled as penicillin allergic have longer hospital stays, increased exposure to suboptimal antibiotics, and an increased risk of methicillin-resistant Staphylococcus aureus and Clostridioides difficile. The primary aim with our quality improvement initiative was to increase penicillin allergy delabeling to at least 10% among all hospitalized pediatric patients reporting a penicillin allergy with efforts directed toward patients determined to be low risk for true allergic reaction. METHODS: Our quality improvement project included several interventions: the development of a multidisciplinary clinical care pathway to identify eligible patients, workflow optimization to support delabeling, an educational intervention, and participation in our institution's quality improvement incentive program. Our interventions were targeted to facilitate appropriate delabeling by the primary hospital medicine team. Statistical process control charts were used to assess the impact of this intervention pre- and postpathway implementation. RESULTS: After implementation of the clinical pathway, the percentage of patients admitted to hospital medicine delabeled of their penicillin allergy by discharge increased to 11.7%. More than one-half of those delabeled (51.2%) received a penicillin-based antimicrobial at time of discharge. There have been no adverse events or allergic reactions requiring emergency medication administration since pathway implementation. CONCLUSIONS: Our quality improvement initiative successfully increased the rate of penicillin allergy delabeling among low-risk hospitalized pediatric patients, allowing for increased use of optimal antibiotics.
BACKGROUND:Penicillinallergy is reported in up to 10% of the general population; however, >90% of patients reporting an allergy are tolerant. Patients labeled as penicillinallergic have longer hospital stays, increased exposure to suboptimal antibiotics, and an increased risk of methicillin-resistant Staphylococcus aureus and Clostridioides difficile. The primary aim with our quality improvement initiative was to increase penicillinallergy delabeling to at least 10% among all hospitalized pediatric patients reporting a penicillinallergy with efforts directed toward patients determined to be low risk for true allergic reaction. METHODS: Our quality improvement project included several interventions: the development of a multidisciplinary clinical care pathway to identify eligible patients, workflow optimization to support delabeling, an educational intervention, and participation in our institution's quality improvement incentive program. Our interventions were targeted to facilitate appropriate delabeling by the primary hospital medicine team. Statistical process control charts were used to assess the impact of this intervention pre- and postpathway implementation. RESULTS: After implementation of the clinical pathway, the percentage of patients admitted to hospital medicine delabeled of their penicillinallergy by discharge increased to 11.7%. More than one-half of those delabeled (51.2%) received a penicillin-based antimicrobial at time of discharge. There have been no adverse events or allergic reactions requiring emergency medication administration since pathway implementation. CONCLUSIONS: Our quality improvement initiative successfully increased the rate of penicillinallergy delabeling among low-risk hospitalized pediatric patients, allowing for increased use of optimal antibiotics.