994. Effect on Β-lactam Usage Following Implementation of Clinical Pharmacy Services to Improve Β-lactam Allergy History Documentation

Abstract

BackgroundThe purpose of this study was to implement a pharmacy-initiated β-lactam allergy assessment and to determine its impact on antibiotic prescribing patterns. Avoiding the use of β-lactams due to a documented allergy may lead to inferior treatment outcomes, particularly for indications where β-lactams are preferred.MethodsThis performance improvement study was conducted at a large community-based academic healthcare system in Delaware. A β-lactam allergy algorithm was developed to guide allergy assessments and categorize patients as low risk for possible reaction, possible type 1 reaction or insufficient information. Pharmacy residents and clinical pharmacists were educated on how to conduct the assessments, which were then performed on inpatients with a β-lactam allergy that were prescribed a non-β-lactam antibiotic from December 2018 through March 2019. The primary outcome of this study was the percentage of patients ordered a β-lactam antibiotic pre- and post-implementation of the assessment. Secondary outcomes included: allergy assessment classifications, number of patients with an allergy discrepancy, percentage of patients switched to a β-lactam antibiotic, development of a reaction, and the number of allergy consultations ordered. The primary endpoint was analyzed using a Chi-square test.ResultsThe percentage of patients prescribed a β-lactam pre- and post-implementation was 59% and 63%, respectively (P = 0.055). A total of101 patients had an allergy assessment performed. Assessments resulted in 45% of patients categorized as low risk, 45% as possible type 1 reaction and 10% as insufficient information. In summary, 33% of patients were changed to a β-lactam following completion of an assessment and zero patients experienced a reaction. Additionally, 69% of patients had an allergy discrepancy in their electronic medical record, and four patients received an allergy consultation.ConclusionThe use of clinical pharmacy services to perform β-lactam allergy assessments was successful, as the majority of patients with a low-risk allergy classification were changed to a β-lactam antibiotic. The next steps for this project include engagement of infectious diseases and allergy specialists to further optimize clinical practice.Disclosures All authors: No reported disclosures.