997. Practical partnering of Antibiotic Stewardship and Allergy to address referrals to Penicillin allergy debunking clinic at a VA Medical Center

Abstract

BackgroundThe majority of Penicillin (PCN) allergies can be “debunked.” During acute medical care, opportunities to refer for formal evaluation are often overlooked, hampered by medication-interactions and lack of time and resources for bedside testing. Frequently, inpatients are not referred for PCN debunking evaluations (PCN-DE). Antimicrobial Stewardship Teams (ASTs) who partner with Allergy Clinical Teams (ACTs) can work collaboratively to target those who would benefit from de-labeling and are unlikely to otherwise be referred for formal evaluation.MethodsThe DCVAMC is an urban 240 bed 1a complexity acute and LTC teaching hospital with both on-site AST and well-established ACT. β-lactam allergy was tracked by the AST in inpatient, outpatient and long-term care setting utilizing a clinical surveillance system (TheraDoc, DSS Inc.) and allergy education was incorporated into prospective auditing rounds. PCN-DE involved face-face visit with an Allergist and careful history, chart/medication review. Option for skin testing (Pre-Pen, ALK Abello) with/without oral challenge performed at the discretion of ACT. EMR was altered to reflect results.ResultsWe collaborated to develop a PCN-DE outpatient Allergy Clinic on the hospital campus. 2,564 designed β-lactam allergy alerts were identified as part of routine AST workflow prior to the initiation of the clinic in October 2017. Referrals resulted from AST prospective audits, consults to ACT and by surveillance of historical allergy history among acute and LTC admissions. Providers, including trainees, were engaged through education and encouraged to place outpatient referrals at the time of discharge or upon follow-up. ACT evaluated patients in groups of 2–3/session, roughly one clinic/month. Mean age of patients tested 56.3y (24–80y) with 35% >65yo; to date, (19/26) 73% have been successfully de-labeledConclusionThe success in de-labeling after formal evaluation is well established. Developing working relationships with allergists and encouraging providers to recognize often overlooked opportunities to refer to existing or newly established clinics is easily adopted by ASTs. In conjunction with screening, targeted education and referral to PCN-DE as a part of routine stewardship workflow has practical and immediate benefits.Disclosures All authors: No reported disclosures.