Identifying and overcoming barriers to inpatient Penicillin allergy de-labeling by non-allergists.

Abstract

Given the public health burden of a penicillin (PCN) allergy label, non-allergists have been called to evaluate and de-label low risk patients. We discuss barriers identified in implementing a QI initiative aimed to train non-allergists to risk stratify and de-label low risk PCN allergy patients. A PCN allergy risk stratification tool and workflow were created to identify, risk stratify, and de-label low risk patients after oral amoxicillin challenge. The initiative was presented to stakeholders of an adult inpatient unit in a focus group. Participants completed a pre and post survey. Comfort with managing anaphylaxis and priority of PCN allergy de-labeling were assessed via ordinal scale from 0 (none) to 10 (high). Discussion and survey responses identified perceptions and barriers regarding PCN allergy evaluation. 10 participants completed pre and post survey. Barriers to implementing a PCN de-labeling initiative were: lack of provider time, fear of provoking anaphylaxis, poor recognition/management of anaphylaxis, and view of initiative as low priority. Only 50% could identify criteria for anaphylaxis on pre survey (increased to 100% on post), and 60% could identify treatment (increased to 90%). Median pre and post survey comfort level with managing anaphylaxis was 5 and 7 respectively. Median pre & post survey priority of PCN allergy de-labeling was 4.5 and 8 respectively. Successful PCN allergy de-labeling by non-allergists requires identification of clinical champions, ongoing education regarding anaphylaxis, developing sample scripts/dialogue, and reducing time burden by integrating risk tools with decision support guidance and documentation templates into the EMR.