Qualitative analysis of healthcare provider perspectives to evaluating beta-lactam allergies

Abstract

There's a lack of understanding of the barriers reported by healthcare providers when evaluating beta-lactam allergies, but knowledge of these barriers is required for practical and effective implementation interventions. We interviewed twenty-five healthcare providers, consisting of physicians, nurses, and pharmacists practicing in the areas of intensive care, emergency medicine, infectious disease, and general hospital practice. Interviews occurred between Sept 2021-July 2023. Twenty-three of the providers were practicing in the United States. A semi-structured interview guide grounded in the theoretical domain framework was used for the interviews. Deductive and inductive analysis was performed on the interview transcripts and translated into intervention recommendations using the Behavior Change Wheel. Widely held beliefs included a lack of clear policy for allergy evaluation, confusing or missing documentation of allergy information, confidence in personal and colleague abilities to evaluate allergies when information is available, and pharmacists as the provider most equipped to evaluate beta-lactam allergies. Health systems should adopt and disseminate policies for beta-lactam allergy evaluation and promote the use of pharmacists in drug allergy evaluation when possible. Allergy sections of electronic health records should be reworked to encourage unambiguous documentation of allergy reactions and support using previously tolerated beta-lactam antibiotics.