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R&E Foundation Update: Best Practices Award Winner – A Pharmacist-Driven Penicillin Allergy Overhaul

24 Nov 2020 5:06 PM | Anonymous

Best Practices Award Winner – A Pharmacist-Driven Penicillin Allergy Overhaul

Becca Nolen, Infectious Diseases and Antimicrobial Stewardship Pharmacist at SSM Health-St. Mary’s Hospital received the Best Practices Award during the Virtual KCHP/MSHP Spring Meeting for her project entitled “A Pharmacist-Driven Penicillin Allergy Overhaul.”

One of the most commonly reported allergies in the United States is to penicillin. Historically, cross-reactivity between penicillin and other beta-lactam antibiotics has been estimated at 10%, but recent literature has shown that the beta-lactam ring does not confer cross-reactivity, and the true likelihood of cross-reactivity is significantly lower than previously reported (approximately 1%).

This program consists of pharmacist-led interventions at SSM Health St. Mary’s Hospital – St. Louis, including education of providers when beta-lactams may be appropriate in penicillin-allergic patients, beta-lactam allergy questionnaires, and penicillin skin testing in patients who have penicillin allergies and are not on a penicillin or cephalosporin for treatment of infection. A real-time best-practice alert (BPA) that identifies patients for the  Antimicrobial Stewardship pharmacist to review and assess which of the aforementioned interventions would be most appropriate. Patients are excluded if they are on antibiotics for surgical prophylaxis, duration of antibiotics is <48 hours, or if they are on appropriate antibiotics that were not a penicillin or cephalosporin. Data were collected during a pilot of the project from November 2018 to February 2019, though the project is still on-going.

During the study period, 297 BPAs were generated and 214 patients were excluded, mostly for being on antibiotics less than 48 hours. 83 patients were on appropriate antibiotics that were not a penicillin or cephalosporin. Recommendations to switch antibiotics were made on 30 patients, and one penicillin skin test was completed during the study period. Interventions were accepted in 90% of patients, and no patients had adverse drug reactions or required supportive care after switching to a penicillin or cephalosporin. Since the study time period, 12 penicillin skin tests have been performed.

This project has helped educate our providers on the appropriate management of infected patients with reported penicillin allergy, as well as to expand the role of pharmacist. The utilization of unnecessary broad-spectrum antibiotics has been reduced, which could potentially lead to shorter hospital stays and less repeated use of broad-spectrum antibiotics in penicillin -allergic patients.

If you have any questions about this project, please contact Becca Nolen at Rebecca.Nolen@ssmhealth.com.

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