Background: ~ 1 in 10 patients has a penicillin allergy listed, but up to 90% of those patients may tolerate penicillins and/or cephalosporins. This inaccurate history and documentation leads to altered clinical decision making and the use of 2nd or 3rd line antibiotics, and can lead to adverse short and long term outcomes at both the patient and population level.
Purpose: To improve penicillin allergy history taking and documentation, that can then be translated into the EMR to facilitate optimized antibiotic utilization, as well as minimize provider alerting.
Description: Using multiple approaches, we developed a screening tool in our EMR to obtain more detailed information on patients with a PCN allergy listed, based on evidence to suggest high or low risk ‘true’ allergy likelihood. These patients then trigger a review by pharmacy to evaluate discrete elements and review medication/allergy history, which are then translated into a new unique PCN allergy (Allergy: Penicillins, Tolerates Cephalosporins) when a ‘true’ PCN allergy seems low likelihood. This new allergen is visible in the EMR to providers, and does NOT trigger alerts when ordering Cephalosporin antibiotics for patients, thus facilitating more appropriate antibiotic utilization. This enhanced history taking also facilitates translating PCN allergies to ‘intolerances’ as appropriate, and has allowed for significant improvement in allergy documentation overall.
Conclusions: Since going live with changes in January 2020, over 4500 unique patients across 33k inpatient encounters have had a PCN allergy updated to the new “Pencillins: Tolerates Cephalosporins” allergy. This has translated to an average of 61.3 alerts per week that have been suppressed for providers, and a proportional improvement in antibiotic stewardship of cephalosporin antibiotics. Secondary outcomes of improved improved allergy documentation (decrease in deficient allergy documentation from 47.55% to 15.75% of all patients) and increase in documentation of PCN intolerance vs allergy (increase in PCN intolerance from 32.64% to 35.93% of pts with a PCN allergy) have also been materialized. Subtle changes to allergy history taking and documentation have led to significant changes which can be translated to improved patient care and provider experience.