A practical guide for pharmacists to successfully implement penicillin allergy skin testing

Bland, Christopher M.; Bookstaver, P Brandon; Griffith, Nicole; Heil, Emily L.; Jones, Bruce M; Justo, Julie Ann; Staicu, Mary L.; Torney, Nicholas; Wall, Geoffrey C.

doi:10.1093/ajhp/zxy043

Cited by 33 publications

(47 citation statements)

References 35 publications

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“…Each center must assess their available resources and develop a process for implementing penicillin allergy assessment and skin testing. Additionally, programs involving pharmacists should evaluate state laws to determine appropriate roles within the PST process, especially regarding administration of the PST components [20].…”

Section: Discussionmentioning

confidence: 99%

Clinical and Economic Outcomes of Penicillin Skin Testing as an Antimicrobial Stewardship Initiative in a Community Health System

Jones

Avramovski

Concepción

et al. 2019

Open Forum Infectious Diseases

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Background Penicillin skin testing (PST) is a novel way to reduce the use of broad-spectrum agents in penicillin-allergic patients. This study evaluated the outcomes of patients with antimicrobials prescribed with and without PST in a community health system. Methods We performed a quasi-experimental study that compared an intervention group of 100 patients who completed PST over an open enrollment period beginning January 2016 with a matched control group of 100 patients who were penicillin allergic. Patients in the control group were matched to infection diagnosis codes of members of the PST group and randomly selected and matched on a 1:1 basis. The primary outcome was noncarbapenem beta-lactam days of therapy (DOT). The secondary outcome assessed the average cost of antimicrobial therapy for the intervention group before and after PST. Results Seventy of the 98 patients (71%) who tested negative had changes directly made to their antimicrobial regimens. Beta-lactam DOT for the PST group were 666/1094 (60.88%, with 34.82% being a penicillin specifically). Beta-lactam DOT for the control group consisted of 386/984 (39.64%, with 6.4% being a penicillin specifically). The chi-square test of homogeneity for beta-lactam DOT between the 2 groups was significant ( P < .00001). Changes to the antimicrobial regimen after PST saved the average patient $353.03 compared with no change in the pre-PST regimen ( P = .045). Conclusions PST led to immediate antimicrobial de-escalation in the majority of patients who tested negative. This led to a significant increase in beta-lactam usage, specifically penicillins. These benefits were also associated with significant cost savings to patients.

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Section: Discussionmentioning

confidence: 99%

Clinical and Economic Outcomes of Penicillin Skin Testing as an Antimicrobial Stewardship Initiative in a Community Health System

Jones

Avramovski

Concepción

et al. 2019

Open Forum Infectious Diseases

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“…This optimization of antimicrobial therapy is not only clinically beneficial, but has also been shown to reduce costs associated with antimicrobial regimens 10,15‐17 . Resource limitations in some health care systems have led to the underutilization of allergy assessment and skin testing 18 . To date, most published methods for employing penicillin allergy assessment and skin testing (PAAST) services in the inpatient setting have focused on the use of specialty physicians (eg, allergists, infectious diseases specialists) or nurses for performing skin testing 19‐21 .…”

Section: Introductionmentioning

confidence: 99%

“…This is largely due to local and state regulatory barriers for pharmacists to perform the skin test 22‐23 . Each state Board of Pharmacy makes an independent determination of whether testing is within the scope of pharmacist practice, and many have never addressed the topic 18 . Published reports of pharmacist‐administered models, as well as the availability of a PAAST certificate training program indicated for pharmacists, may encourage simplified regulatory approval and reduce the legal challenges associated with the implementation of pharmacist‐administered models across the nation 18,26 …”

Section: Introductionmentioning

confidence: 99%

Regulatory approval, implementation, and brief assessment of a pharmacist‐ and pharmacy trainee‐administered penicillin allergy assessment and skin testing program

Griffith

Justo

Winders

et al. 2020

J Am Coll Clin Pharm

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IntroductionPatients with a penicillin allergy, most of which are falsely documented, often receive alternative antibiotic therapy leading to negative outcomes. Pharmacy personnel are well‐positioned to provide allergy reconciliation and penicillin skin testing services.ObjectivesThe purpose of this study was to describe the regulatory approval and implementation of a novel, inpatient pharmacist‐ and pharmacy trainee‐administered penicillin allergy assessment and skin testing (PAAST) service. Impact on allergy reconciliation and antibiotic use was assessed.MethodsThis was a retrospective cohort study describing a pharmacist‐administered PAAST program conducted at a 641‐bed tertiary care medical center in South Carolina. The primary outcome was the proportion of allergies reconciled or resolved pre‐ and post‐PAAST evaluation. The secondary outcomes were the durability of allergy removal and change in antibiotic use post‐PAAST.ResultsRegulatory approval from the Boards of Pharmacy, Medical Examiners, and Nursing was obtained prior to implementation of the program. There were 161 PAAST evaluations, 119 (74%) allergy assessments alone, and 42 (26%) skin tests. Proportion of patients with reconciled allergies improved from 17 (11%) pre‐PAAST to 120 (75%) post‐PAAST evaluation (P < .0001). Among 42 skin tests performed, there were no positive results, 36 (86%) negative results, and 6 (14%) indeterminate results. Antibiotic therapy was optimized in 58% (21/36) of patients with a negative skin test. Following a negative skin test, vancomycin use significantly decreased (44% pre‐test vs 17% post‐test, P = .01) while use of penicillins significantly increased (0% vs 39%, P < .0001). Among 35 patients with allergy labels resolved in the electronic health record after a negative test, there were no occurrences of relabeling among a mean of 7.6 patient encounters.ConclusionImplementation of a pharmacist‐administered PAAST service effectively streamlined antimicrobial therapy and resolved penicillin allergy labels, without relabeling. Advocating for pharmacy personnel to perform services such as PAAST should be considered in other institutions and states.

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“…Griffith et al have demonstrated that both pharmacists and pharmacy students that undergo training can successfully implement and administer a successful testing program. A protocol‐driven treatment strategy similar to what this manuscript and other programs have implemented can be a guide to building and maintaining a program that has been previously published in the literature 3 . The biggest hurdle specifically for penicillin skin testing besides state regulatory approval and scope of practice limitations for pharmacists is time and resource allocation needed to complete the process.…”

mentioning

confidence: 97%

“…It is well established that carrying a documented label of penicillin allergy, occurring in nearly 10% of the population in the United States, results in poor outcomes, such as use of inferior antimicrobials, increased length of stay, and higher rates of multidrug‐resistant infections 1 . Fortunately there have been a number of recent publications, often with pharmacists, demonstrating the benefit of delabeling interventions ranging from lower resource utilization (eg, direct oral challenge) to higher resource utilization, such as penicillin skin testing 2,3 . Pharmacist involvement within penicillin skin testing is not novel, however direct administration of these tests by pharmacists is not common in the literature 4‐7 .…”

mentioning

confidence: 99%

Pharmacists implementing penicillin allergy assessment and skin testing programs for delabeling—What are we waiting for?

Jones

Bland

2020

J Am Coll Clin Pharm

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A practical guide for pharmacists to successfully implement penicillin allergy skin testing

Cited by 33 publications

References 35 publications

Clinical and Economic Outcomes of Penicillin Skin Testing as an Antimicrobial Stewardship Initiative in a Community Health System

Clinical and Economic Outcomes of Penicillin Skin Testing as an Antimicrobial Stewardship Initiative in a Community Health System

Regulatory approval, implementation, and brief assessment of a pharmacist‐ and pharmacy trainee‐administered penicillin allergy assessment and skin testing program

Pharmacists implementing penicillin allergy assessment and skin testing programs for delabeling—What are we waiting for?

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