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

Abstract

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.

Instruction and Simulation to Improve Pharmacy Students’ Knowledge and Confidence Regarding Assessment of Penicillin Allergies

“…A c c e p t e d D r a f t evaluating cross-reactivity potential among beta-lactam antibiotics, and providing other types of allergy evaluations or challenges. [20][21][22][23][24][25] Pharmacist opportunities and involvement in PAAST are also expanding to outpatient settings. 26 Given the significant impact pharmacists can have in PAAST, appropriate education is essential.…”

Beta-lactam comprehensive allergy management program in a community medical center

“…The CAMP team interviewed eligible patients to collect detailed medication allergy histories using a pharmacist-developed questionnaire (Table S1). 20,21 In collaboration with an allergy and immunology physician, interviewed patients were stratified as high, moderate, or low risk of IgE-mediated allergy based on reaction history (Figure S1). Direct beta-lactam drug challenge was recommended for patients with low-risk histories.…”

“…18,19 Limited data exists regarding characteristics, implementation logistics, and outcomes of allergy management programs in nonteaching, community hospitals. 20 Much of the published literature describing successful programs includes medical resident and infectious disease (ID) fellow collaboration or are in states supporting pharmacist-administered PST. Our facility is a nonteaching, urban, community medical center within a multihospital health system.…”

Overview of Beta-Lactam Allergy and the Role of the Pharmacist in Management

“…The reconciled allergies improved from 11% to 75% post-evaluation, and no PSTs were positive. Following PST, antibiotic therapy was optimized in 58% of the patients, the vancomycin use decreased from 44% to 17%, and the use of penicillins increased from 0% to 39% [34].…”