Implementation of a pharmacist-driven penicillin and cephalosporin allergy assessment tool: A pilot evaluation

OBJECTIVE Penicillin is the most commonly reported drug allergy despite the low incidence of true immune-mediated reactions. Penicillin allergy labels have been shown to lead to significant patient, institutional, and public health care consequences. This project’s purpose was to improve quality of care for patients with penicillin and cephalosporin allergies, admitted to a pediatric institution, by implementation of a pharmacist-driven allergy assessment tool. METHODS A group of physicians, pharmacists, and a nurse collaborated for process development. The process was standardized, and a tool was created to assist with assessments. Pharmacists were educated on the importance of this quality improvement project and trained on the process and tool used. Implementation occurred on March 2, 2020. RESULTS During the 3-month implementation period, 40 patients were admitted with a documented penicillin or cephalosporin allergy. Of these, 11 patients (27.5%) received an allergy assessment. Most were identified as having low or moderate risk of recurrent reaction with future use of a penicillin or cephalosporin agent (81.8%), and 2 patients (18.2%) were de-labeled from their documented allergy. CONCLUSIONS Penicillin and cephalosporin allergy assessment implementation at a pediatric hospital was successfully implemented and allowed for identification and initiation of future quality improvement projectincluding implementation of penicillin skin testing and direct oral amoxicillin challenges. ABBREVIATIONS AAAAI, American Academy of Allergy, Asthma, and Immunology; CDC, Centers for Disease Control and Prevention; EHR, electronic health record; IgE, immunoglobulin E; QI, quality improvement.