1060. Barriers in Removing Penicillin Allergy Documentation on Hospital Readmissions
Session: Poster Abstract Session: Stewardship: Improving Treatments
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Slide1.jpg (124.7 kB)
  • Background: Penicillin skin testing (PST) can have a beneficial impact on antimicrobial stewardship. At Vidant Health, a system of 10 hospitals, penicillin allergies are often reinstated into the medical record despite having a negative PST. We assessed barriers for the reinstatement of a non-existent penicillin allergy.

    Methods: 150 patients with symptoms consistent with an IgE-mediated reaction to penicillin had the allergy removed from the medical record (MR) after a negative PST and successful transition to a penicillin agent without any allergic reaction. A retrospective chart review of the same 150 patients was done one year later to assess for hospital reappearances, penicillin allergy reinstatements, demographics, residence, clinical diagnosis, antimicrobial choices and presence of dementia or altered mentation. Long-term care facilities (LTCF) were also contacted to assess whether the penicillin allergy had been removed from their MR. Fischer exact test was used to identify significant risk factors for allergy re-documentation.

    Results: Of the 150 patients with a proven penicillin tolerance, 55 (37%) revisited a Vidant Health emergency department within a year. Of the 55 patients, 47 (85%) required admission and 22 (40%) received a beta-lactam agent once again without adverse effects.  20 (36%) patients had penicillin allergy re-recorded into their MR without a documented reason. The risk factors in patients who had penicillin allergy reinstated (n=20) versus those who did not (n=35) included age >65years (75% vs 37%, P=0.011), residence in a LTCF (75% vs 20%, P=0.0001), acutely altered mentation (80% vs 23%, P<0.0001) and dementia (50% vs 2%, P<0.0001). Penicillin allergy was not removed from the LTCF MR in 70% of the patients with reinstated PCN allergy.

    Conclusion: While PST can help expand antimicrobial choices and reduce healthcare costs, its benefits may be limited by failure to remove the documented allergy from the chart. 35% of patients with a proven penicillin tolerance had the allergy re-recorded. Factors resulting in this include older age, altered mental status, dementia and residence in a LTCF. Healthcare providers should try to avoid erroneously reinstating a penicillin allergy in patients with a negative PST, proven tolerance and lack of subsequent reaction(s) afterwards.

    Ramzy Rimawi, MD1, Paul Cook, MD1, Bassam Rimawi, MD2, Dawd Siraj, MD, MPH3, Muhammad Salman Ashraf, MD4 and Kaushal Shah, M.D.5, (1)Infectious Diseases, East Carolina University, Greenville, NC, (2)Maternal Fetal Medicine and Reproductive Infectious Diseases, Medical University of South Carolina, Charleston, SC, (3)Department of Internal Medicine, Division of Infectious Diseases, East Carolina University/Brody School of Medicine, Greenville, NC, (4)Infectious Disease, Brody School of Medicine, East Carolina University, Greenville, NC, (5)Infectious Diseases, East Carolina University - Brody School of Medicine, Greenville, NC

    Disclosures:

    R. Rimawi, None

    P. Cook, None

    B. Rimawi, None

    D. Siraj, None

    M. S. Ashraf, None

    K. Shah, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.