1854. Improving Documentation of Penicillin Allergies in a Veterans Affairs Health Care System
Session: Poster Abstract Session: Antibiotic Stewardship: Beta Lactam Allergy
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • Penicillin Allergy- Ortiz ID Week 2016.pdf (2.8 MB)
  • Background: An estimated 10-15% of the population has a self-reported penicillin allergy, with up to 20% of hospitalized patients reporting an allergy to penicillin. However, only 1-10% will have evidence of allergy upon skin testing. Inappropriate reporting of penicillin allergy and use of broad spectrum antibiotics results in worse clinical outcomes, longer and more costly hospital stays, and increased rates of C. difficile, VRE, and MRSA.The aim of this quality improvement project was to improve accuracy of penicillin allergy documentation at the South Texas Veterans Health Care System (STVHCS).

    Methods: A review of patients previously admitted to STVHCS with self-reported penicillin allergy was initially made to establish accuracy of documentation in the electronic medical record (EMR). Once this was established, a team of clinical pharmacy specialists made calls to patients with newly documented penicillin allergies using a standardized questionnaire to clarify allergy history. This questionnaire included five key elements of accurate allergy history including name of the medication, nature of the reaction, date of the reaction, timing of the reaction in relation to taking the antibiotic, and other related antibiotics received since the allergy occurred (e.g. other beta lactams).

    Results: 252 unique patients with a penicillin allergy were admitted to STVHCS between 1/1/14 and 3/31/14. Nature of the reaction was documented 54% of the time. Less than 2% of the other key elements were recorded, resulting in a 33% accuracy rate. Between 10/1/2014 and 1/31/2014, 229 patients had a new penicillin allergy documented in the EMR. Of those, 24% were contacted to complete the questionnaire. Upon intervention, nature of the reaction was documented 93%. Documentation of all other key elements was improved to 66% or better. This resulted in an accuracy rate of 86.2%.

    Conclusion: Clarification of penicillin allergies using key elements of an accurate allergy history can greatly improve the accuracy of documentation in the EMR. Clinicians should carefully consider how they document penicillin allergies in the chart, and update allergies if beta lactam antibiotics are given and tolerated in order to facilitate appropriate prescribing in the future.

    Courtney Ortiz, Pharm.D., BCPS1,2,3, Denver Buchanan, Pharm.D.1,2, Lisa Song, Pharm.D.1,2,3, Carrie Gonzalez, Pharm.D.1,2,3 and Kelly Echevarria, Pharm.D,.BCPS, AQ-ID1,2,3, (1)Pharmacy Service, South Texas Veterans Health Care System, San Antonio, TX, (2)Pharmacotherapy Division, The University of Texas at Austin, Austin, TX, (3)Pharmacotherapy Education and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, TX

    Disclosures:

    C. Ortiz, None

    D. Buchanan, None

    L. Song, None

    C. Gonzalez, None

    K. Echevarria, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.