1794. Impact of a Pharmacist-Driven Detailed Penicillin Allergy Interview
Session: Poster Abstract Session: Antimicrobial Stewardship: Impact of Allergy
Saturday, October 6, 2018
Room: S Poster Hall

Background: In the United States, 10% of patients report a penicillin (PCN) allergy. These self-reported allergies may be outdated or inaccurate, which may lead to usage of alternate antimicrobials that may be less effective, more toxic, and/or more expensive. While PCN skin tests (PST) can provide an accurate assessment and de-labeling of PCN allergies, they are not feasible at all institutions. An alternative solution is to conduct a detailed penicillin allergy interview (DPAI), which can potentially lead to de-escalation and/or optimization of antimicrobial therapy.

 

Methods: Pharmacist-driven DPAIs were conducted between December 26, 2017 and March 26, 2018. Adult patients admitted with a documented PCN allergy were interviewed according to a standardized questionnaire. The allergy profile within the EHR was updated and a recommendation to switch to non-carbapenem beta-lactam therapy was made to the prescriber based on a decision algorithm. Objectives of this study include characterization of changes made to the allergy profile within the EHR after DPAI and measuring the number of patients successfully switched to beta-lactam therapy.

Results: A total of 466 patients were admitted with a documented PCN allergy, of which 175 (37.5%) received DPAI.  Of these patients, 133 (76%) required a change to their allergy profile (Table 1). One-hundred thirty-five (77.1%) patients interviewed were on an antimicrobial agent (Figure 1). Forty-two patients (31.1%) met criteria to switch to non-carbapenem beta-lactam therapy, and 31 (73.8%) patients were successfully switched with no adverse events noted.

Conclusion:   A large number of admitted patients with a documented PCN allergy received a DPAI. Implementation of pharmacist-driven DPAIs led to updated, more accurate allergy information within the EHR, as well as de-escalation and/or optimization of antimicrobial therapy. Provider acceptance rate to switch to non-carbapenem beta-lactam therapy was high.

Table 1: Changes to allergy profile

Type of Change

N = 175

No changes

42 (24)

Addition of tolerance history

58 (33.1)

Modification of reaction details

32 (18.3)

Addition of tolerance history AND modification of reaction details

41 (23.4)

Deletion of allergy

2 (1.1)

Figure 1: Initial antimicrobial therapy

Katrina Mann, PharmD1, Sneha Shah, PharmD1 and Janet Wu, PharmD2, (1)Cleveland Clinic Marymount Hospital, Garfield Heights, OH, (2)Cleveland Clinic, Cleveland, OH

Disclosures:

K. Mann, None

S. Shah, None

J. Wu, None

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