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Addressing Inpatient Beta-Lactam Allergies: A Multihospital Implementation.

Kimberly G Blumenthal1, Erica S Shenoy2, Anna R Wolfson3

  • 1Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Mass; Edward P. Lawrence Center for Quality and Safety, Massachusetts General Hospital and the Massachusetts General Professional Organization, Boston, Mass; Harvard Medical School, Boston, Mass.

The Journal of Allergy and Clinical Immunology. in Practice
|May 10, 2017
PubMed
Summary

Implementing a computerized guideline for beta-lactam allergy in hospitals improved patient care. This initiative addressed challenges in managing penicillin allergies, a common issue in inpatient settings, promoting better antibiotic stewardship.

Keywords:
Adverse drug reactionAllergyBeta-lactamDrugGraded challengesGuidelineHypersensitivityPenicillinPolicyQuality improvementStewardshipTest dose

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Area of Science:

  • Health Informatics
  • Infectious Diseases
  • Clinical Pharmacy

Background:

  • Inaccurate penicillin allergy reporting affects 10-15% of inpatients.
  • This contributes to suboptimal antibiotic use and antimicrobial resistance.
  • Interventions are needed to improve penicillin allergy assessment in hospitals.

Purpose of the Study:

  • To describe the implementation roadmap of a computerized guideline for beta-lactam allergy.
  • To share successes and challenges encountered during the implementation process.
  • To empower other healthcare systems to improve care for patients with reported beta-lactam allergies.

Main Methods:

  • A computerized guideline was implemented across 5 hospitals in a single healthcare system.
  • Key steps included team assembly, stakeholder engagement, and approach selection.
  • Change dissemination, measurement establishment, and impact assessment were crucial.

Main Results:

  • Successful implementation of a systematic approach to manage beta-lactam allergies.
  • Identification of key logistical challenges and successful strategies for overcoming them.
  • Demonstrated a pathway for improving care for patients with reported beta-lactam allergies.

Conclusions:

  • Computerized guidelines are feasible for addressing inaccurate penicillin allergies in hospitals.
  • Multidisciplinary collaboration and a structured implementation plan are vital for success.
  • Lessons learned can guide other institutions in optimizing beta-lactam allergy management and antibiotic stewardship.