Quality Improvement to Engage General Pediatrics in Reducing Inaccurate Penicillin Allergy Labels

Area of Science:

• Clinical Medicine
• Pediatrics
• Allergy and Immunology

Background:

• Inaccurate penicillin allergy labels are common in pediatric populations.
• These labels can lead to the use of alternative, potentially less effective or more toxic antibiotics.
• Over-labeling contributes to unnecessary referrals to allergy specialists.

Purpose of the Study:

• To decrease the proportion of patients with inaccurate penicillin allergy labels in a general pediatric clinic.
• To implement and evaluate interventions aimed at label removal.
• To assess the impact on allergy referral rates and label removal during clinic visits.

Main Methods:

• A collaborative quality improvement project was conducted from October 2017 to December 2021.
• Interventions included education, feedback, EHR alerts, and oral amoxicillin challenges.
• Control charts monitored referral rates, label removal, and the overall proportion of penicillin-allergic patients.

Main Results:

• Referral rates to allergy clinic increased significantly from 1.9% to 20.4%.
• In-clinic label removal increased from 1.1% to 6.6% for labeled patients.
• The overall proportion of penicillin allergy-labeled patients decreased from 3.4% to 2.2%.

Conclusions:

• General pediatric practitioners can effectively remove inaccurate penicillin allergy labels with proper education and collaboration.
• Pediatricians can manage low-risk evaluations, reducing the burden on allergists.
• This approach allows specialists to focus on higher-risk patients.