A Rash Decision: Implementing an EHR-Integrated Penicillin Allergy Delabeling Protocol without Adequate Clinician...

Area of Science:

• Clinical Medicine
• Infectious Diseases
• Health Informatics

Background:

• Documented penicillin allergy affects ~10% of patients, but 95% test negative.
• Inaccurate penicillin allergy labeling leads to suboptimal antibiotic use, increasing hospitalizations, costs, and resistance.
• This poses significant risks, including higher rates of resistant infections and mortality.

Purpose of the Study:

• To implement and evaluate an inpatient penicillin allergy delabeling protocol for children.
• To integrate the protocol into the electronic health record (EHR) using clinical decision support (CDS).
• To identify factors influencing clinician adoption and protocol effectiveness across different implementation phases.

Main Methods:

• A mixed-methods approach was used, implementing the protocol in three phases: Pilot, Active Antimicrobial Stewardship Program (ASP), and Mixed CDS.
• Patients were risk-stratified (non-allergic, low-risk, high-risk).
• Process measures included evaluation, oral challenge, and referral rates; primary outcome was delabeling rate; balancing measure was adverse events.

Main Results:

• The Mixed CDS phase showed the lowest evaluation rate (6.4%) but the highest oral challenge (33%) and delabeling rates (43%) when evaluations occurred.
• Pilot and ASP phases had higher evaluation rates (25% and 15% respectively) but lower delabeling rates.
• No adverse events were recorded across all phases.

Conclusions:

• Clinical decision support (CDS) tools can enhance penicillin allergy delabeling in pediatric inpatient settings.
• Successful implementation requires addressing clinician adoption barriers, emphasizing the importance of education and communication alongside CDS.
• Optimizing CDS integration is key to improving antibiotic stewardship and patient outcomes.