Related Experiment Video
Updated: Sep 15, 2025
Antigenic Liposomes for Generation of Disease-specific Antibodies
Published on: October 25, 2018
Assessment of a Stepwise Intervention to Improve Nurse-administered Penicillin Allergy Screening and De-labeling in
Victoria J L Konold1, Filmon Emnetu2, Daniel Pak3
1From the Division of Infectious Diseases, Department of Pediatrics, University of Washington, Seattle, Wash.
Insights
Many children labeled with penicillin allergy can safely have this label removed. A nurse-led screening program improved penicillin allergy de-labeling in pediatric patients.
Area of Science:
- Pediatric Allergy and Immunology
- Infectious Disease Management
- Healthcare Quality Improvement
Background:
- Penicillin antibiotics are crucial for treating childhood infections but are often avoided due to allergy labels.
- Approximately 94% of children with a penicillin allergy label can tolerate penicillin, yet they receive less effective second-line antibiotics.
- This leads to increased risks of treatment failure and adverse events in pediatric populations.
Purpose of the Study:
- To implement and evaluate an efficient penicillin allergy de-labeling strategy in pediatric inpatients.
- To assess the effectiveness of a nurse-administered screening tool and protocolized follow-up actions.
- To improve the management of penicillin allergy documentation in children.
Main Methods:
- Development of an evidence-based screening algorithm and protocol for pediatric inpatients.
- Integration of a screening tool into the electronic health record for nurse administration.
- Utilization of plan-do-study-act cycles to refine the standard protocol and implement electronic health record reminders.
Main Results:
- Nurse-initiated screening for penicillin allergy increased significantly after implementing an electronic reminder system.
- Penicillin allergy de-labeling rates showed improvement following the introduction of a standardized amoxicillin challenge order set and audit feedback.
- Sustained increases in de-labeling were not consistently achieved, indicating a need for ongoing process optimization.
Conclusions:
- A nurse-administered screening questionnaire and standardized follow-up protocols can facilitate safe penicillin allergy de-labeling.
- This approach is effective in hospitals lacking a dedicated penicillin allergy service.
- Optimizing strategies for guideline dissemination and sustained implementation is crucial for successful penicillin allergy de-labeling programs.
Introduction:
Penicillins are first-line treatments for many childhood infections, but providers avoid them when patients report a penicillin allergy, although approximately 94% of these patients may tolerate penicillin. Patients with penicillin allergy labels often receive second-line antibiotics, which increases the risk of treatment failure and adverse events. To address this, programs to implement penicillin allergy de-labeling have increased; however, strategies to accomplish de-labeling most efficiently through guideline dissemination have not been well-studied.
Methods:
A multidisciplinary team created an evidence-based screening algorithm and standard protocol to screen eligible pediatric inpatients and de-label documented penicillin allergies. Plan-do-study-act cycles identified opportunities for improvement to the standard protocol.
Results:
We developed a screening tool to assess the risk of penicillin allergy and integrated it into the electronic health record for administration by clinical nurses. Follow-up actions, including de-labeling or further testing, are automatically communicated to the provider. Nurse-initiated screening increased from 3.8% to 28.1% after adding an electronic "worklist task" reminder. Allergy de-labeling demonstrated special cause variation following the dissemination of a standardized amoxicillin challenge order set and then again after a brief period of audit and feedback; however, the increases were not sustained.
Conclusions:
A nurse-administered screening questionnaire and protocolized follow-up actions can help achieve safe de-labeling at hospitals without a dedicated penicillin allergy service.
Related Concept Videos
01:30Asthma-IV: Nursing Management
First, in...
02:06Allergic Reactions