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Penicillin allergy de-labelling implementation intervention in a UK hospital: a process evaluation, the patient
Neil Powell1,2, Mathew Upton3, Bridie Kent4
1Pharmacy Department, Royal Cornwall Hospital, Truro TR1 3LJ, UK.
Insights
Penicillin allergy de-labelling (PADL) is well accepted by patients when explained clearly. Patients with mild reactions or doubts about their allergy are more likely to undergo testing, with some preferring outpatient settings.
Area of Science:
- Clinical Medicine
- Patient Experience
- Allergy Management
Background:
- Penicillin allergy (penA) records are frequently inaccurate, leading to broad-spectrum antibiotic use and adverse patient outcomes.
- A behavioral intervention package for inpatient penicillin allergy de-labelling (PADL) was developed for adult medical and surgical patients in a UK hospital.
- The intervention was delivered by a multidisciplinary, non-allergist workforce to remove incorrect penA records.
Purpose of the Study:
- To explore patient experiences, beliefs, and concerns regarding the offer of penicillin allergy de-labelling (PADL).
- To understand patient acceptance factors for inpatient PADL.
- To identify patient preferences for testing settings (inpatient vs. outpatient).
Main Methods:
- Semi-structured interviews were conducted with 20 patients offered PADL on medical or surgical wards.
- Data were collected between June and October 2024.
- Inductive reflexive thematic analysis was used to analyze interview data.
Main Results:
- Patients who believed their penicillin allergy was incorrect or had mild index reactions were more likely to agree to testing.
- Most patients considered the hospital a safe environment for PADL testing.
- Patients who accepted PADL reported good explanations of risks/benefits and trusted the healthcare team.
Conclusions:
- Penicillin allergy de-labelling (PADL) is well-accepted by patients, particularly when the process and its benefits are clearly communicated.
- Patient acceptance is higher for those with perceived low-severity reactions or uncertainty about their allergy status.
- Some patients declining inpatient PADL expressed willingness for outpatient testing after recovery.
Background:
Penicillin allergy (penA) records are common, but true penA is rare. PenA records are associated with broad spectrum antibiotic prescribing and negative patient outcomes. We developed a behavioural intervention package to support inpatient penicillin allergy de-labelling (PADL) delivered by a multi-profession non-allergist workforce to remove incorrect penA records from medical and surgical adult inpatients in a UK hospital.
Aims:
To explore the experiences, beliefs and concerns of patients who had been offered PADL.
Methods:
Semi-structured interviews to explore the views of patients admitted to a medical or surgical ward with a penA record and offered PADL between June 2024 and October 2024. Inductive reflexive thematic analysis was used to analyse the data.
Results:
Twenty patients were interviewed. Patients that believed their penA to be incorrect and those that described their index reaction as mild were more likely to agree to testing. Patients considered hospital a safe place to be tested. Some patients thought being acutely unwell was not a barrier to testing, whereas others preferred an outpatient setting once discharged from hospital. De-labelled patients described having a good explanation of the risks and benefits of PADL, were grateful for the opportunity and trusted the healthcare worker and the PADL process.
Conclusion:
PADL was well accepted by patients who described receiving a good explanation of the PADL process. Index reactions perceived as low severity (e.g. non-severe rashes) and/or doubtful of their penA (e.g. unaware they had a penA record) were more likely to accept PADL. Some who declined inpatient PADL would consider outpatient testing once recovered from their acute illness.
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