A Quality Improvement Project to Decrease Inaccurate Penicillin Allergies in Resource-Limited Ambulatory Care Clinics

There is a lack of data on the impact of implementing an interprofessional approach in ambulatory clinics to de-label penicillin-allergic patients (PA) in diverse and lower-income populations.

A quality improvement (QI) interprofessional adult PA assessment/intervention protocol was implemented at two resource-limited ambulatory sites over 4 months, utilizing a post-group-only quasi-experimental study design. Pharmacists performed allergy assessments/Pen-FAST scores with nonallergic histories directly de-labeled. Nonpregnant patients with Pen-FAST scores less than 3 were offered amoxicillin direct oral challenges (DOC), and scores of 3 or greater were offered allergist referrals. Data collection included demographics, allergy information, Pen-FAST score, and outcomes. The primary outcome was the percentage of interviewed patients de-labeled. Secondary outcomes included the percentage de-labeled through different modalities, allergist referrals, and 3- and 6-month antibiotic use and relabeling.

A total of 717 and 388 PA patients were identified at Sites 1 and 2, respectively. Interviews occurred in 228 patients, with 151 (66.2%) and 77 (33.8%) from Sites 1 and 2. The median age (interquartile range [IQR]) was 56 years (41-64), with 168 (73.7%) identified as female. A total of 130 (57%) patients had a Pen-FAST score less than 3. Successful allergy de-labeling was achieved in 74 of 228 (32.5%) patients. De-labeling occurred in 60 patients by allergy assessment and 14 patients through DOC. Allergist referrals occurred in 93 patients. Of de-labeled patients, 8 (10.8%) and 11 (14.9%) received penicillin within 3 and 6 months. Relabeling occurred in one patient within 6 months.

This QI initiative was effective in de-labeling 33% of inaccurate PAs across two ambulatory care clinics with diverse populations.