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

Cadhan McFadden1, Teresita Muniz1,2, Serena Farley3

  • 1Wegmans School of Pharmacy, St. John Fisher University, Rochester, New York, USA.

Journal of the American College of Clinical Pharmacy : JACCP
|April 20, 2026
PubMed
Summary
This summary is machine-generated.

This study successfully de-labeled 33% of patients with inaccurate penicillin allergies (PA) using an interprofessional approach in diverse ambulatory clinics. The quality improvement initiative demonstrated effectiveness in reducing allergy labels.

Keywords:
ambulatory carehypersensitivitypenicillinspharmacists

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Area of Science:

  • Clinical Pharmacy
  • Quality Improvement Science
  • Allergy and Immunology

Background:

  • Limited data exists on de-labeling penicillin allergies (PA) in diverse, lower-income populations via interprofessional approaches.
  • Accurate allergy assessment is crucial for appropriate antibiotic selection and patient outcomes.
  • The prevalence of inaccurate penicillin allergies impacts healthcare resource utilization.

Purpose of the Study:

  • To evaluate the effectiveness of an interprofessional quality improvement (QI) protocol for de-labeling penicillin-allergic patients in resource-limited ambulatory clinics.
  • To assess the impact of the protocol on allergy de-labeling rates and patient outcomes in diverse populations.

Main Methods:

  • A 4-month QI initiative implemented an interprofessional PA assessment/intervention protocol at two ambulatory sites.
  • Pharmacists conducted allergy assessments using the Penicillin-FAST (Pen-FAST) score; direct de-labeling occurred for non-allergic histories.
  • Patients with Pen-FAST scores <3 underwent direct oral challenges (DOC); scores ≥3 were referred to allergists.

Main Results:

  • Interviews were conducted with 228 patients; 32.5% (74/228) were successfully de-labeled.
  • De-labeling was achieved through allergy assessment (60 patients) and DOC (14 patients).
  • 93 patients were referred to allergists; only one patient was relabeled within 6 months.

Conclusions:

  • The QI initiative effectively de-labeled 33% of inaccurate penicillin allergies in diverse ambulatory care populations.
  • An interprofessional approach is effective for penicillin allergy de-labeling in resource-limited settings.
  • This strategy can reduce the burden of inaccurate allergy labels and improve antibiotic stewardship.