De-labeling Inaccurate Penicillin Allergies: Improving Referral Rates for Penicillin Allergy Testing

BACKGROUND: An estimated 8%-25% of the global population has a penicillin allergy label; however, only 1% have a true allergy when tested. Patients with a penicillin allergy label incur higher healthcare costs, have worse health outcomes, and are more often prescribed broad-spectrum antibiotics.

LOCAL PROBLEM: The setting for this evidence-based quality improvement project is a university-based student health clinic. Patients often present for bacterial infections best treated with beta-lactam antibiotics. Inappropriate penicillin allergy labels contribute to suboptimal treatment. The project aimed to increase recommended penicillin allergy testing referrals for patients with penicillin allergy labels by 50% within three months of implementation.

METHODS: The Evidence-Based Practice Improvement Model (EBPI) was used to guide this project's development, implementation, and evaluation. PDSA cycles were used to introduce and test the practice change processes incrementally. Outcome measures evaluated the number of patients recommended to receive referrals for penicillin allergy testing for 3 months pre-implementation and post-implementation.

INTERVENTIONS: An education session was provided to clinicians to discuss the importance of addressing penicillin allergy labels and introducing the standardized penicillin allergy assessment tool. A standardized penicillin allergy assessment template was integrated into the electronic health record (ERH) workflow to prompt providers to address penicillin allergy labels and recommend referrals for penicillin allergy testing.

RESULTS: Recommended referrals for penicillin allergy testing in patients with penicillin allergy labels increased from 3.8% to 57.8%, a 1421% increase over pre-implementation rates.

CONCLUSIONS: Using a standardized penicillin allergy assessment template increased recommended penicillin allergy testing referral rates in patients with penicillin allergy labels. The results of this project demonstrate that with simple interventions, primary care providers can be key drivers in increasing referrals for penicillin allergy testing. Project sustainability is high since the process was integrated and accepted into clinical flow, and there was no cost associated with the process.