Improving documentation and referral practices of self-reported penicillin allergy in the electronic health record

Purpose of Project. There is growing interest in penicillin allergy delabeling strategies since the emergence of antimicrobial resistance that involves allergy reconciliation and allergy referral to undergo formal skin testing and/or oral challenge. The study objective was to identify trends in clinical evaluation and management of a reported penicillin allergy. Methodology. A retrospective cohort study design was used to determine the prevalence and characteristics of penicillin allergy documentation and referral practices between January 1, 2019 and December 31, 2019 at an outpatient, internal medicine practice. Statistical analysis of demographic characteristics, penicillin allergy information, and number of allergy referrals was performed. Results. A total of 503 patients (67.1%; 431 not documented, and 72 occurred more than 10 years ago) with reaction onset dates amenable to traditional penicillin allergy evaluation methods of skin testing and/or drug challenges. Five patients (0.7%) had a documented referral to an allergist, of which two patients continued to have a penicillin allergy listed in their medical record despite having a negative skin test. Unknown reaction (5.9%, n = 44), no documented reaction (80.2%, n = 601), rash (5.6%, n = 42), urticaria (1.9%, n = 14), and gastrointestinal upset (1.1%, n = 8) were the most commonly reported reactions to penicillin. Implications for Practice. The findings support the need to implement a standardized process to evaluate a reported penicillin allergy and to identify patients that will benefit from a referral to allergy. The project identified opportunities to improve the quality of allergy documentation and referral practices in the outpatient setting.DNPIncludes bibliographical reference