关键词: Allergy Anaphylaxis Antibiotic Antibiotic allergy Cephalosporin Drug Drug allergy Hypersensitivity IgE mediated Immune-mediated Inpatient Penicillin

Mesh : Allergy and Immunology / education statistics & numerical data Anti-Bacterial Agents / therapeutic use Cross Reactions Drug Hypersensitivity / drug therapy epidemiology immunology Drug Prescriptions / statistics & numerical data Education / methods Follow-Up Studies Humans Inpatients Practice Guidelines as Topic Professional Practice Skin Tests

来  源:   DOI:10.1016/j.jaip.2014.02.003

Abstract:
BACKGROUND: Inpatient providers have varying levels of knowledge in managing patients with drug and/or penicillin (PCN) allergy.
OBJECTIVE: Our objectives were (1) to survey inpatient providers to ascertain their baseline drug allergy knowledge and preparedness in caring for patients with PCN allergy, and (2) to assess the impact of an educational program paired with the implementation of a hospital-based clinical guideline.
METHODS: We electronically surveyed 521 inpatient providers at a tertiary care medical center at baseline and again 6 weeks after an educational initiative paired with clinical guideline implementation. The guideline informed providers on drug allergy history taking and antibiotic prescribing for inpatients with PCN or cephalosporin allergy.
RESULTS: Of 323 unique responders, 42% (95% CI, 37-48%) reported no prior education in drug allergy. When considering those who responded to both surveys (n = 213), we observed a significant increase in knowledge about PCN skin testing (35% vs 54%; P < .001) and loss of PCN allergy over time (54% vs 80%; P < .0001). Among those who reported attending an educational session (n = 62), preparedness to determine if an allergy was severe significantly improved (77% vs 92%; P = .03). Other areas, including understanding absolute contraindications to receiving a drug again and PCN cross-reactivity with other antimicrobials, did not improve significantly.
CONCLUSIONS: Inpatient providers have drug allergy knowledge deficits but are interested in tools to help them care for inpatients with drug allergies. Our educational initiative and hospital guideline implementation were associated with increased PCN allergy knowledge in several crucial areas. To improve care of inpatients with drug allergy, more research is needed to evaluate hospital policies and sustainable educational tools.
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