PDF(Pubmed)
Abstract：
Objective: To describe the impact of pharmacy driven penicillin allergy assessments on de-labeling penicillin allergies and antibiotic streamlining opportunities for hospitalized patients. Design: Multi-center, retrospective case-series study. Setting: A health system of 4 non-teaching hospitals. Participants: Patients aged 18 years and older with a physician order for a pharmacist penicillin allergy assessment. Exclusion criteria consisted of patients with anaphylaxis or a type II penicillin allergy, anaphylaxis of any cause within 4 weeks, refusal of penicillin allergy skin test (PAST), antihistamine use within 24 hours, penicillin intolerance, immunosuppression or immunosuppressive medications, or skin conditions that could interfere with PAST. Interventions: The primary endpoint evaluated the number of de-labeled penicillin allergies after pharmacists provided penicillin allergy assessments. Secondary endpoints evaluated the percent of patients with antibiotics deescalated to beta-lactam antibiotics and classification of notable interventions made by pharmacists. Measurements and Main Results: There were 35 patients who met inclusion criteria. Twenty-four patients underwent both penicillin allergy skin testing and oral (PO) amoxicillin challenge. Five patients had allergies de-labeled only after a pharmacist interview. Four patients received only the PO amoxicillin challenge and 2 patients received only PAST. Penicillin allergies were de-labeled from the electronic health record (EHR) in 31 (89%) patients despite all testing negative for a penicillin allergy from PAST or a PO amoxicillin challenge. Four patients had the allergy re-added to the chart on subsequent admissions. No patients experienced a reaction from PAST, PO amoxicillin challenge, or subsequent beta-lactam antibiotics. Twenty-eight (80%) patients had their antibiotic therapy changed as a result of the allergy assessment. Seventeen patients were de-escalated onto beta-lactam antibiotics and aztreonam was stopped in 6 patients. Conclusion: Results from this study suggests that pharmacists expanding their scope of practice with PAST is a safe and effective allergy de-labeling tool. Pharmacist-driven penicillin allergy assessments could provide antibiotic cost savings and avoid aztreonam use. The study supports the need to emphasize education for patients and caretakers regarding allergy testing results to avoid relabeling in future hospital visits.
摘要：
目的：描述药学驱动的青霉素过敏评估对住院患者青霉素过敏和抗生素精简机会的影响。设计：多中心，回顾性病例系列研究。设置：4家非教学医院的卫生系统。参与者：18岁及以上的患者，医生要求进行药剂师青霉素过敏评估。排除标准包括过敏反应或II型青霉素过敏的患者，4周内任何原因的过敏反应，拒绝青霉素过敏皮肤试验（PAST），在24小时内使用抗组胺药，青霉素不耐受,免疫抑制或免疫抑制药物，或可能干扰PAST的皮肤状况。干预措施：在药剂师提供青霉素过敏评估后，主要终点评估了去标记的青霉素过敏的数量。次要终点评估了抗生素降级为β-内酰胺类抗生素的患者百分比，并对药剂师的显着干预措施进行了分类。测量和主要结果：有35例患者符合纳入标准。24名患者接受了青霉素过敏皮肤测试和口服（PO）阿莫西林攻击。仅在药剂师访谈后，五名患者的过敏症标签才被取消。4名患者仅接受PO阿莫西林攻击，2名患者仅接受PAST。尽管所有PAST或PO阿莫西林攻击的青霉素过敏测试均呈阴性，但31名（89％）患者的电子健康记录（EHR）中的青霉素过敏被去标记。四名患者在随后入院时将过敏重新添加到图表中。没有患者经历过PAST反应，PO阿莫西林挑战，或随后的β-内酰胺抗生素。28名（80％）患者的抗生素治疗因过敏评估而改变。17名患者停用β-内酰胺抗生素，6名患者停用氨曲南。结论：这项研究的结果表明，药剂师使用PAST扩大其实践范围是一种安全有效的过敏去标记工具。药剂师驱动的青霉素过敏评估可以节省抗生素成本并避免使用氨曲南。该研究支持有必要强调对患者和看护者进行有关过敏测试结果的教育，以避免在将来的医院就诊中重新标记。
